Feature Researcher: Dr. Geoffrey W. Cundiff

Geoffrey W. Cundiff, M.D., F.A.C.O.G., F.A.C.S, F.R.C.S.C

 I am the Dr. Victor Gomel Professor and Head of the Department of Obstetrics and Gynaecology at the University of British Columbia. A native of Texas, I received my medical degree from the University of Texas Southwestern Medical Center and completed a residency in Obstetrics and Gynaecology at Parkland Hospital in Dallas, Texas.   My main interest was in gynaecologic surgery so I pursued fellowships in Urogynecology and Endoscopy at Greater Baltimore Medical Center, and Reconstructive Pelvic Surgery at Duke University Medical Center.  After my training, I joined the faculty at Duke University, where I developed a training program for endoscopic surgery, doing some of the initial research in endoscopic surgical education.  I then joined the faculty of the Johns Hopkins Medical Institutes, where I had several administrative roles, including, Chair of the Department of Obstetrics and Gynecology at Johns Hopkins Bayview Medical Center, and Deputy Director of the Department of Gynecology and Obstetrics for Johns Hopkins Medical Institutes. I then moved to Vancouver and joined the Faculty of Medicine at UBC in 2006.

I have broad-based research interests ranging from the epidemiology of pelvic floor disorders, to anatomy, to education, to the prevention of maternal obstetrical trauma.  I have published more than 140 peer reviewed publications and 6 books, and I think I am best known for outcomes research for pelvic floor disorders including, surgical and non-surgical treatments, which has led to multiple multi-centered randomized trials. I have advocated patient-based outcomes measures and worked to develop and validate such measures.  Presently I work as a research scientist at the Centre for Health Evaluation Outcomes Sciences and the Women’s Health Research Institute.

My clinical practice, based at the Centre for Pelvic Floor Competence, is dedicated to the diagnosis and treatment of pelvic floor disorders. This offers an excellent educational environment, and what  I enjoy the most is teaching, especially in the operating theatre and I have been very fortunate to receive multiple teaching awards. Currently my present educational initiatives are the development of a competency-based curriculum for resident education and a program for practicing surgeons to expand their surgical skills.

What is your day job?

I am lucky to be able to participate in a wide variety of activities related to academic medicine. My clinical practice is focused on Female Pelvic Medicine and Reconstructive Surgery (FPMRS), and most of my patients are referred for tertiary care. Half of my clinical time is dedicated to surgery, which facilitates one of my favourite activities, surgical education of postgraduate learners. Research is another primary focus and this also offers the opportunity to mentor new investigators. The remainder of my time is dedicated to administration. This includes serving as the Head of the UBC Department of Obstetrics and Gynaecology, an academic appointment, and in operational roles including the Head of the Regional Department of Obstetrics and Gynaecology and the Physician Lead for the Maternal Child Program for Vancouver Coastal Health.

What is your primary research focus?

While my early mentors urged me to focus my research interests, I have always found that difficult. My research career began in the early 1990’s and at that point was focused on my area of clinical expertise, FPMRS. I was part of a multidisciplinary research team at Duke University Medical System that produced some of the initial research in FPMRS. I subsequently moved to Johns Hopkins University, where I established a new multi-disciplinary pelvic floor center. I was the clinical lead on the NOBLE project a national study that defined the epidemiology of Overactive Bladder and continued this epidemiological work as a member of the Boston Area Community Survey that investigated the epidemiology of bladder pain and interstitial cystitis. But my research interests were broader then epidemiology and I initiated a number of multi-centered research programs that included an RCT to define best practice in pessary use, and a surgical RCT to compare different surgical approaches to rectocele repair.

This success in outcomes research allowed me to become an investigators on two NIH sponsored networks, the Urinary Incontinence Treatment Network (UITN), and the first Pelvic Floor Disorders Network (PFDN).  As a member of the PFDN, I was an investigator in the CARE trial, which published more than a dozen publications to define and optimize the use of sacral colpopexy.  I also participated in the Childbirth and Pelvic Symptoms Study (CAPS), which explored the burden of pelvic floor injury after childbirth.  In fact, maternal and neonatal birth trauma, and methods to optimize labour to minimize them have been another major focus of my research program. Recently, this area of my research has focused on the development of quality indicators and patient-centered outcomes for childbirth. I have also maintained in interest in surgical education including surgical anatomy.

What drew you to the subject?

For all of my research endeavours, the absence of evidence to define best practice is what drew me as an investigator. FPMRS is a new sub-specialty and there are many gaps in the knowledge of how best to diagnose and treat women who suffer from pelvic floor issues. The epidemiological evidence tying pelvic floor disorders to birth trauma begs for data on how to prevent these injuries. And similarly, my desire to optimally teach learners is the driving force behind my interest in surgical education.

Patient centered outcomes are a recurring theme in research.  My early studies on surgery for pelvic organ prolapse countered the established norm of defining success by anatomical measurements, by adding the relief of patient’s symptoms as the primary outcome measure.  However, the absence of objective quality of life measures challenged the scientific value of this approach. This sparked a research program in developing and validating standardized quality of life instruments and translating them into other languages for multi-centered studies.

What do you find are the biggest challenges in pursuing research while being a clinician?

Without any doubt, the biggest challenge is finding time for research.  Patient care always comes first, and administrative demands are notoriously impatient. But the research questions that arise form both of these pursuits demand answers as well, so the trick is to reserve time to address them. It is a fact of being a researcher that it cannot provide the same remuneration as clinical and administrative endeavours.  Instead, the compensation comes in satisfaction from using scientific methods to answer important questions.

What are the greatest supports for your research?

My colleagues are the greatest support for my research.  This includes faculty and learners both in our department and at other institutions across the globe. These collaborators bring their energy, and complimentary expertise that dramatically expand my scholarly reach.

What are your future plans and goals? What would you like your research to achieve?

New surgical innovations for pelvic floor disorders tend to focus on efficacy with less emphasis on risks and complications. I am dedicated to pursuing a more balanced approach that balances the benefits of efficacy with the risk of complications.  This will not only provide more balanced assessment of new technologies but also help to define the subpopulations that will benefit from them.

Within my obstetrical research program, I want to continue work on developing patient centered outcomes for labour and defining and validating performance indicators for labour that optimize maternal and fetal outcomes.

When you aren’t busy being a clinician and a researcher – what do you do?

There is still a lot of British Columbia for me to see and experience. I am most driven by the remote spots that are accessible by kayak, sailboat, bike or skis.