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Overall Goals of Female Pelvic Medicine and Reconstructive Surgery Fellowship Training

Female pelvic medicine and reconstructive surgery physicians provide consultation services and comprehensive management of women with pelvic floor disorders, including urinary incontinence, lower urinary tract disorders, pelvic organ prolapse, and childbirth-related injuries. Comprehensive management includes the preventive, diagnostic, and therapeutic procedures necessary for the total care of the female patient with these conditions, complications, and sequelae resulting from pelvic floor disorders.

Accredited programs

FPMRS training should educate the fellow regarding the outpatient evaluation of pelvic organ prolapse and urinary incontinence, as well as overactive bladder, urinary retention, painful bladder syndrome, disorders of defecation.  Diagnostic procedures taught should include simple and complex urodynamics (including filling and voiding cystometry and uroflowmetry), cystourethroscopy, neurodiagnostic studies and anal ultrasound. Non-surgical therapies for the management of prolapse, namely pessary fitting, should also be mastered.

With respect to surgical training, the FPMRS fellow should become adept at performing surgery for the management of urinary incontinence, including sling procedures, periruethral injections, retropubic urethropexy, sacral neuromodulation, posterior tibial nerve stimulation, chemodenervation, and removal or revision of sling.  For the surgical management of pelvic organ prolapse the fellow should learn abdominal procedures — including colpopexy, uterine suspension and hysterectomy (total and supracervical); laparoscopic procedures (with and without robotic assistance) — including colpopexy, uterine suspension and hysterectomy; vaginal procedures — including hysterectomy, colpocleisis, colpopexy (intraperitoneal and extraperitoneal approaches), removal of pelvic mesh; other surgeries on the urinary system — including vesicovaginal and urethrovaginal fistula repair, urethral diverticulectomy, ureteroneocystostomy, ureteral stent placement, retrograde pyelography, urethrolysis, other genital procedures — including construction of a neo-vagina, and surgical procedures on the bowel system — including repair of anal sphincter laceration, and rectovaginal fistula repair.

Progressing through the fellowship

By the end for the fellowship training, the graduating fellow will be responsible for comprehensive preoperative assessment, postoperative care, and outpatient clinic evaluation of FPMRS patients. Fellows will be expected to perform as surgeons and/or first assistants in the operating room. The fellow will have developed advanced surgical skills in open and endoscopic cases and will be able to perform or actively assist in all complex FPMRS operations. In addition the fellow will have administrative duties to help the chief residents in urology and obstetrics and gynecology organize the service including teaching residents and medical students. The fellow will have learned how to communicate and interact with other consulting services, and will have developed administrative and leadership skills.

Medical Knowledge

  1. Anatomy, embryology, physiology of the genitourinary system
  2. Pathology of relevant urologic (bladder) and gynecologic (vaginal and urethral) malignancies
  3. Principles of preoperative assessment and post-operative management of FPMRS surgical patients
  4. Principles of management of FPMRS surgical patients
  5. Principles of surgery including hemostasis, wound healing, would complications, electrolyte and fluid replacement, and surgical nutrition
  6. Understand indications and use of intraoperative consultations and combined surgery with other sub-specialties.
  7. Understanding and knowledge of all relevant endoscopic FPMRS surgeries including laparoscopic and robotic abdominal sacral colpopexy
  8. General knowledge of obstetric complications and how to manage them
  9. Knowledge of management of common surgical complications
  10. Pharmacology, principles of metabolism, action and toxicity of commonly used drugs in FPMRS patients, including antibiotics and drugs used to treat neurogenic and non-neurogenic voiding dysfunction
  11. Understand principles of diagnosis and management male urinary incontinence including post-prostatectomy incontinence

Patient Care

  1. Perform an appropriate history and physical exam in the clinic and wards.
  2. Order appropriate laboratory, radiological and diagnostic procedures
  3. Demonstrate knowledge in the interpretation of laboratory investigations and  radiologic imaging
  4. Arrive at an acceptable plan of management of the disease process, including differential diagnosis
  5. Manage patients through their hospital stay and demonstrate knowledge of and an ability to recognize potential complications of the disease process on operative procedures.
  6. Demonstrate the ability to perform inpatient rounds, write accurate and legible progress notes, dictate discharge summaries, and write prescriptions
  7. Provide a plan for the patient follow-up
  8. Assessment of FPMRS inpatient consultations
  9. Assessment of FPMRS consultations from the emergency room
  10. Assessment and triage of calls from patients

Expected Technical Skills

  1. Perform all urodynamic procedures  independently
  2. Perform all cystoscopic procedures independently, including stent placement and retrograde pyelography
  3. Place, fit, and remove pessary/incontinence ring
  4. Perform all major FPMRS  cases as surgeon or first assistant
    1. Urethral sling
    2. Periurethral injections
    3. Retropubic suspensions
    4. Sacral nerve stimulation
    5. Removal/revision of sling and urethrolysis
    6. Removal of eroded mesh
    7. Colpopexy, uterine suspension, hysterectomy (total and supracervical), colpocleisis
    8. Insertion of vaginal mesh
    9. Repair of vesicovaginal, urethrovaginal, rectovaginal, colovesical fistulae, and urethral divertic ulectomy
    10. Contraction of neovagina
    11. Repair of anal sphincter laceration
    12. Pelvic organ prolapse repair
      1. Cystocele, rectocele, enterocele, vault prolapse repair


  1. The ability to be honest, reliable and respectful of racial, gender and religious characteristics of patients, their families and other members of the health care team
  2. Understand the professional, legal and ethical codes by which physicians are bound.
  3. Exhibit appropriate personal and interpersonal professional behavior.
  4. Deliver highest quality patient care with ethics, integrity, honesty and compassion
  5. The ability to recognize when to seek assistance from peers and senior colleagues.
  6. The ability to give and receive advice in a manner that is consistent with harmonious function of the health care system

Interpersonal and Communication Skills

  1. Listen effectively
  2. Establish professional relationships with patients and their families
  3. Inform patients and families about their condition at an appropriate  and understandable level
  4. Obtain a relevant history from the patient
  5. Write clear consultation notes, progress notes, discharge summaries and clinic evaluations.
  6. Present at ward round in a clear and organized manner.
  7. Present patient details in indications conferences
  8. Communicate effectively with allied health care professionals

Systems-based Practice

  1. Utilize health care resources wisely
  2. Understand the importance of and mechanisms to safely utilize resources in a cost-effective manner to benefit the patients

Practice-Based Learning and Improvement

  1. Develop effective self-directed learning strategies for continuing education and assessment of knowledge base
  2. Critically appraise sources of medical information and be aware of resources available
  3. Read around clinical cases
  4. Prepare and lead junior residents at indications conferences
  5. Present and participate actively at morbidity and mortality conferences
  6. Actively participate at journal club
  7. Participate in teaching medical students
  8. Prepare and present clinical cases at grand rounds

Milestones are designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation.  For each period, review and reporting will involve selecting milestone levels that best describe a fellow’s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty.

Level 1: The fellow demonstrates milestones expected of an incoming fellow.
Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level.
Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship.
Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target.
Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level.

After Fellowship training

Subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS) began in 2013 for those urologists who demonstrate a practice in FPM-RS of sufficient breadth and complexity that would be expected of a subspecialist in this field. Applicants approved by the Board to enter the process of subspecialty certification must be engaged in the active practice of FPM-RS urology, and must hold a current unrestricted general certificate in urology issued by the American Board of Urology.

Candidates for subspecialty certification must be in the active practice of FPM-RS. Applicants will be required to provide the Board with an electronic log of 12 months in length to include all office visits, as well as all hospital, ambulatory care, and office procedures for each facility where they practice, for the same consecutive twelve-month period.  The log must demonstrate that the candidate has an adequate number of FPM-RS surgery cases within index case categories as designated by the Board.  Candidates must hold a current valid medical license, and be able to document 30 hours of Category 1 FPMRS focused CME hours earned within two years prior to applying for certification. 

A computer-based examination comprises the final component of subspecialty certification.  The FPMRS Subspecialty Certification Examination is offered annually each summer. The four hour examination consists of approximately 180 multiple choice questions designed to assess knowledge of the field of FPMRS including the topics of: ethics and professionalism, genetics, biostatistics and epidemiology, lower urinary tract physiology and pharmacology, endocrinology, female sexual dysfunction, benign female pelvic disorders, urinary infection and management, congenital and acquired anomalies of the female pelvis and genitalia, techniques of tissue transfer, congenital and acquired neurologic diseases affecting the urinary tract, urodynamics, imaging (diagnostic, interventional and therapeutic), pathology, pain management, developmental anatomy and physiology, trauma, issues of defecation, and the open, endoscopic, laparoscopic and robot assisted operative techniques.  Candidates will have three opportunities to pass the examination, within the first six years of completing fellowship training.

All subspecialty certificates are time limited and subject to MOC. When a Diplomate becomes certified in a subspecialty, the Diplomate’s general certificate will be extended to coincide with the expiration date of the subspecialty certificate. The Diplomate will enter the MOC process after completing subspecialty certification.

Fellows who have completed ABOG sponsored programs should contact the ABOG for information regarding application for FPM-RS subspecialty certification.