Obstetrics and Gynecology
Uniformed Services University of the Health Sciences
Department of Obstetrics and Gynecology
4301 Jones Bridge Road
Bethesda, Maryland 20814-4799
Christopher M. Zahn, MD
Col (Ret), USAF, MC
Professor and Chair
Department of Obstetrics and Gynecology
Phone: (301) 295-3430
FAX: (301) 295-0419
Ms. Tanya Christian
Phone: (301) 295-3777
FAX: (301) 295-0419
Katerina Shvartsman, MD
Director of Clinical Clerkships
Phone: (301) 295-3777
Phone: (301) 295-3430
Fax: (301) 295-0419
Structure of the Clinical Training
First Year Fellow
Structured clinical training occurs in the first 15 months of the fellowship. Twelve months of the first year are entirely devoted to clinical training. In a typical rotation sequence the fellow begins with a 6 week rotation on the NIH Reproductive Endocrinology Service. This service provides fellows with experience and didactic training in the fundamentals of reproductive endocrinology and the function of the hypothalamic-pituitary-ovarian axis. In addition, disorders of reproduction are covered, including uncommon diseases of the reproductive tract, such as challenging cases with developmental anomalies of the female reproductive tract. Next, the fellow rotates for 6 weeks on the fully accredited adult and pediatric endocrine service at the NIH Clinical Center (see http://www.cc.nih.gov). During this six-week experience, the fellow will be primarily responsible (under direct supervision of adult and pediatric endocrine faculty) for the evaluation and treatment of common endocrine disorders such as hyper- and hypothyroidism, premature thelarche, diabetes mellitus, and growth disorders. Furthermore, due to the truly unique environment of the NIH, the fellow will gain invaluable exposure to rare endocrine disorders such as Cushing's syndrome, McCune-Albright syndrome, precocious puberty of many etiologies, acromegaly, pituitary tumors, and varied syndromes of multiple endocrine neoplasias. It is this experience which permits the reproductive endocrine fellow to collaborate with faculty from other disciplines on the most challenging of endocrine cases and deepens the fellow's understanding of evaluation of complex endocrine disorders. This rotation is followed by six week rotation on clinical genetics at the NIH on the fully accredited Genetics Service of the National Human Genome Research Institute. The genetics rotation includes training on the most recent tools for genetic research, as well as fundamental principles of genetics of relevance to Reproductive Endocrinology.
With that solid foundation, fellows then begin rotations alternating between three clinical experiences: 1) the clinical and operative reproductive endocrine service at Walter Reed Bethesda; 2) the ART program at Walter Reed Bethesda; or 3) Shady Grove Fertility Center. While on rotation in the clinical reproductive service at Walter Reed Bethesda the first-year fellow is primarily responsible for the clinical management (with close supervision) of patients typically encountered in a reproductive endocrine/infertility clinic. This is a busy clinical service with approximately 800 new patients and 2400 return visits annually. The fellow is directly involved in all facets of patient care including the evaluation and treatment of reproductive endocrine/infertility disorders. The fellow participates as "primary surgeon" on all operative cases of the service under supervision and guidance of program faculty. In addition, fellows perform transvaginal sonography for detection of early pregnancy, controlled ovarian stimulation, and hysterosaplingography. The fellow is instructed in the current evaluation and treatment of common reproductive endocrine/infertility disorders such as anovulation, hirsutism, pituitary dysfunction, amenorrhea, recurrent abortion, contraception, and pubertal disorders. In addition, on rotation at Walter Reed Bethesda the first year fellow receives extensive operative training in current methods of surgical treatment of infertility including LASER and video-laparoscopy, advanced pelviscopy, robotics, diagnostic and operative hysteroscopy including resectoscope techniques, microsurgical methods including tubal reanastomosis, and medical and surgical management of ectopic pregnancies.
During the first year, the fellow also rotates for 6 weeks on the ART service at Walter Reed, an ART program that performs 400-450 cycles annually. During this rotation the first year fellow is intimately involved in all aspects of assisted reproduction. The ART experience and training encompasses: patient selection which is performed at weekly clinical/preoperative meeting, ovarian monitoring, evaluation of sperm and laboratory values, ovum retrieval, and embryo/gamete transfer techniques, and intrauterine inseminations. During the first year, the fellow is responsible for the management of any cases requiring hospitalization for complications of infertility treatment such as ovarian hyperstimulation syndrome or pelvic inflammatory disease. Through close supervision and guidance the first year fellow is expected to become competent in the diagnosis and treatment of most problems relating to the practice of reproductive endocrinology. Also during the first year, the fellow will rotate at Shady Grove Fertility Center, one of the largest ART programs in the U.S. that performs over 4000 cycles annually. Fellows will participate in care of the ART patient and gain exposure to oocyte donation and ART as it is practiced in an Academic Private Practice setting.
Second Year Fellow
Second year fellows will complete the 15 months of clinical training in September of the first year. To provide additional depth to their clinical training, fellows will rotate for 2 weeks on the Male Infertility service while at Walter Reed Bethesda during which time fellows work closely with Dr. Robert Dean who specializes in treatment of the infertile male. Following that experience, fellow rotate for 2 weeks on the ART laboratory rotation at Walter Reed Bethesda under the direction of Dr. Aidita James, on-site ART laboratory director. This laboratory rotation provides the fellow with introduction to the methods used in assisted reproduction and in vitro handling and assessment of gametes and embryos. Finally the fellows will rotate again on the NIH Reproductive Endocrinology teaching service. Upon completion of the core clinical training, the second-year fellow then selects a laboratory within the intramural research program of the National Institute of Child Health and Human Development (see http://www.nichd.nih.gov/) or at USUHS for the conduct of a research thesis. During the remaining nine months of the second year, the fellow will be primarily responsible for the research thesis and the performance of basic or clinical duties related to the thesis.
Fellows are required to take two formal graduate level courses during their training which have been arranged through the fully accredited sponsoring medical school at USUHS. These courses are administered to graduate and medical students of the university and will be taken for a letter grade with an exam on which the fellows are expected to perform well. The required statistical course is Statistics (PY0801). As a second course, fellows may choose to take Advanced Mammalian Reproduction (PYO512) or Recent Progress in Molecular and Cellular Endocrinology (PHO508). Other choices for a second graduate level course are available, but will require prior approval. Due to the heavy clinical demands of the first year, it is expected that the fellow will take the courses in the second or third years of the fellowship.
Third Year Fellow
The third year fellow is primarily responsible for the completion of a research project relating to the chosen thesis. It is expected that the fellow will devote 90% of time to the completion of a thesis project that will be published in a peer-reviewed journal. Rather than simply a prolonged two-year fellowship, the program is structured to allow the fellow to focus research effort (20 months of protected time) on a particular problem in order to achieve a depth of understanding which will serve as a foundation for a future independent research program.
Other than weekend call (see below), the only clinical responsibilities of the third year fellow are a four week participation in the ART program at Walter Reed Bethesda during which time the senior fellow assumes an "acting attending" level of responsibility for the execution of an ART cycle. During the four week ART experience which typically occurs in the latter half of the senior year, the fellow is expected to be familiar with all aspects of patient selection, ovarian stimulation, ovum retrieval and gamete/embryo transfer. The fellow will answer questions and deal with problems/dilemmas faced in the conduct of an ART program. During this experience the faculty will closely observe the fellow, but the emphasis will be on permitting the fellow to make decisions and function at an attending level. This experience represents the final step in a graduated level of responsibility, and will also assure that program graduates are up-to-date with the most recent advances in the changing field of assisted reproduction.
There are many opportunities for instruction, both formal and informal during the fellowship. Structured training includes a series of introductory seminars geared to the first year fellows that takes place from July to September of the first year. These introductory seminars provide a historical perspective and basic understanding of the practice of Reproductive Endocrinology. There is a weekly NIH teaching rounds conference where challenging cases are reviewed and discussed with faculty and fellows. In addition, all faculty and fellows of all years are expected to attend the weekly Pre-operative and Fellows' conference. In addition, fellows attend weekly Branch research conferences sponsored by the Program in Reproductive and Adult Endocrinology (PRAE) at NICHD and present updates on thesis work at the weekly "Research in Progress Conference" at NIH. Core ACGME training objectives are covered in special NIH grand rounds and via courses at NIH or Walter Reed Bethesda. NIH Endocrine Grand Rounds provides additional training in medical, pediatric, and reproductive endocrine conditions. Regular attendance at a monthly Journal club is expected. Finally, fellows regularly attend ART clinical meetings where management of patients pursing ART is discussed and outcomes are reviewed.
In addition to larger groups, mentors of individual laboratories to which the fellow affiliates generally meet on a weekly basis to review research progress. Furthermore, fellows are encouraged to participate in didactic training offered at national meetings, such as the American Society for Reproductive Medicine, the Society for Gynecologic Investigation and the Society for the Study of Reproduction. Moreover, fellows are encouraged to attend specialty meetings in their chosen interest areas, such as a Keystone meeting on hormone action.
Call and Duty Hours
Fellows in the first year cover an average of 2-3 in house calls at Walter Reed over the course of the entire first year. There is no in-house call in years two and three. Throughout the fellowship, fellows will average one weekend call per month, which involves ART patient care (sonography and retrievals). This call is not in house and typically completed by the 2PM on the call day. The program rigorously adheres to all ACGME and ABOG duty hour regulations.