Urogynaecology

I About The Programme
II Assessment and Evaluation
III Target Audience and Eligibility Requirements
IV Other Information

I About The Programme

Name of Programme

Urogynaecology Fellowship Programme

Overview

KK Urogynaecology unit was set up in April 1993 with the aim of providing world-class services for the management of lower urinary tract disorders and pelvic floor dysfunction. The opening of KK Urogynaecology Centre in November 2001 affirms the unit’s commitment and vision to provide quality care and services for our patients.

The KK Urogynaecology Centre is the first urogynaecology centre in Asia, providing unparalleled one-stop services for the investigation, diagnosis and treatment of female bladder disorders and pelvic floor dysfunction, with an average of 20 000 patients’ attendances each year. On July 2008, we were promoted from unit to full department status. At present, we have one fully-trained specialist, 3 visiting specialists, 2 staff registrars, a few rotating residents, 3 urogynaecology trainees, 3 urodynamic nurses and 6 clinic specialist assistants serving our patients at our centre. In addition, the centre provides an excellent and challenging opportunity for training local and overseas doctors and nurses, and is also actively involved in research.

For more information onthe Department of Urogynaecology, click here.

Aim of Programme

• To improve knowledge, practice, teaching and research;
• To promote the training and development of specialised expertise, facilities and clinical material that will benefit patients with urogynaecological conditions;
• To establish a close understanding and working relationship with other disciplines;
• To encourage coordinated management of relevant clinical services;
• To be responsible for advanced training and research in the subspecialty field.
  

Duration of Programme

12 months

Number of Training Places

2 Fellows per year

Learning Outcomes

Doctors wanting to specialise in Urogynaecology must, in their training, acquire a working knowledge of all the skills mentioned below in order to be able to attend to their non-subspecialist colleagues’ enquiries.

1. A detailed knowledge of:

• embryology and anatomy of the pelvis, the pelvic musculature and the pelvic viscera;
• physiology of urinary and faecal control;
• pathology of abnormal urinary and faecal control;
• neurotransmission and the pharmacology of drugs acting directly and indirectly on the lower urinary tract.

2. A basic knowledge of:

• imaging of upper and lower urinary tracts;
• design and statistical analysis of clinical trials;
• function of urodynamic equipment.

3. Experience in the assessment of patients with lower urinary tract disorders by:

• clinical assessment;
• urodynamic assessment;
• cystourethroscopy;
• radiological imaging.

4. Clinical competence in the following:

• The medical and surgical management of pelvic floor dysfunction, including genital tract prolapse.
• The surgical and medical management of lower urinary tract dysfunction.
• The long-term care of patient with intractable incontinence. 
  

Content Areas

The programme covers the following areas:

1. Embryology and anatomy of the pelvis, the pelvic musculature and the pelvic viscera;
2. Physiology of urinary and faecal control;
3. Pathology of abnormal urinary and faecal control;
4. Neurotransmission and the pharmacology of drugs acting directly and indirectly on the lower urinary tract.
5. Imaging of upper and lower urinary tracts
6. Design and statistical analysis of clinical trials;
7. Function of urodynamic equipment;
8. Clinical and urodynamic assessments;
9. Cystourethroscopy and radiological imaging;
10. Medical and surgical management of pelvic floor dysfunction, including genital tract prolapse;
11. Surgical and medical management of lower urinary tract dysfunction;
12. Long-term care of patient with intractable incontinence.
    

Training Methods

Tutorials and journal clubs are conducted on a regular basis. Running clinics and daily ward rounds are under the supervision of consultants or senior consultants. Surgeries are performed under direct supervision of consultants or senior consultants. Maintenance and review of log book for specific procedures performed and competency level is mandatory. Research projects are carried out throughout the training period.

Tentative plan:

Months 1 to 3

• Report to supervising officer, UG Centre
• Briefing on departmental activities and role in department
• Orientation tour of hospital facilities
• Follow the team in daily ward rounds
• Attend all operative sessions and clinics
• Assist in surgeries
• Assist in clinic sessions
• Attend urodynamics clinics
• Attend monthly Journal Club / Subject Reviews
• Attend hospital CME activities
• Attend monthly research meeting / admin meeting

Review at the end of the 3rd month and plan new programmes for the remainder of program for Fellows here for 6 months or more.

Months 4 to 12

• Same as the above (Months 1 to 3)
• Hands-on surgery from the 4th month
• Participate in selection and development of patient education and training material such as pamphlets and video tapes for teaching of doctors, paramedical staff and patients
• Participate in research, teaching, workshops, conferences and departmental activities

End of Programme

• Review of programme and feedback session
• Completion of project, if any
• Preparation of report

There will be no rotation to other department/institution throughout the attachment period.

The same supervisor assigned at the start of the attachment will remain throughout the attachment period unless under special circumstances, where the supervisor assigned has resigned or left for overseas training.

Team of Experts

The Paediatric Urogynaecology Fellowship Programme is managed by the following experts.

II Assessment and Evaluation

Aims of Assessment

Fellows are required to continually demonstrate the following six competencies throughout the programme:

(A) Patient Care

Fellows must:

1. take a pertinent urogynaecological history in patients presenting with the common problems of uterovaginal prolapse and urinary incontinence;
2. perform a urogynaecological examination including familiarity with the sims speculum, left lateral position for examination and grading the type/degree of prolapse;
3. assist in the urodynamic laboratory;
4. interpret urodynamics result (residual urine, uroflow and cystometry) and the significance of it with respect to further management;
5. counsel patients on treatment options: either non-surgical treatment (pelvic floor exercise, ring pessary), lifestyle modification or surgical treatment;
6. perform vaginal hysterectomy, pelvic floor repairs and mid-urethral sling under supervision;
7. assist in mesh surgeries, sacrospinous fixation;
8. perform cystoscopy independently. 
   

(B) Medical Knowledge

Fellows must:
1. understand the anatomy and physiology of basic urogynaecological sciences such as:
   • embryology and anatomy of the pelvis, the pelvic musculature and the pelvic viscera;
   • physiology of urinary and faecal control; • pathology of abnormal urinary and faecal control;
   • neurotransmission and the pharmacology of drugs acting directly and indirectly on the lower urinary tract.
   
   
2. have a basic knowledge of:
   • imaging of upper and lower urinary tracts;
   • function of urodynamic equipment.
   
   
3. understand the principle of the following diagnostic tests:
   • urinalysis;
   • erect stress test;
   • urodynamic studies;
   • ultrasound scan;
   • PAP smear.
   
   
4. understand the following conditions:
   • pelvic organ prolapse – types and classification;
   • stress urinary incontinence;
   • overactive bladder/frequency urgency syndrome;
   • voiding dysfunction;
   • recurrent urinary tract infections;
   • other urinary symptoms, e.g. haematuria and dysuria.
   
   
5. understand the management of the following:
   • the medical and surgical management of pelvic floor dysfunction including genital tract prolapse;
   • the surgical and medical management of lower urinary tract dysfunction;
   • the long-term care of patients with intractable incontinence;
   • postoperative care of urogynaecological patients. 
   

(C) Practice-Based Learning and Improvement

Fellows must:
1. follow the team in daily ward rounds;
2. attend all operative sessions and clinics;
3. assist in surgeries and clinic sessions;
4. attend urodynamics clinics;
5. attend monthly journal club/subject reviews and monthly research meetings/admin meetings;
6. prepare weekly gynaecological audits of surgical cases;
7. participate in research, teaching, workshops, conferences and departmental activities
   

(D) Interpersonal and Communication Skills

Fellows must:
• work effectively as a team;
• refer to other allied health workers, in particular the physiotherapist whom we work closely with;
• effectively communicate with anaesthetic colleagues when managing urogynaecology pre-operative patients who are often old and have multiple co-morbidities. 
  

(E) Professionalism

Fellows must respect patients’:
1. confidentiality;
2. wishes;
3. privacy. 
   

(F) Systems-Based Practice

Fellows must:
1. understand the process of shared care of urogynaecological patients referred to our department by other specialists, including other O&G doctors;
2. interact effectively with the nurses, physiotherapist and senior members of the team;
3. understand operation-related procedures, e.g. consent taking, counseling for operations, time-out procedure, post-operative care and listing of various surgeries;
4. understand the role of the physiotherapist, e.g. pelvic floor exercises, electrical stimulation and bladder drills, in order to fully utilise the services.
   

Assessment Approaches

The clinical fellow will be assessed periodically and will receive an end-of-fellowship report and certificate. Clinical fellows must remain under Level 1 supervision for the entire duration of their training. They will be assessed (using SMC Form T3) during the following time points:

• 3rd month;
• 6-monthly intervals;
• end of term.

Clinical fellows must maintain a logbook of cases.

Evaluation Process

General overall grading system

The general overall grading system evaluates the Fellow’s performance upon completion of the fellowship programme. All Fellows will be given a general overall grading status at the end of the fellowship programme based on the grading criteria requirements incorporating the six competencies based knowledge, skills and performance that Fellows must demonstrate throughout the programme.

*Fellows who have attained a USP grade are given the following options:

• Repeat or extend fellowship posting
• Remediation in areas that are deficient
• Withdraw from the programme     
  

III Target Audience and Eligibility Requirements

Target Audience

Specially for doctors who are interested in specialising in urogynaecology.

Pre-requisite/Eligibility Requirement(s)

Candidates must:

• be 2 years post-membership;
  
• be able to perform common gynaecological surgeries, eg. THBSO, LSCS and simple vaginal surgeries;
• be self-sponsored, ie. sponsored by Government bodies or companies;
• be able to be attached for a minimum of 12 months;
• fulfil the Singapore Medical Council’s requirement;
• be prepared to be involved in research, clinical work and surgeries during the attachment.
  

IV Other Information

Course Fees

Course fee will be determined upon application.

Funding

Candidates should be self-funded or have funding from external sources/institutions.

Certification

A certificate of fellowship will be awarded upon completion of the programme.