Gynecologic Oncology Fellowship Program

The Mount Sinai Medical Center has several clinical components which include the Mount Sinai Hospital, City Hospital at Elmhurst, Queens General Hospital, Mount Sinai Queens Hospital, Englewood Hospital, The Bronx Veteran's Administration Hospital and a network of over twenty affiliated medical institutions. Our attendings also have a presence at hospitals in New Jersey and Connecticut. Women with complex oncologic issues are brought to the Mount Sinai Medical Center to augment the fellows clinical exposure. The Division of Gynecologic Oncology functions both as an educational and clinical resource to these institutions for women requiring gynecologic oncology care. The essential hub of this network is the amalgamation between the Mount Sinai Hospital and the Elmhurst Hospital Center which, for thirty years, have had a totally integrated residency program in obstetrics and gynecology with a faculty common to both hospitals and with an established flow of patients as a single service. Women requiring gynecologic oncology care, either surgical or otherwise, are treated at the Mount Sinai Medical Center. Throughout the span of a week the fellows work with each of the attendings so that the academic and clinical instructional diversity are preserved. This has resulted in the division being assigned two full-day operating rooms every day of the week for our patients. We have restricted the Fellows clinical responsibilities to the Mount Sinai Medical Center with the only off- campus exposure limited to the Radiation Oncology Rotation for selected brachytherapy application sessions at Queen's General Hospital due to the higher volume of women with advanced stage cervical cancer. We have designated office space in the Ruttenberg Cancer Center where we evaluate our patients and administer chemotherapy. Our Division has a user friendly electronic medical records platform which helps optimize patient care.

The goal of our program is uncomplicated: to train fellows in the surgical and medical skills required as gynecologic oncologists to deliver optimal patient care; to develop the intellectual strengths and organization of thought to permit analysis and possible solution of new and old problems in the field of gynecologic oncology and to have broad and committed exposure to outstanding basic and clinical scientists to permit continued growth and education to achieve academic excellence. Fellows are seen as colleagues and academicians where teaching and research are expected and supported. The major strength of our program is the clinical and scientific expertise in all areas of surgical, medical and tumor biology at the Mount Sinai Medical Center coupled with excellent residents and medical students along with a fantastic physical plant and the exposure to a dynamic and diverse patient population.

The history of this fellowship is interesting and internationally respected due to the contributions and dedication from two pioneers of gynecologic oncology, Drs. Saul Gusberg and Carmel Cohen. These two physicians assisted in the creation of the sub-speciality of Gynecologic Oncology in the United States and established the Division of Gynecologic Oncology at the Mount Sinai Medical Center. Our division presently consists of ten board certified gynecologic oncologists:

Full-time Faculty

Linus Chuang MD – Director Gynecologic Oncology, Associate Professor

David A Fishman MD – Professor, Director of Gynecologic Oncology Fellowship

Carmel Cohen MD – Professor

Konstantin Zakashansky, MD – Assistant Professor

Nimesh Nagarsheth, MD – Assistant Professor

Monica Prasad-Hayes MD – Assistant Professor

Affiliated Faculty

Herbert Gretz MD MBA – Associate Professor, Director Minimally Invasive Surgery

Peter Dottino MD – Associate Professor

Rudy Segna MD – Assistant Professor

Jamal Rahaman MD – Associate Professor

The Division at Mount Sinai has had a strong and longstanding tradition in Minimal Invasive surgery and was the first fellowship program to embrace laparoscopy for Gynecologic Cancer management in 1992. We have developed a very strong Robotic's program, led by Drs Rahaman, Gretz, Prassad, Chuang, Zakashansky and Nagarseth and established a robust training curriculum. This program offers dry lab and animal (wet) lab training followed by a graduated surgical training from bedside assistance, through proctored console training and finally independent console experience. We have secured a dedicated daVinci Robot for Gynecologic Surgery available every day, and have established a stable well trained operating room Robotic Nursing team. Over the last 3 years, the graduating fellows have been able to achieve independent priveleges in Gynecologic Robotic Surgery and have been proficient in unsupervised practice.

David A. Fishman, MD is the Fellowship Director and the Director of Gynecologic Oncology Research. He was recruited to the Division in January 2009 from New York University Medical School, where he was Professor of Obstetrics and Gynecology, and Director of Gynecologic Oncology. An internationally recognized gynecologic oncologist, Dr. Fishman is especially noted for his innovative research on the regulation of ovarian metastasis and in developing new methods for the detection of early stage ovarian carcinoma. He established The National Ovarian Cancer Early Detection Program in 1999 with a UO1 grant from the National Cancer Institute and philanthropic support. He addresses the research productivity of the fellows and has started a weekly research laboratory meeting. He has identified resources, assigned mentors, set benchmarks, timelines, and deadlines for fellow research projects. Since joining the Division at Mount Sinai, he has received multiple NIH and philanthropic grant awards and is an investigator on multiple national and international grants focusing on the ovarian cancer tumor microenvironment.

Divisional Conferences

1. Gynecologic Oncology weekly tumor board
The fellow conducts a weekly planning conference which is attended by the gynecologic oncology staff, radiation oncologists, the oncology nurses, the appropriate social worker, and selected other members of the medical center faculty when required. This weekly conference is a planning session for all patients on the service and decisions are reached in concert by the members attending. By conducting this conference, the fellow, in fact prepares plans for all patients and thus receives the input and criticism of a variety of experts thus achieving a significant benefit. Enrollment in clinical trials is also discussed and all morbidities and mortalities presented and discussed.

2. Fellows Weekly Didactic Conferences
At 4PM every Tuesday, a didactic lecture is held for the fellows by one of the Gyn Oncology or invited Faculty. Another session is held on Wednesday at 8AM supervised by Dr Fishman when topics from the curriculum are addressed.

3. Journal Club
On Thursday at 7:30 am Journal club is held by one of the Gyn Oncology Faculty

4. Weekly Lunch Conference
Thursday at 12:30pm, the Fellows run a didactic lunch conference on Gyn Oncology topics with all the residents invited and with at least 4 of the Gyn Onc Faculty in attendance.

5. Cancer Center Multidisciplinary Tumor Conference
Every Friday at 7:30 am, the Cancer Center has a Multidisciplinary tumor conference attended by all the oncologic specialities, pathologists, radiologists and radiotherapists. The Gyn Onc Division has the responsibility of presenting every 6 weeks and one of the Fellows would present. The Faculty and Fellows attend every week to participate in the discussions and reviews.

6. Gynecologic Pathology Weekly Slide Review
Every Tuesday at 5:00 pm, the Fellows and Residents on service review all the pathology slides from all the surgical cases on the Gyn Onc Service during the previous week with one of the Gyn Pathology Attendings during Tumor Board Conference.

7. Monthly Gynecologic Pathology Conference
Once a month, from 7:00am – 8:00 am on a Wednesday, a Gyn Pathology Review is conducted by the Gyn Pathology Attending Staff on the unusual and interested cases from the preceding month.

8. Weekly Departmental Grand Rounds and Didactics
The Departmental Grand Rounds are held Wednesday Mornings at 8:00 am, with presentations by invited speakers who have achieved National or International acclaim in their particular interest. From 9:00 am to 12:00 noon there are also didactic lectures where the fellows participate either in the audience or as the designated Lecturer on a Gyn Oncology Topic. Some of these lectures are given by the Gyn Onc Faculty as well.

9. Daily Chemotherapy Review
On a daily basis, all of the Chemotherapy administration orders are written by the Fellow on service and reviewed with the designated Attending. This review allows the fellow the opportunity to discuss the nuances of chemo-pharmacology, and review the literature and data justifying the regimens being utilized.

10. Weekly Basic Science Review and Lab Meeting
Every Wednesday at 5pm Dr Fishman conducts a basic science review and a translational lab meeting with the Fellows and the members of all the collaborating labs.

11. Special Attending Service Rounds
All attendings conduct weekly rounds on afternoons with the Fellows and Residents.

12. Monthly Ovarian Cancer Translational Research Conference
On Thursday at 3pm, a monthly Ovarian cancer translational research conference is held and co-ordinated with Dr Stuart Aaronson, Dr Matignetti and Dr Fishman and invited speakers from extra-mural centers of excellence would present to our Faculty, fellows and Research collaborators.

Other Seminars and Lectures

The fellow attends lectures in the medical center appropriate to cancer education including named lectures, post graduate seminars, departmental lectures from the basic science faculty and the clinical faculty. The fellow also attends monthly evening sessions of the New York Gynecologic Oncology Group – New York Phase II consortium which is a consortium comprised of faculty from the New York University School of Medicine, the Albert Einstein School of Medicine, Cornell Medical School, New York Medical College, and the Icahn School of Medicine. This consortium includes leading medical oncologists and gynecologic oncologists from the greater New York area, as well as biomathematicians and frequent outside representatives of pharmaceutical houses and governmental agencies. During these exchanges formal protocols are developed and the fellows are often called upon to provide the basic literature searches from which protocol proposals can be evaluated.

Some of the other formal standing lectureships attended by the fellows include the Cancer Center Weekly Lectureships given by authoritative outside speakers on all aspects of oncologic research including with translational clinical application; the Dean's Lectureship Series ( major lectures are given by international figures on a subject usually dealing with molecular biology); the Institutional Oncology Fellow Lectureship Series ( weekly lectures on Friday provided by in-house experts on topics designed for the education of oncology fellows in all of the various disciplines and supported by each of those disciplines to provide a common course).

The formal courses currently required, with the recent change approved by the Board Division, are the 'Biostatistical Concepts and Methods' and the Department of Microbiology Graduate School Course 'Molecular Mechanisms of Disease'. The latter courses is offered through Icahn School of Medicine and is now better designed for the needs of postgraduate work in a university setting, they are more vigorous in construct and they have replaced the previously attended courses. The Biostatistics course is organized by Dr David Grimes and partly underwritten by The Foundation for Exxcellence in Women's Health Care and is approved by ABOG , and was attended by our fellows during the last 2 years. The six-day curriculum provides an intensive introduction to epidemiology, research methods, and data analysis. The content of the program has been developed following the ACCME accreditation guidelines designed to fulfill the Fellowship requirement for a university graduate-level course in quantitative techniques and is available exclusively for obstetricians/gynecologists enrolled in ABOG - approved Fellowships. The location of the course is Stevenson, Washington and is offered February 7-13, May 16-22, and August 29 – September 4 with the number of participants is limited to 25 per course

Scientific Meetings

The fellow attends several scientific meetings in the region and is sent once a year to a major scientific meeting (usually within the discipline of gynecologic oncology) outside of the region, such as the annual meeting of the Society of Gynecologic Oncologists. Examples of other meetings attended include the following: ASCO, Meetings of the Society of Laparoendoscopic Surgeons, ACOG, AAGL, the American Association for Cancer Research 'Molecular Biology in Clinical Oncology Workshop', the Berlex/Bayer Oncology Foundation Education Grant in 'Epidemiology and Clinical Trial Design Course', the National Gynecologic Oncology Fellows' Forum, and meetings of the New York Obstetrical Society.

Electives

1. Radiation Therapy: The fellow spends two months in the Department of Radiation Therapy, working under the direction of Dr. Richard Stock, the department director, and his staff, especially Dr. Sheryl Green who is devoted to the radiation therapy for gynecologic oncology. Our fellows' education can occur by virtue of a supervised "hands on" preceptorial program which will allow participation in the management of all patients with gynecologic cancers, as well as, all patients being planned, localized, and started on radiotherapeutic programs. There are didactics in radiation physics, as well as daily instruction in radiation physics designed to meet the needs of a gynecologic oncologist as outlined by the Division.

2. Neoplastic Diseases: The fellow rotates to the Division of Medical Oncology where for one month, under the supervision of Dr James Holland (Professor Emeritus) and Dr. Janice Gabrilov (Director of the Medical Oncology Fellowship) and with the full time attending staff of medical oncologists, the fellow works as a member of that Division. The fellows also spend some dedicated time with Dr George Raptis, Director of The Breast Cancer Center, on patient rounds and in the out-patient offices.

3. Surgical Intensive Care Unit: The fellow rotates for one month to the Intensive Care Unit working under the supervision of its director, Dr. Ernest Benjamin. This includes, of course, all techniques of internal and external monitoring, catheter placement, physiologic support for the critically ill patient and understanding of surgical metabolism. In the conduct of these rounds, didactic information is dispensed and the faculty comes from the Department of Surgery, Anesthesiology and subdivisions of internal medicine.

4. Gynecologic Pathology: The fellow rotates through the Department of Pathology working directly in the Division of Gynecologic Pathology with Dr. Liane Deligdisch and Dr. Tamara Kalir, who are superb gynecologic.

5. Surgical Speciality Rotation: The fellow spends one month during the first year on a hybrid rotation. During the months they spend time with Dr David Samadi (Chief of Robotic Surgery at Mount Sinai) assisting with Robotic Urologic Surgery, Dr Christins Weltz with breast Surgery, Dr Jin Chun with plastic and reconstructive procedures and Dr Simon Hall, (Chairman of the Department of Urology) with reconstructive urologic procedures including conduits and pouches.

6. Surgical Services: The fellow rotates through the vascular service, reconstructive surgery, colorectal and surgical oncology. The vascular service is directed by Dr Michael Marin who is also Chairman of the Department of Surgery. There are more than 1000 procedures performed annually. The colorectal service includes Dr. Joel Bauer, a nationally recognized pelvic surgeon, who has had extensive experience in treating inflammatory bowel disease. Dr. Bauer and his colleagues operate daily on a large number of patients with recurrent bowel problems requiring diversions, pouch revisions, creation of continent pouches, and management of inflammatory, adhesive, and oncologic disorders. He also gets a unique experience in the management of complex fistulas, such as colo-vesical, and colo-vaginal fistulas. The fellow spends on month on the Surgical Oncology-Hepatobiliary Service working with Dr Myron Schwartz and team. On this rotation they get invaluable experience and exposure in advanced laparoscopic and open upper abdominal surgery including diaphragmatic, hepato-biliary, pancreatic and gastric procedures. The fellows also train in Hyperthermic Intra-operative intraperitoneal chemotherapy (HIPEC) with Dr Daniel Labow.The fellow spends one month during the first year on a hybrid rotation. During the month they spend time with Dr David Samadi (Chief of Robotic Surgery at Mount Sinai) assisting with Robotic Urologic Surgery, Dr Christina Weltz with breast surgery, Dr Jin Chun with plastic and reconstructive procedures and Dr Simon Hall, (Chairman of the Department of Urology) with reconstructive urologic procedures including conduits and pouches.

7. Surgical Intensive Care Unit: The fellow rotates for one month to the Intensive Care Unit working under the supervision of its director, Dr. Ernest Benjamin. During this experience, our fellow works with two other rotating fellows. Our fellow has full parity with these rotators and has full exposure and responsibilities of management for all patients in the Surgical Intensive Care Unit.

8. Gynecologic Pathology: The fellow rotates through the Department of Pathology working directly in the Division of Gynecologic Pathology with Dr. Liane Deligdisch and Dr. Tamara Kalir, who are superb academic gynecologic pathologists.