Thank you for your interest in a Gynecologic Oncology Fellowship at the University of North Carolina. We hope you're able to find the information you need on our website.
Applicants must have completed a residency program in Obstetrics and Gynecology either in the United States or Canada. The University of North Carolina will participate in ERAS for the Fellowship. Have your completed application* submitted to ERAS by March 15 for fellowship starting July 1. Following faculty review of applications received, selected applicants will be granted an interview in Chapel Hill during the summer months.
*Completed application consists of the following:
Jennifer Davis will contact candidates with the status of your application. She will either inform candidates their file is complete or what items are needed. Thanks so much for your interest in the University of North Carolina Gynecologic Oncology Fellowship Program!
The Fellowship Training Program in Gynecologic Oncology at the University of North Carolina at Chapel Hill is designed to prepare highly skilled sub-specialists dedicated to the care of women with gynecologic malignancy, spanning the depth and breadth of the specialty. To achieve this, all educational experiences are supervised by Board Certified/Eligible Faculty in Gynecologic Oncology in a supportive clinical environment capable of delivering comprehensive cancer care. Acquisition and development of research skills is an important component of the educational process and critical and analytic thinking are an expectation for completion of fellowship. The faculty of the Division of Gynecologic Oncology support the clinical and research missions of the Fellowship Training program by mentoring fellows to achieve future successes as clinicians, academicians and as national leaders in Gynecologic Oncology.
If you have any questions at all about the application process, or about our training program, please e-mail or call Jennifer Davis at 919-843-2077.
Seven board certified gynecologic oncologists (Wesley C. Fowler, Jr., MD, Daniel Clarke-Pearson, MD, John Soper, MD, Linda Van Le, MD, John F. Boggess, MD, Paola Gehrig, MD, Wendy Brewster, PhD MD and Victoria Bae-Jump, PhD, MD.) are all clinically active. All attending physicians normally supervise inpatient care on allotted rotations to assist in the clinical care of patients and the teaching of fellows. In addition, all surgical cases are staffed by our fellows, which provides a robust and diverse clinical volume and diversity of technique. In addition, we have structured an outpatient rotation within our fellowship that ensures that all new patient consults are conducted by our fellows in conjunction with an attending. Our faculty and fellows enjoy daily interaction and while there are formal teaching activities, learning and teaching are an integral component of all our daily activities. Our faculty members have outstanding reputations both regionally and nationally and are involved in all aspects of our discipline from research to policy, administration to education. These activities create for our fellows a rich academic culture that we are confident will help inspire future participation in our society after graduation.
UNC Hospitals includes a 708 bed main hospital, neurosciences, children’s and a dedicated women’s hospital. The N.C. Women’s Hospital was opened in March of 2002 and is a beautiful, state of the art facility containing outpatient, inpatient and operating room facilities dedicated to women’s health care. All of the Fellow’s clinical experience occurs within this facility. With 22 inpatient beds and 6 operating rooms, the gynecologic oncology service has ample inpatient resources to provide comprehensive care to women newly diagnosed with cancer as well as to our patients needing adjuvant treatment and management of complications related to their disease. A fully staffed Emergency Room, three Surgical Intensive Care Units, one Medical Intensive Care Unit and a Cardiac Care Unit physically connected to the women’s hospital provide all acute and intensive care needs for complicated patients. Our Fellows follow our patients into and out of the Intensive Care Units, which are open and therefore provide a collaborative patient care and learning experience. In addition, our outpatient gynecology oncology clinic is located in the same hospital providing a seamless connection between inpatient and outpatient services. Our clinic provides outpatient follow-up and new patient evaluation and serves as a walk-in evaluation clinic during daylight hours. In addition, we have a self contained, comprehensive outpatient chemotherapy infusion service within our gynecologic oncology clinic. With 12 infusion chairs operating 10 hours per day, 5 days a week, all outpatient chemotherapy administration for our division is performed in this facility. Renovations are underway at present to increase this area by 4-6 additional infusion chairs. While our division provides comprehensive surgical, medical and chemotherapy to our patients, we have the support of many outstanding clinical departments within the school of medicine including Surgical Oncology, Urology, Plastic Surgery, Radiation Oncology, Hematology-Oncology, Interventional Radiology and Pathology.
The gynecologic oncology program offers the trainees an abundance of oncology patients with a variety of clinical and surgical problems. For the period January – December 2006, there were 668 admissions to the Gynecologic Oncology service for a total of 3,037 hospital bed days. There were 601 patients who presented with new invasive gynecologic lesions and 98 patients seen for recurrence. There were 827 major surgical procedures performed by the Gynecologic Oncology Service last year.
Outpatient Gynecology Oncology Service: During both clinical years (year 1 and 3), each fellow rotates in the gynecology oncology clinic every third week. The clinic fellow is in clinic all day on Monday, Tuesday, Thursday and Friday and they have standardized clinic patient visit templates that include new cancer patient evaluations, return patient visits and chemotherapy patient exams. Two attending physicians are assigned to clinic each day and are immediately available to answer fellow questions and assist with patient assessments. In addition, all new cancer patient work-ups are conducted by the fellow along with an assigned attending physician and treatment plans are discussed and decided together. In this way, essentially all new cancer patients seen in our practice are evaluated in the clinic with a fellow and they are involved in all treatment decisions. We currently average over 90 new patient referrals every month, meaning that each fellow will evaluate over 700 new gynecology oncology patients over the course of their two clinical years.
To ensure experience with continuity of care, the clinic fellows are scheduled an average of eight return patients each clinic. During these visits, the fellows are responsible for performing post-operative assessments, monitoring response to chemotherapy and radiation treatment, managing side effects from chemotherapy, radiation and surgery, and monitoring disease status. As with all clinical activities, two attending physicians are physically present in clinic at all times to assist the fellows with decision making. The fellow assigned to clinic also participates in triage of walk-in patients in conjunction with our clinic triage nurse. During the last 12 months, we saw a total of 13,880 clinic visits as a group. The fellows are, therefore, given an ample exposure to the depth and breadth of outpatient clinical scenarios in gynecology oncology.
The final learning opportunity for our fellows while rotating through our clinic is in the area of chemotherapy. As a division, we oversee all chemotherapy infusions within our gynecology oncology clinic. We have eight infusion chairs currently, and will shortly be expanding to thirteen. The gynecology oncology chemotherapy clinic is staffed by four full time infusion nurses who delivered over 2,600 infusions during the last calendar year. Our fellows are involved in all aspects of the chemo-infusion clinic including triage of patient labs, evaluation and treatment of side effects, and exams for monitoring response to treatment. Their resources for learning include our well trained and experienced nursing staff, the two attending physicians assigned to clinic each day as well as four full time nurse clinicians, who follow all of our cancer patients under active treatment.
When taken as a whole, our fellows are given an outstanding exposure to outpatient gynecologic oncology. The clinic fellow does not have any responsibility for the inpatient service, does not make rounds and does not take service call. This ensures balance in their schedule, assures compliance with duty hours, and gives a needed opportunity for independent study when not needing to focus on the demands of a busy clinical service. Furthermore, the clinic fellow is free from all clinical responsibilities every Wednesday, which is reserved for research and administrative time. Wednesday afternoons are protected for didactic learning as well as Departmental and Divisional academic activities.
Our clinic fellow’s performance is evaluated by each attending formally as part of the bi-annual evaluation process, however, development as a clinician is assessed daily. Direct feedback is given as part of the teacher/learner interaction that occurs over each new patient visit. This provides an excellent mechanism for the Faculty to assess a fellow’s development and ability to earn independence and increased responsibility.
Inpatient Gynecology Oncology Service: Two fellows are assigned to the inpatient gynecology oncology service on a rotational basis at all times. One fellow is designated as “on call” and is primarily responsible for the overall organization and delegation of responsibility of care during the week they are on rotation. In addition, the “on call” or “A” fellow is responsible for conducting weekend rounds and taking home call for the week assigned to the service. Fellow “B” serves in support of the “A” fellow in covering operating room cases and assists with rounds and the day-to-day responsibilities of running the service. Morning rounds are conducted daily and are attended by both fellows, the residents and medical students and are organized by the “A” fellow. Daily treatment plans are established for each patient on the inpatient service and in the ICU when relevant and all questions are reviewed with the Surgical and Consult Attending assigned to cover the inpatient service for the week. A second “teaching rounds” is conducted every evening with the Attending covering the service for the week. In addition to reviewing the treatment plans for each patient, teaching rounds serve to provide didactic teaching opportunities in the context of the patients being cared for on service. Fellows are given increasing independence as the fellowship progresses with respect to decision making and patient disposition. The fellows have attending backup on all decisions throughout the day, however, as they demonstrate competence, the fellows increasingly make more and more independent decisions. In addition to overseeing daily patient care, the inpatient fellows take transport and referral calls from other clinical services in-house as well as from regional referring physicians and hospitals.
Operating Room Experience: Both fellows assigned to the inpatient gynecology oncology service attend all surgical cases. Currently, we have on average seven operating room starts/week for gynecologic oncology cases. In the last twelve months, our service conducted over 820 operative procedures. This means that each fellow will participate in over 500 operative cases during their clinical fellowship. All surgical procedures are attended by a gynecology oncology faculty member. As the fellows’ experience and ability evolves, fellows are granted increasing responsibility both as primary surgeon as well as teaching surgeon in the context of resident participation. All of our faculty are versed in the procedures outlined in Guide to Learning in Gynecology Oncology. As a division, we routinely perform gastrointestinal as well as urologic procedures in the context of cancer care as well as plastic soft tissue reconstruction. In addition, we have outstanding collaborative relationships with surgical oncology, urology, plastic surgery and interventional radiology. Our fellows benefit from their surgical consultation when appropriate. All surgical training is centered around patient safety and outcomes. With seven attendings, the fellows are exposed to a diverse spectrum of surgical techniques for treating disease.
In addition to traditional surgical technique, our division has a robust minimally invasive gynecology oncology program. Incorporating both laparoscopic and robotic techniques, our fellows are taught all aspects of minimally invasive hysterectomy and staging for gynecologic malignancy. At the beginning of the first clinical year, focus is given to teaching the fellows how to perform simple hysterectomy and oophorectomy either laparoscopically or robotically and the fellows assist with radical hysterectomy and pelvic and para-aortic lymph node dissection. As the fellows demonstrate an understanding of anatomy and technique and basic minimally invasive skills, they are instructed in laparoscopic and robotic lymph node dissection and radical hysterectomy. We feel that by teaching open and minimally invasive techniques simultaneously, the fellows gain a greater understanding of technique, surgical planes and 3 dimensional thought as it relates to surgical treatment of disease. Over the last 12 months, our division performed over 335 laparoscopic cases, including 147 hysterectomies and 117 lymph node dissections and performed over 120 robotic cases including simple hysterectomy, radical hysterectomy and pelvic and para-aortic lymph node dissection.
Given that our fellows are involved in all new patient work-ups and follow all of our patients after surgery on the inpatient rotation, they receive a true 360 degree education in surgical management of gynecologic malignancy.
Surgical Intensive Care Unit: The fellow is assigned to a one-month rotation in the SICU, and 100% of time is spent in clinical activity. Dr. Renae Stafford, Director, Surgical Intensive Care Unit, coordinates this rotation and oversees the supervision and evaluation of the fellow. Learning objectives for the rotation are outlined in the Guide to Learning in Gynecology Oncology. In brief, the fellow performs as a member of the SICU team, and is responsible for the admission, evaluation, and management of critically ill patients, under the supervision of the assigned Surgical or Anesthesia attending. Emphasis is placed upon ventilator management, sedation, venous access procedures and physiology of the critically ill patient. The fellow participates in lectures given to the surgical residents assigned to the SICU, and is assigned night call as a SICU resident.
Radiation Oncology: Each of the clinical fellows rotates one day a month on the radiation oncology service. Under the direction of Dr. Mahesh Varia, the fellows directly participate in the outpatient radiation oncology clinic and evaluate both new and return patients, participate in treatment planning and are instructed in all aspects of radiation therapy for the gynecologic patient. The objectives during these rotation days come directly from the Guide to Learning in Gynecologic Oncology. Fellows become familiar with treatment planning, dosimetry, the physics of radiation therapy, simulation, brachytherapy, placement of vaginal tandem and ovoids, assessment of treatment response and management of radiation related side effects. By integrating their radiation oncology experience throughout their fellowship, as opposed to one concentrated block, we feel that the fellows will assimilate more knowledge as they will be following the care plans of most of the patients on our service that are being treated with radiation. By becoming integrated members of the gynecologic radiation oncology service, our fellows receive an outstanding education that cannot be learned solely from a book. Dr. Varia has been directing gynecologic oncology radiation services for over 20 years at UNC. In addition to his excellent clinical acumen, Dr. Varia is an active participant in the Gynecologic Oncology Group and an author on several past and currently active protocols.
Pathology: Each of our clinical fellows spend one half day per month on the gynecologic oncology pathology service. Under the direction of Dr. Debra Budwit, the fellows work directly with one of three gynecology specialty trained pathologists to review all gynecologic oncology surgical cases from the week prior. Specific attention is given to diagnosis, clinical behavior, histologic analysis, and immunochemical analysis. By structuring the rotation this way, our fellows are typically reviewing the pathology material from the patients that they operated on the week prior. Our division conducts a treatment planning disposition conference every Wednesday afternoon where we review all surgical cases from the week prior. The cases the fellows review in the morning are presented in the afternoon in the context of treatment planning. Therefore, they get to learn the work-up in clinic, the surgical technique in the operating room, the pathology diagnosis at the microscope, the treatment options in conference and then implement those treatments on the ward and in clinic. In addition to the week’s clinical cases, a comprehensive teaching file exists and is used to ensure that the fellows achieve the pathology objectives as outlined in the Guide to Learning in Gynecologic Oncology. Lastly, our pathologists generously provide our fellows with a comprehensive review of gynecologic oncology pathology towards the end of their fellowship which serves as an excellent preparation for their written and oral board examination.
Dysplasia Clinic: In order to provide our fellows experience with the diagnosis and treatment of pre-invasive neoplasia of the genital tract, we have each clinical fellow rotate every three weeks for half a day in a formal dysplasia clinic. Over the two clinical years, this provides each fellow a total of 34 clinics. We currently see over 1,000 dysplasia clinic visits per year where all pre-invasive abnormalities are evaluated, from ASCUS to carcinoma-in-situ. In the course of treating dysplasia in the last twelve months, the fellows participated in 84 LEEP procedures and performed over 50 cold knife cone biopsies, 45 laser procedures for the ablation of pre-invasive genital lesions and condyloma, and over 22 simple excisions of pre-invasive genital lesions. The fellow is instructed and evaluated on their proficiency at the comprehensive evaluation and management of all pre-invasive genital conditions and their learning objectives are outlined in the Guide to Learning in Gynecology Oncology.
During the first year of clinical fellowship, first year fellows along with the faculty explore the fellows’ research interests. The fellows are given clinical projects ranging from chart reviews and case reports, to review articles and book chapters to help stimulate their interest in academic productivity. These activities most often result in publication and participation in national meetings giving the fellows the opportunity to “taste” success and to help focus their interests. The fellows are provided time on Wednesdays to pursue their clinical research projects. It is the expectation of each fellow that they identify a mentor among the faculty who will help them formulate a thesis within the first six months of fellowship. The faculty mentor does not necessarily need to be the individual who will conduct the research with the fellow, but is responsible for making sure that the fellow stays on task throughout their three years and ensures that the fellow graduates with a suitable thesis in order to satisfy their board requirements. The fellowship director reviews and documents the fellows’ progress toward completion of their thesis at each biannual evaluation meeting and helps the fellows triage their ongoing research commitments to prevent them from being over committed and to maximize productivity.
During the second year of fellowship, the fellows are assigned eleven months of protected research time. During this year they do not have any clinical responsibilities. [They will have an additional day of protected research time per month during their clinical years (year 1 and 3).] We feel there are distinct advantages to having our fellows complete a year of clinical work prior to initiating their research year. First, the fellows are able to become integrated into a new environment and hospital system. They are able to develop an area of interest and research plan during the first clinical year so that they can be more productive during their research rotation. Fellows can compete for funding sources the year prior to beginning their projects. Lastly, the fellow is able to get a break from the intensity of clinical service, which we feel enhances their productivity when on service. Dr. John F. Boggess and Dr. Paola A. Gehrig serve as the basic science research coordinators. They share 500 square feet of lab space in the MacNider Building, which is adjacent to the academic offices. Dr. Chunxiao Zhou is an MD/PhD with a particular interest in women’s cancers and works full time as a Research Associate within the Department of Obstetrics and Gynecology. This laboratory is fully equipped to perform all aspects of molecular biology, immunohistochemistry, and cell culture. Utilizing our faculty’s status as Lineberger Clinical Cancer Center Members, we also have full access to all core facilities at the Cancer Center. Dr. Zhou has developed mature research collaborations with several other laboratories at Lineberger and we collaborate with other members of the cancer center, in particular faculty from Medical Oncology (Dr. Young Whang, MD, PhD) and from the Department of Pathology (Dr. David Kaufmann, MD, PhD). Our fellows have full access to this laboratory and are able to continue with current projects being conducted as well as develop their own hypothesis and complete their experiments with the constant availability of Dr. Zhou.
In July of 2007, Dr. Victoria Bae-Jump joined our division as a full time faculty member. Dr. Bae-Jump has a Ph.D. in pathology and will be participating in a K12 mentored research program with the goal of developing her into an independent investigator capable of running basic and translational research within the division of gynecologic oncology. Both the Department of Obstetrics and Gynecology and the Lineberger Comprehensive Cancer Center have agreed to provide the resources necessary for Dr. Bae-Jump to be successful. We believe that Dr. Bae-Jump is an important addition to our program and has significantly enhance our fellow’s research experience.
Fellows who choose this track use the 12 months of dedicated research time to attain a Masters in Public Health. A faculty advisor within the University of North Carolina's School of Public Health is assigned who solicits a mentor for the fellow and designs curriculum which will satisfy the requirements for a degree of Masters in Public Health. The research year is then dedicated to completing the assigned coursework relevant to the discipline chosen by the fellow (Biostatistics, Epidemiology, Health Behavior/Health Education, Public Policy, Public Health Leadership). The fellow also completes a Masters Thesis as part of this degree program, supervised by the School of Public Health faculty mentor.
For a list of the current fellows in our program please click here.