DEPARTMENT OF OBSTETRICS & GYNECOLOGY DIVISION OF GYNECOLOGIC ONCOLOGY

EDUCATION PROGRAM

FOR FELLOWS IN GYNECOLOGIC ONCOLOGY FACULTY: Steven G. Bernstein, M.D., Clinical Professor Diego Castrillon, M.D., Assistant Professor, Pathology Siobhan Kehoe, M.D., Assistant Professor Samuel Lifshitz, M.D., Clinical Professor David Scott Miller, M.D., Professor, Dallas Foundation Chair in Gynecologic Oncology Alan K. Munoz, M.D., Clinical Associate Professor Elesyia Outlaw, M.D., Assistant Professor, Radiation Oncology Debra Richardson, M.D., Assistant Professor Michael White, Ph.D., Professor, Cell Biology A. Summary description of fellowship program.

This fellowship in gynecologic oncology is a four-year program designed to train obstetrician-gynecologists for productive careers in academic gynecologic oncology. It is sponsored by the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School and is carried out at its main teaching facility: UT Southwestern Medical Center and its affiliate institutions. Two years of the fellowship are devoted to acquiring research skills in the Laboratory of Gynecologic Oncology within the Nancy B. and Jake L. Hamon Center for Therapeutic Oncology Research. The other two years of the fellowship involve clinical training which includes 14 months at UT Southwestern Medical Center (Parkland Memorial and University Hospitals-St. Paul/Zale Lipshy), one month of Pathology and Radiation Therapy, two months of Surgical Critical Care and seven months at Presbyterian Hospital of Dallas and Medical City-Dallas Hospital. Eligibility for this fellowship requires satisfactory completion of an A.C.G.M.E. or R.C.P.S.C. approved residency in Obstetrics and Gynecology, successful completion of the written examination of The American Board of Obstetrics and Gynecology and eligibility for a license to practice medicine from the Texas State Board of Medical Examiners. Fellows accepted to the program must be licensed to practice medicine in the State of Texas prior to initiation of the fellowship.

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1. Goals The goal of this fellowship is the preparation of outstanding obstetrician-gynecologists for productive careers in academic gynecologic oncology. This goal requires that the fellows be provided with the clinical, instructional, and investigational foundation for such a pursuit. As is set forth in the "Guide to Learning in Gynecologic Oncology," training will be provided in the comprehensive screening, diagnosis, and treatment of cancers of the female genital tract and their complications. This includes radical pelvic and reconstructive surgery, chemotherapy and radiation therapy. Particular emphasis is placed on surgical techniques, critical care, clinical trials and investigational agents. This training is that necessary for certifying the fellow as a sub-specialist in gynecologic oncology by the American Board of Obstetrics and Gynecology and the recognition of the fellow, by patients and colleagues, as a consultant in gynecologic oncology. The fellow will be actively involved in the didactic and clinical education of medical students and residents. Basic and clinical research experience will be provided to allow the fellow to design, develop and obtain support for their own studies as well as direct the efforts of others. It is expected that gynecologic oncologists completing this fellowship would be excellent candidates for NIH or other society-supported career development awards. The strengths of this fellowship program are both its research and clinical components. The research years provide dedicated time to acquiring basic investigational skills in a gynecologic oncology laboratory. The fellow will learn the basics of hypothesis-driven research, grant preparation and peer review presentations and publication skills. The fellow has limited clinical assignments and has full-time to devote to this research effort and the graduate course work required by the Board. The clinical aspect of the program is remarkable for its diversity, exposing the fellows to the care of indigent and private patients, as well as university based and private practice faculty. The strengths of the fellowship and its intent of academic preparation has been recognized by the NCI, the American Cancer Society and its Texas Division in the form of awarded Clinical Oncology Fellowships.

2. Education program Fellows in this program acquire experience in the comprehensive management of gynecologic cancer and its complications: radical operations performed on the reproductive organs, resection/anastomosis/bypass of the gastrointestinal and urinary tracts and other pelvic surgery techniques. Fellows also develop skills in dissection of inguinal, pelvic, periaortic lymph nodes and gain experience with plastic reconstructive operations required for restoration of function in women treated for gynecologic malignancy. Fellows perform adjunctive procedures required in these patients such as cystoscopy, sigmoidoscopy and placement of central venous catheters. Experience in the placement and management of thoracic cavity drainage tubes is gained. The program faculty is privileged to perform these procedures and others described in the "Guide to Learning in Gynecologic Oncology." Fellows receive ongoing experience in total parenteral nutrition and in the critical care of the gynecologic oncology patient with further concentrated exposure during a rotation in surgical critical care. Instruction in the diagnosis and management of disorders of the breast is included. Fellows are instructed in the methods and techniques of radiation therapy and participate in the management of patients receiving all forms of these treatments. Fellows acquire an understanding of the principles of radiobiology and radiation physics during a rotation on radiation oncology. They participate as a member of the team that decides the course of treatment, plans radiotherapy, applies radioactive materials and are responsible for the care of radiation therapy inpatients.

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The program faculty is privileged to administer chemotherapy. Fellows acquire basic and clinical knowledge about the mechanism(s) of action, side effects, advantages and disadvantages of agents used in cancer chemotherapy. They gain practical experience in the administration of such drugs and in the recognition and management of complications that may result from the use of such agents. a. Organization of inpatient and outpatient teaching (each hospital)

Facilities utilized for fellow education include UT Southwestern Medical Center, Presbyterian Hospital of Dallas and Medical City-Dallas Hospital. The facilities of UT Southwestern Medical Center include Parkland Memorial Hospital and University Hospital-St. Paul/Zale Lipshy, the James W. Aston Ambulatory Care Center and the Harold C. Simmons Comprehensive Cancer Center which are all contiguous or adjacent to UT Southwestern Medical School. UT Southwestern Medical Center at Dallas is a multifaceted academic medical institution that is nationally recognized for excellence in educating physicians, biomedical scientists and other health care professionals. It was founded in 1943 as the Southwestern Medical College. The medical center includes three degree-granting institutions: Southwestern Medical School, Southwestern Graduate School of Biomedical Sciences and Southwestern Allied Health Sciences School. These three schools train approximately 3,250 medical, graduate and allied health students, residents and postdoctoral fellows each year. In its efforts to bring the latest laboratory findings to the patient's bedside, UT Southwestern supports more than 2,000 research projects annually totaling more than $298 million. The facilities encompass 5.5 million square feet in 20 buildings on 150 acres. The fiscal year 2005 UT Southwestern budget is $892 million and 5,900 faculty and staff are currently employed. UT Southwestern is under the leadership of the president, Dr. Daniel Podolsky, and governed by the nine-member Board of Regents of the UT System who are appointed by the governor of Texas. UT Southwestern was ranked among the top five institutions in America from 1995 to 1999 in a study ranking the research impact of federally funded universities in the United States. Its faculty includes four Nobel Laureates, 15 members of the National Academy of Sciences and 17 members of the Institute of Medicine. The gynecologic oncology patient care aspects of the fellowship are divided into two services: Southwestern Medical Center (Parkland Memorial and University Hospital-St. Paul/Zale Lipshy; James W. Aston Ambulatory Care Center and Simmons Cancer Center) is under the supervision of David Scott Miller, M.D., Siobhan Kehoe, M.D.and Debra Richardson, M.D. The fellow directs all inpatient and outpatient care of gynecologic oncology patients with faculty supervision. The Presbyterian Hospital of Dallas and Medical City-Dallas Hospital services are organized around the outpatient and inpatient private practices of Drs. Samuel Lifshitz, Steven Bernstein, Bruce Fine, and Alan Munoz. The Presbyterian Gynecologic Oncology practice is in the Margot Perot Women's and Children's Hospital where a 2,200 square foot facility is available with four examining rooms as well as a facility for outpatient chemotherapy. The Medical City outpatient unit is similarly equipped. The operating rooms and inpatient units at both facilities are state-of-the-art and available for fellow education in gynecologic oncology. The fellows are intimately

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involved in the inpatient and outpatient diagnosis, evaluation, and treatment of private patients during these ‘off-site’ rotations.

b. Supervision in ambulatory unit and operating room All new gynecologic cancer patients presenting to the Parkland Memorial Hospital Gynecologic Oncology Clinic will be seen by the fellow under supervision by the faculty for evaluation, staging, treatment as well as management of complications thereof. The fellow will be involved in the ambulatory evaluation of private patients seen by the UT Southwestern faculty at Simmons Cancer Center and be responsible for Presbyterian Hospital and Medical City patients during surgery and/or hospitalization. Every major case in the operating room, which relates to gynecologic oncology, requires faculty involvement, for the purposes of supervision of patient management and teaching opportunity. Attending faculty are present for all cases in the operating rooms at all the hospitals and are almost always scrubbed for the purposes of supervision of patient management and teaching opportunity.

c. Conferences Gynecologic oncology fellows are encouraged to attend and actively participate in these relevant conferences: i. Multi-Disciplinary Breast Conference (Tuesday 0715, NC3.222)

ii. Parkland Patient Care Conference: (Tuesday 0800, 4West) Multidisciplinary conference

directed by the fellow and attended by nursing, pharmacy, social work, nutrition, discharge planning, home care, pastoral care, and gynecologic oncology faculty that deals with the total care of the gynecologic oncology patient.

iii. Reproductive Biology Fellows Conference (Tuesday 1200, J6.102)

iv. Introductory Oncology Fellows lectures (Tuesday 1600, Thursday 0730, July-September, NC8.212) Core lectures in chemotherapy and oncology emergencies.

v. Protocol and Chemotherapy Monitoring Conference: (Wednesday 0730 G6.200) All patients under active chemotherapy and/or chemo-radiation treatment are presented by the fellow for review and discussion by faculty. Monitoring of cooperative group, NCI, and industry protocol accrual, compliance, toxicity, and reporting is addressed.

vi. Gynecology Tumor Board: (Wednesday 0800 G6.200) New and recurrent gynecologic cancer cases are presented in a didactic fashion, led by the fellow with participation of faculty and staff from gynecologic oncology, radiology, surgical pathology, radiation therapy, and related specialties as required. Cases are presented and staged by the resident. The fellow then discusses the critical issues of the case and proposes an evidence based treatment plan that is further discussed by the faculty.

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vii. Gynecologic Oncology Grand Rounds: (Eight Wednesdays per year 1100 G6.200 at Parkland Memorial Hospital and two Tuesdays per year 0730 3rd floor Medical Conference Room at University Hospital-St. Paul) presented to the Department of Obstetrics and Gynecology by gynecologic oncology fellows, faculty and visiting professors.

Topics 2008-09 Premalignant Cervical Neoplasia Gestational Trophoblastic Neoplasia Sex Cord Stromal Tumors Vulvar Cancer Endometrial Cancer Cervical Cancer Germ Cell Tumors Principles of Chemotherapy

viii. University lecture series (Wednesday 1600 NB2.102) Weekly lectures given by

national or international visiting professors. Topics related to clinical and basic sciences, many of them relevant to the oncologist.

ix. Divisional Research Meeting. (Second Wednesday 1600 J6.102 Conference Room) Reviews all basic and clinical research within the Division.

x. University lecture series: (Wednesday 1600 NB2.102) Weekly lectures given by national or international visiting professors. Topics related to clinical and basic sciences, many of them relevant to the oncologist.

xi. Gynecologic Oncology Fellow lectures: (First Wednesday 1600, J7.102). Core didactic lectures chiefly presented by the faculty to prepare fellows for their written and oral board examinations in gynecologic oncology.

Topics 2008-09 Chemotherapy/Clinical Pharmacology Total Parenteral Nutrition Principles of Radiotherapy Principles of Palliative Care Recurrent Epithelial Ovarian Carcinoma Staging Uterine Adenocarcinomas Updates on Targeted Therapy Gynecologic Pathology Review Endometrial Sarcoma Clinical Trial Design Overview of Ovarian Cancer

xii. Morbidity and Mortality Conference (last Wednesday 1600 J6.102 Conference Room)

Critical review by faculty, fellows and residents of complications (i.e. unplanned returns to surgery, ICU admissions, or patient deaths) for the preceding resident rotation.

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xiii. Gynecologic Oncology Journal Club (Third Wednesday 1600, J7.102 Conference Room) Current literature on topics in gynecologic oncology are presented and critically reviewed by the fellows and residents.

xiv. Hamon Center for Therapeutic Oncology Research Weekly Seminar (Thursday 0900 NB8.118). Investigators working within the Hamon Center present data on their topic of basic research. Intermittent guest lecturers are also invited.

xv. Hamon Center for Therapeutic Oncology Research Meeting (Thursday 1000 NB8.204). Investigators present their current research and recent data on a rotational basis.

xvi. Simmons Cancer Center Combined Modality Treatment Conference (Friday 0730 NC8.212) Cancer Center wide multidisciplinary treatment planning conference.

xvii. Daily lectures and grand rounds given by different Departments of the Medical School, published in a monthly calendar of events.

xviii. Participation in Post Graduate Course in Obstetrics and Gynecology sponsored by Southwestern Medical School.

d. Seminars and lectures The program includes two university graduate-level courses: i. Biostatistics for Clinical Sciences I – DCS 5391/5491

Summary statistics; probability theory; random variables and distribution functions; point and interval estimation; sampling an measurement; statistical power and samples size; parametric and nonparametric approaches for the analysis of categorical and continuous data; simple linear regression an survival analysis (3 credits).

ii. and at least one of the following: Biostatistics for Clinical Sciences II – DCS 5302 Linear and logistic regression and models (control of confounding and predictive models); categorical data analysis (binomial and Poisson distributions; analysis of paired categorical data, nonparametric methods for ordinal data); survival analysis (Kaplan-Meier curves, hazard functions, censoring, log-rank tests and generalized Wilcoxon tests, Cox regression model) (3 credits). Observational Studies – DCS 5303 Cohort studies (assembly and follow-up, exposure measurement, outcome ascertainment, confounders, multivariate statistics). Case-control studies (selection of controls, sources of bias, analysis); cross-sectional studies, case-series and exposed-subject designs; strengths and limitations of databases; how to gain access and retrieve data; how to define outcomes (3 credits). Epidemiological Concepts and Principles I – DCS 5307

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Population sampling; measures of disease frequency and association; standardized rates/ratios; age, cohort and period analysis; validity and reliability; selection, measurement and confounding biases; sensitivity, specificity and predictive value; risk ratios, odds ratios and number needed to treat; receiver operator curves and diagnostic test performance (3 credits). Conceptual Biostatistics – DCS 5309 Conceptual approach to statistical analysis of biomedical data. The course explains fundamental statistical principles and focuses on explaining the appropriate scientific interpretation of statistical tests rather than the mathematical calculation of the tests themselves. The course covers topics typically used in biomedical publications, including data description ,summary statistics, p values and confidence intervals, contingency tables, sensitivity and specificity of laboratory tests, parametric and non-parametric tests, analysis of variance, correlation, regression, and statistical power and sample size estimation (3 semester hours). Gene Transcription – DCS 5102 This course expands on the fundamental concepts studied in the first-year Core Course, emphasizing experimental strategies, reading of primary literature, critical evaluation of data, and student discussion. The topics will change to keep current with advances in the field. Topics that may be covered include the nucleoprotein complex of the core transcriptional promoter, regulation of the core promoter by upstream elements, transcription factors, transcriptional modulation, cell-specific transcription, and the transcriptional regulation of development (1.5 credits). Tumor Immunobiology – DCS 5172 This course will be a survey of a number of concepts relevant to the biology of cancer and tumor immunology. The individual topics will include chemical carcinogenesis, promoters of tumors after induction with viruses or chemicals, tumor metastasis, tumor dormancy and how the different arms of the immune system affect tumor development and respond to tumors. It will also include various approaches to immunotherapy and vaccination against tumors (1.5 semester hours). Therapeutic Radiological Physics – DCS 5386 The basic principles of high-energy photon, electron, neutron, and proton interactions with tissues and biological systems are introduced in this course. The course reviews the instrumentation applied to the discipline of radiation oncology and includes measurements and computations. Viruses in Human Cancer – DCS 5388 This course offers an introduction to viruses associated with human cancer. Cellular and molecular mechanisms of tumor induction and malignant progression are discussed, including the role of oncogenes and tumor suppressor genes in viral carcinogenesis. Current literature is reviewed in student-led discussions. (3 semester hours)

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e. Scientific meetings

Fellows are encouraged and supported to attend, present before, and participate in scientific meetings. In recent years, UT Southwestern Gynecologic Oncology Fellows have attended and/or presented at the Society of Gynecologic Oncologists, the Society for Gynecologic Investigation, American Society of Clinical Oncology, American Association for Cancer Research, American College of Obstetricians and Gynecologists, Gynecologic Oncology Group, New England Association of Gynecologic Oncologists, Western Association of Gynecologic Oncologists and others (see A.4).

f. Research activities Two years of the fellowship are devoted to acquiring academically productive research skills. One of the unique aspects of this fellowship program is that during these two years the fellow has limited clinical responsibilities and is expected to devote near full time effort toward learning the latest scientific techniques and interacting with other scientists. The goal of this research training is to provide fellows with the scientific basis that will allow them to make significant and unique contributions to the body of knowledge in gynecologic oncology such that they should be able to collaborate with other colleagues, obtain research funding, be independent investigators, and academic gynecologic oncologists. i. Basic Science

The Laboratory of Gynecologic Oncology (NB8.222) has 500 square feet of space and an adjoining office for research activities. The lab is dedicated to the study of the molecular biology of gynecologic cancers under the guidance of division faculty. It is located within the Nancy B. and Jake L. Hamon Center for Therapeutic Oncology Research in the Simmons Biomedical Research Building on the North Campus. The laboratory is focused primarily on translational research, has the facilities for tissue culture, in vitro and in vivo tumor growth assays and also houses the IRB approved gynecologic oncology tumor bank. This lab evaluates the biologic effects of chemotherapy, genetic therapy, and immunotherapy on gynecologic malignancies. The fellow will be involved in some of the many laboratory research projects and encouraged to develop their own projects with faculty supervision that will typically serve as the basis for their thesis. Mentoring of fellows in the laboratory has resulted in two ACOG-Ortho-McNeil grants (1999, 2004), an American Cancer Society-Institutional Research Grant (2003), Society of Gynecologic Oncologists GCF Award for Best Presentation (2005), a ACOG/3M Pharmaceuticals Research Award (2006, 2007) and numerous presentations and publications in recent years (see A.4. and 5.).

ii. Clinical research Fellows desiring a rigorous clinical research curriculum may pursue a Basic Certificate, Graduate Certificate or Master’s Degree in Clinical Science through the UT Health Sciences Center-Dallas Campus Site within the medical complex. Trainees may

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successfully complete the program by completing the core and elective didactics curriculum, achieving commendable feedback from mentors, attending the clinical science lectures and workshops and demonstrating effective completion of their respective clinical science projects. This degree is excellent preparation for those fellows desiring an academic career in clinical trial design and protocol development. . Dr. Miller has detailed experience in the development of and participation in clinical protocols to study various aspects of gynecologic malignancies. He provides mentoring for the transition from trial design to application. The Division develops its own clinical protocols, conducts industry sponsored studies, and is a full member institution (037) of the Gynecologic Oncology Group (GOG). Fellows pursuing a certificate or degree in Clinical Science are encouraged to submit concepts and be active in the GOG and/or investigator-initiated studies.

g. Clinical responsibilities during research years Fellows have greater than 90% protected time for their two years designated for research training. There are no assigned clinical duties at UT Southwestern Medical Center, Presbyterian Hospital or Medical City-Dallas. Fellows have the option to internally decide who might assist the faculty at University Hospital-St Paul/Zale Lipshy when a major gynecologic oncology surgical case (ie, radical hysterectomy, ovarian debulking, exenteration) cannot be scrubbed by the Parkland Hospital on-service fellow due to scheduling conflicts. The frequency of assisting the faculty for these cases averages 1-2 cases per month. Research takes priority over any clinical duty during the week and faculty acknowledge that fellow participation is optional. Fellows during their research time will be responsible for rounding and associated patient care 1 weekend every 1-2 months depending on the senior fellow rotation.

h. Off-service rotations The fellow spends a two-month rotation in the Surgical Intensive Care Unit of Parkland Memorial Hospital under the supervision of Heidi Frankel, MD, Professor of Surgery and Director of the S.I.C.U. The fellow is a full and active participant in the service along with residents from anesthesia and general surgery, and is involved in the care of all patients in the unit, including trauma, vascular, surgical subspecialties, as well as gynecologic oncology. Additional experience is gained in invasive monitoring, respirator management, and parenteral and enteral nutrition. Prior to this rotation the fellow will have been certified by the Advanced Cardiac Life Support and Advanced Trauma Life Support courses. The fellow may take paid in-house night call 2 times per month covering the University Hospital-St. Paul or Parkland Labor & Delivery during the two research years of the program or other off-service rotations (except SICU). This opportunity is entirely optional and occasional fellows have elected not to participate.

i. Progressive responsibility The goal of this training program is directed towards clinical and academic excellence that will produce independent academic gynecologic oncology consultants. This requires a planned and

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progressive program of escalating responsibilities in all areas of training. Close supervision and effective teaching in investigation, clinical activities and teaching capacity will allow progressive development and confidence in analysis of problems, surgical skills and academic progression. The incorporation of one fellow per year to the program, will allow the senior fellow to get progressively involved in clinical and academic activities which require a higher degree of responsibility. This culminates in the senior fellow serving as unofficial attending (‘pretending’) for the final two months of the fellowship.

j. Educational experiences in clinical pharmacology, pathology and radiation Fellows are able to attend a variety of didactic lectures pertaining to clinical pharmacology and sequelae of chemotherapy administration. The Parkland Patient Care Conference, Gynecologic Oncology Fellows lecture series, Introductory Oncology lecture series, Protocol and Chemotherapy Monitoring Conference and others listed in A.2.c. have relevant topics to strengthen the fellows’ knowledge base. Fellows spend a one-month rotation in the Department of Radiation Oncology, under the supervision of Elesyia Outlaw, MD, Assistant Professor of Radiation Oncology where he/she is exposed to didactic sessions in radiation physics and radiation biology. The fellow is involved in the treatment planning and administration of external beam radiation therapy, intracavitary, interstitial and high dose rate brachytherapy as well as radioisotopes in the management of neoplasms. In addition, he/she performs the intracavitary applications and has the opportunity to examine patients during the course of treatment.

3. Responsibilities and activities of fellows in: a. Teaching of residents and students

Residents from UT Southwestern Medical Center and Methodist Hospitals of Dallas rotate on the gynecologic oncology service at the second and third year levels. There are at least three residents participating in the care of patients with gynecologic malignancies at any given time. Senior UT Southwestern medical students or visiting externs may also spend a one-month elective in gynecologic oncology. The fellow will supervise the activities of the residents and students rotating through the service, he/she will guide them in the evaluation and care of gynecologic oncology patients. The fellow will assist the residents in non-radical gynecologic procedures as assigned by the faculty. In this way, the fellow has an opportunity to develop his/her teaching skills. Residents, fellows and faculty work collaboratively at all outpatient facilities, allowing for a reasonable distribution of labor and of teaching effort. The fellow participates in the regularly scheduled junior and senior medical student lectures in obstetrics and gynecology. Each fellow also presents at Departmental Grand Rounds at least once a year. In addition, he/she will have active participation in weekly lectures and journal clubs for residents. The fellow will organize, select cases, and supervise the resident participation of the weekly Tumor Board conference.

b. Benign gynecology

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Fellows and faculty are frequently requested at Parkland Memorial Hospital (approximately 3000 benign gynecology operations annually) or University Hospital-St. Paul as intra-operative consultants for complicated surgical procedures, inadvertent diagnoses of neoplastic diseases, or as consultants for postoperative intensive care or complications. Pre-operatively, fellows serve as primary consultants for the benign gynecology teams evaluating management plans for adnexal masses or other potentially malignant scenarios. Fellows determine which patients would be more appropriate for primary management by the gynecologic oncology service. Faculty coverage for other less suspicious cases is provided as a ‘standby’ service to the Department without fellow coverage. The fellow is not expected to be primarily involved in the management of uncomplicated patients with benign gynecologic diseases.

c. Obstetrics Occasionally, the fellow will be emergently consulted with faculty supervision for an unanticipated obstetrical catastrophe (ie, massive retroperitoneal hemorrhage, peripartum hemorrhage, ureteral transaction at the time of gravid hysterectomy), inadvertent cancer diagnosis, difficult dissection or anticipated combined care patient (ie, cervix cancer during pregnancy for cesarean-radical hysterectomy). More than 16,000 deliveries are performed at Parkland Memorial Hospital each year and this volume allows for a unique fellow experience in surgically managing obstetrical emergencies.

4. Presentations at regional or national meetings by fellows for the preceding 5 years Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Muller CY, Miller DS, Schorge JO. Is Staging of Ovarian LMP Tumors Worth the Effort? A Multicenter Study of 229 Patients. Society of Gynecologic Oncologists’ 35th Annual Meeting, San Diego, CA. February 2004. Rao GG, Coleman RL, Rogers P, Nguyen P. Phase I Clinical Trial of Weekly Paclitaxel, Weekly Carboplatin and Concurrent Radiotherapy for Locally Adcanced Cervical Cancer. Society of Gynecologic Oncologists’ 35th Annual Meeting, San Diego, CA. February 2004. Drake RD, Lee H, Rajanbabu R, Kim J-H, Miller DS, Mok SC, Schorge JO. Evaluation of Plasma Ostepontin in Diagnosing and Monitoring Ovarian Cancer. Society of Gynecologic Oncologists’ 35th Annual Meeting, San Diego, CA. February 2004. Knowles LM, Drake RD, Morrissey C, Rajanbabu R, Miller DS, Minna JD, Schorge JO. Restoration of Slit-2 Function: A Novel Therapeutic Option for Ovarian Cancer? Society of Gynecologic Oncologists’ 35th Annual Meeting, San Diego, CA. February 2004. Drake RD, Kim J, Mok SC, Schorge JO. Evaluation of plasma osteopontin in diagnosing and monitoring ovarian cancer. Oral presentation. Glaxo SmithKline 8th Annual National Gynecologic Oncology Fellows’ Forum, San Diego, California. February 2004. Knowles LM, Drake RD, Morrissey C, Rajanbabu R, Miller DS, Schorge JO. Restoration of Slit-2 function: a novel therapeutic option for ovarian cancer? Oral presentation. Glaxo SmithKline 8th Annual National Gynecologic Oncology Fellows’ Forum, San Diego, California. February 2004.

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Rao GG, Kurien A, Gossett D, Griffith WF, Muller CY. A Case-Control Stufy of Methuylenetetrahydrofolate Reductace (MTHFR) Polymorphisms in Cervical Carcinogenesis. AACR 95th Annual Meeting. Orlando, FL. March 2004. Drake RD, Girard L, Lam DL, Minna JD, Schorge JO. Gene Expression Profiling to Predict Platinum-Sensitivity in Ovarian Cancer. AACR 95th Annual Meeting. Orlando, FL. March 2004. Drake RD, Rao GG, Schorge JO. Gestational trophoblastic disease among Hispanic women: a 20-year experience at Parkland Memorial Hospital. New England Association of Gynecologic Oncologists 24th Annual Meeting, Chatham, MA. June 2004. Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Fertility-sparing surgery for ovarian tumors of low malignant potential: a multicenter analysis. ACOG District VII Annual Meeting, Washington, D.C. October 2004 Drake RD, Rao GG, Schorge JO. Gestational trophoblastic disease among Hispanic women: a 20-year experience at Parkland Memorial Hospital. ACOG District VII Annual Meeting, Washington, D.C. October 2004. Heffernan T, Giannios N, Jenison E. Malignant transformation in a case of chemotherapeutic retroconversion of immature ovarian teratoma. Poster presentation at AMA-RFS Research Symposium, Atlanta, GA. December 2004. Drake RD, Girard L, Lam DL, Minna JD, Schorge JO. Gene expression profiling to predict platinum-sensitivity in ovarian cancer. 9th Annual National Gynecologic Oncology Fellows’ Forum, Tuscon, Arizona. January 2005. Bull SL, Schorge JO, Peyton MJ, Miller DS, Lea JS. Lack of mutations within the EGFR tyrosine kinase domain suggests resistance to gefitinib in ovarian cancer cells. Glaxo SmithKline 9th Annual National Gynecologic Oncology Fellows’ Forum, Tuscon, Arizona. January 2005. Knowles LM, Nandi A, Gurnani P, Miller DS, Mok S, Rosenblatt K, Schorge JO. Serum proteomic profiling to predict early relapse in ovarian cancer. Society of Gynecologic Oncologists’ 36th Annual Meeting, Miami Beach, FL. March 2005. Bull SL. Schorge JO, Peyton MJ, Miller DS, Lea JS. Lack of mutations within the EGFR tyrosine kinase domain suggests resistance to gefitinib in ovarian cancer cells. Society of Gynecologic Oncologist 36th Annual Meeting, Miami Beach, FL. March 2005. Knowles LR, Drake RD, Ashfaq R, Miller DS, Schorge JO. Simplifying the diagnostic workup of molar pregnancy. American College of Obstetricians and Gynecologists 53rd Annual Meeting, San Francisco, CA. May 2005 Drake RD, Rao GG, Schorge JO. The incidence of GTD in Hispanic women: a 20-year experience at Parkland Memorial Hospital. American College of Obstetricians and Gynecologists 53rd Annual Meeting, San Francisco, CA. May 2005.

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Martino MA, Elahi A, Sutphen R, Klippel C, Boren T, Dressman HK, Berchuck A. Expression analysis of genes involved in ovarian cancer metastasis. ASCO Annual Meeting, Orlando, FL. May 2005. Bull SL, Garner EI, Walsh C, Gehrig PA, Schorge JO. Fertility-sparing surgery for 102 patients with cervical adenocarcinoma in situ. Society of Gynecologic Oncologists 37th Annual Meeting, Palm Springs, CA. March 2006. Heffernan T, Kalahasti G, Muneer S, Castro-Rivera E, Schorge J, Miller D, Brekken R, Lea J. Secreted protein acidic and rich in cysteine (SPARC) may predict cervical cancer and modulate resistance to cytotoxic chemotherapy. Poster presentation, Society of Gynecologic Oncologists Annual Meeting, Palm Springs CA. March 2006. Purinton SC, Santillan A, Diaz-Montes TP, Giuntoli II RL, Gardner GJ, Bristwo RE. Cost-effectiveness of routine cytology for endometrial cancer surveillance. Society of Gynecologic Oncologists 37th Annual Meeting, Palm Springs, CA. March 2006. Heffernan TP, Minna JD, Miller DS, Schorge JO, Lea JS. Loss of secreted protein rich and acidic in cysteine (SPARC) may predict cervical carcinogenesis and modulate resistance to cytotoxic chemotherapy. Society of Gynecologic Oncologists 37th Annual Meeting, Palm Springs, CA. March 2006. Bull SL, Garner EI, Walsh CS, Gehrig PA, Schorge JO. Fertility-sparing surgery for 101 patients with cervical adenocarcinoma in situ. Society of Gynecologic Oncologists 37th Annual Meeting on Women’s Cancer, Palm Springs, CA. March 2006. Poster Presentation. Bull SL, Garner EI, Walsh C, Gehrig PA, Schorge JO. Is it worth the risk to preserve fertility in cervical adenocarcinoma in situ? Western Association of Gynecologic Oncologists 35th Annual Meeting, Lake Tahoe, CA. May 2006. Bull SL, Schorge JO, Peyton MJ, Xiang L, Miller DS, Minna JD, Lea JS. Implications of HER family inhibition in targeted therapy of ovarian cancer. 2006 Annual Meeting of the American Society of Clinical Oncology, Abstract 13120. Journal of Clinical Oncology. Vol 24, No 18S; Part 1. 611s, 2006. Lea JS, Kalahasti G, Peyton MJ, Bull SL, Miller DS, Minna JD. Targeted inhibition of EGFR alone in cervical cancers may not produce a clinical response. Society of Gynecologic Oncologists 37th Annual Meeting on Women’s Cancer, Palm Springs, California. Poster Presentation. 2006 Bull SL, Castro-Rivera E, Miller DS, Brekken RA, Lea JS. Modulation of SPARC as a novel therapeutic option for platinum-resistant ovarian cancer cell lines. Western Association of Gynecologic Oncologists 35th Annual Meeting, Lake Tahoe, CA. May 2006. Bull SL, Carbon JG, Miller AF, Miller DS, Brekken RA, Lea JS. APARC modulation decreases tumor growth and confers chemosensitivity in platinum-resistant ovarian cancer. 38th Annual Meeting of the Society of Gynecologic Oncologists. March 2007. Phelps SLB, Wingo SN, Schorge JO, Miller DS. What number of lymph nodes should be removed

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in early stage endometrial cancer? 2007 District VII Annual Meeting of the American College of Obstetricians and Gynecologists. Henderson, NV. October 2007. George Schneider Award for Oral Presentation by a Junior Fellow. Bull SL, Carbon JG, Miller AF, Castro-Rivera E, Arnold S, Miller DS, Brekken RA and Lea JS. SPARC modulation decreases tumor growth and confers chemosensitivity in platinum-resistant ovarian cancer. Society of Gynecologic Oncologists 38th Annual Meeting on Women’s Cancer, San Diego, CA. March 2007. Poster presentation. Wingo SN, Elmore RG, Miller DS, Raheela A, Lea JS. An immunohistochemical evaluation of vascular endothelial growth factor, urokinase-type plasminogen activator, and microvessel density in normal, preinvasive, and invasive lesions of the cervix. March 2007. Boren T, Dressman HK, Cui S, Chan G, Lancaster J. MicroRNAs that underlie response to salvage chemotherapy in ovarian cancer. ASCO Annual Meeting, Chicago, IL. June 2007. Heffernan T, Kalahasti G, Muneer S, Castro-Rivera E, Schorge J, Miller D, Brekken R, Lea J. Secreted Protein, Acidic and Rich in Cysteine (SPARC) as a Predictor of Cervical Carcinogenesis and Regulator of Cervical Cancer Growth. Plenary Session. 36th Annual Meeting of Western Association of Gynecologic Oncology, Sun River, OR. June 2007. Boren T, Phelan C, Huang Y, Liebow M, Federicksen Z, Pankratz V, Goode E, Olsen J, Vierkant R, Cunningham J, Schildkrout J, Sellers T, Lancaster J. Genomic analysis of ovarian cancers can identify single nucleotide polymorphisms associated with ovarian cancer risk. Received “Scholar-In-Training” award. AACR Annual Meeting, Los Angeles, CA. April 2007. Phelps SLB, Wingo SN, Schorge JO, Miller DS. What number of lymph nodes should be removed in early stage endometrial cancer? 2007 District VII Annual Meeting of the American College of Obstetricians and Gynecologists. Henderson, NV. George Schneider Award. Bull SL, Carbon JG, Miller AF, Castro-Rivera E, Arnold S, Miller DS, Brekken RA and Lea JS. SPARC modulation decreases tumor growth and confers chemosensitivity in platinum-resistant ovarian cancer. Gynecologic Oncology; 104: 3,1; S43, March 2007. Cui S, Boren T, Chan C, Indermaur M, Dressman HK, Lancaster J. MicroRNAs that underlie ovarian cancer development and response to chemotherapy. AACR Annual Meeting, Los Angeles, CA. April 2007. Indermaur M, Boren T, Cui S, Chan G, Kressman HK, Lancaster JM. MicroRNA profiles associated with endometrial cancer development and response to Cisplatin and Doxorubicin chemotherapy. Society of Gynecologic Oncologists Annual Meeting, Tampa, FL. March 2007. Indermaur M, Dressman HK, Chan G, Boren T, Cui S, Risinger J, Maxwell L, Berchuck A, Lancaster J. Gene networks that determine endometrial cancer chemo-response. Society of Gynecologic Oncologists Annual Meeting, Tampa, FL. March 2007. Wingo SN, Elmore RG, Miller DS, Ashfaq R, Lea JS. An immunohistochemical evaluation of

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VEGF C, uPA, and microvessel density in normal, preinvasive, and invastive lesions of the cervix. Poster. Society of Gynecologic Oncologist 38th Annual Meeting, San Diego, CA. March 2007. Wingo SN, Elmore RG, Miller DS, Ashfaq R, Lea JS. An immunohistochemical evaluation of VEGF C, uPA, and microvessel density in normal, preinvasive, and invastive lesions of the cervix. Poster. Harold C. Simmons Comprehensive Cancer Center 2nd Annual Scientific Retreat Poster Presentation, Dallas, TX. April 2007. Phelps SLB, Wingo SN, Schorge JO, Miller DS. What number of lymph nodes should be removed in early stage endometrial cancer? 2007 District VII Annual Meeting of the American College of Obstetricians and Gynecologists., Henderson, NV. October 2007. George Schneider Award. Indermaur MD, Boren T, Cragun J, Wenham R, Apte S, Chan G, Kamath SG, Wei H, Dressman HK, Lancaster JM. Formalin-fixed, paraffin-embedded ovarian cancer gene expression signatures associated with platinum response. Society of Gynecologic Oncologist Annual Meeting, Tampa, FL. March 2008. Boren T, Dressman HK, Kamath S, Wei ZZ, Cragun J, Humphrey M, Chen N, Xiong Y, Lancaster JM. MicroRNAs and their target messenger RNAs associated with the development of endometrial carcinoma. Society of Gynecologic Oncologist Annual Meeting, Tampa, FL. March 2008. Boren T, Dressman HK, Wei ZZ, Martino A, Zhang T, Palmer J, Lancaster JM. Gene expression patterns in formalin-fixed, paraffin-embedded endometrial tissue associated with lymph node metastasis. Society of Gynecologic Oncologist Annual Meeting, Tampa, FL. March 2008. Contreras CM, Gurumurthy S, Haynie JM, Shirley L, Akbay E, Wingo SN, Schorge JO, Broaddus RR, Wong KK, Bardeesy N, Catrillon DH. Loss of Lkb1 provokes highly invasive endometrial adenocarcinomas. Poster. Harold C. Simmons Comprehensive Cancer Center 3rd Annual Scientific Retreat Poster Presentation, Dallas, TX, March 2008. Lacour RA, Westin SN, Daniels MS, Meyer LA, Coubey VC, Blank SV, MacDonald, HR, Roman LR, Estes JM, Barnes M, Teoh D, Powell BA, Wingo SN, Schorge JO, Brooks R, Mutch D, Babb S, Sun CC, Urbauer DL, Ramirez PT, Bodurka DC, Gershenson DM, Lu KH. Do BRCA mutations confer a survival advantage in all cases of advanced-stage ovarian cancer? Society of Gynecologic Oncologist 39th Annual Meeting, San Diego, CA, March 2008. Contreras CM, Gurumurthy S, Haynie JM, Shirley L, Akbay E, Wingo SN, Schorge JO, Broaddus RR, Wong KK, Bardeesy N, Catrillon DH. Loss of Lkb1 provokes highly invasive endometrial adenocarcinomas. Poster American Association for Cancer Research, San Diego, CA, April 2008. Schorge JO, Drake RD, Wingo SN, Purinton SC, Xie Y. Gene expression profiling to predict early relapse in ovarian cancer: a strategy for personalizing therapy? New England Association of Gynecologic Oncologists Meeting, June 2008. Schorge JO, Wingo SN, Bhore R, Heffernan TP, Lea JS. Secondary cytoreductive surgery for recurrent platinum sensitive ovarian cancer. New England Association of Gynecologic Oncologist

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Meeting, June 2008. Schorge, JO, Drake RD, Wingo SN, Purinton SC, Xie Y. Gene expression profiling to predict early relapse in ovarian cancer: a strategy for personalizing therapy. New England Association of Gynecologic Oncologist Meeting, June 2008. Lacour RA, Westin SN, Daniels MS, Meyer LA, Coubey VC, Blank SV, MacDonald, HR, Roman LR, Estes JM, Barnes M, Teoh D, Powell BA, Wingo SN, Schorge JO, Brooks R, Mutch D, Babb S, Sun CC, Urbauer DL, Ramirez PT, Bodurka DC, Gershenson DM, Lu KH. Do BRCA mutations confer a survival advantage in all cases of advanced-stage ovarian cancer? Western Association of Gynecologic Oncologist Meeting, June 2008. Heffernan TP, Arnold SA, Rivera L, Carbon J, Brekken RA, Miller DS, Lea JS. Forced SPARC overexpression results in increased tumor size and decreased necrosis in a murine human cervical cancer model. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009. Boren TP, Wingo, SN, Contreras CM, Akbay EA, Schidler MJ, Schorge JO, Miller DS, Castrillion DH. LKB1 promoter methylation status in cervical and endometrial cancers. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009 Schorge JO, Drake RD, Xiao G, Wingo, SN, Xie Y. Gene expression profiling to predict early relapse in ovarian cancer. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009. King L, Wingo S, Heffernan TP, Schorge JO. Intraperitoneal chemotherapy in stage II ovarian cancer: how many patients receive this “standard of care” treatment? Poster presentation at American College of Surgeons North Texas Chapter meeting, March 2009.

5. Publications involving fellows over the past 5 years a. Abstracts

Knowles LM, Drake RD, Morrissey C, Rajanbabu R, Miller DS, Minna JD, Schorge JO. Restoration of Slit-2 function: a novel therapeutic option for ovarian cancer? Gynecol Oncol 2004 92:463. Drake RD, Girard L, Lam DL, Minna JD, Schorge JO. Gene expression profiling to predict platinum-sensitivity in ovarian cancer. Proc Am Assoc Cancer Res 2004 45:518. Rao GG, Kurien A, Gossett D, Griffith WF, Muller CY. A case-control study of methylenetetrahydrofolate reductace (MTHFR) polymorphisms in cervical carcinogenesis. Proc Am Assoc Cancer Res 2004 45:983. Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Muller CY, Miller DS, Schorge JO. Is staging of ovarian LMP tumors worth the effort: a multicenter study of 229 patients. Gynecol Oncol 2004 92:415-6.

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Rao G, Coleman RL, Rogers P, Nguyen P. Phase I clinical trial of weekly paclitaxel, weekly carboplatin and concurrent radiotherapy for locally advanced cervical cancer. Gynecol Oncol 2004 92:426. Drake RD, Lee H, Rajanbabu R, Kim J, Miller DS, Mok SC, Schorge JO. Evaluation of plasma osteopontin in diagnosing and monitoring ovarian cancer. Gynecol Oncol 2004 92:462-3. Knowles LM, Drake RD, Morrissey C, Rajanbabu R, Miller DS, Schorge JO. Restoration of Slit-2 function: a novel therapeutic option for ovarian cancer? Gynecol Oncol 2004 92:463. Lavie I, Rao G, Drake R, Knowles L, Miller D, Schorge J. A reevaluation of hCG surveillance in partial hydatidiform moles. Joint Meeting of the Western Association of Gynecologic Oncologists and The Felix Rutledge Society, 2004 62. Lea, J.S., Ashfaq, R., Muneer, S., Burbee, D.G., Miller, D.S., Minna, J.D., Muller, C.Y. Understanding the mechanisms of FHIT inactivation in cervical cancer for biomarker development. Journal of the Society for Gynecologic Investigation. 2004 11 (5):329-337. Knowles, L, Drake, R, Morrissey, C, Rajanbabu, R, Miller, D, Minna, J, Schorge, J. Restoration of SLIT-2 Function: A Novel Therapeutic Option for Ovarian Cancer. The 2004 GlaxoSmithKline National Gynecologic Oncology Fellow’s Forum, 2004. Williamson E, Martino MA, Hoffman MS, Boren T, Siegfried S, Roberts W, Cantor A, Fiorica J. The incidence of pulmonary embolism after gynecologic oncology surgery. J Clin Oncol. 2005 ASCO Annual Meeting Proceedings 23(16S):5089. Knowles LM, Drake RD, Ashfaq R, Miller DS, Schorge JO. Simplifying the diagnostic workup of molar pregnancy. Obstet Gynecol 2005 105:118s. Bull SL, Schorge JO, Peyton MJ, Xiang L, Miller DS, Lea JS. Lack of Mutations within the EGFR Tyrosine Kinase Domain Suggests Resistance to Gefitinib in Ovarian Cancer Cells. Gynecologic Oncology; 2005 96: 1017-1018. Drake RD, Rao GG, Schorge JO. The incidence of GTD in Hispanic women: a 20-year experience at Parkland Memorial Hospital. Obstet Gynecol 2005 105:119s. Knowles LM, Nandi A, Gurnani P, Miller DS, Mok SC, Rosenblatt K, Schorge JO. Serum proteomic profiling to predict early relapse in ovarian cancer. Gynecol Oncol 2005 96:926. Bull SL, Schorge JO, Peyton MJ, Miller DS, Lea JS. Lack of mutations within the EGFR tyrosine kinase domain suggests resistance to gefitinib in ovarian cancer cells. Gynecol Oncol 2005 96:1017-8.

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Boren T, Martino MA, Williamson E, Twitty P, Siegfried S, Fiorica J. The cost of treating pulmonary embolisms following surgery for gynecological malignancies. J Clin Oncol 2005 ASCO Annual Meeting Proceedings 23(16S):8250 Bull SL, Garner EI, Walsh C, Gehrig PA, Schorge JO. Fertility-sparing surgery for 102 patients with cervical adenocarcinoma in situ. Gynecol Oncol 2006 101:s94. Lea JS, Kalahasti G, Peyton MJ, Bull SL, Miller DS, Minna JD. Targeted inhibition of EGFR alone in cervical cancers may not produce a clinical response. Gynecol Oncol 2006 101:s133-4. Bull SL, Garner EI, Walsh CS, Gehrig PA, Schorge JO. Fertility-sparing surgery for 102women with cervical adenocarcinoma in situ. Gynecologic Oncology 2006 101:1,1; S94. Bull SL, Schorge JO, Peyton MJ, Xiang L, Miller DS, Minna JD, Lea JS. Implications of HER family inhibition in targeted therapy of ovarian cancer. 2006 Annual Meeting of the American Society of Clinical Oncology, Abstract 13120. Journal of Clinical Oncology 2006 24(18S)(Part 1):611s. Heffernan TP, Minna JD, Miller DS, Schorge JO, Lea JS. Loss of secreted protein rich and acidic in cysteine (SPARC) may predict cervical carcinogenesis and modulate resistance to cytotoxic chemotherapy. Gynecol Oncol 2006 (in press). Bull SL, Schorge JO, Peyton MJ, Xiang L, Miller DS, Minna JD, Lea JS. Implications of HER family inhibition in targeted therapy of ovarian cancer. Proc Am Soc Clin Oncol 2006 (in press). Wingo SN, Knowles LM, Carrick KS, Miller DS, Schorge JO. Retrospective cohort study of surgical staging for ovarian low malignant potential tumors. Am J Obstet Gynec 2006 194(5): e20-2. Bull SL, Carbon JG, Miller AF, Castro-Rivera E, Arnold S, Miller DS, Brekken RA and Lea JS. SPARC modulation decreases tumor growth and confers chemosensitivity in platinum-resistant ovarian cancer. Gynecologic Oncology 2007 104( 3,1):S43. Contreras CM, Gurumurthy S, Haynie JM, Shirley L, Akbay E, Wingo SN, Schorge JO, Broaddus RR, Wong KK, Bardeesy N, Catrillon DH. Loss of Lkb1 provokes highly invasive endometrial adenocarcinomas. Cancer Research. 2008 68(3):759-66. Schorge JO, Drake RD, Wingo SN, Purinton SC, Xie Y. Gene expression profiling to predict early relapse in ovarian cancer: a strategy for personalizing therapy? New England Association of Gynecologic Oncologists Meeting, June 13-15, 2008. Heffernan TP, Arnold SA, Rivera L, Carbon J, Brekken RA, Miller DS, Lea JS. Forced SPARC overexpression results in increased tumor size and decreased necrosis in a murine human cervical cancer model. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009. Gynecol Oncol 112(2) S2-S185, 2009

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Boren TP, Wingo, SN, Contreras CM, Akbay EA, Schidler MJ, Schorge JO, Miller DS, Castrillion DH. LKB1 promoter methylation status in cervical and endometrial cancers. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009. Gynecol Oncol 112(2) S2-S185, 2009 Schorge JO, Drake RD, Xiao G, Wingo SN, Xie Y. Gene expression profiling to predict early relapse in ovarian cancer. Society of Gynecologic Oncologists, 40th Annual Meeting, San Antonio, Texas, February 5-8, 2009. Gynecol Oncol 112(2) S2-S185, 2009 Cragum J, Xiong Y, Boren TP, Indermaur MD, Sayer R, Humphrey MM, Cottrill HM, Kamath S, Hakam A, Apte SM, Wenham RM, Berchuck A, Lancaster JM. GPR30expression predicts chemotherapy responsiveness and overall and progression-free survivalin patients with epithelial ovarian cancer. Society of Gynecologic Oncologists, 40th AnnualMeeting, San Antonio, Texas, February 5-8, 2009. Gynecol Oncol 112(2) S2-S185, 2009

b. Book Chapters Schorge JO, Knowles LM, Lea JS. Adenocarcinoma of Cervix. Curr Treat Options Oncol 2004 5(2):119-227. Schorge JO, Bull SL, Lea JS. Current management of in situ and invasive cervical adenocarcinoma. Curr Women’s Health Rev 2005 1:185-96. Purinton SC, Goldstein A. Female sexual function and dysfunction. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Ed. Lippincott Williams & Wilkins. Chapter 38, 436-450, 2007. Purinton, S.C. and A.Goldstein. Female sexual function and dysfunction. The Johns Hopkins Review of Gynecology and Obstetrics. Second Ed. Lippincott Williams & Wilkins. Chapter 38, 153-155, 2007. Pavone ME, Purinton SC, Petersen S. Post-partum care and breast-feeding. The Johns Hopkins Manual of Gynecology and Obstetrics. Third Ed. Lippincott Williams & Wilkins. Chapter 20, 245-252, 2007. Pavone ME, Purinton SC, Petersen S. Post-partum care and breast feeding. The Johns Hopkins Review of Gynecology and Obstetrics. Second Ed. Lippincott Williams & Wilkins. Chapter 20, 82-84, 2007. Knowles LM, Schorge JO. Ovarian sex cord-stromal tumors. Handbook of Gynecologic Oncology, McGraw-Hill. 2007 (in press)

c. Peer-review articles Lea JS, Ashfaq R, Muneer S, Burbee DG, Miller DS, Minna JD, Muller CY. Understanding the mechanisms of FHIT inactivation in cervical cancer for biomarker development. J Soc Gynecol Invest 2004 11:329-37.

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Lea JS, Coleman RL, Kurien A, Schorge JO, Miller DS, Minna JD, Muller CY. Aberrant p16 methylation is a biomarker for tobacco exposure in cervical squamous cell carcinogenesis. Am J Obstet Gynecol 2004 190:674-9. Schorge JO, Drake RD, Lee H, Skates SJ, Rajanbabu R, Miller DS, Kim JH, Cramer DW, Berkowitz RS, Mok SC. Osteopontin as an adjunct to CA125 in detecting recurrent ovarian cancer. Clin Cancer Res 2004 10:3474-8. Drake RD, Lin WM, King M, Farrar D, Miller DS, Coleman RL. Oral dexamethasone attenuates Doxil-induced palmar-plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecol Oncol 2004 94:320-4. Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol 2004 104:261-6. Rao GG, Skinner EN, Gehrig PA, Duska LR, Miller DS, Schorge JO. Fertility-sparing surgery for ovarian low malignant potential tumors. Gynecol Oncol 2005 98:263-6. Lavie I, Rao GG, Castrillon DH, Miller DS, Schorge JO. Duration of human chorionic gonadotropin surveillance for partial hydatidiform moles. Am J Obstet Gynecol 2005 192:1362-4. Li AJ, Giuntoli RL 2nd, Drake R, Byun SY, Rojas F, Barbuto D, Klipfel N, Edmonds P, Miller DS, Karlan BY. Ovarian preservation in stage I low-grade endometrial stromal sarcomas. Obstet Gynecol 2005 106:1304-8. Rao GG, Rogers P, Drake RD, Nguyen P, Coleman RL. Phase I clinical trial of weekly paclitaxel, weekly carboplatin, and concurrent radiotherapy for primary cervical cancer. Gynecol Oncol 2005;96:168-72. Oh JH, Gao J, Nandi A, Gurnani P, Knowles L, Schorge J. Diagnosis of early relapse in ovarian cancer using serum proteomic profiling. Genome Inform 2005 16(2):195-204. Bristow, RE, Purinton SC, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL. Cost-effectiveness of routine cytology for endometrial cancer surveillance. Gynecol. Oncol 103(2), 709-713, 2006. Wingo SN, Knowles LM, Carrick KS, Miller DS, Schorge JO. Retrospective cohort study of surgical staging for ovarian low malignant tumors. Am J Obstet Gynecol 2006 194:e20-22. Drake RD, Rao GG, McIntire DD, Miller DS, Schorge JO. Gestational trophoblastic disease among Hispanic women: a 21-year hospital-based study. Gynecol Oncol 2006 103(1):81-86. Knowles LM, Drake RD, Ashfaq R, Castrillon DH, Miller DS, Schorge JO. Simplifying the pre-evacuation testing strategy for patients with molar pregnancy. J Reprod Med. 2006 52(8):685-688.

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Wingo SN, Knowles LM, Carrick KS, Miller, DS, Schorge JO. Retrospective cohort study of surgical staging for ovarian low malignant potential tumors. Am J Obstet Gynecol. 2006 194(5):20-2. Oh J, Nandi A, Gurnani P, Knowles L, Schorge JO, Rosenblatt, KP, Gao, JX. Proteomic biomarker identification for diagnosis of early relapse in ovary cancer. J Bioinform Comput Biol. 2006 4(6):1159-79. Boren T, LaPolla J, Martino MA, Nirgudkar P. Aggressive angiomyxoma: a case of multiple recurrences and review of the literature. J Pelvic Med Surg 2006 12(4):151-156. Bull-Phelps SL, Garner EI, Walsh CS, Gehrig PA, Miller DS, Schorge JO. Fertility-Sparing Surgery in 101 Women with Adenocarcinoma in Situ of the Cervix. Gynecologic Oncology 2007 107(2):316-9. Boren T, Reyes C, Montenegro R, Raimer K. A case of Evan’s syndrome in pregnancy refractory to primary treatment options. J Matern Fetal Neonatal Med 2007 20(11):843-5. Boren T, Xiong Y, Hakam A, Wenham R, Apte S, Wei Z, Kamath S, Chen D, Dressman H, Lancaster JM. MicroRNAs and their target messenger RNAs associated with endometrial carcinogenesis. Gynecologic Oncology 2008 110(2):206-15. Bull Phelps SL, Schorge JO, Peyton MJ, Shigematsu H, Xiang L, Miller DS, Lea JS. Implications of EGFR Inhibition in Ovarian Cancer Cell Proliferation. Gynecologic Oncology 2008 109(3):411-7. Bull SL, Carbon JG, Miller AF, Castro-Rivera E, Arnold S, Miller DS, Brekken RA and Lea JS. Secreted protein acidic and rich in cysteine as a regulator of murine ovarian cancergrowth and chemosensitivity.Am J Obstet Gynecol. 2008 Nov 5. [Epub ahead of print] Contreras CM, Gurumurthy S,Haynie JM, Shirley L, Akbay E, Wingo SN, Schorge JO, Broaddus RR, Wong KK, Bardeesy N, Castrillon DH. Loss of Lkb1 provokes highly invasive endometrial adenocarcinomas. Cancer Research. 2008 Feb 1;68(3):759-66. Berchuk A, Iversen ES, Luo J, Clarke JP, Horne H, Levine DA, Boyd J, Alonso MA, Secord AA, Bernardini MQ, Barnett JC, Boren T, Murphy SK, Dressman HK, Marks JR, Lancaster JM. Microarray analysis of early stage serous ovarian cancers shows profiles predictive of favorable outcome. Clin Cancer Res 2009 Apr 1;15(7):2448-55 Epub 2009 Mar 24 Wingo, SN, Gallardo TD, Akbay EA, Liang MC, Contreras CM, Boren T, Shimamura T, Miller DS, Sharpless NE, Bardeesy N, Kwiatkowski DJ, Schorge JO, Wong KK, Castrillon DH. Somatic LKB1 mutations promote cervical cancer progression. PLoS ONE. 2009;4(4):e5137. Epub Apr 2.

6. Articles by program faculty published in peer-review journals during the last 5 years

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Muggia FM, Blessing JA, Method M, Miller DS, Johnson GA, Lee RB, Menzin A. Evaluation of Vinorelbine in Persistent or Recurrent Squamous Cell Carcinoma of the Cervix: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92:639-43. Hesketh PJ, Arena F, Patel D, Austin M, D’Avirro P, Rossi G, Colowick A, Schwartzberg L, Bertoli LF, Cole JT, Demetri G, Dessypris E, Dobbs T, Eisenberg P, Fleischman R, Hall J, Hoffman PC, Laber DA, Leonard J, Lester EP, McCachren S, McMeekin S, Meza L, Miller DS, et al. A randomized controlled trial of darbepoetin alfa administered as a fixed or weight-based dose using a front-loading schedule in patients with anemia who have nonmyeloid malignancies. Cancer 2004;100:859-68. Drake RD, Lin WM, King M, Farrar D, Miller DS, Coleman RL. Oral dexamethasone attenuates Doxil®-induced palmar-plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecol Oncol 2004;94:320-4. Moller KA, Gehrig PA, Van Le L, Secord AA, Schorge J. The role of optimal debulking in advanced stage serous carcinoma of the uterus. Gynecol Oncol 2004;94:170-4. Muller CY, Schorge JO, Tomlinson GE, Ashfaq R. BRCAPap? Feasibility of clinical BRCA testing on liquid-based cervical cytology: implications for biomarker development. Cancer Epidemiol Biomarkers Prev 2004;13:1534-7. Rao GG, Skinner E, Gehrig PA, Duska LR, Coleman RL, Schorge JO. Surgical staging of ovarian low malignant potential tumors. Obstet Gynecol 2004;104:261-6. Delin JB, Miller DS, Coleman RL. Other Primary Malignancies in Patients with Uterine Corpus Malignancy. Am J Obstet Gynecol 2004;190:1429-31. Lea JS, Ashfaq R, Muneer S, Burbee DG, Miller DS, Minna JD, Muller CY. Understanding the mechanisms of FHIT inactivation in cervical cancer for biomarker development. J Soc Gynecol Invest 2004;11:329-37. Lea JS, Kurien A, Schorge JO, Coleman RL, Miller DS, Muller CY. Aberrant p16 methylation in squamous cell cervical cancers and high grade squamous dysplasia is a potential biomarker of tobacco induced DNA damage. Am J Obstet Gynecol 2004;190:674-9. Schorge JO, Lea JS, Elias KJ, Rajanbabu R, Coleman RL, Miller DS, Ashfaq R. p16 as a molecular biomarker of cervical adenocarcinoma. Am J Obstet Gynecol 2004;190:668-73. Schorge JO, Drake RD, Lee H, Skates SJ, Rajanbabu R, Miller DS, Kim JH, Cramer DW, Berkowitz RS, Mok SC. Osteopontin as an adjunct to CA125 in detecting recurrent ovarian cancer. Clin Cancer Res 2004;10:3474-8. Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Brenda J, Miller DS, Olt G, King S, Boggess JF, Rocereto TF. Phase III Study of Cisplatin With or Without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: a Gynecologic Oncology Group Study. J Clin Oncol 2004;22:3113-9.

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Miller DS, Blessing JA, Waggoner S, Schilder J, Sorosky J, Bloss J, Shilder R. Phase II evaluation of 9-aminocamptothecin (9-AC, NSC #603071) in platinum-resistant ovarian and primary periotoneal carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 2005;96:67-71. Garcia AA, Blessing JA, Lenz HJ, Darcy KM, Mannel RS, Miller DS, Husseinzadeh N. Phase II clinical trial of capecitabine in ovarian carcinoma recurrent 6-12 months after completion of primary chemotherapy, with exploratory TS, DPD, and TP correlates: a Gynecologic Oncology Group Study. Gynecol Oncol 2005;96:810-7. Long HJ, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV. Randomized phase III trial of Cisplatin with or without Topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol 2005;23:4626-33. Miller DS, Blessing JA, Schilder J, Munkarah A, Lee YC. Phase II evaluation of topotecan in carcinosarcoma of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 2005;98:217-21. Li AJ, Giuntoli RL, Drake R, Byun SY, Rojas F, Barbuto D, Klipfel N, Edmonds P, Miller DS, Karlan BY. Ovarian preservation in stage I low-grade endometrial stromal sarcomas. Obstet Gynecol 2005;106:1304-8. Rao GG, Skinner EN, Gehrig PA, Duska LR, Miller DS, Schorge JO. Fertility-sparing surgery for ovarian low malignant potential tumors. Gynecol Oncol 2005;98:263-6. Lavie I, Rao GG, Castrillon DH, Miller DS, Schorge JO. Duration of human chorionic gonadotropin surveillance for partial hydatidiform moles. Am J Obstet Gynecol 2005;192:1362-4. Lacour RA, Garner EO, Molpus KL, Ashfaq R, Schorge JO. Management of cervical adenocarcinoma in situ during pregnancy. Am J Obstet Gynecol 2005;192:1449-51. Makarla PB, Saboorian MH, Ashfaq R, Toyooka KO, Toyooka S, Minna JD, Gazdar AF, Schorge JO. Promoter hypermethylation profile of ovarian epithelial neoplasms. Clin Cancer Res 2005;11:5365-9. Rao GG, Miller DS. Clinical applications of hormonal therapy in ovarian cancer. Curr Treat Options Oncol 2005;6(2):97-102. Long JH, Bundy BN, Grendys EC, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV. Randomized phase III clinical trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: A Gynecologic Oncology Group study. J Clin Oncol 2005; 23(21):4626-33. Bull SL, Schorge JS, Peyton MJ, Xiang L, Miller DS, Lea JS. Lack of mutations within the EGFR tyrosine kinase domain suggests resistance to gefitinib in ovarian cancer cells. Gynecol Oncol 2005; 96:1017-1018. Ferguson DA, Muenster MR, Zang Q, Spencer JA, Schageman JJ, Lian Y, Garner HR, Gaynor RB, Huff JW, Pertsemlidis A, Schorge J, Becerra C, Williams NS, Graff JM. CAST, a rapid method to

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identify cell-surface and secreted proteins: a large scale screen for breast and ovarian cancer markers. Cancer Res 2005;65:8209-17. Feltmate CM, Lee KR, Johnson M, Schorge JO, Wong KK, Hao K, Welch WR, Bell DA, Berkowitz RS, Mok SC. Whole-genome allelotyping identified distinct loss-of-heterozygosity patterns in mucinous ovarian and appendiceal carcinomas. Clin Cancer Res 2005;11:7651-7. Oh JH, Gao J, Nandi A, Gurnani P, Knowles L, Schorge J. Diagnosis of early relapse in ovarian cancer using serum proteomic profiling. Genome Inform 2005;16:195-204. Rao GG, Miller DS. Hormonal therapy in epithelial ovarian cancer. Expert Rev Anticancer Ther 2006;6:43-47. Lea JS, Kalahasti G, Peyton MJ, Bull SL, Miller DS, Minna JD. Targeted inhibition of EGFR alone in cervical cancers may not produce a clinical response. Gynecol Oncol 2006; 101:1,1:S133-134. Miller DS. Advanced endometrial cancer: is lymphadenectomy necessary or sufficient? Gyneco Oncol 2006;101(2):191-93. Long HJ, Monk BJ, Huang HQ, Grendys EC Jr,, McMeekin DS, Sorosky J, Miller DS, Eaton LS, Fiorica JV. Clinical results and quality of life analysis for the MVAC combination (methotrexate, vinblastine, doxorubicin, and cisplatin) in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. Gynecol Oncol 2006;100:537-43. Wingo SN, Knowles LM, Carrick KS, Miller DS, Schorge JO. Retrospective cohort study of surgical staging for ovarian low malignant tumors. Am J Obstet Gynecol 2006;194:e20-22. Drake RD, Rao GG, McIntire DD, Miller DS, Schorge JO. Gestational trophoblastic disease among Hispanic women: a 21-year hospital-based study. Gynecol Oncol 2006; 103(1):81-86. Oh JH, Nandi A, Gurnani P, Knowles L, Schorge J, Rosenblatt KP, Gao JX. Proteomic biomarker identification for diagnosis of early relapse in ovarian cancer. J Bioinform Comput Biol 2006 4(6):1159-79. Knowles LM, Drake RD, Ashfaq R, Castrillon DH, Miller DS, Schorge JO. Simplifying the pre-evacuation testing strategy for patients with molar pregnancy. J Reprod Med 2007 52(8):685-8. Lea JS, Sunaga N, Sato M, Kalahasti G, Burbee DG, Minna JD, Muller CY. Silencing of HPV 18 oncoproteins with RNA Interference causes growth inhibition of cervical cancer cells. Reprod Sci 2007 14(1):20-8. Bull SL, Carbon JG, Miller AF, Castro-Rivera E, Arnold S, Miller DS, Brekken RA, and Lea JS. SPARC modulation decreases tumor growth and confers chemosensitivity in platinum-resistant ovarian cancer. Gynecol Oncol 2007;104:3,1;S43. Bull Phelps SL, Garner EL, Walsh CS, Gehrig PA, Miller DS, Schorge JO. Simplifying the preevacuation testing strategy for patients with molar pregnancy. R Reprod Med 2007;52(8):685-8.

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Lu KH, Schorge JO, Rodabaugh KJ, Daniels MS, Sun CC, Soliman PT, White KG, Luthra R, Gershenson Dm, Broaddus RR. Prospective determination of prevalence of Lynch syndrome in young women with endometrial cancer. J Clin Oncol 2007;25(33):5158-64. Bull Phelps SL, Garner EL, Walsh CS, Gehrig PA, Miller DS, Schorge JO. Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. Gynecol Oncol 2007;107(2):316-9. Phelps SLB, Schorge SO, Peyton MJ, Shigematsu H, Xiang LL, Miller DS, Lea JS. Implications of EGFR inhibition in ovarian cancer cell proliferation. Gynecol Oncol 2008;109(3):411-17. Miller DS, Blessings JA, Bodurka DC, Bonebrake AJ, Schorge JO. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol 2008;110(1):65-70. Akbay EA, Contreras CM, Perera SA, Sullivan JP, Broaddus RR, Schorge JO, Ashfaq R, Saoorian H, Wong KK, Castrillon DH. Differential roles of telomere attrition in type I and II endometrial carcinogenesis. Am J Pathol 2008;173(2):536-44. Gagnon A, Kim JH, Schorge JO, Ye B, Liu B, Hasselblatt K, Welch WR, Bandera CA, Mok SC: Use of a combination of approaches to identify and validate relevant tumor-associated antigens and their corresponding autoantibodies in ovarian cancer patients. Clin Cancer Res 2008;14(3):764-71. Contreras CM, Gurumurthy S, Haynie Jm, Shirley LJ, Akbay EA, Wingo SN, Schorge JO, Broaddus RR, Wong KK, Bardeesy N, Castrillon DH: Loss of Lkb1 provokes highly invasive endometrial adenocarcinomas. Cancer Res 2008;68(3):759-66. Merritt WM, Lin YG, Han LY, Kamat AA, Spannuth WA, Schmandt R, Urbauer D, Pennacchio LA, Cheng JF, Nick AM, Deavers MT, Mourad-Zeidan A, Wang H, Mueller P, Lenburg ME, Gray JW, Mok S, Birrer MJ, Lopez-Berestein G, Coleman Rl, Bar-Eli M, Sood AK. Dicer, Drosha, and outcomes in patients with ovarian cancer. N Engl J Med 2008:359(25):2641-2650. Akbay EA, Contreras CM, Perera SA, Sullivan JP, Broaddus RR, Schorge JO, Ashfaq R, Saboorian H, Wong KK, Castrillon DH. Differential roles of telomere attrition in type I and II endometrial carcinoigenesis. Am J Pathol 2008;173(2):536-44. Spannuth WA, Nick AM, Jennings NB, Armaiz-Pena GN, Mangala LS, Danes CG, Lin YG, Merritt WM, Thaker PH, Kamat AA, Han LY, Tonra JR, Coleman RL, Ellis LM, Sood AK. Functional significance of VEGFR-2 on ovarian cancer cells. Int J Cancer 2008, Sept 24. Landen CN, Kim TJ, Lin YG, Merritt WM, Kamat AA, Han LY, Spannuth WA, Nick AM, Jennings NB, Kinch MS, Tice M, Sood Ak. Tumor-selective response to antibody-mediated targeting of alphavbeta3 integrin in ovarian cancer. Neoplasia 2008 10(11):1259-67. Miller DS, King LP. Gynecologic oncology group trials in uterine corpus malignancies: recent progress. J Gynecol Oncol 19(4):218-222, 2008

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Wingo, SN, Gallardo TD, Akbay EA, Liang MC, Contreras CM, Boren T, Shimamura T, Miller DS, Sharpless NE, Bardeesy N, Kwiatkowski DJ, Schorge JO, Wong KK, Castrillon DH. Somatic LKB1 mutations promote cervical cancer progression. PLoS ONE 4(4):e5137, 2009 Miller DS, Blessing JA, Krasner CN, Mannel RS, Hanjani P, Pearl ML, Waggoner SE, Boardman CH. Phase II evaluation of pemetrexed in the treatment of recurrent or persistent platinum-resistant ovarian or primary peritoneal carcinoma: A study of the Gynecologic Oncology Group. J Clin Oncol 27(16):2686-91, 2009 Miller DS, Fleming G, Randall ME. Chemo-and radiotherapy in adjuvant management of optimally debulked endometrial cancer. JNCCN 7(5):535-541, 2009 King LP, Miller DS. Recent progress: Gynecology Oncology Group trials in uterine corpus tumors. Rev Recent Clin Trials 4(2):70-4, 2009 Medel NI, Bansal S, Miller DS, Wright JD, Herzog, TJ. Pharmacotherapy of endometrial cancer. Expert Opin Pharmacother 10(12):1939-51, 2009

7. Research opportunity, supervision and thesis guidance The division faculty is privileged to provide ample opportunities for research success to fellows in the program. This is viewed with the highest priority and incorporates a comprehensive, multilayered, and individualized approach to structure the correct environment. The NIH-funded Comprehensive Gynecologic Oncology Tissue and Blood Repository houses samples from more than 500 patients and provides a rich resource for laboratory projects studying gynecologic cancers. 1st year fellows spend their initial three months in the laboratory to become familiar with research techniques and generate data for a possible hypothesis pursuant to their thesis project. This strategy has been very successful, resulting in 1st year fellows presenting their data at the Society of Gynecologic Oncologists annual meeting in four of the last five years. Fellows then have the opportunity to establish a dialogue with faculty to help guide their long-term research plan within the division. The 2nd year of the program includes 12 uninterrupted months of research time to generate a thesis project. The 3rd and 4th year of the program enable the fellow to establish their niche and concentrate on the writing, revising and submission of research papers. The Division of Gynecologic Oncology installed the SGO database in June 1993 to organize the fellows’ clinical experience and facilitate research opportunities. In the past 13 years (effective May 2006), 8817 patients, 5289 tumors, 8790 procedures and 9055 admissions have been entered. Division faculty also facilitate clinical collaborations with colleagues at other institutions. Fellows learn the basics of identifying a clinically interesting research question, data retrieval and analysis, draft preparation, submission, manuscript revision and ultimately publication. Clinical studies culminating in a thesis may be developed by close supervision between fellow and their choice of faculty to provide guidance. Division faculty review the fellows’ work during the monthly Division of Gynecologic Oncology

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Research meeting. Fellows’ research progress will also be formally reviewed at their semi-annual meetings with the Fellowship Program Director and documented for adherence to a sustainable thesis project. The number and variety of research presentations, publications and grants (see A.4. and 5.) reflect the success of this comprehensive, multilayered, and individualized approach.

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B.

1. Block diagram of proposed rotation for each month of program

Fellow

JULY

AUG

SEPT

OCT

NOV

DEC

JAN

FEB

MARC

H

APRIL

MAY

JUNE

1st Year RES RES RES SWMC SWMC SWMC RADONC SICU SICU SWMC SWMC SWMC 2nd Year RES RES RES RES RES RES RES RES RES RES RES RES 3rd Year SWMC SWMC SWMC RES RES RES SWMC SWMC SWMC RES RES RES 4th Year RES RES RES Presby Presby MCD MCD MCD MCD MCD PMH.PRE-

ATTEND PMH.PRE-ATTEND

SWMC = SOUTHWESTERN MEDICAL CENTER PMH.PRETEND = SOUTHWESTERN MEDICAL CENTER/PRE-ATTENDING PRESBY = PRESBYTERIAN HOSPITAL OF DALLAS RADONC = RADIATION ONCOLOGY PATH = PATHOLOGY RES = RESEARCH SICU = SURGICAL INTENSIVE CARE UNIT MCD = MEDICAL CITY-DALLAS

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2. Block diagram of fellowship schedule 2009-10

FELLOW

JULY

AUG

SEPT

OCT

NOV

DEC

JAN

FEB

MARCH

APRIL

MAY

JUNE

WINGO RES RES RES PRESBY PRESBY MCD MCD MCD MCD MCD SWMC SWMCPURINTON SWMC SWMC SWMC RES RES RES SWMC SWMC SWMC RES RES RES BOREN RES RES RES RES RES RES RES RES RES RES RES RES TYNDALL RES RES RES SWMC SWMC SWMC SICU SICU RAD ONC SWMC SWMC SWMC

SWMC = SOUTHWESTERN MEDICAL CENTER PRESBY = PRESBYTERIAN HOSPITAL OF DALLAS MCD = MEDICAL CITY DALLAS RADONC = RADIATION ONCOLOGY PATH = PATHOLOGY RES = RESEARCH SICU = SURGICAL INTENSIVE CARE UNIT

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3. Block diagram of average work week on clinical gynecologic oncology rotation

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

0700 PMH OR (start) 0700 PMH OR ---

--- 0730 Ward Rounds (4-west)

0730 Protocol and Chemotherapy Monitoring Conference (G6.200)

↓ 0730 Ward Rounds (4-West)

↓ 0800 Parkland Patient Care Conference (4-West)

0800 Gynecologic Oncology Tumor Board (G6.200)

↓ 0800 Parkland or University Hospital-St. Paul OR

[variable]

↓ 0830 Parkland Gynecologic Oncology Clinic (start)

(PMH 3rd floor)

↓ ↓ ↓

↓ ↓ 0900 Simmons Cancer Center Clinic (NB2)

↓ ↓

↓ ↓ ↓ ↓ ↓

↓ ↓ 1100 Dept OB/GYN Grand Rounds (G6.200)

↓ ↓

↓ ↓ 1200 Parkland Nurse Practitioner Chemotherapy Rounds (4-West)

↓ ↓

↓ ↓ 1300 Ward Rounds (4-West) ↓ ↓

↓ 1600 Morbidity & Mortality Conference; Journal Club;

Division Research Mtg (J6.102); Gyn Oncology Fellows’ Lecture

(G6.200) [Alternating]

↓ ↓

1700 PMH OR (end) 1700 Parkland Gynecologic Oncology Clinic (end)

1700 Gyn Oncology Fellows Meeting (J7.110) [Monthly]

1700 PMH OR (end)

1700 Parkland and University Hospital-St. Paul

OR (end)

C. Available facilities and space for fellowship training: 1. Laboratory

The Division of Gynecologic Oncology has established a laboratory dedicated to the study of the molecular biology of gynecologic cancers under the guidance of our faculty. This divisional laboratory is located within the Nancy B. and Jake L. Hamon Center for Therapeutic Oncology Research in the Simmons Biomedical Research Building on the North Campus. The majority of the gynecologic oncology laboratory fellow research projects at UTSW will be conducted in the Hamon Center for Therapeutic Oncology Research on the NB8 floor of the Simmons Biomedical Research Building on the North Campus at UTSW. The NB8 floor is a new (1994), state of the art, laboratory research facility of 30,000 gross and 18,000 nsf housing the Hamon Center for Therapeutic Oncology Research and the Moncrief Center for Cancer Genetics. The mission of the Hamon Center for Therapeutic Oncology Research is to develop and implement new ways to improve the prevention, early detection, diagnosis, prognostic assessment, and treatment of human cancer by performing interdisciplinary research that translates findings to and from the laboratory and the clinic. The research includes components of basic laboratory research, preclinical studies, clinical research including development of new therapeutics, molecular early detection of cancer, family genetic studies, chemoprevention, epidemiology (including genetic epidemiology), and related population studies. Current areas of research interest in the center include breast cancer, lung cancer, gynecologic malignancies, pediatric tumors, family cancer genetics, molecular early detection of cancer, microarray expression analysis of many genes in human cancers, testing of new drugs, tumor vaccines, gene therapy, identification of the role of dominant and recessive oncogenes and DNA repair genes, as well as autocrine/paracrine growth factors in the pathogenesis of human cancer. There are 12 Principal Investigators in the Center and over 90 research and/or administrative staff dedicated to the successful operations of the center. The Center is an integral component of a Lung Cancer SPORE and maintains national and international collaborative efforts for all tumor sites. Dr. John Minna is the Director of these integrated Centers and Dr. Adi Gazdar is Deputy Director. The Hamon Center is completely equipped for modern molecular and cell biologic research. The Laboratory of Gynecologic Oncology shares space within the Minna lab encompassing approximately 2000 sf of completely equipped lab space collectively in addition to having access to the extensive core facilities including the Laser Capture microdissection instrument (Arcturus, PixCell) equipped with a 30 and 60 µm laser beam and associated high quality Olympus M081 microscope with objectives, a videocamera, and Sony Monitor) and the leased nanochip technology targeted for use in single nucleotide polymorphism (SNP) analyses. In addition, there are shared core facilities in the Hamon Center for tissue culture, dark rooms, cold rooms, bacteriologic work and incubators, centrifuges, freezers, computers, two ABI 377 DNA sequencers/genotypers with associated computers and software (in a

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dedicated 300 sf room), multiple PCR machines, and a dishwashing/media preparation facility. The DNA sequencing/genotyping facility in the Hamon Center is a shared resource co-directed by Dr. Minna and Dr. Stephen Johnston (NB10, Molecular Cardiology and Director of the Center for Biomedical Inventions at UTSW). The freezers, refrigerators and cold rooms supporting the present UTSW cancer and dysplasia banks are situated directly within the Hamon Center (NB8). Two large -80 degree freezers are exclusively for use by the Laboratory of Gynecologic Oncology. Currently there are ~70 personnel total working in the Hamon Center. The Laboratory of Gynecologic Oncology includes 1-2 full-time research assistants, 2 fellows performing bench research, daily on-site faculty supervision depending on the clinical schedule and the Thursday weekly lab meeting. There are shared facilities in the Cell Biology Dept. including microscopy, imaging center, darkrooms, high speed and ultracentrifuges, scanning densitometer, phosphoimager, spectrophotometers, liquid scintillation and I125 counters, autoclaving and dishwashing facility. The center also has established collaborations (particularly through the Lung SPORE effort) in Bioinformatics with Dr. Skip Garner in the McDermott Center for Growth and Development and the Center for Biomedical Inventions. Animal facilities are housed in the Simmons Building NB3 floor which is a state-of-the-art fully accredited small animal care facility with immunodeprived mouse capability, a facility for transgenic mouse work, facilities for surgical procedures, and a gamma-irradiation source as part of the UTSW Animal Research Center. Specialized space includes: cage washing areas, autoclave areas, refrigerated food storage, bedding storage, diet kitchens, sterile surgical suites, radiology facilities, intensive care units, postoperative care rooms, necropsy rooms, and a diagnostic laboratory. Other features of the Hamon Center include an extensive network of ethernet-linked PCs and printers including those of the PIs and a large file server with internet and email access. These are all ethernet/internet-linked to numerous data resources including that of the National Center Biologic Information (NCBI), National Library of Medicine, and GenBank with full DNA analysis capability. In addition, on the file server is DNAStar software for nucleic acid analysis. There are extensive image processing computers, software, and color printers that are configured for reproducing histologic sections. Dr. Garner also has several high-end MacIntosh and PC-based computers linked together by ethernet and a file server and web site (http://www.pompous.swmed.edu ). In addition, he has on loan from Hewlett Packard, an Exlemplar Super Computer. This computer quarterly gets complete downloads of GenBank and Dr. Garner’s lab has established a state-of-the-art web-based genomic sequence analysis program (PANORMA) as well as a polymorphic marker prediction program (POMPOUS). There is an administrate core of personnel under the direction of Ms. Brenda Zielke to facilitate the grant and operative needs of PIs and research personnel. In addition to the broad selection of Journals available in the Hamon Center, there is also a modern library facility in the same building (NB2).

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The Laboratory of Gynecologic Oncology occupies 500 square feet of reserved space within the Hamon Center. This lab is dedicated to the understanding of molecular genetics and biology of gynecologic malignancies. The lab is equipped with a number of power supplies and apparatuses for analysis of protein, RNA and DNA including isoelectric focusing/gels, minigels, dot blotting, electrophoretic transfer, and DNA sequencing. Experiments involving gene expression analysis have a luminometer, electroporator, and a PCR thermocycler readily available. Additionally, a speedvac system, UV/visible spectrophotometer, scintillation counter, and ultracentrifuge are available for use.

2. Outpatient All outpatient areas are located on-campus and can be quickly and easily reached without driving. a. Parkland Gynecology Clinic

This newly remodeled facility is used exclusively for seeing gynecologic patients. The Division of Gynecologic Oncology has 12 exam rooms available each Tuesday. The clinic is located on the 3rd floor directly beneath the outpatient chemotherapy infusion area on the 4th floor. Eighty to 100 patients are routinely scheduled and interpreter services are readily available in addition to chaperones, nurses, social services and office staff.

b. James W. Aston Ambulatory Care Center This is a modern outpatient facility where UT Southwestern faculty members see private patients in the University practice. Ten exam rooms with adjoining consultation areas are available. Gynecologic services include Aston 5 and the Women’s Center housed on the 6th floor of the Aston Center Building. Gynecologic Oncology office hours currently include Monday and Friday mornings.

c. Harold C. Simmons Comprehensive Cancer Center This modern outpatient facility is housed on the second floor of the NC Building on the North Campus, which is contiguous to the state-of-the–art laboratories used for basic and translational research. The Simmons Cancer Center houses 12 exam rooms and 17 individual chemotherapy infusion rooms. Gynecologic Oncology office hours currently include all-day Mondays and Wednesdays. The arrival of additional faculty in 2006 is expected to significantly expand this practice.

3. Inpatient Parkland Memorial and UT Southwestern University Hospital-St. Paul/Zale Lipshy are located on-campus and can be quickly and easily reached without driving.

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a. Parkland Memorial Hospital PMH is Dallas County’s only public hospital that ensures that health care is available to all Dallas County residents. It was founded in 1894. Parkland is operated by the Dallas County Hospital District, a tax-supported entity of the county of Dallas through Parkland Health and Hospital System. Parkland was the first and still remains the primary teaching hospital for UT Southwestern’s multifaceted educational programs. All of its physician services are provided under contract with UT Southwestern. Its facilities encompass 990 beds in 1.24 million square feet. The annual budget is $820 million and it employs 7,100. It is governed by the seven-member Dallas County Hospital District board of managers, appointed by the Dallas County Commissioners Court. It is under the leadership of Maurine Dickey, chairman of the board and Dr. Ron J. Anderson, president and chief executive officer. In 2004, Parkland was named one of U.S. News & World Report’s best hospitals for the 11th consecutive year and recognized for its excellence in 11 categories: rheumatology, endocrinology, gynecology, urology, otolaryngology, geriatrics, kidney disease, neurology/neurosurgery, gastroenterology, orthopedics and cardiology. In 2004, Parkland ranked #11 in the nation for gynecologic services. Parkland is renowned for its emergency, trauma and burn centers. Women’s Services delivers more than 16,000 babies annually, making it the nation’s largest single-site delivery facility. Parkland is the main provider of care to underserved minorities where 50% of patients are African American, 40% Hispanic and 10% White. All the effective forms of cancer therapy are available and the cancer program is approved by the American College of Surgeons Commission on Cancer. There is a dedicated gynecologic oncology ward (4-West) and clinic that provide comprehensive care for patients receiving surgery, chemotherapy, radiation therapy, pain control and palliative care under the guidance of the fellow and faculty.

b. UT Southwestern University Hospital-St. Paul This was the first private hospital in Dallas founded in 1896 and was also the only Catholic hospital in North Texas. In 2000, the facilities and land were purchased by UT Southwestern, and the hospital was leased and operated by University Medical Center Inc. under combined management with Zale Lipshy. In 2005, University Hospital, St. Paul and Zale Lipshy merged with UT Southwestern Medical Center. UT Southwestern specialists and physicians provide private practice care for its patients. University Hospital-St. Paul currently holds 300 beds (licensed for 550) in its 600,000 square feet. It employs 1,500 staff. The governance consists of the 10-member board of trustees appointed by University Medical Center Inc. St. Paul operates one of the most successful heart and lung transplant programs in the country, ranking number one in survival rates for heart transplants in Texas and consistently among the top 10 percent of programs in the country. More than 100 UT Southwestern faculty physicians and approximately 900 private–practice physicians in all major specialties are on staff. The 12 operating rooms all have state-of-the-art equipment. All the effective forms of cancer therapy are available. There is a tumor registry and the cancer program is approved by the American College of Surgeons Commission on

35

Cancer. There is an oncology floor (3-South) to which the gynecologic oncology service admits.

c. UT Southwestern University Hospital-Zale Lipshy This not-for-profit hospital was named in honor of the Zale and Lipshy families. In 1989, University Medical Center Inc. opened the hospital and began operating Zale Lipshy as the private referral hospital for patients of UT Southwestern physicians. Its facilities have 151 licensed and staffed beds in a total of 300,000 square feet. Zale Lipshy has an annual budget of $100 million and it employs 800 staff. It is governed by the 15-member board of trustees appointed by University Medical Center Inc. Its facilities, which accommodate patients from around the world, include 12 operating suites for specialized surgical care in neurological surgery, orthopaedics, urology, gynecology, otorhinolaryngology, ophthalmology, general and oncological surgery, oral and maxillofacial surgery, vascular surgery, plastic and reconstructive surgery, and breast services. All the effective forms of cancer therapy are available. There is a tumor registry and the cancer program is approved by the American College of Surgeons Commission on Cancer. There is an oncology floor (7th floor) to which the gynecologic oncology service admits.

d. Presbyterian Hospital of Dallas This is an 897 bed non-profit hospital operated by Texas Health Resources with a long-standing affiliation with UT Southwestern Medical School that participates in the teaching of obstetrics and gynecology residents at the senior level. It has a comprehensive multi-disciplinary cancer center. There are more than 1,200 physicians on the medical staff. Presbyterian Hospital offers a full range of care including services for cancer, cardiovascular problems, neuroscience needs, orthopedics, senior care and women's services. The activities of the cancer center include weekly tumor board conferences and bi-monthly gynecologic oncology tumor boards. All the effective forms of cancer therapy are available. There is a tumor registry and the cancer program is approved by the American College of Surgeons Commission on Cancer.

e. Medical City-Dallas Hospital This 598 bed facility was founded in 1974 and is affiliated with Southwestern Medical School. Senior obstetrics and gynecology residents rotate at this location. There are 1,250 physicians on the medical staff practicing 95 specialties. A broad range of sophisticated cancer therapies are available. There is a tumor registry and the cancer program is approved by the American College of Surgeons Commission on Cancer.

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4. Office Fellows have their own private office (J7.116) adjacent to the faculty offices on South Campus. This 150 sf room includes two desks—each with a desktop computer connected to the Ethernet. Bookshelves, file cabinets, one mini-refrigerator and a printer are also provided. The Laboratory of Gynecologic Oncology has a separate desk for each fellow with Ethernet access.

5. Conference Several conference rooms are frequently utilized for fellow education. The three most commonly used rooms are described in detail. a. G6.200

This conference room is part of the Department of OB/GYN and comfortably seats 50-75 people. There is a permanently housed projector connected to a desktop computer and a full-length screen at the front of the room. Weekly conferences within this room include the Protocol and Chemotherapy Monitoring Conference, Tumor Board and OB/GYN Grand Rounds. Monthly conferences include the Gynecologic Oncology Fellows’ lecture series.

b. J6.102 Conference Room There is a large table surrounded by 15-20 swivel chairs. Stationary padded seats surround the back walls for additional seating(maximum 80 people). The front wall has a permanent white Board and the podium is Monthly conferences within this room include the Gynecologic Oncology Division Research meeting, M & M Conference and Journal Club.

c. NB8.204 This 300 sf room is on the North Campus within the Hamon Center for Therapeutic Oncology Research. Weekly conferences include the Laboratory of Gynecologic Oncology research meeting and the Hamon Center research meeting each Thursday.

D. Integration of fellowship program with residency program and other departments 1. UT Southwestern OB/GYN residency program

The Department of OB/GYN a four year approved program with 18 residents at each level of training. The residents rotate in the Division of Gynecologic Oncology and attend all teaching conferences. Residents perform the basic work-up of all admissions, follow patients daily, perform benign gynecologic surgical procedures, assist in radical pelvic surgery and actively participate in journal clubs, conferences and presentation of cases at

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Tumor Board. Fellows are responsible for performing radical procedures, supervising the care of all patients with gynecologic neoplasms, guiding residents in the evaluation of new patients and performance of procedures. In addition, the fellows will assist residents in non-radical gynecologic oncology procedures and will be responsible for the planning and organization of the Tumor Board. Off-service fellows participate in an ongoing pelvic anatomy and dissection course facilitated by faculty members in the Division of Urogynecology to enhance our resident surgical educational curricula. This course, which takes place in the Department of Anatomy at the UT Southwestern School of Medicine, is structured with testing and hands-on fresh-cadaver anatomical instruction of the pelvic organs. Fellows participate in the didactic lectures and pelvic dissections. Formalization of the surgical curricula in a computer-based instructional format has recently been funded through the Association of Professors in Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology (APGO-CREOG). All of the activities described above are under the supervision of a gynecologic oncology faculty member.

2. Relationship with Departments of Surgery, Urology, Medical Oncology and Radiotherapy The relationship of the Division of Gynecologic Oncology with other departments at UT Southwestern Medical School is long-standing and optimal. We do not anticipate that these relationships will change in the future. It is well understood by the Department of Surgery that intestinal surgical procedures, mediport catheter placement and other procedures as they relate to the treatment of gynecologic malignancies and their complications are performed by gynecologic oncologists. Consultation is available when considered necessary by the faculty. Patient care is greatly facilitated by having an open communication in the event of the need for intra-operative consultation at Parkland Memorial Hospital or University Hospital-St. Paul. It is well understood by the Department of Urology that urinary surgical procedures as they relate to the treatment of gynecologic malignancies and their complications are performed by gynecologic oncologists. Consultation is available when considered necessary by the faculty, but there is typically minimal overlap. It is well understood by the Division of Medical Oncology that the management of chemotherapy for gynecologic oncology patients is the responsibility of the Division of Gynecologic Oncology, both at the Parkland Gynecologic Oncology Clinic and the Simmons Cancer Center. There is an open dialogue with medical oncology colleagues for facilitation of patient care when circumstances arise.

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The Division of Gynecologic Oncology has a particularly close relationship with the Department of Radiation Oncology. Faculty and residents attend and actively participate in the multidisciplinary Gynecologic Oncology Tumor Board Conference. Patients requiring inpatient hospitalization for brachytherapy and/or radiation complications are admitted to the gynecologic oncology service on 4-West at Parkland or 3-South at University Hospital-St. Paul.

E. Previous and current fellows 1. Previous fellows trained:

Werner Wester-Ebbinghaus, M.D., 1975-76

Women’s Health Specialists, Yuma, AZ John R. McCauley, M.D., 1976-77

Gynecologic Surgery, Sparta, TN James E. Graham, M.D., 1978-80

Genesys Hurley Cancer Institute, Flint, MI (retired) David Gal, M.D., 1979-83

American University of Antigua, Professor and Clinical Chair of Obstetrics & Gynecology, New York, NY

Wayne A. Christopherson, M.D., 1982-85

University of Pittsburgh Medical Center, Pittsburgh, PA Andrew Berchuck, M.D., 1984-85

Director of the Duke Division of Gynecologic Oncology F. Bayard Carter Distinguished Professorship Duke Comprehensive Cancer Center, Durham, NC

Diane A. Semer, M.D., 1989-92

Physicians East, Greenville, NC Katherine Economos, M.D., 1990-93

Associate Clinical Professor, Obstetrics & Gynecology Cornell University-Weill Medical College Director of Division of Gynecologic Oncology New York Methodist Hospital, New York, NY

David L. Tait, M.D., 1991-94

Blumenthal Cancer Center, Charlotte, NC

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Carolyn C. Muller, M.D., 1993-96 Director and Associate Professor, Division of Gynecologic Oncology University of New Mexico Health Sciences Center, Albuquerque, NM

Joseph Santoso, M.D., 1994-97

Director and Associate Professor, Gynecologic Oncology Division University of Tennessee, Memphis, TN

Vivian von Gruenigen, M.D., 1995-98

Chairman, Division of Obstetrics and Gynecology Medical Director of Women’s Health Services Summa Health System Akron City Hospital, Akron, OH

John D. O'Boyle, M.D., 1996-99

Lieutenant Commander Medical Corp., Director of Gynecologic Oncology Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, VA Associate Professor, USUHSC

Wei-Chien Michael Lin, M.D., 1997-2001

Women’s Cancer Center of Southern California, Sherman Oaks, CA Jayanthi Sivasothy Lea, M.D., 2000-04

Blumenthal Cancer Center, Division of Gynecologic Oncology Carolina’s Medical Center, Charlotte, NC

Gautam Gorantla Rao, M.D., 2001-05

Assistant Professor of Obstetrics & Gynecology Vanderbilt University Medical Center, Nashville, TN

Richard David Drake, M.D., 2002-06

Assistant Professor of Obstetrics & Gynecology Cleveland Clinic Foundation, Cleveland, OH

Lynne Marie Knowles, M.D., 2003-07

Texas Oncology, P.A., Austin, TX Shawna L. Bull Phelps, M.D., 2004-08

Texas Oncology, P.A., Dallas, TX Thomas P. Heffernan, M.D., 2005-09

North Texas Gynecologic Oncology, Dallas, TX

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2. Current fellows in the program: Shana Nicole Wingo, M.D., 2006-10

Texas A&M University, College Station, TX, B.S., 1997; UT Southwestern Medical School, M.D., 2002; UT Southwestern Medical Center, Residency, 2006

Scott Christopher Purinton, M.D., Ph.D., 2007-11

Furman University, Greenville, SC, B.S., 1993; University of Florida, Ph.D. 1999; University of Miami, M.D., 2003; Johns Hopkins Hospital, Residency, 2007

Todd Patrick Boren, M.D., 2008-12

Texas A&M University, College Station, TX, B.S. 1998; Louisiana State University School of Medicine, New Orleans, LA, M.D., 2002; Bayfront Medical Center, St. Petersburg, FL, 2006, Residency; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 2008, Post-Doctoral Research Fellowship

Miriam Leah Tyndall, M.D., 2009-13

Louisiana State University, Baton Rouge, LA, B.S., 2001; American University of the Caribbean, Netherlands Antilles, M.D., 2005; University of Tennessee, Memphis, TN, Residency, 2009

F. Other physician trainees assigned to the gynecologic oncology service

Six months each academic year there is one 2nd year OB/GYN resident from Methodist Hospitals of Dallas (affiliated residency) who rotates in the Division of Gynecologic Oncology (role already described). There are no other physician trainees that might interfere with the planned training program of a fellow.

G. Anticipated changes in the program, faculty, or patient referral During these tumultuous and uncertain times in medicine, the only thing that can be surely anticipated is change. The division has anticipated change and the fellowship is prepared to flex to accommodate it. The program has been remarkably stable for the past 15+ years under the leadership of Dr. David Miller. The monthly meeting between all four fellows and the Program Director is an open exchange to identify and address weaknesses in the program and has resulted in numerous mutually beneficial changes over the past few years. This dialogue will undoubtedly continue to improve the program. The private patient referral base of Drs. Miller Richardson and Kehoe has greatly expanded in the past few years at the Simmons Cancer Center and University Hospital-St. Paul. UT Southwestern Medical Center has made the growth of the Simmons Cancer Center a high priority and is providing financial and marketing resources to facilitate this goal. The expansion of the private patient referral base has been an unexpected, but fortuitous event for the

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fellowship program. The volume and complexity of the surgical experience has been broadened for each of the fellows and this has been universally recognized as a positive change. The main patient base for the fellowship has historically been Parkland Memorial Hospital. Parkland is operated by the Dallas County Hospital District that has taxing authority through Dallas County property taxes. Parkland is dedicated to providing care to all residents of Dallas County regardless of ability to pay. The other private hospitals of Dallas have shown little interest in caring for these patients. Most patients are referred to the Division because they have no insurance. With the widening gap between rich and poor, more people unable to obtain insurance, and no universal health care on the horizon, we anticipate this patient base will remain stable or increase since it has been remarkably consistent over the past few decades. In the unlikely event that the patient base might receive some sort of coverage and seek care elsewhere, the Division can flex and comfortably accommodate them in our "private" facilities.

H. Our program’s methods for evaluating a fellow’s progress Fellows are frequently given informal feedback from the Fellowship Program Director regarding their progress toward accomplishing the terminal objectives described in the "Guide to Learning in Gynecologic Oncology" of The Division of Gynecologic Oncology of the American Board of Obstetrics and Gynecology. Every 6 months each fellow is evaluated by the faculty using the E*Value Evaluation System (example enclosed). These evaluations become part of the fellows’ permanent file and may be viewed directly be the fellow on-line. These evaluations are then used to facilitate discussion between the fellow and the Fellowship Program Director during the semi-annual performance review. Feedback is provided and academic career guidance is facilitated in this review. Minutes from these meetings are documented, shown to the fellow and placed in their permanent file. Fellow's appointments are for one year and are renewed at the mutual consent of the Program Director, faculty, and the fellow. Other requirements include successful completion of the Advanced Cardiac Life Support and Advanced Trauma Life Support courses and the two required post-graduate courses. Prior to completing the fellowship, the fellow must have submitted for publication research projects suitable for use as a thesis for their gynecologic oncology board examination.

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