Followship Training (English)

Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. The Division has been approved by The Royal Thai College of Obstetricians and Gynecologists (RTOG) in 1999 to set a two-year fellowship that prepares trainees for certification in the subspecialty of gynecologic oncology.

At present, 600-700 new gynecologic cancer patients are treated each year in the Division of Gynecologic Oncology. Approximately three fourths of the patients are cervical cancer which is the major problems in the northern region of Thailand comprising 12 million population (Table1). Major gynecologic cancer operations account for 300-400 cases each year (Table 2&3).

 TABLE 1 : Gynecologic Oncology Registry : Chiang Mai University 1997-200

Cervix	547 (75.3)	483 (72.9)	497 (75.3)	502 (71.3)	500 (70.8)
Ovary	87 (12.0)	83 (12.5)	82 (12.4)	96 (13.6)	90 (12.7)
Corpus	48 (6.6)	47 (7.1)	49 (7.4)	56 (8.0)	63 (8.9)
Vulva	20 (2.7)	21 (3.2)	15 (2.2)	29 (4.1)	23 (3.3)
Vagina	11 (1.4)	10 (1.5)	2 (0.3)	9 (1.3)
Fallopian tube	0	2 (0.3)	6* (0.9)	5 (0.7)	3 (0.4)
Gestational trophoblastic tumors	14 (1.9)	16 (2.4)	8 (1.2)	13 (1.9)	18 (2.6)
Total	662 (100)	660 (100)	660 (100)	660 (100)	660 (100)
Site	Number (%)	Number (%)	1999 Number (%)	2000 Number (%)>)	2001 Number (%)

 TABLE 2 : Diagnostic Procedures and Operations for Cervical Cancer 1997-2001

Procedure & Operation	1997	1998	1999	2000	2001
Colposcopy	227	235	463	371	369
LEEP	61	35	166	207	194
Cervical Conization	66	65	79	13	14
Simple Hysterectomy for CIN	118	110	155	182	121
Wertheim Operation	55	77	113	120	116

TABLE 3 : Operations for Ovarian, Corpus and Vulvar Cancer 1997-2001

Operations	1997	1998	1999	2000	2001
Primary CRS for ovarian cancer	41	35	53	67	40
secondary CRS for ovarian cancer	17	3	7	3	5
Second look operation	6	5	4	–	–
Surgical staging for corpus CA	33	28	26	36	43
RV & BIL	10	16	5	13	5

CRS = Cytoreductive surgery RV & BIL = Radical vulvectomy & bilateral inguinal lymphadenectomy

FELLOWSHIP PERIOD

Two years (beginning of academic year: first of July each year)

TRAINING OBJECTIVES AND DESCRIPTION

The fellowship program in gynecologic oncology is designed to train young gynecologists to develop the skills necessary to practice gynecologic oncology. The 2-year program is clinically oriented and offers extensive experience in radical and conservative cancer operative procedures and related issues including medical and radiation oncology, palliative care and pain management. The fellows would acquire the skill and knowledge necessary to determine the most appropriate therapeutic regimen for each cancer patient. The fellows should be able to effectively integrate the principles, applications, and risks of the various alternative therapeutic modalities into a treatment plan appropriate for each patient.

EDUCATIONAL CURRICULUM

Year 1 :

The fellows spend 8 months on gynecologic oncology service. The fellows are responsible for preoperative and postoperative patient care and perform surgical procedures under supervision of an attending surgeon : Clinical training is also emphasized in the out patient department (OPD), where fellows are responsible for both new-patient evaluations and follow-up surveillance. Fellows are given training in several specialized clinics including colposcopy, LEEP, and cryosurgery. Fellows act as second assistant in the first half and as first assistant in the second half of first year training. The fellows must actively participate in regularly scheduled conferences including Morbidity and Mortality Conference, Gynecologic Oncology Conference, Journal Club, Gynecologic Radiation Oncology Conference, Gynecologic Medical Oncology Conference and Gynecologic Pathology Conference. Furthermore, the fellows are rotated to study in Gynecologic Cytology Unit (1 month), Gynecologic Pathology Unit (1 month), and Radiation Oncology Section (2 months).

Year 2 :

The second year fellows act primarily as consultants, moderators of the conference and manage the ward, OPD and perform the majority of the operative procedures. Fellows must be rotated to study in Medical Oncology Division and attend courses on clinical epidemiology and biostatistics. Every fellow is required to complete at least one clinical research project that is suitable for publication during their two years training.

CERTIFICATION

Upon satisfactory completion of the two-year Fellowship in Gynecologic Oncology, the fellow is eligible to sit for the written and oral examination of the Subcommittee Board on Gynecologic Oncology of the RTOG for a certificate of special competence in Gynecologic Oncology.

ELIGIBILITY

Applicants must have completed their core Residency Training in Obstetrics and Gynecology prior to beginning the gynecologic oncology fellowship. Physicians who will have completed a Residency Training in Obstetrics and Gynecology and will be qualified to sit for the Thai Board of Obstetrics and Gynecology written and oral examination are also eligible to apply for a fellowship position.

VISITTING FELLOWS

Fellows from overseas or other institutes in Thailand are also welcome for an elective course in a short period to study and exchange experiences.

HOW TO APPLY

Fellowship applications must be submitted via RTOG Office before March 31 of each year. Two letters of recommendation will be required, one of which should be from the director of the residency program. Selected applicants will be invited to Chiang Mai for a formal interview. Interviews take place over a half day and include participation of the entire staff. Applicants have the opportunity to tour the facility and to meet with the current fellows. The final selection of fellows is made by a joint meeting of all staff members. Two positions are available for fellowship each year.

Requests for applications and further information about the fellowship program should be directed to :

Associate Professor Jatupol Srisomboon, M.D.
Program Director of Gynecologic Oncology Fellowship
Department of Obstetrics & Gynecology
Faculty of Medicine, Chiang Mai University
Chiang Mai 50200, THAILAND. Telephone : 66-53-945552-4

Fax : 66-53-217144

E-mail : jsrisomb@mail.med.cmu.ac.th