Minimally Invasive Gynecologic Surgery (MIGS) Fellowship

What MIGS Fellowship Actually Is

Minimally invasive gynecologic surgery fellowship is a one-year post-residency training program accredited by the American Association of Gynecologic Laparoscopists (AAGL). It is built around advanced operative laparoscopy, robotic-assisted gynecologic surgery, operative hysteroscopy, and the full anatomical complexity of benign pelvic disease. Programs vary in emphasis—some lean heavily toward endometriosis excision and complex adhesiolysis, others toward robotics and uterine-sparing myomectomy—but all share the structural goal of producing surgeons who can manage what a generalist cannot.

Three clarifications matter before you go further:

• MIGS is not urogynecology. Female pelvic medicine and reconstructive surgery (FPMRS) is a separate ABOG/AUGS-accredited subspecialty focused on pelvic floor dysfunction, prolapse, and incontinence. The patient populations and skill sets overlap minimally.
• MIGS is not gynecologic oncology. Gyn-onc is a four-year fellowship with chemotherapy training and a fundamentally different disease burden. MIGS surgeons occasionally assist on oncologic staging but do not manage malignancy independently.
• MIGS is not simply "doing everything laparoscopically." The fellowship trains surgeons to handle pathology—stage IV endometriosis obliterating the posterior cul-de-sac, a 14-centimeter fibroid uterus, a didelphic uterus with obstructed hemivagina—that most board-eligible gynecologists appropriately refer. The training is about expanding the ceiling of what is technically possible through a minimally invasive approach, not merely replacing open cases with ports.

Fellowship programs are listed and match-administered through AAGL's fellowship management system. See the current season timeline on our data pages for application window specifics.

The Defining Cognitive Profile of a MIGS Surgeon

Operating in a two-dimensional visual field to manipulate three-dimensional anatomy through fixed-port fulcrum points is a specific cognitive task. Not every technically competent surgeon finds it intuitive, and intuition here is not innate—it is built through deliberate repetition—but the people who build it fastest share a recognizable mental profile.

Spatial reasoning under constraint. MIGS surgeons think in planes. When they encounter a frozen posterior cul-de-sac, they are mentally mapping the course of the ureter through a field distorted by fibrosis before the first instrument enters. This is not intuition; it is trained spatial modeling. Residents who naturally sketch anatomical relationships when reviewing cases, who find themselves mentally "flying through" the pelvis on cross-sectional imaging, and who can identify instrument orientation from a laparoscopic still without rotating the image tend to build this skill efficiently.

Procedural problem-solving over diagnostic puzzle-solving. Internal medicine draws people who enjoy working backward from ambiguous data to a diagnosis. MIGS draws people who have already tolerated diagnostic ambiguity in clinic and now want to fix the problem with their hands. The intellectual pleasure is in the execution—the sequence of steps, the tissue plane developed cleanly, the uterus removed intact through a port. This is not a lesser form of thinking; it is a different one. Residents who find clinic satisfying but who experience OR time as distinctly more energizing are pointing toward this profile.

Deliberate technical perfectionism. MIGS surgeons review their own video. They watch back a cystotomy repair and identify what they would do differently. They read operative technique papers—not because a board exam requires it, but because the question of whether a barbed suture closure is equivalent to interrupted suture for a laparoscopic myomectomy actually interests them. This is not compulsiveness; it is applied craftsmanship. The surgeon who finishes a case and immediately wants to know how to make the next one better is a better fit than the surgeon who finishes and wants to move on.

Comfort with complexity-without-certainty. Endometriosis surgery in particular involves intraoperative decision-making with incomplete preoperative mapping. Imaging understates disease burden reliably. The surgeon who is dysregulated by the gap between the preoperative plan and intraoperative findings will find this work exhausting. The surgeon who treats that gap as the interesting part of the job is describing a MIGS career.

Core Personality Traits That Predict Fit

These are behavioral clusters, not personality types. Use them as self-assessment prompts, not a checklist to perform for fellowship programs.

1. High frustration tolerance for technical difficulty. Laparoscopic suturing is hard. Robotic knot-tying has a learning curve. Dense adhesiolysis near the bowel is slow, tedious, and high-stakes. Residents who respond to technical difficulty with increased focus and curiosity—rather than avoidance, anxiety, or performance threat—are describing fit. Self-assessment: When a case goes harder than expected, do you feel more engaged or more drained?

2. Intrinsic drive toward iterative skill-building. MIGS competence is built by doing the same procedure many times, modifying technique, and tracking the difference. This is not exciting in the way a novel clinical puzzle is exciting; it is satisfying in the way a craft improves with practice. Residents who use sim labs between cases, who ask to repeat procedures rather than move to new ones, and who find the fifth myomectomy more interesting than the first because now they can feel the improvements are describing this trait. Self-assessment: Do you prefer variety across cases or depth within a technical skill set?

3. Teaching instinct. MIGS fellows are expected to teach residents. Academic MIGS attendings spend meaningful OR time handing controls back. The surgeon who cannot tolerate a resident's slower, less elegant execution—who takes back the case at the first sign of inefficiency—will be a poor educator and a poor fit for academic MIGS positions. Self-assessment: When you supervise a junior trainee in the OR, do you experience their fumbling as an obstacle or as the job?

4. Research curiosity oriented toward outcomes and technique. MIGS research is heavily quantitative outcomes-based: complication rates, conversion rates, patient-reported outcomes, operative time. It also encompasses simulation validation, device evaluation, and surgical education research. Residents who are drawn to clinical questions—does this approach improve this outcome?—rather than basic science are better positioned. Self-assessment: Can you identify a MIGS question that genuinely bothers you, that you want answered?

5. Comfort with a longitudinal relationship to benign disease. MIGS patients often have chronic conditions—endometriosis, fibroids, adenomyosis—that require management before, during, and after surgery. The surgeon who wants to operate and never see the patient again will find the clinic component unsatisfying. The surgeon who enjoys being the person the patient returns to when symptoms recur or recurrence is suspected has a better match. Self-assessment: Does long-term involvement with the same patient's chronic condition feel like continuity or like repetition?

6. Tolerance for anatomical unpredictability. MIGS anatomy is not textbook anatomy. Endometriosis obliterates planes. Fibroids distort landmarks. Prior surgery creates adhesions that move everything. Surgeons who require clean anatomy to operate confidently will struggle. Those who treat distorted anatomy as a navigation problem rather than a threat are describing fit. Self-assessment: When imaging suggests unusual anatomy, is your first response curiosity or dread?

7. Preference for defined operative episodes over open-ended management. Unlike chronic disease management in internal medicine, most MIGS problems have an operative solution that can be executed in a defined time window. The postoperative recovery is finite. The satisfaction structure is episodic—patient comes in with a problem, you fix it surgically, they recover. This appeals to people who want their effort to produce visible, bounded results. Self-assessment: Do you find the "before and after" structure of surgical care satisfying or incomplete?

8. Intellectual engagement with instrumentation and technology. MIGS has more direct engagement with surgical technology than most fields—robotic platforms, energy devices, single-port systems, hysteroscopic tools. Surgeons who are curious about how tools work, who read device literature, who ask manufacturer representatives technical questions rather than ignoring them, tend to contribute more to a MIGS team and enjoy the work more. Self-assessment: Do new surgical devices interest you technically, or do you treat them as indifferent upgrades?

What Your Day Actually Looks Like

A practicing MIGS attending in an academic center typically structures the week around two to three OR half-days, one to two clinic half-days, and variable administrative and teaching time. The operative block is the organizing unit of the day.

OR day, morning block. A three-case laparoscopic morning might include a complex hysterectomy for adenomyosis with obliterated posterior cul-de-sac, a robotic myomectomy for a large intramural fibroid, and a hysteroscopic polypectomy with Essure removal. Each case requires a different instrument setup, a different assistant brief, and a different cognitive approach. The attending arrives ahead of the first patient to review imaging, check equipment, and brief the resident or fellow who will assist. Operating room efficiency—patient positioning, trocar placement, teaching moments without losing efficiency—is a technical and interpersonal skill that develops over years of attending practice.

Clinic. MIGS clinic is largely benign gynecology with a surgical focus. Patients present with abnormal uterine bleeding, pelvic pain, ultrasound-detected fibroids, suspected endometriosis, or postoperative follow-up. A substantial proportion will have been referred from generalist gynecologists specifically because their anatomy or disease complexity exceeds what is manageable in a standard practice. Counseling is detailed: explaining the difference between UAE, endometrial ablation, myomectomy, and hysterectomy to a patient with symptomatic fibroids who wants to preserve fertility requires time and precision. Clinic is not administrative filler; it is where the surgical problem is defined and the patient relationship is built.

Consults. Inpatient MIGS consults come from emergency gynecology—ectopic pregnancy, ovarian torsion, hemorrhagic corpus luteum—and from surgical colleagues who have encountered pelvic pathology. MIGS surgeons at centers with strong programs may be called for intraoperative bowel injury in a complex laparoscopic case, or to assist general surgery with pelvic adhesions in an abdominal procedure.

Operative density versus general practice. A generalist OB/GYN in a community setting may perform a variable mix of obstetrics and gynecologic surgery, with operative volume dependent on call structure, panel size, and practice composition. A MIGS subspecialist operates more frequently, on more complex cases, and without the obstetric call obligation that fragments surgical continuity in general practice. This is one of the practical attractions: if operating is what you want to do, MIGS concentrates it.

Lifestyle, Hours, and Work-Life Calculus

MIGS is not a lifestyle subspecialty in the way dermatology or ophthalmology are understood to be. It is a surgical subspecialty with a more favorable call structure than general OB/GYN, but it is not surgery-lite.

Call structure. Most MIGS attendings carry call for urgent and emergent gynecologic cases—ectopic pregnancy, torsion, hemorrhage, postoperative complications. This is different from full obstetric call, which adds laboring patients, deliveries, and the temporal unpredictability of an obstetric service. The decision to pursue MIGS rather than general OB/GYN is in part a decision to concentrate call on gynecologic emergencies and accept the loss of obstetric continuity. Weekend OR urgencies for ectopic or torsion are real; they are also finite and episodic in a way that obstetric call is not.

Academic versus private practice. Academic MIGS positions involve more teaching, more research expectation, more committee obligation, and often more complex operative referrals. Compensation structure differs from private practice; see our compensation data pages for current figures. Private practice MIGS positions—particularly in large GYN-focused groups or with hospital employment—may offer higher operative volume with less administrative overhead, but also less protected research time and variable fellow training involvement. Neither is uniformly better; they represent different structures for the same clinical work.

Geographic flexibility. MIGS fellowship training concentrates at academic centers, but the skill set is deployable in most markets large enough to sustain a referral base. Smaller markets may not generate sufficient case volume to maintain advanced MIGS competency. Surgeons who need geographic flexibility—following a partner, returning to a home region—should research whether their target market can support a MIGS-focused practice before committing to the subspecialty path.

The honest calculus. If your primary reason for choosing OB/GYN was the obstetric relationship—laboring patients, deliveries, the long-term maternal care arc—MIGS progressively removes that from your working life. If your primary reason was complex benign pelvic surgery performed well, MIGS concentrates it. These are not compatible motivations over a career horizon, and it is worth being explicit about which one drives you before fellowship application.

The Kinds of Problems MIGS Surgeons Solve

Before committing to the training pathway, you should be able to answer honestly: do these disease processes genuinely interest me? Not "do I respect the patients who have them" or "do I understand their importance"—but does this pathology engage my clinical curiosity?

Endometriosis. The dominant disease of MIGS practice. Chronic, under-diagnosed, incompletely understood, and surgically challenging. Endometriosis implants can involve ovaries, peritoneum, uterosacral ligaments, bowel serosa, bladder, ureter, and diaphragm. Surgical excision—not simply fulguration—of all visible disease is the technical standard that MIGS training is designed to achieve. The surgeon who finds endometriosis surgery intellectually satisfying is operating at the frontier of what imaging cannot fully characterize and what guideline consensus cannot fully resolve. The surgeon who finds it tedious will find the most common MIGS case to be the most miserable part of the job.

Uterine fibroids. Leiomyomata represent the most common benign uterine tumor. Their surgical management—myomectomy versus hysterectomy, laparoscopic versus robotic versus hysteroscopic versus open, morcellation decisions in the post-FDA-guidance era—involves real complexity in counseling and technique. Uterine-sparing surgery for patients who want to preserve fertility or avoid hysterectomy is a high-stakes technical exercise, and the outcomes data on recurrence and subsequent fertility are imperfect enough to make counseling genuinely challenging.

Adenomyosis. Diffuse or focal, adenomyosis presents diagnostic and surgical challenges that remain incompletely solved. Surgical management ranges from conservative resection to hysterectomy, and the field lacks consensus on optimal approach for fertility-preserving cases. This is a disease space where MIGS surgeons contribute meaningfully to outcomes research.

Müllerian anomalies. Congenital uterine anomalies—septate uterus, unicornuate uterus, uterine didelphys, vaginal septa—require hysteroscopic, laparoscopic, or combined surgical correction in selected patients. The anatomy is unusual, the operative planning requires careful imaging interpretation, and the stakes are high in the context of reproductive outcomes. This is lower-volume work but high-skill-demand work.

Chronic pelvic pain and abnormal uterine bleeding. Both are presentations, not diagnoses. The MIGS surgeon's role is to identify surgically addressable pathology—endometriosis, polyps, submucosal fibroids, interstitial fibroids—and to be honest with patients when the pain or bleeding is not surgically curable. This requires comfort with uncertainty and skill in managing patient expectations when surgery is not the answer, which is not a trivial part of the job.

Green Flags: Signs MIGS Is a Strong Match

These are behavioral signals, not abstract preferences. They are observable patterns—in yourself and reported by your attendings—that suggest MIGS alignment.

• You stay after your cases end to watch additional OR cases, particularly complex laparoscopic ones, without being asked and without logging the time.
• You have read operative technique papers—not review articles, not Up to Date, but step-by-step surgical technique descriptions—because you wanted to understand how a specific problem is approached, not because a case was coming up.
• You review your own operative video. You can identify what you would do differently. You do not find this process punishing; you find it useful.
• You have sought out the sim lab or box trainer on your own time. You have practiced suturing, knot-tying, or instrument handling outside of scheduled sessions.
• When you encounter a complex pelvic anatomy on imaging or in the OR, your dominant response is curiosity about what you are seeing and how you would approach it, not anxiety about what could go wrong.
• You have had a conversation with a MIGS attending that went beyond your required rotation—you asked to meet with them specifically to discuss fellowship, technique, or research.
• You find the clinic component of MIGS—the surgical counseling, the imaging review, the preoperative planning—as interesting as the OR, not merely obligatory.
• You have a research question in MIGS that you can articulate without prompting. Not a vague interest in "surgical outcomes" but a specific question—a comparison, a gap in the literature, an outcome that is not being measured.
• When colleagues describe MIGS work as repetitive or narrow, you disagree with that characterization from your own experience, not defensively, but because it does not match what you have seen.
• You have asked a MIGS attending to critique your technique. You applied the feedback. You asked again.

Honest Mismatches

These are not disqualifications from OB/GYN. They are signals that MIGS may not be the right subspecialty direction, and identifying them early saves you a fellowship year and a career in the wrong room.

Obstetrics is your primary clinical passion. If the best days of your residency are on labor and delivery—if you find the management of a complex labor, a shoulder dystocia, a peripartum hemorrhage to be more engaging than anything you do in the OR—MIGS will progressively remove the work you find most satisfying. Maternal-fetal medicine is the subspecialty that concentrates and deepens that clinical engagement.

You want high-continuity longitudinal care as the center of your practice. MIGS provides some longitudinal care, particularly for chronic conditions like endometriosis. But the organizing unit of practice is the operative episode, not the ongoing relationship. If what you most want is to be someone's primary care gynecologist across decades—managing their contraception, menopause, STI screening, and general health—MIGS subspecialization moves you away from that model, not toward it.

Technical repetition feels like stagnation, not improvement. If you find yourself disengaged by the fifth myomectomy because you have already done it, MIGS practice will produce this feeling regularly. The subspecialty is built on procedural refinement over decades. Surgeons who need novelty at the case level rather than at the technique level will find the work increasingly unstimulating.

Uncertainty in operative findings is genuinely distressing to you. Endometriosis surgery in particular requires intraoperative decision-making with incomplete information. If the gap between preoperative imaging and intraoperative findings reliably produces dysregulation—anxiety, avoidance, performance degradation—this is worth taking seriously before choosing a subspecialty where that gap is the norm.

Your interest in MIGS is primarily about avoiding obstetric call. This is a common, understandable motivation and it is insufficient on its own. Avoiding something is not a foundation for a subspecialty career. If the primary driver is call reduction rather than genuine engagement with the operative and clinical work, the fellowship year and the practice that follows will feel thin. FPMRS and academic general gynecology also reduce obstetric call burden through different routes; those paths are worth examining if call structure is the primary variable.

How MIGS Compares to Adjacent Paths

Four dimensions matter most for this comparison: operative complexity ceiling, research expectation, patient population, and training length. The table below uses general characterizations based on typical program structure; individual programs vary.

• MIGS vs. Urogynecology (FPMRS)
  FPMRS is a three-year ABOG/AUGS-accredited fellowship. The operative focus is pelvic floor reconstruction—prolapse repair, anti-incontinence procedures, fistula repair—rather than endometriosis, fibroids, or uterine pathology. Patient population skews older and includes more complex reconstructive anatomy. Research expectation is high at competitive programs; FPMRS has a mature clinical trials culture. MIGS is one year; FPMRS is three, with a different certification pathway. If the pelvic floor and reconstruction domain engages you more than benign uterine and peritoneal disease, FPMRS is the more coherent path. If your operative interest is in excisional surgery for endometriosis and uterine pathology, MIGS is more directly relevant.
• MIGS vs. Gynecologic Oncology
  Gyn-onc is a four-year fellowship with chemotherapy training, inpatient oncology management, and surgical staging. The operative complexity ceiling is high—radical hysterectomy, lymphadenectomy, cytoreductive surgery—but the disease burden is malignant, which changes the nature of patient relationships and the emotional register of the work substantially. Research expectation is high; gyn-onc has strong representation in the clinical trials literature. The training commitment is longer and the scope of practice is broader. If cancer surgery and oncologic management engage you, gyn-onc is not adjacent to MIGS—it is a different field. If your interest is benign pelvic pathology and you are drawn to gyn-onc primarily for the operative complexity, it is worth examining whether MIGS provides the surgical challenge you are actually seeking without the four-year training investment and oncologic scope.
• MIGS vs. Generalist OB/GYN
  A generalist gynecologist in a practice that has minimized or eliminated obstetrics can build a high-volume laparoscopic practice without fellowship training. The ceiling of operative complexity is lower—complex endometriosis, large myomectomy, and significant adhesive disease appropriately refer to subspecialists—but the breadth of practice is wider and the training commitment is residency only. Fellowship is not required to perform excellent gynecologic surgery; it is required to perform the highest-complexity cases at a technically defensible standard. The decision is partly about ceiling and partly about identity: do you want to be the person cases are referred to, or do you want to manage most gynecologic surgery yourself and refer selectively?

Building Your Candidacy During Residency

Fellowship applications are evaluated on operative skill, scholarly activity, letters of recommendation, and demonstrated commitment to the field. All four are built during residency, and the timeline matters.

Intern and second year. Orientation phase. Your primary task is building basic laparoscopic competency and identifying which MIGS attendings at your program are potential mentors. Introduce yourself to the MIGS service, be present beyond requirement, and let your interest be visible through behavior rather than through stated aspiration. Join AAGL as a student or trainee member; the annual congress is accessible and exposes you to the research and technical culture of the field early.

Second and third year. Research engagement. Identify a scholarly project with a MIGS mentor. Outcomes research, retrospective case series, simulation studies, and quality improvement projects are all appropriate. The goal is a submitted or published paper before fellowship applications open, or at minimum a project in late-stage preparation that you can discuss specifically and authoritatively. Programs evaluating your application will read your abstracts and papers; they will also ask you about them in interviews. If you cannot explain your methodology and findings clearly, the paper is less valuable than no paper.

Third and fourth year. Operative visibility. Request MIGS cases directly. Ask to be called for complex laparoscopic cases when you are available, even outside your scheduled rotation. Ask your mentors to evaluate your technique formally—not just casually, but in writing, using a structured assessment framework. This documentation matters for letters of recommendation. Your case log should reflect intentional accumulation of laparoscopic and hysteroscopic cases; passive accumulation of whatever your rotation provides is insufficient at competitive programs.

Letter of recommendation strategy. MIGS fellowship programs want letters from MIGS-trained surgeons who have operated with you repeatedly and can speak to your technical trajectory, not just your character. A strong letter describes specific cases, specific technical skills, specific improvements observed over time. One letter from a MIGS subspecialist who knows your hands is worth more than three letters from program directors who know your attendance record. Cultivate those operative relationships early enough that the writer has real material.

AAGL involvement. Presenting at the AAGL annual congress as a resident—abstract, video, poster—is visible to fellowship program directors who attend. It also demonstrates initiative that a letter of recommendation can specifically corroborate.

Research, Innovation, and Academic Expectations

MIGS has a relatively young evidence base compared to fields like gyn-onc or FPMRS. This is a feature, not a deficiency: the research questions are open, the methodology is accessible to a fellow with good mentorship, and meaningful contributions to the literature are achievable in a one-year fellowship.

The dominant research paradigms in MIGS are:

• Clinical outcomes research: Comparing approaches to myomectomy, hysterectomy, or endometriosis excision on perioperative outcomes, fertility outcomes, and patient-reported quality of life. Retrospective database studies are common; prospective trials exist but are challenging to power for rare outcomes.
• Simulation and surgical education research: Validating simulation platforms for laparoscopic skill assessment, measuring learning curves for robotic surgery, evaluating structured training curricula. This domain is accessible to fellows with limited prior research infrastructure and aligns naturally with MIGS's teaching culture.
• Device and technology evaluation: Energy device comparisons, robotic platform performance studies, hysteroscopic instrument evaluation. Often industry-adjacent; methodological rigor varies and fellows should be aware of conflict-of-interest considerations.
• Quality improvement: Reducing complications, improving patient selection, standardizing consent processes for high-complexity procedures. QI work is valued at academic programs and is achievable in a fellowship year.

Competitive programs expect applicants to arrive with a prior scholarly record—not necessarily extensive, but present and defensible. A single well-conducted retrospective study with clear methodology and honest limitations is worth more than a list of co-authorships on papers you cannot explain. Programs that weight research heavily will ask you about it in the interview; be prepared to discuss your specific contribution, what you would do differently, and what question you want to answer next.

The Application and Match Landscape

MIGS fellowship operates through the AAGL fellowship match. The match timeline, program list, and application materials are administered through AAGL's fellowship management platform. See the current season timeline on our data pages for specific window dates.

The number of accredited MIGS fellowship programs is substantially smaller than the number of residency programs; the match is concentrated and competitive. Most programs accept one or two fellows per year, which means the total match capacity nationally is limited. This has structural implications: a strong candidate with one weak component—a thin research record, a single MIGS letter instead of two—is more exposed than in a larger match.

What programs evaluate. Based on the structure of the match and feedback reported in the literature and AAGL publications, programs consistently weight: operative skill as assessed by letter writers who have personally supervised the applicant; scholarly activity as evidenced by publications, presentations, and the applicant's ability to discuss their work; genuine engagement with the field beyond required rotations; and interpersonal fit as assessed through the interview. Programs differ in how heavily they weight research versus clinical skills, and visiting rotations—if offered and accessible—provide both visibility and a direct assessment of fit.

Letter of intent. Most MIGS fellowship programs request a personal statement or letter of intent that should accomplish specific things: articulate why MIGS specifically rather than adjacent paths, describe the scholarly project or contribution you bring, and convey a credible long-term vision for how fellowship training connects to your intended practice. Generic statements that could apply to any surgical subspecialty are distinguishable from specific, grounded ones. The program reading your letter has seen hundreds; specificity and honesty about your actual clinical experiences read differently than curated language that hits expected themes.

Interview structure. Most programs conduct in-person or virtual interviews that include conversation with current fellows, faculty interviewers, and program leadership. The purpose is bilateral: they are assessing fit, and you are assessing whether the program's operative mix, research culture, and mentorship structure match what you need. Come with real questions—about case volume, about the operative complexity of cases fellows manage independently versus with direct supervision, about what former fellows are doing now.

Your Self-Assessment Checklist and Next Step

Use this checklist honestly, not as a performance. A "no" is information, not a verdict.

• ☐ When I review my best clinical days in residency, OR time is more energizing than clinic, rounds, or obstetrics.
• ☐ I have sought out MIGS cases beyond what my rotation required—stayed late, asked to be called, shown up for complex laparoscopy outside my schedule.
• ☐ I find endometriosis, fibroids, and complex pelvic anatomy genuinely interesting as clinical problems, not merely as conditions I know how to manage.
• ☐ I have reviewed my own operative video, or I have asked an attending to review it with me and give specific feedback.
• ☐ I can articulate a research question in MIGS that I want answered, and I can explain why it matters.
• ☐ I have a MIGS-trained surgeon at my program who knows my work in the OR well enough to write a specific, technically substantive letter.
• ☐ I have considered urogynecology and gyn-onc specifically and can explain why MIGS fits my interests better—not just why I prefer it, but what about the clinical scope and operative work drives the choice.
• ☐ I have joined AAGL as a trainee member, or I have a concrete plan to do so this month.
• ☐ The prospect of practicing without an obstetric component—permanently, not just during fellowship—does not feel like a loss of something important to me.
• ☐ I can describe specific cases I have done or observed that confirmed my interest in MIGS, beyond "I liked the laparoscopic hysterectomy" level of specificity.

If you marked eight or more: your self-report is consistent with MIGS fit. The next concrete step is to email a MIGS attending at your program this week—not to announce your interest, but to ask a specific question about their practice, their research, or a case you observed. That conversation starts a relationship that a letter of recommendation requires.

If you marked five to seven: there is genuine interest here but also uncertainty worth examining. The uncertainty may be informational—you have not had enough MIGS exposure to have strong signal—or it may be motivational. Seeking additional MIGS operative experience and a direct conversation with a MIGS fellow about what fellowship year looks like will sharpen the picture before you commit to the pathway.

If you marked fewer than five: read through the mismatches section again without defensiveness. Another OB/GYN path may fit better, and identifying that earlier rather than later is the most useful thing this page can do for you.

Adjacent pages on this site: Urogynecology Fellowship Fit, Gynecologic Oncology Fellowship Fit, OB/GYN Residency Craft, and the Fellowship Match Timeline data page.