The goal of this program is uncomplicated: to educate fellows in basic skills required by gynecologic oncologists to deliver superior 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 exposure to sufficient talent and imagination to permit continued growth and education for the rest of a professional career. The major strength in this program lies in its provision of wide expertise in all of the areas required for training and in the provision of a patient population from which the application of skills can be learned.

The contributions and dedication of two dynamic leaders in the field of gynecologic oncology, Drs. Saul Gusberg and Carmel Cohen, are recognized and admired on a local, national and international scale. They are responsible for the establishment and development of the Division of Gynecologic Oncology at the Mount Sinai Medical Center. The foundation that they created and legacy they passed on is very palpable and critical for the future success of our program.

The goals of this program have not changed and they are to educate fellows not only to mature into scholarly professionals but also to provide unparalleled patient care. The basis of both these objectives is to develop the intellectual strengths and organization of thought to permit analysis and offer contributions to the ever changing field of gynecologic oncology which will serve them and society well throughout their careers. The major strength of the program is its provision of a diverse attending staff that have accrued their expertise in institutions across the country. Along with this wide array of clinical acumen comes the volume of cases that provides the exposure to all facets of gynecologic oncology.

In 2004 the Divisional leadership transitioned to Dr Dottino as Division Director and Dr Rahaman as Fellowship Director (confirmed in 2006 by ABOG). The new divisional leadership took on the positions with the intent of expanding the academic and research capabilities of the division. During this transition, we have become a full member of the Gynecologic Oncology Group which offers our patients and fellows exposure to national protocols. We have also tapped into the extensive translational research facilities of the Mount Sinai School of Medicine. As the division that contributes the largest volume of cancer cases to the institution, we have been earmarked as key components in the support of basic science research. Consequently, we have been granted access to globally recognized scientists and state of the art facilities to provide our fellows the opportunity to pursue any basic science research endeavor they have an interest in. This alliance between clinical experts and the scientists working on cutting edge research is an example of the teamwork that we are establishing in order to enhance fellowship training, patient care and divisional contributions to the field of gynecologic oncology.

Our revamped division is now represented by eleven gynecologic oncologists organized in an efficient manner so that the patient catchment area has expanded, providing the largest volume of clinical material the department has ever seen. Our attendings have a presence at several hospitals covering the states of New York, New Jersey and Connecticut. All patients with complex oncologic issues or that are of academic interest are brought to the Mount Sinai Medical Center to provide the clinical exposure for the fellows. The one weakness of this strategic deployment of manpower is that not all the gynecologic oncologists are present at Mount Sinai on a daily basis. However, 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 expansion has resulted in a several-fold increase in volume and has resulted in the division being assigned two full-day operating rooms every day of the week for our patients. We also have designated office space in the Ruttenberg Cancer Center to see surgical patients, consults and administer our chemotherapy. We have also been given over 2000 square feet of administrative office space along with a designated GOG office and staff. One perceived weakness is the lack of a comprehensive gynecologic oncology data base. This issue has been resolved because we now have established this data base as part of a comprehensive prospective bio-repository which includes serum, tissue and linked clinical data which is now collected prospectively on all Gynecologic Oncology operative cases. In addition, the Gynecologic Oncology Faculty Practice has successfully converting to a comprehensive electronic medical charting which has further enhanced our data collection and storage. These new initiatives compliment the SGO database, which we have continuously and prospectively entered all our clinical data since 1992 when we were selected as one of the inaugural beta testing sites.

The Division recruited Sara Higgins Phd, in 2007, a behavioral scientist to established our behavioral science research initiatives and initiate an alliance with the Palliative care team to establish an early intervention comprehensive Palliative care program for all Gynecologic Oncology patients. She has also spearheaded a new initiative with a portable electronic medical record that captures patient and family data that allows establishment of a data warehouse to allow data mining to define cancer risk attributes and track quality assurance parameters. Dr Higgins is available to the fellows and divisional faculty to assist in establishing protocols, research design, data assimilation, statistical analysis and manuscript preparation for publication. She is partially funded by the American Cancer Society to investigate the role of bio-behavioral factors in thrombosis in Gynecologic Cancers. She is also a co-investigator in a prospective study to evaluate the impact of hypnosis on patients undergoing Gynecologic Surgery.

Ellen Kapito, RN was recruited to the Division in January 2007 as the Clinical Research Nurse to co-ordinate all Clinical Trials including National GOG chemotherapy trials.

Clinical instruction is performed simply. This service believes in a preceptorial technique with demonstration and Socratic exchange. Because the service is dynamic and because instructors are always available, the preceptorial relationship is employed continuously and there is no difference in the technique between in-patient and out-patient application. The fellow attends patients with instructors in the operating room, at the bed side, in the out-patient chemo-infusion suite, and in the Ruttenberg Cancer Center. The degree of responsibility is increased for the fellow proportional to skill and experience. The model for this has developed at the Mount Sinai Hospital, and has been applied to patient material at the other hospitals in our medical center.

Every operative procedure is staffed by an attending physician on the gynecologic oncology service. These physicians are faculty members within the division. On other services, these physicians are designated liaison physicians to the gynecologic oncology service, or are the teaching faculty of the service involved. Ambulatory activity includes the clinics within the Division of Gynecologic Oncology, the Department of Neoplastic Diseases and the Department of Radiation Oncology. In each of these circumstances, appropriate teaching faculty are physically present to supervise the activities of the gynecologic oncology fellow. This, again, is done in preceptorial fashion except where didactic instruction is either required or preferred.

1. Gynecologic Oncology Weekly Tumor Board: The fellow conducts a weekly planning conference which is attended by the gynecologic oncology staff, the oncology nurse, 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. The conference is accredited for 1 hour CME credit.

2. Fellows Weekly Didactic Conference: At 6:30 a.m. on Tuesday, a didactic lecture is held for the fellows by one of the Gyn Oncology or invited Faculty.

3. Journal Club: On Thursday at 3pm Journal club is held by one of the Gyn Oncology Faculty. An alternate time of 7:30 a.m. is allocated when there is an Ovarian Cancer Translational meeting.

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 a.m., 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 8-10 times per year and one of the Fellows would present under the preceptorship on a Faculty Member. Dr Rahaman, the Faculty and Fellows attend every week to participate in the discussions and reviews.

6. Gynecologic Pathology Weekly Slide Review: Every Thursday at 3:00 p.m., 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. The monthly Ovarian cancer translational meeting replaces this conference.

7. Monthly Gynecologic Pathology Conference: Once a month, from 7:00 a.m. - 8:00 a.m. on a Wednesday after the Gyn Tumor Board , a Gyn Pathology Review is conducted by the Gyn Pathology Attending Staff on the unusual cases from the preceding month.

8. Weekly Departmental Grand Rounds and Didactics: The Departmental Grand Rounds are held Wednesday Mornings at 8:00 a.m., with presentations by invited speakers who have achieved National or International acclaim in their particular interest. From 9:00 a.m. to 12:00 p.m. 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 assigned to the Gyn Onc Faculty.

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 Director of the Gyn Oncology Chemo-Infusion Service (Dr Rahaman) or another 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. Chief of Service Rounds: Dr Cohen, Dottino and Rahaman conduct afternoon rounds with the team at 4 p.m. on Mondays, Tuesdays and Thursdays.

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 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 Mount Sinai 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 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 Biostatistics Department Graduate School Course 'Biostatistical Concepts and Methods' and the Department of Microbiology Graduate School Course 'Molecular Mechanisms of Disease'. These courses are 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 John Mandelli, who is also the Biostatistician for the New York Gynecologic Oncology Group' and is now employed part time by our Division to provide supervision to the Fellows as well as Attending Staff in the conduct of all our research activities.

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: Meetings of the Society of Laparoendoscopic Surgeons, ACOG, ASCO, AAGL, the American Association for Cancer Research 'Molecular Biology in Clinical Oncology Workshop', the Berlex 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, and the Metropolitan Gynecologic Cancer Society.

In our program the third year is devoted to research based on the rationale that during the first two years of fellowship the fellow will interact with investigators in the institution, select an area of interest, and prepare for the third year research project. In this way, we anticipate that the fellow will be able to maximize the entire year with adequate antecedent preparation. There are, of course, opportunities for clinical investigation in which the fellow participates prior to the third year of formal research. These efforts often result in publications which will be listed later in this narrative.

One of our previous fellows, Dr. Ginger Gardner, was the recipient of the Gyn Cancer Fund/NCI Award sponsoring her for two years at the NCI as a Mount Sinai gyn oncology fellow and her program was accepted by the Division Board as fulfillment of her research requirement during the fellowship. Dr. Nimesh Nagarsheth, another fellow spent his research year with Dr. Peter Brooks in his laboratory at New York University School of Medicine. Dr. Brooks is a well funded researcher in cancer biology investigating extracellular matrix reactions in tumor systems. Our two most recent fellows have completed their research within Mount Sinai's Cancer Basic Science core facility. Dr Zakashansky worked on the role of lymphangiogenesis with Dr Michele Skobe. Dr William Bradley has investigated the function of KLF6 as a novel regulator of VEGF in Ovarian cancer cell lines.

While we have identified Dr. Stuart Aaronson, as a departmental resource for sponsoring research, our institutional philosophy has required a diminution of the appointment of PhD's by the clinical departments and has substituted a cloistering of such investigators within centers of focused investigation within the basic sciences. While this strategy removes direct control from the clinical departments, it does make available a cross fertilization, shared space, and an interest from the basic scientists in collaboration with clinician-scientists who can help formulate appropriate questions and provide access to clinical material.

We have recently established a monthly multi-disciplinary Ovarian Cancer Translational Group meeting which brings all the various basic scientist as well as clinicians to a common forum to advance the Division's research platform.

In addition, the fellows are encouraged to conduct clinical research under the pre-ceptorship of the faculty, and they would present their work at National and Regional meetings during the second and third year. ( Please see a list of conference presentations and current research below).

The third year fellow has protected time for basic science research and is only required to cover the service every third week-end. This arrangement allows us to remain compliant with the Bell Commission ( less than 80 hrs per week for all fellows) and also affords the research fellow the ability to maintain their clinical skills.

It is the philosophy of the Division of Gynecologic Oncology to allow each new fellow to demonstrate a comfortable level of performance and then by preceptorial education punctuated by didactic education to improve the level of performance and increase the knowledge of the fellow. Responsibility is granted commensurate with the fellows' progress, both in terms of acquired skills and improved knowledge. Interpersonal skilled development is encouraged at every level.