Fellowship in Minimally Invasive Surgery
Curriculum
July, 2011
T. Paul Singh, M.D.
Director of Minimally Invasive Surgery
Assistant Professor of Surgery
Department of Surgery
Division of Minimally Invasive Surgery
47 New Scotland Avenue, MC-61
Albany, NY12208
Phone: (518) 262-5374 Fax: (518) 262-6397
Table of Contents
Introduction3
Eligibility4
Faculty5
Goals and Objectives6
Components of the Program and Weekly Schedule7
Clinical Experience8
Research9
Educational Responsibilities10
Conference Schedule10
Evaluation Process11
Vacation13
Leave of Absence13
Moonlighting Policy13
Medical students: Policy on Harassment14
The General Surgery Residency15
405 Resident Supervision17
Clinical Resources18
Professional Resources19
Introduction
Welcome to the Minimally Invasive Surgery Fellowship at AlbanyMedicalCollege! The following manual is intended to outline your goals and objectives for the next 12 months. We anticipate that you will have a challenging yet momentous experience during your training.
T. Paul Singh, M.D.
Director of Minimally Invasive Surgery
Assistant Professor of Surgery
Brian Binetti, M.D.
Assistant Professor of Surgery
Eligibility
Successful candidates for the position of Clinical Fellow must have completed a Residency In General Surgery. Candidates must have also graduated from a Liaison Committee on Medical Education (LCME) accredited medical school or possess certification from the Educational Commission for Foreign Medical Graduates (ECFMG). In addition, candidates must be eligible for medical licensure in the State of New York. Additional information regarding the requirements for New YorkState licensing can be obtained by contacting the Medical Board at the address below. Privileges as Attending Surgeon must be obtained at AlbanyMedicalCenterHospital once a New YorkState medical license is obtained.
This program participates in the Minimally Invasive Surgery match process, governed by The Fellowship Council. Applications for fellowship may be obtained through The Fellowship Council website (see below).
New York State Education Department
Office of the Professions
StateEducationBuilding – 2nd Floor
89 Washington Avenue
Albany, NY12234
Phone: (518) 474-3817
Website:
The Fellowship Council
11300 West Olympic Blvd, Suite 600
Los Angeles, CA90064
Phone:(310) 437-0555
Fax: (310) 437-0585
Email:
Website:
Faculty
Steven C. Stain, M.D.TRANSPLANT SURGERY
Neil Lempert Professor and Chairman of SurgeryDavid J. Conti, M.D.
Program Director, Surgery Residency
Anthony J. DeLuca, M.D.Chief, General Surgery
Professor of Surgery
Associate Program Director, Surgery ResidencyMichael Gallichio, M.D.
Associate Professor
COLORECTAL SURGERY
Edward C. Lee, M.D.TRAUMA SURGERY
Associate ProfessorHashim M. Hesham, M.D.
Director, Section of Colorectal SurgeryAssistant Professor
Brian Valerian, M.D.Carl Rosati, M.D.
Assistant ProfessorAssociate Professor
Associate Professor
David J. Kuehler, M.D.
Jonathan C. CaneteAssistant Professor
Assistant Professor
Sharon Samuels, M.D.
CRITICAL CAREAssistant Professor
Joseph L. Pfeifer, III, M.D.
Associate ProfessorDaniel Bonville, D.O.
Assistant Professor
Dan R. Thompson, M.D.
Associate Professor
Sophia Socaris, M.D.
Associate Professor of Surgery and Anesthesiology
BREAST AND ENDOCRINE SURGERY
Todd D. Beyer, M.D.
Assistant Professor
Donna M. Pietrocola, M.D.
Associate Professor
PEDIATRIC SURGERY
Thomas R. Weber, M.D.
Professor of Surgery
PLASTIC SURGERY
Jerome D. Chao, M.D.
Assistant Professor
James Dolph, M.D
Assistant Professor
James D. Koumanis, M.D.
Assistant Professor
Stephane Braun, M.D.
Program Director
SURGICAL ONCOLOGY
Ankesh Nigam, M.D.
Associate Professor
Muhammad Hena, M.D.
Associate Professor
Goals and Objectives
The goal of the MIS Fellowship is to provide the Fellow with the necessary training and education to be comfortable in the performance of a wide variety of minimally invasive operations. The Fellow will be exposed to the broad applications of minimally invasive surgery, including bariatric surgery, surgery for gastroesophageal reflux disease (GERD), hernia surgery, and solid organ surgery. The Fellow will have ample opportunity to participate in both basic science and clinical research, and scholarly activity with presentations in national and international symposia is expected. The Fellow will be provided with the necessary stimuli to pursue a successful career in either private practice or academic surgery upon completion of the Fellowship.
Components of the Program
The activities of the fellow will be a blend of clinical experience, research, and teaching responsibilities for medical students and General Surgery residents. Clinical experience is to include both operative time and clinic hours. Prior fellows have performed both basic science research, as well as clinical research. Topics have varied from surgical education to virtual reality simulation. Teaching responsibilities will range from formal Grand Rounds presentations for the Department of Surgery to informal clinical instruction in the operating room and surgical clinic.
The activities will be divided as follows:
Clinical60%
Research20%
Teaching/Education20%
Weekly Schedule
Monday:AM: Operating Room
PM: Operating Room
Tuesday:AM: Endoscopy
Clinic
PM: Clinic
Wednesday:AM: Operating Room
Research
Training Laboratory
PM: Operating Room
Research
Medical Student Didactic Lectures
Thursday:AM: Clinic
Training Laboratory
PM: Clinic
Research
Training Laboratory
Friday:AM: Operating Room
Research
PM: Operating Room
Research
Clinical Experience
The Fellowship offers a broad clinical experience which may be tailored to the needs or goals of the specific Fellow. As a tertiary referral center, we are provided with a broad range of surgical pathology. The Fellow will be exposed to a large volume and array of this surgical pathology and learn the minimally invasive applications to treating these diseases:
GENERAL SURGERY
Bariatrics
Gastroesophageal reflux disease
Paraesophageal hernia
Achalasia
Ventral hernia
Inguinal Hernia
Hematologic disorders
Hepatobiliary disorders
COLORECTAL SURGERY
Diverticulitis
Colon cancer
PEDIATRIC SURGERY
Gastroesophageal reflux disease
Hematologic disorders
ENDOCRINE SURGERY
Disorders of the adrenal gland
TRANSPLANT SURGERY
Living donor nephrectomy
SURGICAL ONCOLOGY
Disorders of the adrenal gland
Hepatobiliary disorders
OPERATIVE EXPERIENCE
The Fellowship operates with a mentor system. The Fellow will act as the assistant surgeon early during the training period. As the Fellow’s skill increases, she or he will graduate to the role of Primary Surgeon under supervision, and assist the Surgery Resident in performing procedures. The Fellow will also be responsible for teaching the Surgery Resident in open general surgery cases and minor surgical operations. In addition, the Fellow will become familiar with robotic-assisted surgery, and eventually perform operations as Primary Surgeon using the robot.
ENDOSCOPY
The Fellow will perform both upper and lower endoscopy under the supervision of Attending Surgeons from Minimally Invasive Surgery and Colorectal Surgery. The Fellow will also supervise resident performed endoscopy.
CLINIC
Office hours are to be attended on a regular basis. This will include follow-up on existing patients, as well as the evaluation of new patients. Minor procedures (e.g. adjustable gastric band fills) are occasionally performed in the clinic.
Research
The Fellow is expected to actively engage in research throughout the Fellowship. There is ample opportunity to initiate both basic science and clinical research projects. The Fellow is required to complete Albany Medical Center Institutional Review Board (IRB) Certification for Investigator Training during the first month of Fellowship. This is an online course which may be completed within a few hours. All research efforts mustinclude at least one General Surgery resident.
The Division of Minimally Invasive Surgery actively collaborates with the Department of Mechanical, Aerospace, and Nuclear Engineering at Rensselaer Polytechnic Institute and the Adirondack Area Network. Additional collaborative research efforts are encouraged.
Prior areas of investigation:
Natural Orifice Translumenal Endoscopic Surgery (NOTES)
Robotic surgery outcomes
Gastric bypass outcomes
Surgical virtual reality simulation
Methods of laparoscopic training
REQUIREMENTS
Scientific abstracts must be submitted for oral or poster presentation to the following societies’ annual meetings:
1. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
2. Society of Laparoendoscopic Surgeons (SLS)
In addition, the Fellow is encouraged to submit abstracts to other nationally recognized symposia, such as the American College of Surgeons, American Society for Bariatric Surgery, Digestive Disease Week, Minimally Invasive Robotic Association, andSouthwestern Surgical Conference, to name a few.
It is expected that the Fellow see to it that scientific abstracts eventually lead to manuscript publication in peer-reviewed journals.
RESOURCES
STATISTICS
Ashar Ata, M.P.H., Statistician, Department of Surgery
Phone:
Email:
IRB and INVESTIGATOR TRAINING OPTIONS
Phone: (518) 262-5182
Website: accessible via AMC Intranet
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
ANIMAL RESOURCE FACILITY
Phone: (518) 262-5389
Website: accessible via AMC Intranet
Educational Responsibilities
It goes without saying that the Fellow will be expected to intellectually engage both medical students and residents in clinical settings. The Fellow will also be responsible for weekly interactive Problem-Based Discussions with the medical students during an eight-week period. These topics are presented in the “Surgery III Course Book” for medical students.
The Fellow will also be responsible for a one-hour Minimally Invasive Surgery presentation for Grand Rounds for the Department of Surgery.
DIDACTIC CONFERENCES
The Department of Surgery holds the following required conferences for Faculty on Thursdays. The Fellow is expected to attend these conferences.
7:00 AMGrand RoundsME-700
Includes Departmental Grand Rounds, invited guests, faculty lectures, Senior and Chief Resident presentations, and Journal Club.
5:00 PMMorbidity & MortalityHyuck Auditorium
Deaths and complications from the previousweek are reviewed. The Senior Resident from each service is responsible for case presentation.
MIS TRAINING LABORATORY
The Minimally Invasive Surgery training laboratory is located in J-407. The Fellow has access via ID-Swipe, and a key to the office will be given to the Fellow. The laboratory contains box trainers, videoscopic equipment, re-usable and disposable instruments, virtual reality simulators, and open surgery training equipment.
The Fellow will have designated time to supervise General Surgery residents in the acquisition of Minimally Invasive Surgical skills. This is an excellent opportunity to perfect her or his own skills. Laparoscopic tasks are derived from the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS). Senior residents will receive certification in Fundamentals of Laparoscopic Surgery (FLS).
TEXTBOOK READING
One of the following textbooks is recommended:
- Mastery of Endoscopic and Laparoscopic Surgery. Nathaniel Soper, Lee Swanstrom, Steve Eubanks.
- Laparoscopic Surgery of the Abdomen. BruceMacFadyen, Maurice Arregui, Steve Eubanks, Doulgas Olsen.
- Laparoscopic Surgery: Principles and Procedures. Daniel B. Jones
Evaluation Process
The Fellow will be evaluated by the Director of Minimally Invasive Surgery on a quarter-annual basis. Evaluation criteria are based on the Accreditation Council for Graduate Medical Education (ACGME) six general competencies:
- Patient Care
- Medical knowledge
- Practice-Based Learning and Improvement
- Interpersonal and Communication Skills
- Professionalism
- Systems-Based Practice
The AlbanyMedicalCollegefellowship program in Minimally Invasive Surgery requires the fellow to develop competencies in the 6 areas listed above to the level expected of a new practitioner. Toward this end, the fellowship defines the specific knowledge, skills, and attitudes required and provides educational experiences in order for the fellow to demonstrate the following competencies.
PATIENT CARE
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Fellows are expected to perform the following:
- Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
- Gather essential and accurate information about their patients
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
- Develop and carry out patient management plans
- Counsel and educate patients and their families
- Use information technology to support patient care decision and patient education
- Perform competently all medical and invasive procedures considered essential for the area of practice
- Provide health care services aimed at preventing health problems or maintaining health
- Work with health care professionals, including those from other disciplines, to provide patient-focused care
MEDICAL KNOWLEDGE
Fellows must demonstrate knowledge about established and evolving biomedical, clinical, and cognitive (epidemiological and socio-behavioral) sciences and the application of this knowledge to patient care. Fellows are expected to perform the following:
- Demonstrate an investigatory and analytic thinking approach to clinical situations
- Know and apply the basic and clinically supportive sciences which are appropriate to their discipline
PRACTICE-BASED LEARNING AND IMPROVEMENT
Fellows must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Fellows are expected to perform the following:
- Analyze practice experience and perform practice-based improvement activities using a systematic methodology
- Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
- Obtain and use information about their population of patients and the larger population from their patients are drawn
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and of information on diagnostic and therapeutic effectiveness
- Use information technology to mange information, access on-line medical information, and supplement their own education
- Facilitate the learning of students and other health professionals
INTERPERSONAL AND COMMUNICATION SKILLS
Fellows must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates. Fellows are expected to perform the following:
- Create and sustain a therapeutic and ethically sound relationship with patients
- Use effective listening skills and elicit and provide information using effective nonverbal, explanatory questioning, and writing skills
- Work effectively with others as a member or leader of a health care team or other professional group
PROFESSIONALISM
Fellows must demonstrate a commitment to carrying out professional responsibilities and sensitivity to a diverse patient population. Fellows are expected to perform the following:
- Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and families that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and ongoing professional development
- Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical treatment, confidentiality of patient information, informed consent, and business practices
- Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
SYSTEMS-BASED PRACTICE
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Fellows are expected to perform the following:
- Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
- Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
- Practice cost-effective health care and resource allocation that does not compromise the quality of care
- Advocate for quality patient care and assist patients in dealing with system complexities
- Know how to partner with health care managers and health care providers to assess, coordinate, improve health care and know how these activities can affect system performance
Vacation
The Fellow will be entitled to 4 weeks of vacation. Prior approval is required by the MIS Program Director and Chairman by submitting the form entitled “Department of Surgery Record of Absence for Faculty Members and Mid-Levels”. One week of vacation should be reserved for your final month of training to accommodate time needed for packing, moving, etc.
Leave Of Absence
A brief leave of absence for illness, family or personal reasons can be arranged with the MIS Director. Formal and significant leave of absence must be arranged in advance (if possible) with the Program Director.
FMLA is available for a total of 12 weeks. This is unpaid leave for a family medical situation. Benefits continue during this period.
Moonlighting
Moonlighting is permitted with permission by the MIS Program Director and Chairman. This is not to interfere with normal clinical duties and/or call responsibility.
Policy on Harassment of Medical Students
The rules of good behavior should guide all activities: with faculty, with students, with nursing staff and, of course, with patients and families.
Medical students pay dearly for the privilege of working with you on clinical services. This gives you the opportunity to think and act as an educator and to develop discursive knowledge of surgery. Inattention to medical students will not be tolerated.
Although correction and criticism is an integral part of the students learning experience, we must all be careful to avoid any behavior that could be considered harassing. Treat others as you would like to be treated. Mentoring is an important aspect of all professions. Your opportunity to mentor students is a privilege.
Any student complaint regarding harassing behavior will be taken with great concern by the Course Director and the Chairman. Students are instructed to bring any complaint of substance to the Course Director, in private, for discussion. If both agree, the issue will be brought forward to the Chairman and the College’s Committee on Harassment, if appropriate.
Be aware that harassing behavior will not be tolerated and may be cause for summary dismissal.
General Surgery Residency
Introduction
The Department of Surgery of the AlbanyMedicalCenter sharesthe tripartite goals of the AlbanyMedicalCenter, Albany, New York- Education, Patient Care and Medical Research.
Located in the capital city of New York State the AlbanyMedicalCenterHospital, a 631 bed tertiary care facility and New YorkState designatedlevel one trauma center performs over 30,000surgical procedures each year. Training programs exist in General Surgery as well as the surgical specialties of Neurological Surgery, Orthopedic Surgery,Otolaryngology and Urology. Advanced training is offered in Cardiothoracic Surgery, Minimally Invasive Surgery (includingBariatric Surgery), Plastic Surgery, Transplantation and Vascular Surgery. An Integrated Training Program in Plastic Surgery is also offered for medical student applicants. All of the training programs have full ACGME accreditation.
The General Surgery Training Program at the AlbanyMedicalCenter dates back to the concluding years of World War II when Dr. Eldridge Campbell formalized the residency in Surgery. Under Drs. Charles Eckertand Samuel Powers the program prospered, training a generation of General Surgeons who became board certified and carried their mentors' skills and talents to serve the wider geographic area of the Northeast.
The faculty of the Division of General Surgery now number 27with representation from all of the principle, secondary and tertiary areas of General Surgery. These include breast, endocrine, gastrointestinal and colorectal, oncologic, pediatric, trauma, transplantation and vascular surgery. Our residents work with all of our faculty, gaining experience in all areas of General Surgery. Over10,000 General Surgery cases were performed in 2006 with resident participation in virtually every case. Graduating Chief Residents have completed over 1100 major cases representing an experience that places them in the 90th percentile of national resident case experience. Chief residents generally complete over 350 cases during the final year of residency training. Rotations to the SamuelStrattonVeteransAffairsMedicalCenter (a 158 bedfacility adjacent to the AlbanyMedicalCenter) and to St. Peter's Hospital (a 452 bed general hospital)round out the resident'sclinical experience.