Dr. James Daniell:  “Hi, I’m Dr. Jim Daniell from Nashville, Tennessee and we’re here at the annual AAGL Laparoscopy and Hysteroscopy Convention which is in Orlando this year.  I want to talk briefly with Dr. Roseann Maikis who I understand is originally from Long Island, New York.  As you can see, Roseann is a young physician, she has just finished her training in obstetrics and gynecology, and she is currently actively training in one of the new AAGL/SRS fellowship programs.  For some background - the SRS, which is the Society of Reproductive Surgeons, has had a fellowship program that is one year in length for about ten years.  This now is being combined with the AAGL as a new fellowship to be more organized, more structured, and I think it will be a better experience for those physicians who have an interest in advanced training in gynecologic endoscopy.  So I wanted to ask Roseann a few questions about how she got to where she is today.  Roseann, was it early on in your residency that you got interested in laparoscopy or what led you to it?”

Dr. Roseann Maikis:  “Yes, it was actually very early on.  It was the first or second year when we started to do laparoscopy, and I found a particular interest in it and thought that this was something that I might want to pursue for the rest of my career.”

Dr. James Daniell:  “When you were in medical school on your rotation, did you get exposed to laparoscopy at that level?”

Dr. Roseann Maikis:  “No, not in medical school, it was just in residency.”

Dr. James Daniell:  “Now you trained in Virginia, I understand, is that right?”

Dr. Roseann Maikis:  “Yes, the University of Virginia for residency.”

Dr. James Daniell:  “That’s an excellent program and from my experience, I think, that’s one of the programs that has a better experience in laparoscopy.  Then in your rotation, how did you become aware that there was the opportunity to do extra training even beyond a residency for training in endoscopy?”

Dr. Roseann Maikis:  “One of my professors is a reproductive endocrinologist and he has a special interest in laparoscopy as well.  Since I was interested, I asked him how to pursue extra training and he put me in touch with one of the directors of the preceptorships, and from there I got information about all of the fellowships.” 

Dr. James Daniell:  “So it was word of mouth.”

Dr. Roseann Maikis:  “Yes, it was word of mouth.”

Dr. James Daniell:  “Now hopefully this conversation we’re having will become available on the website on OBGYN.net, and I think it’s particularly going to be featured in the new part of the OBGYN.net website which is going to be focused towards residents.  So we want to let you talk to the people who are currently obstetric and gynecologic residents.  Tell them the reasons in your mind why you felt you needed to spend an extra year in your life to go and get advanced training.  What made you do that?  It’s a big commitment to do something like that.”

Dr. Roseann Maikis:  “It is a big commitment, it’s obviously an extra year of training and an extra year of putting off sort of the rest of your life which you know is certainly a concern.  However, I think in residency you sort of get an introduction to laparoscopy.  You sample the different types of surgeries that are available, and maybe you get a little bit of training and become proficient in a sense in some of the techniques but really don’t ever master laparoscopy.  With the growing trend toward minimally invasive surgery these days, in practice it’s very important to have adequate training in these modalities both for yourself as well as for patients.  The better you are at these sorts of things, obviously, the better you’ll take care of patients.  There’s also the issue of safety, which I think is very important.  We are taught practically in residency how to do laparoscopy but very few people ever actually sit down and say these are the safe things and these are the non-safe things in terms of entry techniques, in terms of electricity and modalities to actually use in laparoscopy, and so I think fellowship gives a lot more in depth training on all of these aspects.”

Dr. James Daniell:  “It will make you more competent, and it will make you have a better sense of when to hold them and when to fold them I guess.”

Dr. Roseann Maikis:  “That’s exactly right.”

Dr. James Daniel:  “You’ll probably in your fellowship see more volumes.  Now you’re almost halfway through with the one-year fellowship, can you tell us sort of what your schedule is, like a weekly schedule?  What you do in the fellowship?”

Dr. Roseann Maikis:  “We usually operate everyday; we operate every morning and then we see patients in the afternoon so it averages out to be probably between 1-3 cases per day which is between 5-15 cases a week.  At this point in the fellowship, I’ve actually done more than 100 laparoscopy and hysteroscopy cases which is a very large volume concentrated in a small amount of time which is very good for training.”

Dr. James Daniell:  “I think that’s a lot of cases and I understand you’ve even told me that your contemporaries that you’ve been talking to are somewhat jealous of you because they’re sitting around the office treating yeast infections and looking for surgery to do.”

Dr. Roseann Maikis:  “That’s correct.”

Dr. James Daniell:  “And they are doing less laparoscopic operative surgery.  So to this point, you’ve been happy with your decision?”

Dr. Roseann Maikis:  “Most definitely.”

Dr. James Daniell:  “And you think it’s a decision that you’re happy you made?”

Dr. Roseann Maikis:  “Most definitely.”

Dr. James Daniell:  “I guess we could say that you are lucky that you were able to become aware of the fellowship.  I think now it will become a lot easier for those of you out there who are in training in obstetrics and gynecology or even medical students who are looking ahead even further.  Thanks to OBGYN.net it’s now possible to go to the web and learn about these new fellowships.  The AAGL is developing a new website – aagl.net, and very soon at that website there will be information posted about this new fellowship and about the process for application.  It’s been sort of informal in the past with the SRS. What did your application consist of?  What happened with you when you decided you wanted to inquire?  Did you fill out some paperwork or take a test?”

Dr. Roseann Maikis:  “I filled out some paperwork, I didn’t take a test.  There was a standard application even though the sites themselves are very disjointed, the application is central and standardized in the Society for Reproductive Surgeons, and I actually sent it to the central site and also to the preceptor who I was interested in.”

Dr. James Daniell:  “So basically it was just an individual agreement between the two of you.”

Dr. Roseann Maikis:  “There was no match, and there was no formal process.”

Dr. James Daniell:  “In the future, not this year but certainly beginning for the academic year of 2002, there will be a match program for this fellowship and that will make it very familiar for all of you who matched for your residencies.  It’s the same process but a smaller scale thing but already there have been at least seventy inquiries by current active obstetric and gynecologic residents about this new fellowship.  There’s a lot of support by industry, and there’ll be opportunities to do research in the new joint AAGL/SRS fellowship, opportunities to work closely with the various manufacturers of endoscopic equipment, and I think it will be a very good career enhancing move for young gynecologists who are interested in getting better training, more experience, and who want to make operative endoscopy a major focus of their practice.  I do believe that minimally invasive surgery is the way of the future and to do it safely and to do it comfortably where you feel that you’re working within your skill level and that you have the skill level to do more difficult things is very important.  I congratulate you Dr. Maikis on making this career choice.  I think ten years from now you’ll look back and think even though you delayed maybe your private practice opportunities for a year that you, hopefully, will find it was a worthwhile experience.  I’m sure that Dr. Maikis will be happy to correspond with any people who want to correspond with her.  I might ask you that - do you want to give out your e-mail address in case any residents want to contact you?  What is your e-mail address?”

Dr. Roseann Maikis:  “Sure, it’s r.maikis@nashville.com - very easy to remember.”

Dr. James Daniell:  “There you go, for those of you who want to have a dialogue with Dr. Maikis about her experiences, she’s in the trenches right now doing a lot of gyn endoscopic cases, and that might be something that you want to learn more about.  I want to thank OBGYN.net for giving me the opportunity to talk with you this morning, Dr. Maikis, and I congratulate you on your career choice.”

Dr. Roseann Maikis:  “Thank you.”

Dr. James Daniell:  “I hope you’re successful on your career choice and you don’t have any severe complications during your fellowship training and go on to become one of the leaders in gynecologic endoscopic surgery in America.  Thank you.”