Education, Research & Didactics

Research Expectations

Each fellow will be expected to be involved in many research projects that are being conducted in the Division of Intra-Abdominal Transplant during the course of their fellowship.

Each fellow will be given one day per week of protected research time, with the expectation they will complete and submit at least one project for presentation at a national meeting and written up for publication.

Each fellow will be encouraged to identify a research mentor early in their fellowship to help them develop their research skills.

Fellows will be expected to attend at least one national meeting per year throughout both years of their fellowship. Financial support will be provided for registration and travel to these meetings. Protected time will be granted in order to travel to these meetings including the ASTS Fellows Symposium.

Clinical Expectations

Goals

• Evaluate UNOS organ offers and asses organ quality for transplant.
• Achieve proficiency in organ procurement, determine organ quality during procurement and understand all possible anatomical variations and techniques available.
• Evaluate Patients for transplant, include indications and contraindications for liver and kidney transplantations.
• Understand UNOS and OPTN regulations related to transplant care.
• Function effectively with interdisciplinary health care team, including nurses and physicians, including in the OR
• Become familiar with post-operative care and long term care of transplant patients, including immunosuppression management

Objectives

• Independently evaluate candidates for transplantation, asses the patients suitability and risks for transplant and postoperative complications
• Independently evaluate potential living donors, evaluate candidacy and determine organ suitability for donation
• Learn management of transplant patients after surgery, treatment of rejection and other surgical and medical complications.
• Understand immunosuppressive drugs, including induction and maintenance,; recognized side effects and complications related to them.
• Perform simple and complex organ recovery from deceased donor.
• Perform kidney transplantation, liver transplantation and living donor nephrectomy.
• Understand UNOS and OPTN regulations
• Participate in quality improvement project for the transplant program.
• Participate in Division and Department of Surgery educational conferences and processes.

Inpatient Transplant Service

• Pre-transplant liver patients are admitted to the Primary Hepatology service
• Surgical team serves as a consulting service for inpatient evaluations (eg. Fulminant Hepatic Failure, acute decompensations)

Transplant Surgery Service

• Post-op Liver, Kidney, & Pancreas transplant patients (including patients readmitted for post-operative complications)
• Mid-level coverage provided daily (including weekends) with six FTE Nurse Practitioners
• PGY – 3 General Surgery Residents rotate on service for one months at a time every other month.
• Night-time coverage provided by General Surgery Night Float Residents as well as dedicated Transplant Physician Assistants
• The inpatient service is staffed on weekdays by a dedicated Transplant Pharmacist, Dietician, and Social Worker

The fellow’s responsibilities will include leading Multi-disciplinary rounds each morning, communicating throughout the day with the mid-level providers, liaising with the SICU house staff on all transplant patients, communicating with Transplant Nephrology & Transplant Hepatology house staff, reviewing biopsy results with Transplant pathology when needed, and updating the Transplant attending surgeon on service for the week throughout the day.

The fellow will be expected to review all inpatient/ED consults themselves or with house staff and/or midlevel providers. The fellow will be expected to be available to both the Attending surgeon, and the mid-level providers through-out the day to manage any issues that arise (in compliance with the ASTS managed time policy).

Through the management of the inpatient service it is expected that the fellow will learn the key concepts of induction and maintenance immunosuppression, medical management of post-operative transplant patients, the recognition of surgical complications and the management there of, as well as the management of infectious, immunologic, and malignant complications of transplantation and chronic immunosuppression.

Operative Experience

Donor Procurements

The fellow will be expected to develop independence in multi-organ procurement over the first six months of their fellowship and develop their skills through graduated responsibility in the operating room.

After six months the fellow will be expected to travel independently with a resident or PA for DBD donors. An attending surgeon will always travel with the fellow for DCD procurements, however it will be expected that by the end of the two-year fellowship the fellow will be independent in DCD procurements as well.

As part of the donor procurement curriculum the fellow will be expected to learn about the appropriate evaluation of organ offers both liver and kidney and the interpretation of cross-match results under the supervision of the on call attending surgeon.

Transplants

It is expected that the fellow will be present at as many transplants as possible during their fellowship (in compliance with the ASTS managed time policy). Fellows will develop independence in kidney and liver transplant over the course of their fellowship through a program of graduated responsibility in the operating room.

The fellow will be expected to participate in the education of general surgery residents and medical students who are rotating with the Transplant team.

Outpatient Clinic Experience

The fellow will be expected to participate in at least one half day clinic per week.

This dedicated clinic time will rotate through all of the different disciplines of outpatient management including:

• Pre-transplant evaluations – Liver & Kidney
• Post-transplant follow-up – Liver & Kidney
• Living Donor Evaluations – Liver & Kidney

Weekly Education Sessions

Department of Surgery

Grand Rounds: every Wednesday at 7 am

Morbidity & Mortality Rounds: every Monday at 5 pm: Fellows will be responsible for presenting cases and/or supervising the presentations by General Surgery Residents rotating with the Transplant team.

Division of Intra-Abdominal Transplant

Multidisciplinary conferences:

• Liver Radiology Review Conference – weekly multi-disciplinary review of liver tumor patients (involves Radiology, IR, Hepatology, and Transplant surgeons)
• Kidney & Pancreas Transplant Multi-Disciplinary Review Board
• Waitlist Review
• LD Case Discussions
• Liver Transplant Multi-Disciplinary Review Board
• Waitlist Review
• New Case Discussions

Didactic Lecture Series:

• Weekly hour long teaching sessions given by the Transplant Faculty with a curriculum designed to include topics from Surgical, Nephrology, Hepatology, Infectious Disease, and Pathology disciplines.

Monthly Educational Sessions

Morbidity and Mortality conferences:

• Kidney & Pancreas M&M – Cases to be presented by Fellow and/or Residents
• Liver M&M – Cases to be presented by Fellow and/or Residents

Division of Intra-Abdominal Transplantation Journal Club

• Journal articles to be presented by Fellow in an informal multi-disciplinary environment

Kidney & Liver QAPI/Protocol Meetings

• The fellow will participate in these meetings to learn how protocols are developed and adjusted over time.

Evaluation Process

The Fellow will be evaluated on an ongoing basis by all members of the Surgical Teaching Faculty. It is expected that feedback will be given in a constructive and timely manner.

Formal evaluations will occur every six months and will include a written evaluation completed by all clinical faculty and a sit-down performance review with the Program Director.

The Program Director will conduct informal reviews which occur every three months with one of the clinical faculty, in the form of a sit-down meeting, to serve as an interim evaluation and an opportunity for the fellow to discuss any problems or concerns that they may have.

These meetings will also serve as a checkpoint to help the fellow and the faculty direct the fellow’s experience over the next three months. A summative review and evaluation takes place at the conclusion of the fellowship.