Fellowship in Minimally Invasive SurgeryCurriculum

July, 2011

T. Paul Singh, M.D.Director of Minimally Invasive Surgery

Assistant Professor of Surgery

Department of SurgeryDivision of Minimally Invasive Surgery

47 New Scotland Avenue, MC-61Albany, NY 12208

Phone: (518) 262-5374 Fax: (518) 262-6397

Table of Contents

Introduction 3

Eligibility 4

Faculty 5

Goals and Objectives 6

Components of the Program and Weekly Schedule 7

Clinical Experience 8

Research 9

Educational Responsibilities 10

Conference Schedule 10

Evaluation Process 11

Vacation 13

Leave of Absence 13

Moonlighting Policy 13

Medical students: Policy on Harassment 14

The General Surgery Residency 15

405 Resident Supervision 17

Clinical Resources 18

Professional Resources 19

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Introduction

Welcome to the Minimally Invasive Surgery Fellowship at Albany Medical College! 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 SurgeryAssistant Professor of Surgery

Brian Binetti, M.D.Assistant Professor of Surgery

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EligibilitySuccessful 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 York State licensing can be obtained by contacting the Medical Board at the address below. Privileges as Attending Surgeon must be obtained at Albany Medical Center Hospital once a New York State 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 DepartmentOffice of the ProfessionsState Education Building – 2nd Floor89 Washington AvenueAlbany, NY 12234Phone: (518) 474-3817Website: www.op.nysed.gov/med.htm

The Fellowship Council11300 West Olympic Blvd, Suite 600Los Angeles, CA 90064Phone: (310) 437-0555Fax: (310) 437-0585Email: info@fellowshipcouncil.orgWebsite: www.fellowshipcouncil.org

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Faculty

Steven C. Stain, M.D. TRANSPLANT SURGERYNeil Lempert Professor and Chairman of Surgery David J. Conti, M.D.

Program Director, Surgery ResidencyAnthony J. DeLuca, M.D. Chief, General SurgeryProfessor of SurgeryAssociate Program Director, Surgery Residency Michael Gallichio, M.D.

Associate ProfessorCOLORECTAL SURGERYEdward C. Lee, M.D. TRAUMA SURGERYAssociate Professor Hashim M. Hesham, M.D.Director, Section of Colorectal Surgery Assistant Professor

Brian Valerian, M.D. Carl Rosati, M.D.Assistant Professor Associate ProfessorAssociate Professor

David J. Kuehler, M.D.Jonathan C. Canete Assistant ProfessorAssistant Professor

Sharon Samuels, M.D.CRITICAL CARE Assistant ProfessorJoseph L. Pfeifer, III, M.D.Associate Professor Daniel Bonville, D.O.

Assistant ProfessorDan R. Thompson, M.D.Associate Professor

Sophia Socaris, M.D.Associate Professor of Surgery and Anesthesiology

BREAST AND ENDOCRINE SURGERYTodd D. Beyer, M.D.Assistant Professor

Donna M. Pietrocola, M.D.Associate Professor

PEDIATRIC SURGERYThomas R. Weber, M.D.Professor of Surgery

PLASTIC SURGERYJerome D. Chao, M.D.Assistant Professor

James Dolph, M.DAssistant Professor

James D. Koumanis, M.D.Assistant Professor

Stephane Braun, M.D.Program Director

SURGICAL ONCOLOGYAnkesh Nigam, M.D.Associate Professor

Muhammad Hena, M.D.Associate Professor

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Goals and ObjectivesThe 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.

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Components of the ProgramThe 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:Clinical 60%Research 20%Teaching/Education 20%

Weekly ScheduleMonday: AM: Operating Room

PM: Operating Room

Tuesday: AM: Endoscopy ClinicPM: Clinic

Wednesday: AM: Operating Room Research Training LaboratoryPM: Operating Room Research Medical Student Didactic Lectures

Thursday: AM: Clinic Training LaboratoryPM: Clinic Research Training Laboratory

Friday: AM: Operating Room ResearchPM: Operating Room Research

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Clinical ExperienceThe 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 SURGERYBariatricsGastroesophageal reflux diseaseParaesophageal herniaAchalasiaVentral herniaInguinal HerniaHematologic disordersHepatobiliary disorders

COLORECTAL SURGERYDiverticulitisColon cancer

PEDIATRIC SURGERYGastroesophageal reflux diseaseHematologic disorders

ENDOCRINE SURGERYDisorders of the adrenal gland

TRANSPLANT SURGERYLiving donor nephrectomy

SURGICAL ONCOLOGYDisorders of the adrenal glandHepatobiliary disorders

OPERATIVE EXPERIENCEThe 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.

ENDOSCOPYThe 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.

CLINICOffice 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.

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ResearchThe 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 must include 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 outcomesGastric bypass outcomesSurgical virtual reality simulationMethods of laparoscopic training

REQUIREMENTSScientific 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, and Southwestern 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.

RESOURCESSTATISTICSAshar Ata, M.P.H., Statistician, Department of SurgeryPhone: Email: AtaA@mail.amc.edu

IRB and INVESTIGATOR TRAINING OPTIONSPhone: (518) 262-5182Website: accessible via AMC Intranet

INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)ANIMAL RESOURCE FACILITYPhone: (518) 262-5389Website: accessible via AMC Intranet

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Educational ResponsibilitiesIt 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 CONFERENCESThe Department of Surgery holds the following required conferences for Faculty on Thursdays. The Fellow is expected to attend these conferences.

7:00 AM Grand Rounds ME-700Includes Departmental Grand Rounds, invited guests, faculty lectures, Senior and Chief Resident presentations, and Journal Club.

5:00 PM Morbidity & Mortality Hyuck AuditoriumDeaths and complications from the previous week are reviewed. The Senior Resident from each service is responsible for case presentation.

MIS TRAINING LABORATORYThe 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 READINGOne of the following textbooks is recommended:

Mastery of Endoscopic and Laparoscopic Surgery. Nathaniel Soper, Lee Swanstrom, Steve Eubanks.

Laparoscopic Surgery of the Abdomen. Bruce MacFadyen, Maurice Arregui, Steve Eubanks, Doulgas Olsen.

Laparoscopic Surgery: Principles and Procedures. Daniel B. Jones

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Evaluation ProcessThe 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 Albany Medical College fellowship 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 CAREFellows 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:

1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families

2. Gather essential and accurate information about their patients3. Make informed decisions about diagnostic and therapeutic interventions based on patient

information and preferences, up-to-date scientific evidence, and clinical judgment4. Develop and carry out patient management plans5. Counsel and educate patients and their families6. Use information technology to support patient care decision and patient education7. Perform competently all medical and invasive procedures considered essential for the

area of practice8. Provide health care services aimed at preventing health problems or maintaining health9. Work with health care professionals, including those from other disciplines, to provide

patient-focused care

MEDICAL KNOWLEDGEFellows 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:

1. Demonstrate an investigatory and analytic thinking approach to clinical situations2. Know and apply the basic and clinically supportive sciences which are appropriate to

their discipline

PRACTICE-BASED LEARNING AND IMPROVEMENTFellows 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:

1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology

2. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems

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3. Obtain and use information about their population of patients and the larger population from their patients are drawn

4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and of information on diagnostic and therapeutic effectiveness

5. Use information technology to mange information, access on-line medical information, and supplement their own education

6. Facilitate the learning of students and other health professionals

INTERPERSONAL AND COMMUNICATION SKILLSFellows 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:

1. Create and sustain a therapeutic and ethically sound relationship with patients2. Use effective listening skills and elicit and provide information using effective nonverbal,

explanatory questioning, and writing skills3. Work effectively with others as a member or leader of a health care team or other

professional group

PROFESSIONALISMFellows must demonstrate a commitment to carrying out professional responsibilities and sensitivity to a diverse patient population. Fellows are expected to perform the following:

1. 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

2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical treatment, confidentiality of patient information, informed consent, and business practices

3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities

SYSTEMS-BASED PRACTICEFellows 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:

1. 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

2. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources

3. Practice cost-effective health care and resource allocation that does not compromise the quality of care

4. Advocate for quality patient care and assist patients in dealing with system complexities5. 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

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VacationThe 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 AbsenceA 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.

MoonlightingMoonlighting is permitted with permission by the MIS Program Director and Chairman. This is not to interfere with normal clinical duties and/or call responsibility.

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Policy on Harassment of Medical StudentsThe 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.

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General Surgery ResidencyIntroductionThe Department of Surgery of the Albany Medical Center shares the tripartite goals of the Albany Medical Center, Albany, New York - Education, Patient Care and Medical Research.Located in the capital city of New York State the Albany Medical Center Hospital, a 631 bed tertiary care facility and New York State designated level one trauma center performs over 30,000 surgical 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 (including Bariatric 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 Albany Medical Center dates back to the concluding years of World War II when Dr. Eldridge Campbell formalized the residency in Surgery.  Under Drs. Charles Eckert and 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 27 with 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.  Over 10,000 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 Samuel Stratton Veterans Affairs Medical Center (a 158 bed facility adjacent to the Albany Medical Center) and to St. Peter's Hospital (a 452 bed general hospital) round out the resident's clinical experience.

Resident OpportunitiesThere is ample opportunity for residents to join our faculty in their clinical research endeavors.  With the adjacent medical college, New York State Wadsworth Laboratories and Ordway Research Center there is a great opportunity to participate in both basic science and translational research proximate to the Medical Center campus.  The Center's association with Rensselaer Polytechnic Institute, The State University at Albany School of Public Health and a score of local colleges and universities provide additional opportunities for creative research opportunities with advanced degree options available at these institutions.  Each resident at the PGY-3 and PGY-4 levels is required to prepare and present a scholarly research project at the annual Research Paper Day in June.  We expect that many of these projects will eventually be presented or published regionally or nationally. Residents are involved with medical students at all levels of training.  We hope that in teaching others there is an inestimable benefit to the resident.  All resident participate in daily work rounds, weekly teaching rounds and in student tutorial sessions.  A close working relationship of faculty, residents and students creates an environment that fosters dynamic learning by all.Graduates of our training program have uniform success in completing the certification process of the American Board of Surgery.  Most go on to fellowship training in the subspecialty areas of surgery - usually achieving their first choice of training program.

Resident DutiesThe On-Call duties of residents have been adjusted as part of the implementation of New York State regulation 405.4 and the recent ACGME mandate on work hours of trainees.  These regulations are seen as an asset to the program and do not hamper the proper clinical experience of our surgical residents.  Chief residents generally take call from home, except when covering

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the Acute Care Surgery service (every third night).  Senior and junior residents generally cover, on average, every 5th night throughout the year (varying from every third on Acute Care Surgery and at the Veterans Hospital).  There is a board eligible/certified surgeon in house at all times for immediate resident consultation.

Evaluation of resident performance by faculty and peers occurs during and at the completion of each rotation assignment.  The faculty and Chief Residents meet quarterly to formally evaluate resident performance.  A letter of evaluation is generated and provided to the resident. Subsequent to this meeting the Program Director meets with each resident to review the evaluation and discuss remediation.  A yearly in-training examination is used to assess strengths and weaknesses in both basic and clinical science.  An oral examination (mimicking the exam of the American Board of Surgery) is provided for all residents at the PGY-3 level and above. Residents have the opportunity to evaluate the rotations, faculty and program in general in an anonymous way.  These comments, as well of those of a resident's committee are provided to the faculty at the quarterly faculty meeting.

AccreditationThe General Surgery Residency Program is fully accredited by the Accreditation Council for Graduate Medical Education and the American Board of Surgery through its Residency Review Committee. There are 4 residents in each year of postgraduate training. The residency is 5 years in length. Positions in PGY-1 are available for residents who have been accepted into a surgical specialty which requires preliminary experience in general surgery.

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Policy on 405.4 Staff SupervisionIt is a New York State requirement that residents receive direct supervision of their activities. A board eligible or board certified surgeon will be in house 24 hours a day, every day. This surgeon serves as the surgical resident supervisor.

The surgical supervisor is expected to be available to supervise the activities of all in-house surgical (general and specialty) residents. Should an emergent situation arise and the attending surgeon not be immediately available, the supervisor is expected to participate in the immediate care of this patient as supervisor of the resident involved and as a surrogate for the attending surgeon of record. The supervisor and resident must communicate with the attending of record such an event immediately following resolution of the event. This role includes resident activities in the Critical Care Unit, on patient care units, and in the Emergency Room.

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Clinical ResourcesThe Albany Medical Center is equipped with an Intranet, accessible from any hospital computer with internet access.

http://intranet/

“Clinical resources” may be found on the Intranet homepage, right side of the screen. Resources include Sorian® Clinicals to view current and prior medical records and laboratory data, Stentor iSite® to view radiographic studies, Micromedex, and Physician Orders in pre-printed form.

Intranet access may be obtained from your home computer via Citrix web client by contacting Robert Bashaw, the Citrix administrator, at BashawR@mail.amc.edu.

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Professional ResourcesBelow is a compilation of web resources that may be helpful to you throughout your fellowship year.

EDUCATIONAL REFERENCESFundamentals of Laparoscopic Surgery (FLS) www.flsprogram.orgNational Cancer Institute www.cancer.govNatural Orifice Surgery Consortium for Assessment and Research www.noscar.orgWebSurg www.websurg.com

MEDICAL BOARDSAmerican Board of Surgery1617 John F. Kennedy BoulevardSuite 860Philadelphia, PA 19103Phone: (215) 568-4000Fax: (215) 563-5718www.absurgery.org

New York State Education DepartmentOffice of the ProfessionsState Education Building – 2nd Floor89 Washington AvenueAlbany, NY 12234Phone: (518) 474-3817 www.op.nysed.gov/med.htm

SURGICAL SOCIETIES

American College of Surgeons (ACS)633 N. Saint Clair StreetChicago, IL 60611-3211Phone: (800) 621-4111Fax: (312) 202-5001www.facs.org

American Society for Bariatric Surgery (ASBS)100 SW 75th Street, Suite 201Gainesville, FL 32607Phone: (352) 331-4900Fax: (352) 331-4975www.asbs.org

Minimally Invasive Robotics Association (MIRA)C/O Arnold Byer, M.D. Executive Director Department of Surgery, Hackensack University Medical Center 30 Prospect AvenueHackensack, NJ 07601Fax: (201)-996-2021E-mail : abyer@humed.comwww.teleroboticsurgeons.com

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Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)11300 West Olympic BoulevardSuite 600Los Angeles, CA 90064Phone: (310) 437-0544Fax: (310) 437-0585www.sages.org

Society of Laparoendoscopic Surgeons (SLS)7330 SW 62nd Place, Suite 410Miami, FL 33143-4825Phone: (800) 446-2659Fax: (305) 667-4123www.laparoscopy.org

Society for Surgery of the Alimentary Tract (SSAT)900 Cummings Center#221-UBeverly, MA 01915Phone: (978) 927-8330Fax: (978) 524-8890www.ssat.com

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