This revised Fellowship Leave Policy is effective immediately and will apply to graduates of the current academic year (2019-2020).
Candidates for certification are required to complete 24 or 36 months of graduate medical education in an Obstetrics and Gynecology fellowship program(s) that is ACGME-accredited at the time of completion of training. These are:
- Complex Family Planning (CFP): 24 months
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS): 36 months
- Gynecologic Oncology (GO): 36 months
- Maternal-Fetal Medicine (MFM): 36 months
- Reproductive Endocrinology and Infertility (REI): 36 months
These are the approved lengths of training by the American Board of Medical Specialties for subspecialty certification in Obstetrics and Gynecology.
Most fellows will be in a setting that follows an academic year calendar that starts each year on July 1 and concludes on June 30. In many cases, the academic year will occur within either 12 one-month or 13 four-week blocks, and the fellowship will be completed in two or three years. In other situations, the training may be extended for additional months or completed over more years. Some fellows may also be participating in additional non-accredited years of fellowships.
Approved Leave from Fellowship
This policy applies to leaves of absence for medical, parenting, and caregiver leave. This policy is designed to align with circumstances covered by the Family and Medical Leave Act (FMLA), which allows for reasonable unpaid leave for certain family and medical reasons. These reasons may include:
- The birth and care of a newborn, adopted, or foster child
- The care of an immediate family member (child, spouse, or parent) with a serious health condition
- The fellow’s own serious health condition
This leave policy does not apply to other personal leave and/or interruptions from a fellowship (e.g., prolonged vacation/travel, unaccredited research experience, unaccredited clinical experience, military or government assignment outside the scope of the subspecialty, etc.). This policy likewise does not apply to periods of time for which a fellow does not qualify for credit by reason of fellow’s failure to meet academic, clinical, or professional performance standards.
Extension of Fellowship Beyond the End of an Academic Year
If completion of fellowship dates change, fellows are eligible for certification dependent on one of the following:
- If they are anticipated to complete training by September 30, they may apply for and take the Qualifying Examination that academic year.
- If they complete their fellowship after September 30, they will not be eligible to take the Qualifying Examination in the original academic year. Such graduates will be eligible to apply for the next academic year’s Qualifying Examination.
Fellows are expected to take allotted personal (vacation and/or sick) time according to local institutional policies. Foregoing personal time (vacation or sick leave) by banking such time in order to shorten the required 24 or 36 months of fellowship, or to “make up” for time lost due to sickness or other absence, is not permitted.
Leaves of Absence or Interruption in Training
Leaves of absence and vacation may be granted at the discretion of the Program Director consistent with local institutional policy and applicable laws. The number of days that equals a “week” is a local issue that is determined by the institution and Program Director, not ABOG. Vacation weeks may be taken as part of approved leave or in addition to approved leave.
Yearly leave: The total of such vacation and leaves for any reason — including, but not limited to, vacation, medical, parenting, caregiver, or personal leave — may not exceed 12 weeks in any single year of fellowship. If the maximum weeks of leave per fellowship year are exceeded, the fellowship must be extended for a duration of time equal to that which the fellow was absent in excess of 12 weeks in the F1, F2, or F3.
Total leave: In addition to the yearly leave limits, a fellow must not take a total of more than:
- 20 weeks (five months) of leave over three years during an FPMRS, GO, MFM or REI fellowship.
- 16 weeks (four months) of leave over two years during a CFP fellowship.
If this limit is exceeded, the fellowship must be extended for a duration of time equal to that which the fellow was absent in excess of 16 or 20 weeks. Such extensions of training must have an educational plan outlined for the continued training with specific educational and clinical experience goals and objectives to be achieved.
Unaccrued personal time may not be used to reduce the actual time spent in a fellowship, nor to “make up” for time lost due to medical or other leave. Time missed for educational conferences does not count toward the leave thresholds.
Core Clinical Experience
All fellows must have core clinical training that includes the breadth and depth of the subspecialty. The Program Director is required to attest to the fellow's satisfactory performance, competence, and completion of the program. The Program Director is expected to sign on behalf of the program, not as an individual.
Each fellow is required to maintain a record of the number and type of procedures performed to demonstrate the adequacy of their operative experience. Fellows are required to submit their clinical experience in the ACGME Case Log system following the instructions and policies outlined.
Each fellow is required to complete a minimum amount of core clinical experience in each subspecialty that must be met for eligibility for certification:
- CFP: 12 months
- FPMRS: 18 months
- GO: 24 months
- MFM: 18 months
- REI: 12 months
Neither the length of a fellowship nor clinical experience volume are substitutes for development of clinical and technical competence. However, with inadequate clinical experiences and/or insufficient surgical volume, it may not be possible to develop or assess clinical competency. ABOG is concerned about and will be monitoring the success of graduates completing a fellowship in less time and the effect, if any, on OB GYN and subspecialty certification.
Since subspecialty certification is not completed until after a year of independent practice, some learning and skill development may, of necessity, continue beyond the fellowship.
Research and Elective Experience
Fellows must complete a minimum number of months of research and electives:
- CFP: six months of research and six months of electives
- FPMRS: 12 months of research and six months of electives
- GO: 12 months of research; electives within 24 core clinical months
- MFM: 12 months of research and six months of electives
- REI: 18 months of research and six months of electives
The electives may be clinical or research in accordance with the ACGME program requirements and ABOG certification standards. ABOG defines electives as focused specific clinical and/or research experiences selected at the discretion of the Program Director and fellow.
Fellows should prioritize using elective months for blocks of leave in meeting certification requirements. GO Fellows should prioritize using research months first and core clinical experience second for blocks of leave to meet certification requirements.
Yearly leave: An interruption of more than 24 weeks (six months) in any academic year of training must be reported to ABOG by the Program Director. The report must include an explanation for the absence from training, a block diagram of completed clinical experience, a plan for re-entry, and a proposed educational plan describing the clinical and research rotations plus goals and objectives for the remaining training. In most cases, such an interruption should lead to an extension of the fellowship by an additional fellowship year. There must be a description of the proposed research experience. ABOG will review the report focusing on the breadth and depth of the clinical and research experience and either approve or disapprove the educational plan of fellowship training.
Total leave: Fellows who take more than six months of leave within the first 36 months (24 months for CFP) of their fellowship must have a review of their proposed fellowship training. The Program Director must submit a block diagram displaying the clinical and research rotations completed for review and approval by ABOG. Particular attention will be directed to the core clinical experience. If ABOG determines that there are deficiencies in training, ABOG may require extra months of clinical experience to be eligible for certification.
Fellows who take more than six months of leave within the first 36 months (24 months for CFP) of their fellowship also must have their clinical experience log reviewed to verify that they have met the contemporary program graduate minimum clinical procedural experiences. ABOG may also establish minimum clinical and procedural experiences for eligibility for certification. If ABOG determines that there are deficiencies in training, ABOG may require extra months of clinical and/or surgical experience to be eligible for certification.
Fellowship in More Than One Program
When a fellow’s graduate education and clinical experience have been gained in more than one program, the application to take the Qualifying Examination must be accompanied by verification of the candidate’s satisfactory performance in each program.
Fewer than six months in any fellowship program will not count toward meeting the 24- or 36-month certification standard.
Revised Policy Date: February 7, 2020
Examples of When Training Extensions Are Required (or Not Required)
A GO fellow takes six weeks of leave in F1 and F2, and eight weeks in F3. This is a total of 20 weeks. There is no required extension of the fellowship.
An FPMRS fellow takes four weeks of leave in F1, 12 weeks of parenting leave plus three weeks’ vacation in F2, and four weeks of leave in F3. This is 15 weeks leave in the F2 and 23 weeks of total leave. The fellowship must be extended by three weeks.
An MFM fellow takes four weeks of leave in F1, 12 weeks in F2, four weeks in F3. This is a total of 20 weeks. There is no required extension of the fellowship.
An REI fellow takes 12 weeks of leave in F1, four weeks in F2, 12 weeks in F3. This is a total of 28 weeks. The fellowship must be extended by at least eight weeks with an educational plan submitted and approved by ABOG.
A CFP fellow takes four weeks of leave in F1 and 12 weeks in F2. This is a total of 16 weeks. There is no required extension of training.