Program Introduction for Interviewing Fellows

• Dartmouth-Hitchcock Health System
• Program Information
• Upper Valley Life

A Message from Kris Strohbehn, MD – FPMRS Program Director

The Dartmouth-Hitchcock Health System

Dartmouth-Hitchcock Health is New Hampshire’s only academic health system and the state’s largest private employer, serving a population of 1.9 million across northern New England. D-H provides access to more than 1,800 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC). DHMC was named in 2019 as the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in 13 clinical specialties and procedures.

DHMC is located in Lebanon, NH, at the central western border of NH, adjacent to VT. We see patients from NH, VT, MA, NY and ME. Dartmouth-Hitchcock Health has a network of member hospitals, and clinics. Within the FPRMS Division we do outreach clinics in Keene, NH (Cheshire Medical Center), New London, NH (New London Hospital) and Bedford / Manchester, NH.

View More Information about D-HH

Program Information

Department of OB-GYN Mission

We deliver high quality, evidence-based care in a respectful, compassionate and caring environment. We are committed to timely access and clear communication with our patients and colleagues. We advance the science of health care delivery through education, research and continuous quality improvement.

Introduction

A video message from Ilana Cass, MD, Chair, Department of Obstetrics and Gynecology; VP, Obstetrics and Gynecology Service Line at Dartmouth-Hitchcock; Professor of Obstetrics & Gynecology.

The FPRMS Division is a busy clinical practice; we evaluate and treat the full spectrum of pelvic floor disorders for our patients. Treatment options include conservative and surgical management of pelvic organ prolapse, urinary and fecal incontinence, as well as fistulas and urethral diverticula. With an emphasis on transvaginal approaches, our fellows will become diverse and skilled transvaginal, conventional laparoscopic and robotic surgeons.

Division Faculty

The Division of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) was started in 2000 with the fellowship beginning in 2019. Our faculty includes four physicians, and two nurse practitioners.

	Anne Cooper, MD, MA Assistant Professor of Obstetrics and Gynecology, DHMC Research Interests: Microscopic hematuria, decision aids for management of urge urinary incontinence Bibliography: National Library of Medicine NCBI
	Paul Hanissian, MD Student clerkship director; Assistant Professor of Obstetrics and Gynecology, DHMC Board Certified, FPMRS Student Clerkship Director for Ob/Gyn Fellowship: Dartmouth-Hitchcock Medical Center in Pelvic and Reconstructive Surgery, 1995 – 1996 Ob/Gyn Residency: Maine Medical Center, 1991 – 1995 Research Interests: Novel pessary design, pull-out strength testing in an animal model for sacral colpopexy
	Amy Morrissette, APRN Nurse Practitioner, Bedford/Manchester Office Amy sees the full spectrum of urogynecology patients, including prolapse, incontinence, pessary management. She assists in pre- and post-operative visits and coordinates the high volume population in the southern region of NH.
	Jonathan Shaw, MB, BCh, BSc (Hons) Assistant Professor of Obstetrics and Gynecology Research Interests: Autologous tissue grafts for prolapse, urinary incontinence Bibliography: National Library of Medicine NCBI
	Susan Shinn, APRN Nurse Practitioner, DHMC Lebanon
	Kris Strohbehn, MD Professor of Obstetrics and Gynecology, DHMC; Vice Chair of Gynecology, DHMC; Program Director, FPRMS Fellowship; Division Director, Division of FPRMS Research Interests: Clinical outcomes for prolapse, novel pessary, decision-making aids Bibliography: National Library of Medicine NCBI

Fellows - Division of Female Pelvic Medicine & Reconstructive Surgery

	Kristen Gerjevic, MD, MPH  2019-2022 Following completion of her Ob/Gyn Residency at Dartmouth-Hitchcock, Dr. Gerjevic earned her Master of Public Health Degree, in the Leadership in Preventative Medicine Residency at Dartmouth-Hitchcock. In her fellowship, she has successfully completed projects for using decision aids for patient treatment of pelvic organ prolapse, presented at the 2019 AUGS/IUGA meeting and a video presentation accepted at the (now postponed) 2020 SGS meeting “A minimally invasive modification for Fascia Lata mid-Urethral Sling". Bibliography: National Library of Medicine NCBI
	Colby Schrum, DO 2020-2023 Colby completed his Ob/Gyn residency at Abington Hospital in Pennsylvania and spent one year in practice prior to starting his fellowship at Dartmouth-Hitchcock. He has been accepted for video presentation of a novel method for autologous fascia sling placement at the 2021 SGS meeting and plans to continue research in pelvic floor imaging and clinical outcomes.
	Paul Wadensweiler, MD, MSc 2021-2024 Dr. Wadensweiler completed his Ob/Gyn residency at the University of California, Irvine, where he conducted the largest descriptive study to date on bowel obstruction after sacrocolpopexy. He looks forward to focusing his future research on the needs of female athletes and sport-induced pelvic floor dysfunction. Paul also hopes to expand upon his pursuit of global health during his fellowship at Dartmouth-Hitchcock.

Other Faculty

Colorectal Surgery

View Introduction Video by Lauren Wilson, MD

	Srinivas J. (“Joga”) Ivatury, MD Division Chief, Colon and Rectal Surgery Assistant Professor of Surgery, Geisel School of Medicine, Dartmouth
	Lauren Wilson, MD Clinical Assistant Professor of Surgery, Geisel School of Medicine, Dartmouth
	Matthew Wilson, MD Assistant Professor of Medicine, Geisel School of Medicine, Dartmouth

Gastroenterology

View Introduction Video by Eric Shah, MD

Eric Shah, MD Assistant Professor of Medicine, Geisel School of Medicine, Dartmouth

Geriatric Medicine

View Introduction Video by Catherine Dubeau, MD

Catherine Dubeau, MD Professor of Medicine, Geisel School of Medicine, Dartmouth

Urology

View Introduction Video by E. Ann Gormley, MD

E. Ann Gormley, MD Professor of Surgery, Geisel School of Medicine, Dartmouth

Transgender Medicine Program

Currently, the gynecology department offers a Gynecology Gender Clinic twice per month for routine gynecology care and surgical consults for hysterectomy and oophorectomy for gender diverse patients. This clinic in part of a multidisciplinary transgender clinic at our institution that includes urology, plastic surgery, gynecology, psychiatry, dermatology, and primary care. Through this collaborate group, we offer combined procedures and all stages of our newly launched surgical program in phalloplasty, metoidioplasty, and vaginoplasty.

Ella Damiano, MD Obstetrics & Gynecology

Physical Therapy

Jo Ellen Gardner, PT

Ellen Kfoury, PT

Rotation Schedule

Fellows rotate in one month blocks.

• Urogyn
  We have divided Urogynecology rotations into an “Urogyn A” and “Urogyn B”.
  • Urogyn A Fellow fellow spends much of their rotation at the main campus, DHMC Lebanon. Their rotations include rotating in clinic, urodynamics, inpatient consults, the main operating room, the outpatient surgery center. They may cover Bedford / Manchester once per week.
  • Urogyn B fellow will do outreach clinics in Keene, Bedford / Manchester, and the operating room at Cheshire Medical Center. They will also fill in for OR coverage at the main campus. They rotate with Dr. Catherine Dubeau, a gerontology expert, ½ day per week to see Geriatric Medicine patients with urinary incontinence. They will rotate with physical therapy intermittently in year 1.
• Research
  The Research rotation is at least two consecutive months per rotation, with four months of research every year of the fellowship, totaling 12 months during the fellowship. The time is dedicated to research only, with the only clinical responsibilities being a ½ day continuity clinic at least twice monthly. The fellows will develop a hypothesis driven thesis, which is defended at the end of the fellowship.
• Urology
  During the second year, fellows rotate with Dr. Ann Gormley and the Urology Department for a two-month block.
• Gastroenterology/ Colorectal Surgery
  During the third year, the fellow rotates in Gastroenterology with Dr. Eric Shah, and the motility lab; and with Colorectal Surgery, focusing on anoscopy, fistula repairs, rectopexy, common colorectal disorders.

Continuity clinic is scheduled weekly, ½ day per week, except twice monthly during research blocks.

Benefits / Policies

GME benefits are outlined in the link below:
https://gme.dartmouth-hitchcock.org/resources/resident-fellow-benefits.html

In addition to the benefits outlined on the page above, FPMRS also provides a $1000/annum for program use and department supplemental funding for additional expenses.

Important/Required GME Policies – Please Read Prior to Your Interview

• Eligibility Requirements
• Selection Process
• Visa Policy
• Example Agreement of Appointment

All GME Policies are can be reviewed here:
https://gme.dartmouth-hitchcock.org/policies/gme_policies.html

Conferences

There are formal didactic lectures for FPRMS fellows on Thursday AM, in addition to journal club. There is a joint conference with Urology quarterly on Friday, which provides an opportunity for review of topics of interest and complex cases with our Urology colleagues. There is also a joint conference with Gastroenterology, Colorectal Surgery and Radiology monthly to review complex pelvic floor cases.

• Urology urodynamics conference - Monthly
• GI Radiology conference - Monthly
• FPMRS didactics - Twice a Month
• Colorectal Surgery conference - Monthly
• FPRMS Journal club - Twice a Month
• Didactic Teaching for Residents - Monthly
• Research Meeting - Monthly
• Preop Conference - Monthly
• Departmental Grand rounds, M & M’s - Weekly
• Combined Urology / Urogynecology Rounds - Quarterly

Fellow Research

• PGY-5
  • White Belt training, Human subjects research training (orientation)
  • Literature review
  • Identify scholarly project
  • Mentor
  • Study plan
  • Yellow Belt training
  • Scholarly activity project proposal
  • Begin data collection
• PGY-6
  • Project development and data acquisition, data analysis
• PGY-7
  • Complete data analysis, present at annual meeting
  • Write publishable scientific thesis

There is 12 months of protected time for research in the 3-year FPRMS Fellowship. The timeline for completing research projects is outlined in the slide.

All clinical research at D-H overseen through the Clinical Trials Office: http://one.hitchcock.org/intranet/departments/dartmouth_clinical_trials_office

There is departmental funding allocated to foster resident and fellow research projects, including some help with statistical analysis. There is also a commitment to help fund residents and fellows who are first author for regional and national scientific meetings.

The Clinical Research Unit is available to assist with patient recruitment and trials:
https://med.dartmouth-hitchcock.org/dh_clinical_research_unit.html

Procedure Case Logs – Fellow & 2019 Chief Residents

This table summarizes the cases for Dr. Gerjevic in her first year of fellowship. The volume is less than anticipated due to cancellation of all elective cases after the Covid 19 pandemic. The resident volumes for the 2019 graduating Chief Residents are also included.

Current Resident Photos

OB-GYN Residency Program

Leadership Preventive Medicine Residency

Combined training in Preventive Medicine and Ob-Gyn.

• Builds on TDI strengths in outcomes research, improvement, population health and institutional commitment to quality, safety, and value
• MPH degree from TDI – tuition paid by program!
• Opportunity to lead change and improvement at DHMC
• 2 month governmental public health experience
• Dedicated faculty coach; teaching opportunities; unique multi-specialty resident/fellow/faculty group
• May incorporate research in one year of program (3 + 1)
  • continue clinical work (app.20% time) in ob-gyn
  • moonlighting allowed
• Graduates are in demand and employers are very interested in their mix of clinical skills plus improvement and change knowledge and experience
• Visit the LPMR web page, email tina.c.foster@hitchcock.org or contact an alum to learn more!

Electives & Global Health

The FPRMS faculty have several connections for global health opportunities. Dr. Strohbehn has traveled to the Hospital de Familia, in Nuevo Progreso, Guatemala every other year. This hospital caters to under-resourced individuals in the mountains of northwest Guatemala. He has been with a team three times and Dr. Gerjevic traveled with him as a DHMC Ob/Gyn resident in 2017. Dr. Jonathan Shaw served as a Consultant Urogynecologist at the Tenwek Hospital, in Kenya for two years, after completing his fellowship in 2016. He has traveled annually to Kenya since starting at Dartmouth-Hitchcock and has been coordinating with Tenwyk Hospital to start a Kenya-based residency there. He will continue trips to Kenya annually. He was planning to travel to Kenya with the Ob/Gyn Residency Program Director, Dr. Fisher, as well as Dr. Gerjevic and a 3rd year Ob/Gyn resident. Unfortunately, this trip was cancelled due to the Covid-19 pandemic.

Note: Opportunity to travel depends on the current state (safety) of the country for travel.

Other Ob/Gyn Department Divisions / Colleagues

• General Ob/Gyn
• Reproductive Endocrinology and Infertility
  • Human Embryology and Andrology Laboratory:
    Navid Esfandiari, PhD
  • Boston IVF Bedford (PGY-2 rotation)
    Kristen Wright, MD
• Division of Gynecologic Oncology
• Certified Nurse Midwives

Orientation, Simulation & Skills Labs

DHMC has a Patient Safety Training Center, also known as the “Sim Center”.

There are skills labs, including suturing, laparoscopic and robotics training. The department participates in simulation and also has annual anatomic dissection at the cadaver lab at the Geisel School of Medicine at Dartmouth.

Match Communication Code of Conduct

We follow the NRMP guidelines for the Match process. We will not contact you but are happy to hear from you and to answer questions you may have that are not answered during the application and interview process.

Upper Valley Life

Lebanon, New Hampshire was Rated Best Small Town in America. There are many outdoor activities available in the Upper Valley for all seasons. Activities include:

• Road biking, gravel biking, fat tire biking, mountain biking
• Hiking in the white mountains of NH, the green mountains of VT, hiking segments of the Appalachian trail, the Long Trail (VT)
• Running
• Rock climbing, ice climbing
• Swimming outdoors and indoor facilities during the winter
• Sailing, water skiing on many lakes
• Kayaking, sculling, rowing canoeing, paddle boarding on Connecticut River or lakes
• Skiing, alpine, XC, back country
• Ice skating, hockey
• Maple sugaring

The cultural opportunities in the upper Valley are similar to towns of 300,000 or more, likely due to the influences of Dartmouth College and Dartmouth-Hitchcock Medical Center.

• Hopkins Center at Dartmouth College has numerous theatre events, concerts, films, including 5-6 films previewed for the Telluride film festival before public viewing.
• Opera North and the Lebanon Opera House in Lebanon, NH provide high quality theatre and opera productions, in addition to live concerts.
• Northern Stage in White River Junction, VT is the preeminent year-round theater company in the region, offering professional productions of world premieres, classics, and musicals.
• Museums: the Hood Museum (photo shown on right, courtesy of Dartmouth) at Darmouth; Montshire Museum of Science in Norwich, VT
• Vermont Institute of Natural Sciences
• The Upper Valley Trails Alliance (UVTA) strives to form and support partnerships with any town, organization or person in the Upper Valley willing to work on the improvement and sustainable development of public trails.

View area photos by visiting the links below:

• Dartmouth-Hitchcock Instagram
• Upper Valley Land Trust Instargram
• Dartmouth Outing Club Instagram

For more on life in the Upper Valley, visit this web page:
https://gme.dartmouth-hitchcock.org/resources/life_leb_hanover.html

City distances:

• Boston: 2 – 2.5 hours by Dartmouth Coach
• NYC: 4 hours by Dartmouth Coach
• Montreal: 3 hours by car