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This ACGME-approved fellowship is a one-year comprehensive clinical and research program at the Cedars-Sinai Medical Center, one of the largest hospitals in the Los Angeles area. The goal of this program is to teach competent general surgeons to become especially well versed in the diagnosis and management of diseases and disorders of the colon, rectum and anus. The program is managed under the auspice of Dr. Phillip Fleshner, Colorectal Fellowship Program Director. The primary teaching responsibilities are with Dr. Fleshner and his associates, all of whom are board-certified colorectal surgeons actively involved with surgical education and research. This program prepares the fellow to apply for and successfully obtain certification by the American Board of Colon and Rectal Surgery.
The program can be characterized as a rotating preceptorship. The fellow spends approximately two months alternately with each of the primary teaching attendings. The fellow works very closely with all of the program's colorectal surgeons. The fellow performs history and physical examinations on new and established patients, makes ward rounds alone or with one of the attending staff, writes progress notes, orders and interprets diagnostic tests, performs and assists surgical procedures, learns and performs diagnostic and therapeutic colonoscopy, teaches and participates in assigned conferences, and presents clinical cases when necessary. Additionally, the fellow spends time with other members of the Cedars-Sinai teaching staff, gaining valuable insights into enterostomal care, anorectal and colonic physiologic testing, anorectal ultrasound and pelvic floor disorders. Essentially all aspects of colorectal surgery will be observed, managed, and discussed within this one-year experience.
Approximately 250 patients are seen in the office each week. During clinic and office hours, there is a one-to-one teaching ratio with an experienced colorectal surgeon. New and established patients are assessed with the attending surgeon. Since the fellow also participates in inpatient care, he/she has the opportunity to follow patients before, during and after surgery. Anoscopy, rigid and flexible sigmoidoscopy, sclerotherapy, infrared photocoagulation and rubber band ligation of hemorrhoids, and minor office-based anorectal procedures are performed.
Over 60 endoscopic procedures are performed weekly, including sigmoidoscopy, colonoscopy and pouchoscopy. In the endoscopy suite, the fellow learns the basics of gastrointestinal endoscopy and then performs diagnostic procedures. As the year progresses and his/her personal competence is demonstrated, the fellow learns and performs colonoscopic polypectomy and other therapeutic endoscopic techniques.
Furthermore, there are approximately 20 abdominal and anorectal surgeries performed in the operating room each week. The entire spectrum of colorectal surgical procedures are available to the fellow. Specialized cases, including but not limited to rectovaginal fistulas, sphincter repairs, rectal prolapse surgery, and ileal/colonic pouches are available to the fellow regardless of the rotation he/she is currently on.
In the anorectal physiology lab, the fellow learns and personally performs anorectal manometry, pudendal nerve studies, anorectal biofeedback and anorectal ultrasound. These activities are performed under the guidance of other Cedars-Sinai Medical Center attendings, all of whom are recognized experts in their field of interest. This experience also teaches how these diagnostic tests are important in the clinical management of patients with colorectal diseases. The fellow also learns from expert nurses the art and science of enterostomal therapy.
A typical week as a colorectal surgery fellow begins on Monday morning, when he/she assists and performs diagnostic and therapeutic colonoscopy. On Monday afternoons, the fellow spends time in the anorectal physiology lab performing manometry, biofeedback, pudendal nerve studies, and anorectal ultrasound. On Tuesdays, the fellow spends the entire day in the operating room assisting and performing a variety of colorectal surgical procedures. On Wednesday mornings, the fellow performs colonoscopy. On Wednesday afternoons, the fellow is in the private office setting with one of the attending staff. Thursdays and Fridays are spent in the operating room.
Clinical conferences, seminars, journal club and one-on-one instruction are important parts of the Cedars-Sinai Colorectal Fellowship Program. The fellow actively participates in the following:
- A weekly one-hour Inflammatory Bowel Disease clinical conference involving colorectal surgeons and the gastroenterology staff. Clinical cases are presented in an attempt to optimize medical and surgical management of these diseases. The fellow is expected to present and discuss cases at these conferences.
- A weekly Colorectal Surgery Clinical Conference lasting one-hour with all colorectal staff in attendance. At this conference, cases operated on in the previous week are discussed. Specific indications, diagnostic management, surgical procedures, and complications are also addressed. The fellow is expected to present and discuss cases at these conferences. In the last week of each month, this conference becomes a Journal Club. Journals aimed at gastrointestinal disease will be discussed. The primary journal will be Diseases of the Colon and Rectum.
- A weekly one-hour course dedicated to review core subjects is conducted. This conference is based upon the ASCRS Textbook Colon and Rectal Surgery. Roughly one chapter is reviewed and presented by the fellow every two weeks, with the entire book being covered during the year.
- A weekly review of CARSEP. Five questions are reviewed weekly by the fellow
- A monthly Colorectal Surgery Morbidity and Mortality conference is conducted. The fellow is expected to participate and present cases of the attending colorectal staff.
- A monthly multidisciplinary Colorectal Cancer Tumor Board. The fellow is expected to participate and present cases of the attending colorectal staff.
- A weekly General Surgery Clinical Conference, addressing the diagnostic workup and therapeutic approach to a number of diseases, including those of the colon and and therapeutic approach to a number of diseases, including those of the colon and rectum. The fellow is expected to actively participate, and it is mandatory for the fellow to lecture at this conference once a year.
The fellow's opportunities in clinical and basic research are outstanding. The fellow is encouraged to pursue a number of research projects and publish at least two research papers during the year. The fellow is sponsored to attend the yearly national American Society of Colon and Rectal Surgeons meeting and all meetings of the Southern California Chapter of Colorectal Surgeons. Other national or regional meetings will be sponsored if the fellow has a paper accepted for presentation.
Surgical training in Singapore has been recently integrated into the Cedars-Sinai Colorectal Surgery Fellowship. This unique experience allows for a global exchange of the art and science of modern colorectal surgery. The fellow, along with the Program Director, will spend a weeklong academic, research and clinical interchange with colorectal surgeons at the National University Hospital. This aspect of the program is an all-expense paid experience, promoting and encouraging collaboration in clinical and academic colorectal surgery.
Although the colorectal staff will take 'first' call, the fellow is expected to take 'second' call. The fellow takes call from home. These hours will comply with all of ACGME work hour guidelines. If necessary, the fellow will evaluate these patients in the office, hospital or emergency room under the guidance of the attending on call. Weekend rounds are performed by the fellow on one of the weekend days. The fellow will have four weeks of vacation.
Stephen Yoo, MD
Appointments and Applications
One colorectal fellow is chosen each year for the Cedars-Sinai's Colorectal Fellowship Program. Qualified applicants must have completed a general surgery residency program at an accredited facility. To apply to the program, please contact the Electronic Resident Application Service (ERAS).
Applications for each academic year, which begins on July 1, should be completed by August of the previous year. If the fellow is considered for an appointment at this competitive program, he/she will be asked to come to Los Angeles for an interview with the program director and faculty members. Interviews are conducted during September and October each year.
We believe that the Cedars-Sinai Colorectal Fellowship is one of the finest in the country. Should you have any questions about our program, please contact:
|Phillip R. Fleshner, MD, Program Director,|
|Colon and Rectal Surgery Fellowship|
|8737 Beverly Blvd., Ste. 101|
|Los Angeles, CA 90048|
|Phone: (310) 289-9224|
|Fax: (310) 289-8995|
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