Female Pelvic Medicine and Reconstructive Surgery Certification

Educational Objectives

The goal of this program is to improve the management of female pelvic floor dysfunction. After hearing and assimilating this program, the clinician will be better able to:

    1.   Describe requirements for certification in Female Pelvic Medicine and Reconstructive Surgery.

Summary

History: first synthetic sling described mid-20th century, but early attempts at treatment fraught with complications; classic sling developed by McGuire in 1978; initially few surgeons performed sling procedures; recent availability of new materials, anchors, and surgical kits has resulted in upsurge of pelvic floor surgeries by urologists and gynecologists; previously urologists focused mainly on anti-incontinence procedures, while gynecologists performed hysterectomies and prolapse surgery

Professional society: Urodynamic Society founded in 1978; mission statement concerned with providing research and training in urology and urodynamics; first fellow graduated from University of California, Los Angeles, in 1978; in early 2000s, name changed to Society for Urodynamics and Female Urology (SUFU) to reflect surgical component; in 2013, name expanded to Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (still abbreviated SUFU) to include male and female urology as well as treatment of fecal incontinence

Evolution of education: urology and gynecology specialties began to collaborate; in early 2000s, fellowship certification created by American Board of Obstetrics and Gynecologists and American Board of Urology; fellowship programs previously not standardized or overseen by regulatory body; in 2012, American Board of Medical Specialties recognized Female Pelvic Medicine and Reconstructive Surgery (FPMRS) as official subspecialty of both urology and gynecology; fellowship programs regulated by Accreditation Council for Graduate Medical Education (ACGME) and Residency Review Committee of their respective specialty (either urology or gynecology); currently 10 urology-based and 44 gynecology-based FPMRS fellowships in United States;  residency program for urology historically 6 yr and gynecology 4 yr, so programs require 2 yr FMPRS fellowship for urologists and 3 yr for gynecologists, including 1 yr of research

Certification: first FPMRS certification examination administered June 2013; “grandfathering” period ends in 2015, within which time candidates may submit case logs of pelvic floor reconstruction and anti-incontinence procedures (not including male urology) and take FPMRS examination; graduation from ACGME-certified fellowship program not stipulated for “grandfather” candidates, but required thereafter; speaker encourages eligible candidates, especially those who frequently perform pelvic floor surgery, to apply for FPMRS certification; FPMRS now included in core curriculum of urology residency training and seen more frequently on board examinations

Implications: FPMRS training improves quality of care for patients; provides opportunity to collaborate with gynecology colleagues and each other; enhances quality of research through multicenter studies; helps define outcome measures; practical implications yet to be determined

Readings

Bradley CS, Nygaard IE: Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 2005;106(4):759-66; Bump RC et al: The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996 Jul;175(1):10-7; Burrows LJ et al: Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 2004;104(5):982-8; Doaee M et al: Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J 2014 Feb;25(2):153-63; DeLancey J et al: Current status of the subspecialty of female pelvic medicine and reconstructive surgery. Am J Obstet Gynecol 2010 Jun;202(6):658; Eva UF et al: Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women. Acta Obstet Gynecol Scand 2003;82(3):280-6; Nygaard I: Female pelvic medicine and reconstructive surgery: the next decade. Female Pelvic Med Reconstr Surg 2014 Mar-Apr; 20(2):63-4; Ostergard DR: Urogynecology and pelvic reconstructive surgery: office preoperative evaluation of the incontinent female. Int J Gynaecol Obstet 1995 Jul;49:S43-7; Pahwa AK et al: Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review. Clin Anat 2014 Sep 25 doi:10.1002/ca.22472; Patel DA et al: Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 2006;195(1):23-8; Slieker-ten Hove MC et al: Prediction model and prognostic index to estimate clinically relevant pelvic organ prolapse in a general female population. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(9):1013-21; Swift S et al: Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005 Mar;192(3):795-806; Wieslander CK: Clinical approach and office evaluation of the patient with pelvic floor dysfunction. Obstet Gynecol Clin North Am 2009 Sep;36(3):445-62.

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, members of the faculty and planning committee reported nothing to disclose.  

Acknowledgements

Dr. Kobashi spoke at the 7th Annual UC San Diego Urology Postgraduate Course: Evidence-Based Urology Update, held March 14-15, 2014, in San Diego, CA, and presented by the UC San Diego School of Medicine and UC San Diego Moores Cancer Center. For more information about upcoming courses by UC San Diego School of Medicine, please go to cme.ucsd.edu. The Audio Digest Foundation thanks the speakers and the sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

UR372403

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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