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FPMRS Certifying Exam Preparation

Blueprint

The content of the Certifying Examination will be based on the blueprint for Female Pelvic Medicine and Reconstructive Surgery. The major categories and subcategories are shown below including the percentages of the categories.

 

Diagnosis and Exam

  • Diagnose and differentiate types of lower urinary tract dysfunction
  • Perform comprehensive history and physical exam (e.g. POP-Q; myofascial pelvic exam; pelvic muscle tone, strength, and coordination; pelvic muscle spasm and trigger points)
  • Select, perform, and interpret results of initial diagnostic testing (e.g. pad test; post-void residual; urinalysis, culture, and sensitivities; cough stress test)
  • Perform and interpret results of advanced diagnostic testing (e.g. urodynamics, cystoscopy)
  • Obtain and interpret results of voiding diary tests
  • Obtain and utilize results of sleep study tests
  • Perform interventions to address lower urinary tract dysfunction
  • Counsel patients on lower urinary tract dysfunction pathophysiology and diagnostic testing


Counseling on Efficacy, Risks, and Benefits of Non-Surgical Treatments

  • Pelvic floor physical therapy
  • Pharmacologic therapy
  • Urethral bulking
  • Onabotulinum toxin A injection
  • Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
  • Pessaries


Non-Surgical Treatments

  • Urethral bulking
  • Onabotulinum toxin A injection
  • Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
  • Pessaries


Post-Procedural Management of Non-Surgical Treatments

  • Monitor therapeutic effects and adjust treatment
  • Manage complications or side effects of non-surgical treatment


Counseling on Efficacy, Risks, and Benefits of Surgical Treatments

  • Retropubic suspension
  • Midurethral sling
  • Autologous fascial sling
  • Neuromodulation (Sacral Neurostimulation)


Surgical Treatments

  • Retropubic suspension
  • Midurethral sling
  • Autologous fascial sling
  • Neuromodulation (Sacral Neurostimulation)
  • Manage complications of surgical treatment

Diagnosis of Bladder Injury

  • Cystoscopy
  • CT urogram
  • Retrograde pyelogram
  • Voiding cystourethrogram
  • Evaluate for complex fistula


Treatment of Bladder Injury

  • Cystotomy repair
  • Vesicovaginal fistula repair (vaginal)
  • Vesicovaginal fistula repair (minimally invasive)
  • Vesicovaginal fistula repair (abdominal)
  • Treatment of uterovaginal fistula repair
  • Treatment of colovesical fistula
  • Interpositional graft


Diagnosis of Ureteral Injury

  • Cystoscopy
  • CT urogram
  • Retrograde pyelogram
  • Ureterolysis
  • Ureteral catheter / stent


Treatment of Ureteral Injury

  • Stent
  • Ureteroneocystotomy
  • Ureterouretostomy
  • Percutaneous nephrostomy tube
  • Boari flap
  • Psoas hitch
  • Interpositional graft


Diagnosis of Urethral Injury

  • Cystoscopy
  • Voiding cystourethrogram


Treatment of Urethral Injury

  • Urethrovaginal fistula repair
  • Martius flap

Diagnosis and Exam

  • Diagnose and differentiate types of pelvic organ prolapse
  • Perform and interpret results of post-void residual tests
  • Perform and interpret results of urinalysis, culture, and sensitivities tests
  • Counsel patients of pathophysiology and indications and results of additional testing


Non-Surgical Treatments

  • Counsel patients regarding efficacy, risks, and benefits of pelvic floor physical therapy
  • Counsel patients regarding efficacy, risks, and benefits of pessaries
  • Perform pessary fitting
  • Counsel patient on management of pessary care
  • Manage complications or side effects of non-surgical treatment


Counseling on Efficacy, Risks, and Benefits of Surgical Treatments

  • Vaginal hysterectomy
  • Minimally invasive (laparoscopic) hysterectomy
  • Abdominal hysterectomy
  • Anterior compartment native tissue repairs
  • Posterior compartment native tissue repairs
  • Vaginal mesh and graft augmented repairs
  • Open abdominal sacrocolpopexy
  • Minimally invasive (laparoscopic) sacrocolpopexy
  • Vaginal native tissue apical suspensions
  • Minimally invasive (laparoscopic) native tissue apical suspensions
  • Hysteropexy
  • Rectopexy
  • Obliterative procedures


Surgical Treatments

  • Vaginal hysterectomy
  • Minimally invasive (laparoscopic) hysterectomy
  • Abdominal hysterectomy
  • Anterior compartment native tissue repairs
  • Posterior compartment native tissue repairs
  • Vaginal mesh or graft augmented repairs
  • Open abdominal sacrocolpopexy
  • Minimally invasive (laparoscopic) sacrocolpopexy
  • Vaginal native tissue apical suspensions
  • Minimally invasive (laparoscopic) native tissue apical suspensions
  • Hysteropexy
  • Rectopexy
  • Obliterative procedures


Complications of Surgical Treatments


Augmentation of Surgical Materials

  • Counsel patients regarding different types of mesh and graft materials (e.g. allograft, autograft, xenograft, synthetic)
  • Identify and manage complications of mesh and graft materials
  • Counsel patients regarding alternatives, risks, benefits, and complications associated with mesh and graft materials

Diagnosis and Exam

  • Diagnose and differentiate types of fecal incontinence and defecation disorders
  • Perform and interpret results of endoanal ultrasound tests
  • Perform and interpret results of pelvic floor ultrasound tests
  • Perform and interpret results of anorectal manometry tests
  • Obtain and interpret results of defecography tests
  • Obtain and utilize results of colonoscopy tests
  • Obtain and interpret results of motility studies
  • Obtain and interpret results of fistulogram tests
  • Obtain and interpret results of CT tests
  • Counsel patients on pathophysiology and diagnostic testing of fecal incontinence and defecation disorders


Counseling on Efficacy, Risks, and Benefits of Non-Surgical Treatments

  • Pelvic floor physical therapy
  • Pharmacologic therapy
  • Bulking
  • Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
  • Pessaries


Non-Surgical Treatments

  • Bulking
  • Neuromodulation (Posterior Tibial Nerve Stimulation, PTNS)
  • Pessary fitting and placement


Post-Procedural Management of Non-Surgical Treatments

  • Monitor therapeutic effects and adjust treatment
  • Manage complications or side effects of non-surgical treatment


Surgical Treatments

  • Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Neuromodulation (Sacral neurostimulation)
  • Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Rectovaginal fistula repair
  • Counsel patients regarding efficacy, risks, and benefits of the surgical treatment: Anal sphincteroplasty
  • Perform neuromodulation (Sacral neurostimulation)
  • Perform rectovaginal fistula repair
  • Perform anal sphincteroplasty
  • Manage complications or adverse effects of surgical treatment

Diagnosis and Exam

  • Diagnose and differentiate types of congenital anomalies
  • Obtain and interpret results of diagnostic testing (e.g. ultrasound, MRI, karyotype, hormone testing, hysteroscopy)
  • Counsel patients on urogenital anomalies including pathosphysiology and diagnostic testing


Non-Surgical Treatments

  • Counsel patients regarding timing, efficacy, risks, and benefits of non-surgical treatments (e.g. expectant management, vaginal dilation)


Counseling on Timing, Efficacy, Risks, and Benefits of Neovagina Surgical Procedures

  • McIndoe
  • Laparoscopic Vacchietti
  • Laparoscopic Davydov
  • Resection of septum


Neovagina Surgical Procedures

  • McIndoe
  • Laparoscopic Vacchietti
  • Laparoscopic Davydov
  • Resection of septum


Complications or Adverse Effects of Neovagina Surgical Procedures

  • Manage complications or adverse effects of neovagina surgical procedures

Diagnosis and Exam for Urethral Mass

  • Diagnose and differentiate types of urethral masses
  • Perform and interpret results of pelvic floor ultrasound
  • Perform and interpret results of cystoscopy diagnostic testing
  • Obtain and interpret MRI results
  • Counsel patients on urethral mass pathophysiology and diagnostic testing
  • Manage complications or adverse effects of treatment


Counseling on Efficacy, Risks, and Benefits on Treatment Options for Urethral Mass

  • Observation
  • Drainage
  • Excision
  • Urethral reconstruction
  • Concomitant anti-incontinence procedure


Treatment Options for Urethral Mass

  • Observation
  • Drainage
  • Excision
  • Urethral reconstruction
  • Concomitant anti-incontinence procedure

Urinary Tract Infection (UTI)

  • Evaluate and diagnose UTIs
  • Manage acute, chronic, and complicated UTIs
  • Diagnose and treat urogenital atrophy


Hematuria

  • Obtain and interpret results of initial diagnostic testing (e.g. post-void residual; urinalysis, culture, and sensitivities; cystoscopy and biopsy)
  • Obtain and interpret results of advanced diagnostic testing (e.g. CT urogram/IVP, urine cytology, renal ultrasound)
  • Counsel patients on hematuria pathophysiology and diagnostic testing

  • Describe and apply knowledge of anatomy to safely perform surgery and avoid complications (e.g. vascular and nerve supply, bladder, urethra, anatomic supports, ureter, anal sphincter, rectum, small bowel, large bowel)
  • Describe and apply knowledge of central and peripheral nervous system anatomy as it applies to the etiology and treatment of pelvic floor disorders (urinary tract dysfunction, fecal incontinence)

  • Identify and perform preoperative testing depending on patient comorbidities (e.g. immunosuppression, diabetes, cardiovascular disease)
  • Identify and perform preoperative testing depending on patient population (e.g. geriatric)
  • Manage perioperative anticoagulation (e.g. prevention of VTE, chronic anticoagulation)
  • Position patient to decrease adverse outcomes
  • Utilize intraoperative techniques to minimize vascular, visceral, and urinary tract injuries
  • Manage intraoperative injuries (e.g. vascular, bowel, urinary tract, and nerve)
  • Manage postoperative medical and surgical complications
  • Manage prolonged urinary catheterization

Ethics and Professionalism

  • Systematically engage in practice review to identify health disparities
  • When engaged in shared clinical decision making, incorporate patient, family, and cultural considerations in making treatment recommendations
  • When providing care for patients, considers psychological, sexual, and social implications of various treatment options


Patient Safety

  • Systematically analyze the practice for safety improvements (e.g. root cause analysis)
  • Systematically engage in practice reviews for safety improvements (e.g. root cause analysis)
  • Incorporate the standard use of procedural briefings, "time outs", and debriefings in clinical practice
  • Participate in the review of sentinel events, reportable events, and near misses
  • Implement universal protocols (e.g. bundles, checklists) to help ensure patient safety


Interpersonal Communication Skills

  • Communicate to patient and family regarding adverse outcomes and medical errors
  • Demonstrate sensitivity and responsiveness when communicating with a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
  • Provide comprehensive information when referring patients to other professionals


Systems-Based Practice

  • Incorporate considerations of cost awareness and risk-benefit analysis in patient care
  • Provide care with multidisciplinary teams to promote safety and optimize patient outcomes


Patient-Based Learning and Improvement

  • Design or participate in practice or hospital quality improvement activities


Evidence-Based Medicine

  • Incorporate evidence-based practices and national guidelines to improve practice patterns and outcomes
  • Implement evidence-based protocols to enhance recovery after surgery (ERAS)
View a Printable Version of the 2021 Certifying Exam Topics