Female Pelvic Medicine and Reconstructive Surgery—What Does Certification Mean?
Purpose of Review
There are advantages and disadvantages of subspecialty certification for physicians, trainees, patients, and society at large. As female pelvic medicine and reconstructive surgery (FPMRS) became the second subspecialty of urology to offer subspecialty certification, understanding the effects of FPMRS subspecialty certification on the healthcare system is important.
While subspecialty certification may improve training, identify experts, and ultimately lead to improved patient outcomes, certification might also be unnecessary for some physicians, weaken residency training, and limit the number of physicians who are deemed qualified to offer certain treatments. As pelvic floor disorders can considerably affect quality of life, and their prevalence is expected to increase with the aging population, high-quality FPMRS care is needed. In this article, we describe the history of FPMRS subspecialty certification as well as its potential advantages and disadvantages as suggested by literature.
There are advantages and disadvantages of FPMRS subspecialty certification. Further research is needed to assess the effect of FPMRS subspecialty certification on patient outcomes.
KeywordsBoard certification Female pelvic medicine and reconstructive surgery Patient outcomes
Compliance with Ethical Standards
Conflict of Interest
Steven J. Weissbart, Alan J. Wein, and Ariana L. Smith each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.American Board of Medical Specialities. Board Certification and Maintenance of Certification 2017 [Available from: http://www.abms.org/board-certification/.
- 3.Flexner A, Pritchet H, Henry S. Medical education in the United States and Canada bulletin number four (the Flexner report). The Carnegie Foundation for the Advancement of Teaching: New York (NY); 1910.Google Scholar
- 7.American Board of Medical Specialities. ABMS History of Improving Quality Care 2017 [Available from: http://www.abms.org/about-abms/history/.
- 8.• American Board of Medical Specialities. Frequently Asked Questions 2017 [Available from: http://www.abms.org/about-abms/faqs/. This reference provides meangful information on the certification process from the American Board of Medical Specialities.
- 10.DeLancey JO. Current status of the subspecialty of female pelvic medicine and reconstructive surgery. Am J Obstet Gynecol. 2010;202(6):658. e1-. e4.Google Scholar
- 11.The Committee on Female Pelvic Medicine and Reconstructive Surgery. Guide to Learning in Female Pelvic Medicine and Reconstructive Surgery 2003 [Available from: http://www.documentshare.org/images/server01/27022017/12/90ff6c450e275c2e00bfe842dcf3b6f4.pdf.
- 12.The American Board of Obstetrics and Gynecology and The American Board of Urology. General and Special Requirements for Graduate Medical Education in the Subspecialty of Female Pelvic Medicine and Reconstructive Surgery 2011 [Available from: http://studylib.net/doc/18758029/general-and-special-requirements-for-graduate-medical-edu...
- 14.The American Board of Urology. Female pelvic medicine and reconstructive surgery subspecialty [Available from: http://www.abu.org/subspecialty/female-pelvic-medicine-and-reconstructive-surgery-subspecialty/.
- 15.Whiteside JL. What is female pelvic medicine and reconstructive surgery? Female Pelvic Medicine & Reconstructive Surgery. 2010;16(5):255–6.Google Scholar
- 18.American Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Female Pelvic Medicine and Reconstructive Surgery (Obstetrics and Gynecology or Urology) 2012 [Available from: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/221-486_female_pelvic_medicine_2017-07-01.pdf.
- 22.• Jacobs KM, Hernandez LH, Thomas TN, Waddell LM, Kavic SM, Graziano SC. Perceptions of Posthysterectomy cystoscopy training in obstetrics and gynecology residency programs. Female Pelvic Med Reconstr Surg. 2015;21(2):66–9. This study demonstrates how providing residents with education in FPMRS may improve patient outcomes.CrossRefPubMedGoogle Scholar
- 23.Barocas DA, Mitchell R, Chang SS, Cookson MS, editors. Impact of surgeon and hospital volume on outcomes of radical prostatectomy. Urol Oncol: seminars and original investigations: Elsevier; 2010.Google Scholar
- 26.Tejwani R, Wang H-H, Young B, Greene N, Wolf S, Wiener J, et al. Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures. J Pediatr Urol. 2016;12(6):388. e1-. e7.Google Scholar
- 27.• Liu JS, Nettey O, Vo AX, Hofer MD, Flury SC, Kielb SJ. Prolapse repair with and without apical resuspension—practice patterns among certifying American urologists. Neurourol Urodyn. 2017;36(2):344–8. This article identifies different practise patterns of FPMRS trained urologists CrossRefPubMedGoogle Scholar
- 31.•• Brueseke T, Muffly T, Rayburn W, Connolly A, Nieto M, De La Cruz J, et al. Workforce analysis of female pelvic medicine and reconstructive surgery, 2015 to 2045. Female Pelvic Med Reconstr Surg. 2016;22(5):385–9. This article provides important data on the anticipated prevelance of pelvic floor disorders over the next decades as well as the number of FPMRS providers that will be available to care for women with pevic floor disorders. CrossRefPubMedGoogle Scholar
- 34.U.S. Food and Drug Administration. Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse 2011 [Available from: https://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/ucm262760.pdf.
- 36.U.S. Food and Drug Administration. Information for Health Care Providers for POP 2017 [Available from: https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/ucm345204.htm.
- 39.American Urological Association. Subspecialty Certification 2013 [Available from: http://www.auanet.org/guidelines/subspecialty-certification.
- 40.Jordan GH, Granatir T, Ritchey ML. Look for MOC changes in 2017. In: American Board of Urology says; 2016.Google Scholar
- 41.Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al., editors. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and, vol. 2014. Mayo Clinic Proceedings: Elsevier; 2015.Google Scholar
- 43.Krisch JA. Board certification and fees anger doctors 2015 [Available from: https://well.blogs.nytimes.com/2015/04/13/board-certification-and-fees-anger-doctors/.
- 47.Polland A, Richter LA. Development of female pelvic medicine and reconstructive surgery fellowship programs following the deadline for senior accreditation. Urology Practice. 2017;Google Scholar
- 48.• Danford JM, White NC, New M, Fletcher S, Blume JD, Ward RM. The fellowship effect: how the establishment of a fellowship in female pelvic medicine and reconstructive surgery affected resident vaginal hysterectomy training. Am J Obstet Gynecol. 2014;211(5):559. e1-. e6. The article investigates how the initiation of a fellowship program can effect residents’ operative experiences. Google Scholar
- 49.• Chaudhry Z, Tarnay CM. Assessing resident surgical volume before and after initiation of a female pelvic medicine and reconstructive surgery fellowship. J Surg Educ. 2017;74(3):450–4. The article investigates how the initiation of a fellowship program can effect residents’ operative experiences. CrossRefPubMedGoogle Scholar
- 50.Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int. 2008;101(11):1388–95.CrossRefPubMedGoogle Scholar
- 51.•• Bayne CE, Gomella PT, DiBianco JM, Davis TD, Pohl HG, Rushton H. Testicular torsion presentation trends before and after pediatric urology subspecialty certification. J Urol. 2017;197(2):507–15. This article provides important data on a potential detrimental effect of pediatric urology subspecialty certification. CrossRefPubMedGoogle Scholar