Advanced GI MIS/Bariatric Fellowship Program

Overview: This is a one-year advanced minimally invasive, GI, and bariatric surgery fellowship with a strong experience in therapeutic flexible endoscopy including per oral endoscopic myotomy (POEM).  Graduating fellows will have enough experience to be certified by the Fellowship Council, the American Society of Bariatric and Metabolic Surgery (ASMBS), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). It is one of the oldest MIS fellowships in the country and an inaugural member of the Fellowship Council. Our program has been in continuous existence since 1996. We have graduated more than 53 fellows.

Mission: The Houston Methodist Hospital MIS/Bariatric fellowship strives to help competent surgeons become master surgeons. We are dedicated to advanced MIS training. We believe that these fellowships are an important educational experience. In our one-year fellowship program, fellows and faculty commit to a one year relationship wherein we seek to provide our fellows with technical and cognitive training that will enable them to go beyond “competence” and achieve mastery within the fields of general, GI, and bariatric surgery. We want to create desirable candidates for both academic and private practice settings. We want to create candidates whom patients will seek out for their surgical care.

Location: The fellowship is based exclusively at the Houston Methodist Hospital (HMH), the largest adult hospital in the Texas Medical Center. HMH operates over 830 beds and 78 operating rooms and is ranked number one in Texas and in the top 20 nationwide by US News and World Report. It is an academic affiliate of Weill Cornell Medical School with 36 ACGME and 7 non-ACGME accredited training programs.

Faculty:

Team A:

• Vadim Sherman, MD, FACS Fellowship Director                                  
• Lee Morris, MD, FACS

Team B:  

• Nabil Tariq, MD, FACS Fellowship Co-Director                                  
• Patrick Reardon , MD, FACS

Clinical Experience: This is a high volume program accepting two fellows per year. The fellows work with all four faculty, spending time rotating on the two clinical teams. Each team is staffed with a resident and/or intern and a physician assistant. The fellow is expected to run the team. The majority of cases are advanced foregut (Nissen, Linx, POEM, diaphragmatic hernia, etc.), bariatric, and abdominal wall reconstruction. There is also a strong experience in common bile duct exploration, gastric pacing, and diaphragm pacing. Very little colon work is done and no robotics. In addition to the operative experience, there is extensive exposure to advanced therapeutic flexible GI endoscopy both in the OR and the endoscopy suites. This includes upper and lower endoscopy, dilation, stenting, radiofrequency mucosal ablation, polypectomy, endoscopic mucosal resection, Stretta, and endoscopic suturing.

Non-clinical Opportunities: This fellowship is based in a busy, academic, tertiary care center. As part of the culture, academic activity is strongly encouraged. Research opportunities are readily available. However, the sophistication of the project will rely on the dedication of the fellow to perform the work as there is no rotation for research, no built-in funding support, and no research infrastructure designed solely for the support of fellows. Fellows will be allowed to block time from their clinical activities to work on research projects and are required to submit at least one video to a major meeting and one manuscript or book chapter for publication. The Fellowship Co-director works with the fellow to create an academic productivity plan at the beginning of each year. Because minimally invasive surgery is a video-based realm, fellows are required to learn video editing. To support this effort, a complete studio, including digital still and video cameras, digital and analog recorders, lighting equipment, a sound booth, and computers and software for all video and audio editing purposes are provided. Travel and registration fees are paid for any fellow who has work accepted for podium presentation at a national meeting. Fellows are also strongly encouraged to attend the SAGES Therapeutic Endoscopy Course for Fellows in the fall and the national meetings for the American College of Surgeons and SAGES.

Skills Training: Given the time-compressed fellowship experience, it is important for fellows to get up to speed with their basic technical skills as soon as possible. This is a key to independent work in the operating room. To aid in this pursuit, fellows have 24/7 access to the Inanimate Skills Lab (ISL) – a 1,500 sq ft laboratory where they are expected to rehearse to proficiency on laparoscopic and endoscopic skills. The ISL is conveniently located one floor up from the operating rooms and staffed with a full time technician.

Fellows will also do wet-lab skills training in MITIE (Methodist Institute for Technology, Innovation, and Education) – a 40,000 sq ft education and research facility where over 6,000 healthcare professionals train annually. MITIE’s mission is to help practicing surgeons acquire new procedural skills and integrate new technologies into their practices. Animate and cadaver labs are made available for the fellows to rehearse whole procedures in a simulated environment. There is also the opportunity for fellows to audit MIS and endoscopic training programs that are being conducted in MITIE for practicing surgeons and endoscopists. Hands-on training for these programs is made available as space allows.

Characteristics of a successful fellow in our program: Fellows that are successful in this program are motivated, trustworthy, self-directed, and resilient. They are also comfortable in merit-based progression to independent work. Technically they possess good basic laparoscopic skills (proficient at the Fundamentals of Laparoscopic Surgery tasks) and are able to work with their non-dominant hand.

Take-home Message: This is a busy and diverse fellowship with experienced faculty who are leaders in their field and love to teach. The clinical experience is more diverse than most fellowships with a broad MIS experience, plenty of bariatric surgery volume, and an emphasis on cutting-edge surgical endoscopy – an area we see as the future of MIS surgery. Graduated fellows have become chairs of departments of surgery, professors of surgery, leaders in national surgical organizations, and very productive and successful non-academic surgeons. In fact, we’ve multiple of our own graduates into our department and hospital system. We believe this fellowship provides a strong platform for graduating fellows to become leaders in their field.

Basic Program Information:

• Location: The Texas Medical Center, Houston, Texas
• Primary Program Site: Houston Methodist Hospital
• Primary Hospital: Total bed size, # OR's, # Surgical ICU beds:
• Secondary Program Site:
• Secondary Hospital: Total bed size, # OR's, # Surgical ICU beds: None
• Clinic locations and schedule:
• University Affiliation: Weill-Cornell Medical College
• School of Medicine Affiliation: Weill Cornell School of Medicine
• Year Program and/or Designation Established: 1996
• Number of Faculty: 4
• % of Program Clinical: 95
• % of Program Research: 5

Additional Program Information:

• Interaction with Residents: Some cases shared
• Is there a General Surgery Residency at the Primary Institution? Yes
• Is there a General Surgery Residency at the Secondary Institution? No
• Is there a curriculum in place for fellowship? Yes
• Is there a skills lab at the institution with fellow access? Yes
• Are there teaching conferences available for the fellow? Yes
• Is there an evaluation tool for fellow by faculty in place? Yes
• Is there an evaluation tool for faculty by fellow in place? Yes
• Papers Accepted For Publication where PD was an author: 5
• Publications that Involved Input from the Fellow: 5
• Are funds available for the Fellow to attend conferences? 1

Malpractice Insurance Information:

• No Information provided.

Contact Information For Questions:

Tahitia Martin
Phone: 713-363-9607
Fax: 713-790-2992
Email: tmartin@houstonmethodist.org

Facilities

• Dry Lab
• Wet lab
• Library
• Administrative Support
• Clinical Research
• Simulation Lab