Curriculum

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Minimally Invasive Gynecologic Surgery fellows in an operating room at Mayo Clinic in Rochester, Minnesota.

Clinical training

As a fellow, you will learn essential tools for identifying the right surgery for the right patient through patient evaluation, utilizing a systematic history and physical, employing diagnostics to identify pathology and then establish an individualized treatment plan. Learning takes place within the paradigm of the Mayo Clinic philosophy where “the needs of the patient come first.”

Mayo Clinic offers a rich clinical experience. There are no private patients at Mayo Clinic, and this offers a great opportunity to care for a wide variety of local, national, and international patients with both common and rare conditions.

Fibroid center

The Mayo Clinic Fibroid Clinic offers a comprehensive approach to fibroid care, and is in a unique position to offer patients all available options for non-surgical and surgical treatment of fibroids.

As a fellow, you will have an opportunity to collaborate with Interventional Radiologists for patients desiring uterine fibroid embolization or focused ultrasound treatment, and will also be able to participate in the counseling and performance of gynecologic surgery for fibroids including:

Radiofrequency ablation
Myomectomy
Hysterectomy

Depending on the fibroid burden, the approach to myomectomy may include laparoscopy, robot-assistance, mini-laparotomy, and in some cases a traditional open technique.

We expect fellows to be competent in the perioperative assessment and counseling as well as technical skills associated with these procedures.

Endometriosis

As a fellow, you will participate in a multidisciplinary endometriosis care group where you will manage all stages of endometriosis and employ both medical management and surgery.

The program includes a collaborative endometriosis MRI imaging conference where radiology and gynecology review protocoled MRIs to refine the management plan for deep infiltrating disease.

Emphasis is placed on the preoperative workup to multidisciplinary surgery as well as the evaluation for other contributors of pelvic pain. Advanced endometriosis surgery, including deep endometriosis of the bowel, ureter, bladder, and diaphragm is completed primarily by the MIGS surgeons, with multidisciplinary coordination for deep endometriosis requiring resection of bowel and other organs as indicated.

Pelvic pain

The Mayo Clinic Chronic Pelvic Pain (CPP) clinic focuses on multidisciplinary care of these complex patients.

Utilizing a team-based approach, our team of advanced practice providers triage eligible patients followed by pre-visit planning to optimize their in-person visit. Our nurse practitioners see these patients along with the MIGS fellows and staff.

Within Mayo, we work very closely with physical therapy, cognitive behavioral therapy specialists, internal medicine, gastroenterology, radiology, and the anesthesia pain clinic as needed to provide holistic care to our patients.

Hysteroscopy

The Mayo Clinic MIGS division leads a robust hysteroscopy practice including high volume office hysteroscopy. More than 1,000 office hysteroscopies are performed annually, consisting primarily of flexible diagnostic procedures but also office operative polypectomy and removal of malpositioned IUD.

The office practice compliments the more complex operative hysteroscopy procedures performed in the operating room:

Myomectomy
Adhesiolysis
Polypectomy
Resection of septa

Reproductive surgery

As a fellow, you'll have a unique opportunity to work with REI surgeons and a dual fellowship (MIGS and REI) trained physician, Zaraq Khan, M.B.B.S., during your surgical rotations.

This collaboration provides unique exposure and surgical training in complex müllerian anomalies, tubal surgery, fibroid, and advanced endometriosis surgery, as well as cutting-edge ovarian tissue transplantation surgeries in women actively seeking fertility.

As a fellow, you'll practice targeted surgical techniques to help in maintenance of ovarian reserve or enhance fertility directly.

By the end of the fellowship, you will be able to counsel a patient for surgical intervention versus referral for assisted reproductive techniques (ART) in women with benign gynecologic conditions who are otherwise actively seeking fertility.

Rotations

Rotations may be offered in urogynecology, gynecology oncology, and colorectal surgery to supplement your training as a gynecologic surgeon and foster collaborative care.

Call frequency

Our fellows participate in the service call pool with other fellows, with a frequency of one to two of seven nights per week.

Didactic training

Our unique fellowship offers a three-site, cutting-edge didactic program where our fellows can learn from faculty and other fellows at Mayo Clinic Arizona and Florida campuses.

Our division’s didactic program in Rochester, Minnesota, includes Journal Club, simulation, team-based learning, mock cases, and M&M.

Research training

Opportunities for research at Mayo Clinic are abundant. Our fellows enjoy research support with funding and protected time leading to scientific presentations and peer-reviewed publications. There are opportunities for you to complete additional training in research methodology if desired. The program strives for excellence in research and giving you the skills and experience to launch an academic career.

As a fellow, you will be expected to complete at least one IRB-approved research study from start to finish while enrolled in the program, culminating in a manuscript suitable for publication in a peer-reviewed journal. Fellows will start additional IRB-approved studies as time and motivation allows, and may assist in other IRB-approved research studies ongoing in the department. Fellows should expect to submit and participate in scientific meetings each year, with oral presentations, videos, or poster presentations.

Mayo Clinic departmental research support includes but is not limited to productive clinical and laboratory research faculty available for guidance and mentoring, a statistical support team, a research coordinator team, and access to a full-service academic library.

The MIGS department contains multiple patient databases (including hysteroscopy, endometriosis, fibroids) available for research projects, as well as access to larger epidemiological databases such as the Rochester Epidemiology Project (REP), and collaborations with “big data” such as Optum Labs.

In addition to onsite research support, the Mayo Clinic School of Graduate Medical Education has a generous stipend to support trip days and travel reimbursements for research presentations. During clinical rotations, fellows have protected time for research endeavors, as well as distinct research rotations.