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Michael Heit Professor

  • Department of Gynecology & Obstetrics
    Associate Professor
  • Emory Saint Joseph's Hospital
    Women's Center, 7th floor, Suite 700
    5673 Peachtree Dunwoody Road
Head shot of Michael Heit

Overview

My mother taught kindergarten and first grade in Spanish Harlem for over thirty years and instilled a love for learning in me from an early age. Teaching is in my blood, and it remains a passion of mine as I awaken to begin each new day at the office or the operating room. While in college I began my career as an educator when my Botany teacher inspired my desire to become a teaching assistant for her pupils at the State University of New York at Binghamton. I found joy in teaching medical students and junior residents surgical techniques in the operating room while serving as administrative chief resident during my Obstetrics and Gynecology residency training program at Washington University Medical Center. These desires carried through to my Urogynecology fellowship training program at Rush Presbyterian Medical Center where I was awarded the Outstanding Teacher Professor as a first-year fellow by the Obstetrics and Gynecology Residents in training.

Teaching remained a guiding principle as I transitioned from trainee to young faculty in the Department of Obstetrics and Gynecology at the University of Louisville. As a Division Director of one, I felt that a large clinical volume would be the foundational key to meeting my goals of recruiting additional faculty and beginning a fellowship training program within my division. I began by educating referring physicians in their operating room suites on urogynecology surgical techniques after deciding that it would be in my best interest to surgically assist them in managing their patients rather than expecting referrals for evaluation and management as a primary surgeon at a new institution. The clinical volume in referrals to my division increased exponentially as I had hoped, once these referring physicians gained confidence in my surgical expertise and realized their patients would be in good hands as primary surgeon.

My teaching of surgical technique expanded to residents in training at my institution because they worked closely with me in the evaluation of patients in my clinical office and as primary surgeon in my own operating suite. I learned early on that I derived my greatest satisfaction from guiding residents as primary surgeons as their surgical assistant because I could retract, expose, and develop bloodless surgical planes in this role, fostering surgical success while maintaining efficiencies and patient safety in the operating room. It was through these efforts that I was awarded three Outstanding Teaching Professor awards at the University of Louisville and the CREOG National Faculty Award for Excellence in Resident Education.

I hope to continue my teaching efforts as an Emory School of Medicine faculty member. I was driven by my passion for teaching to return to full time academic medicine which provides me with the opportunity to contribute to the professional development and education of young and mid-career faculty members, fellows, residents, and medical students as evidenced by my previous accomplishments outlined below. Specifically, I hope to continue my teaching of the scientific method to young clinical researchers, collaborate with colleagues on point of capture prospective data collection, and educate the next generation of gynecologists in female pelvic medicine and reconstructive surgery, minimally invasive surgery, and gender affirming surgery.

My early experiences with clinical research as a young faculty member were rewarding yet unfulfilling. I guided residents through their chosen urogynecology specific research projects and was successful in securing a second-place Searle Resident Research Paper Award at the District VI ACOG meeting in my first year of employment. However, the win internally rang hollow because I felt unprepared to lead learners in the scientific method.

From my viewpoint, leadership is an essential component to effective teaching because it provides learners with an example, or roadmap to guide their inferential knowledge. My desires to lead and educate the next generation of clinical researchers prompted my enrollment in the newly developed Epidemiology and Clinical Investigative Science program for clinical faculty at the University of Louisville. From 1997 until 2005, I completed coursework, wrote my Masters thesis, completed my PhD dissertation and defense, and secured NIH funding for my Model for Explaining Differences in Incontinence Care Seeking (MEDICS) project while supporting the clinical research mission of our division. It is because of these experiences that I have been able to make the following contributions to science of which I am most proud.

The novel use of endoluminal intravascular ultrasonographic catheters to study urethral sphincter anatomy. We were the first group to use ultrasound images to characterize urethral sphincter anatomy and volume to describe the pathophysiologic differences in urinary incontinence subtypes. Patients with detrusor instability had anatomic variations when compared with those with normal urodynamic tests. These findings provide an anatomic basis for the physiologic findings in patients with "urethrogenic" detrusor instability. It was concluded that a loss of urethral resistance as measured by maximal urethral closure pressure is associated with changes in urethral anatomy identified by intraurethral ultrasonography. We published four articles on this topic in leading journals in the field.

Collaboration with a world-renowned biomarker scientist (JB Klein) at the University of Louisville to first identify and then establish the clinical utility of biomarkers for interstitial cystitis (IC) which is a disorder without pathognomonic signs, symptoms, or definitive diagnostic testing. We identified four proteins that differed significantly between patients with IC and asymptomatic control (AC) subjects. These urine protein isoforms may be biomarkers for IC.

Collaboration with a dermatologic scientist in Philadelphia, PA and the novel use of an instrument designed to assess the biomechanical properties of skin in vivo. We adapted the instrument and software to measure the in vivo biomechanical properties of vaginal skin in women with and without pelvic organ prolapse and after sacrocolpopexy with mesh augmentation. In our studies, women with pelvic organ prolapse had significantly more extensible vaginal skin than women with normal pelvic support. Furthermore, vaginal extensibility was related to pelvic organ prolapse quantification stage in a linear fashion. Our findings suggest that local, rather than systemic, alterations in biomechanical skin properties are associated with pelvic organ prolapse. Furthermore, our studies suggested that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.

Adapted the established "Theory for Care Seeking Behavior" for explaining differences in incontinence care seeking in a racial/ethnically heterogeneous female population. The purpose of this project was to determine if race/ethnicity explained differences in incontinence care seeking after controlling for established confounders including differences in socioeconomic status and access to care variables. This project was awarded NIH funding and served the basis for both my Master of Science thesis and PhD dissertation. Racial/Ethnic differences in incontinence care seeking were independently associated with incontinence care seeking after adjusting for socioeconomic status and other established confounders of care seeking behavior. Black and Hispanic women were less likely to seek care for urinary incontinence compared to White women.

Led a multidisciplinary team from the Departments of Nursing, Obstetrics and Gynecology, and Psychology at Indiana University School of Medicine in the study of post-discharge recovery after pelvic reconstructive surgery in women with pelvic organ prolapse. I am preparing a grant application for NIH funding for a "prehabilitation" randomized controlled trial to guide preoperative patient preparation having already established a valid measure and identifying predictors of postdischarge recovery after laparoscopic sacrocolpopexy. We identified the following predictors of recovery at 1 or more time points: sociodemographic/clinical predictors: older age, higher body mass index, fewer comorbidities, and greater preoperative pain predicted greater recovery; surgical predictors: fewer perioperative complications and greater change in the leading edge of prolapse after surgery predicted greater recovery; psychosocial predictors: less endorsement of doctor's locus of control, greater endorsement of other's locus of control, and less sick role investment predicted greater recovery. Identified sociodemographic/clinical, surgical, and psychosocial predictors should provide physicians with evidence-based guidance on recovery times for patients and family members. This knowledge is critical for informing future research to determine if these predictors are modifiable by changes to our narrative during the preoperative consultation visit. These efforts may reduce the postdischarge surgical recovery for patients with pelvic organ prolapse after laparoscopic sacrocolpopexy, accepting the unique demands on each individual's time. So far, this work has resulted in 6 peer-reviewed publications.

Academic Appointment

  • Division Director, Gynecologic Specialties, Gynecology and Obstetrics, Emory University School of Medicine
  • Associate Professor, Gynecology and Obstetrics, Emory University School of Medicine

Education

Degrees

  • PhD from University of Louisville
  • MSPH from University of Louisville
  • MD from Saint Louis University School of Medicine
  • BS from State University of New York at Binghamton

Research

Publications

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