Gynecologic Oncology Certifying Exam Preparation

• Obtain a history including pertinent oncologic history to generate a differential diagnosis and obtain and interpret laboratory evaluations, imaging studies, and other diagnostics
• Determine if surgical or non-surgical intervention is indicated
• Complete a preoperative surgical fitness assessment through the identification of relevant medical comorbidities and clinical findings; and complete preoperative medical consultation to optimize patient outcome
• Determine the indicated surgical intervention and approach
• Identify alternatives to surgery and counsel patients about risks, benefits, and alternative interventions
• Identify and counsel patients regarding fertility-sparing options
• Use prophylaxis and preventative measures to reduce perioperative morbidity

• Apply knowledge of anatomy and physiology required for surgery
• Apply knowledge of operative instruments
• Apply knowledge of the indications for surgical staging and perform the appropriate surgical intervention
• Perform the appropriate surgical intervention
• Surgically manage gynecologic malignancies
• Surgically manage complex nonmalignant conditions
• Surgically manage gestational trophoblastic disease (GTD)
• Surgically manage abnormal placentation
• Perform intraoperative surgical consultation
• Identify and manage intraoperative complications
• Revise operative plan based on intraoperative findings and patient condition

• Implement strategies to reduce postoperative complications
• Evaluate, identify, and manage surgical postoperative complications
• Evaluate, identify, and manage postoperative complications
• Apply postoperative strategies, including nutritional requirements and the use of supplements, pain management, and IV fluids
• Identify and manage the critically-ill postoperative patient (e.g. hemodynamic monitoring, ventilatory support)
• Communicate operative findings, results, and complications with patient and family
• Coordinate postoperative transition of care

Understanding the Pharmacology, Mechanism of Action, and Toxicities Associated with Non-Surgical Management

• Chemotherapy
• Endocrine therapy
• Immunotherapy
• Molecularly-targeted therapy
• Identify, counsel, and manage acute and delayed radiation-related toxicities

Applying Knowledge of Non-Surgical Management to Patient Care

• Apply knowledge of indications, contraindications, and goals of treatment for primary gynecologic cancers and their precursors in order to establish a timeline for initiation and completion of non-surgical therapy
• Apply knowledge of indications, contraindications, and goals of treatment for recurrent gynecologic cancers and their precursors in order to establish a timeline for initiation and completion of non-surgical therapy
• Incorporate prognosis in treatment discussions with patient
• Apply knowledge of radiation therapy in the treatment of gynecologic cancers
• Identify indication for treatment using brachytherapy devices
• Counsel patients on gynecologic cancer clinical trial availability, eligibility, and participation
• Manage or co-manage oncologic emergencies related to cancer progression or therapies
• Coordinate postoperative care of GTD and choriocarcinoma

• Counsel patients and perform comprehensive family history after identifying relevant genetic risk factors and indications for genetics testing
• Identify the indications for genetics testing and counseling
• Apply knowledge of hereditary cancer syndromes to patient care
• Collaborate with specialists in genetics to manage patient care
• Counsel patient on prognosis and treatment based on genetic testing results
• Counsel patient regarding indications for risk-reducing interventions
• Counsel patient on treatment options based on molecular testing results

• Manage long-term effects of surgical and medical cancer treatment
• Develop and implement an evidence-based surveillance plan for gynecologic cancer patient, including collaborations with other disciplines
• Collaborate with other disciplines to provide survivorship and surveillance care
• Perform evaluation for suspected disease recurrence

• Counsel patient on advanced care planning
• Implement multi-disciplinary palliative care in management of gynecologic cancer patient
• Counsel patient and family regarding timing and role of hospice and end of life care
• Manage cancer-related symptoms such as pain, anorexia, fatigue, nausea, etc.
• Counsel patient on the role of palliative procedures and interventions
• Incorporate nutritional assessment and intervention in supportive and end-of-life patient care

Surgical Procedures

• Simple vaginal hysterectomy
• Total hysterectomy plus or minus BSO
• Modified radical or radical abdominal hysterectomy
• Laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and robotic abdominal hysterectomy
• Modified radical or radical laparoscopic hysterectomy and radical robotic abdominal hysterectomy
• Radical cytoreduction
• Lymphadenectomy and sentinel lymph node mapping (e.g. inguinal, femoral, pelvic, para-aortic area)
• Simple and radical vaginectomy
• Vulvectomy (e.g. skinning, simple, partial, radical)
• Pelvic exenteration (e.g. anterior, posterior, total)
• Omentectomy
• Placement of feeding jejunostomy/gastrostomy
• Resection and re-anastomosis of small bowel
• Bypass procedures of small and large bowel
• Mucous fistula formation of small and large bowel
• Ileostomy and colostomy
• Repair of fistula, vesicovaginal fistula with primary closure, and cesicovaginal fistula with secondary closure using interposition of autologous tissue(s)
• Resection and re-anastomosis of large bowel, including low anterior resection and re-anastomosis
• Splenectomy
• Liver biopsy
• Diaphragmatic resection
• Partial and total cystectomy
• Ureteroneocystostomy, including bladder flap or psoas fixation
• Ureteral surgery
• Urinary tract conduit (e.g. ileum, colon)
• Incision and drainage of abdominal or perineal abscess
• Neovagina (e.g. split thickness skin graft, pedicle graft, myocutaneous graft)
• Pelvic floor reconstruction (e.g. omental pedicle graft, transposition of myocutaneous grafts)
• Insertion of intracavity and interstitial radiation application
• Laser ablation
• Dilation and curettage for GTD

Diagnostic Procedures

• Cystoscopy
• Laparoscopy
• Colposcopy and cone/LEEP excision
• Sigmoidoscopy

• Cancer genetics
• Biologic properties of cancer cells and molecular processes involved in carcinogenesis and aging on cancer biology and cancer genetics
• Gynecologic cancer disease burden and risk factors
• The role of histopathology and special testing (e.g. immunohistochemistry, molecular studies)
• Pharmacogenomics, pharmacodynamics and mechanism of action of relevant agents
• Fundamentals of radiobiology and radiation physics
• Immunology in the prevention, diagnosis, and treatment of gynecologic cancers

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, consider 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 and 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 patient safety and optimize patient outcomes

Practice-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)