Curriculum

Program Description

The program provides a well-balanced exposure to surgical procedures, endoscopy, and office practice.  This includes training in open, laparoscopic, and robotic surgery.  A key strength of our program is the comprehensive training in each of the core aspects of colon and rectal surgery, including colorectal cancer, inflammatory bowel disease, anorectal conditions, diverticular disease, pelvic floor disorders, and others.  Opportunities for research abound and are encouraged.

Goals and Objectives

The primary goal of the Colon and Rectal Surgical Fellowship is to develop excellent colon and rectal surgeons who are capable of thriving in both the clinical and academic environment.  Our strength is providing varied surgical and endoscopic cases to allow development of excellent skills in those areas.  Knowledge is also gained in the clinic and office settings so that outpatient problems can be competently managed.  Didactic conferences and Journal Club help the trainee to gain a high level of clinical knowledge to complement procedural skills.

The objective of the Colon and Rectal Surgery Fellowship is to provide sufficient education and training  to ensure certification by The American Board of Colon and Rectal Surgery.  This education and training is to be obtained in four primary areas:

Procedural

This consists of endoscopic and operative experience.  Procedures will be logged using the format provided by The American Board of Colon and Rectal Surgery.  Operative procedure guidelines have been provided by the board. The procedure log will be reviewed semiannually by the program director.

Hospital Care

The fellow is expected to participate in the care of non-surgical patients.  This will include evaluation of emergency department patients, consultations, and rounds.  Faculty will evaluate performance in this area as part of the quarterly evaluation process.

Outpatient Care

The fellow will log exposure to outpatient visits in the clinic and faculty offices.  The minimum objective will be the outpatient experience survey of the program directors association.  This log will be reviewed semiannually by the program director.

Academic Program

The fellow is expected to acquire a sufficient knowledge base by in-depth reading of standard textbooks of colon and rectal surgery.  Recommended texts include Gordon and Nivatvongs, as well as the ASCRS textbook.  The fellow should also have a working knowledge of relevant literature, especially from our specialty journal, Diseases of the Colon and Rectum.

The curriculum used will be The Core Curriculum for Colon and Rectal Surgery: Knowledge Essentials for Residency Training. 

The fellow will be required to submit an abstract to the annual meeting of The American Society of Colon and Rectal Surgery and will be encouraged to participate in regional society meetings.

Educational Objectives

• Alimentary and Digestive System (Colon, Rectum, Anus) 
  
• Demonstrate an understanding of the anatomy, physiology, and pathophysiology of the colon, rectum, and anus.
  
• Demonstrate the ability to manage problems of the colon, rectum, and anus that are amenable to surgical intervention.
  

• Surgical Endoscopy (Colon, Rectum, Anus) 
  
  • Demonstrate knowledge of and the ability to use a variety of endoscopic instruments in the screening, diagnosis, and treatment of various diseases of the colon, rectum, and anus.
    
• Minimal Access Surgery (Colon, Rectum, Anus) 
  
  • Demonstrate an understanding of the applications and risks of minimal access surgery.
    
  • Demonstrate an understanding of the technical and physiologic principles of minimal access surgical techniques.
    
  • Develop specific technical skills and demonstrate proficiency in performance of basic laparoscopy and robotic surgery with special emphasis on the colon, rectum, and anus. 

Curriculum

The academic curriculum is based on the “Core Curriculum for Colon and Rectal Surgery; Knowledge Essentials for Residency Training” developed by the Association of Program Directors for Colon and Rectal Surgery.  The colon and rectal surgery fellow leads the Colon and Rectal Surgical Service at Corewell Health with assistance from the senior general surgery resident.  This provides for training in inpatient and outpatient surgical and endoscopic procedures.  The fellow staffs the outpatient clinic under supervision of attending staff, where patients with colon and rectal surgical problems are seen on referral from other resident clinics.  Time is spent each week in the private office of an attending colon and rectal surgeon for exposure to office practice.

Didactics

A weekly educational conference is provided by the Department of Colon and Rectal Surgery.  Presentations include core curriculum topics, interesting case presentations, morbidity and mortality presentations, CREST modules, and a weekly Tumor Board.  A journal club is held monthly.  

The colon and rectal surgery fellow is also invited to attend the various conferences presented by the Department of Surgery as he or she finds appropriate.

Research

A research project is required for completion of the program.  Recent poster and podium presentations have been made at the meetings of the Michigan Society of Colon and Rectal Surgery as well as the American Society of Colon and Rectal Surgery.  Ample clinical material allows for a wide spectrum of potential clinical research projects.

Conferences

A colon and rectal surgery conference is held every Monday morning and the general schedule is as follows:

• 1st Monday – Fellow lecture given to general surgery residents
• 2nd Monday – Interesting Case Conference/Indications Conference
• 3rd Monday – Attending lecture/CREST review
• 4th Monday – Morbidity and Mortality 

Multidisciplinary Tumor Board/Rectal Cancer conference is held on Wednesday mornings.

Journal Club is held on the first Wednesday of the month from September to May.

Supervisory Lines of Responsibility

• The individual patient care activities of the colon and rectal surgery fellow are to be performed under the direct supervision of the specific faculty member involved with each case.
  
• Clinic patients are the primary responsibility of the colon and rectal surgery fellow under the supervision of the faculty member assigned to the clinic according to schedule.
  
• The colon and rectal surgery fellow will be informed as to the faculty night and weekend call schedule to expedite patient care during those times.
  
• The program director will be responsible for the program requirements as described in the Graduate Medical Education Directory.
  
• The departmental chairman will be responsible for the administrative program of the Department of Colon and Rectal Surgery.

Duty Hour and Moonlighting Policy

• The colon and rectal surgery fellow will not be on duty for more than 80 hours per week averaged over 4 weeks.
  
• The program does not require in-house call.
  
• The fellow will have at least one day in seven free from all educational and clinical responsibilities averaged over 4 weeks.
  
• The fellow may be called in from home on a very limited basis but this will not occur on days off.  The indications for call-ins are expected to be evaluation of patients in the emergency room or for emergency surgical cases.  These specific call-ins will be at the discretion of the faculty for interesting or unusual patients deemed to be of educational value.  The vast majority of the weekend consults and emergencies are handled by the in-house general surgery residents.
  
• It is the policy of the Colon and Rectal Surgery Department to not allow either external or internal moonlighting.
  
• The fellow’s weekly duty hours will assume to be from 6:00 am to 6:00 pm.  The fellow is asked to count any duty hours beyond 6:00 pm and also to account for any weekend duty hours.  The fellow is also asked to log telephone calls and returns to the hospital to tend to patient evaluations and surgical procedures.  This log will be reviewed on a monthly basis by the program director.

Patient Population

Corewell Health cares for a unique population of patients.  We are one of the largest health care providers in the state of Michigan and attract a large number of newly diagnosed cancer patients from self-referrals as well as tertiary referrals to our center.  Our patients are ethnically diverse, representing the broad spectrum of cultures from the greater Detroit suburbs and outlying communities.

Vacation Policy

For the purposes of vacation policy, a “week” is defined as seven (7) consecutive days.  All fellows will receive four (4) weeks paid vacation including educational leave for one approved conference per academic year.  No fellow should be denied a legitimate request for vacation time, provided such request does not compromise patient safety.  All vacation requests must be received no later than the first day of the preceding month.