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Minimally Invasive Surgery

Minimally Invasive Surgery - Curriculum


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:

  • Clinical   60%
  • Research  20%
  • Teaching/Education 20%

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 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 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:

  • Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
  • 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.


RESOURCES
STATISTICS
Ashar Ata, M.P.H., Statistician, Department of Surgery
Phone: 
Email:  AtaA@mail.amc.edu

IRB and INVESTIGATOR TRAINING OPTIONS
Phone:  (518) 262-5182
Web site: accessible via AMC Intranet

INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
ANIMAL RESOURCE FACILITY
Phone:  (518) 262-5389
Web site:  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.

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.  Bruce MacFadyen, 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 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 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    
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