This fellowship program is designed as a rotating preceptorship. Fellows spend about one month to two months with the each of the primary teaching attending physicians and work very closely with the program's colorectal surgeons. Fellows take histories and perform physical examinations on new and established patients, make ward rounds alone or with one of the attending staff, write progress notes, order and interpret diagnostic tests, perform and assist surgical procedures, learn and perform diagnostic and therapeutic colonoscopies, teach and participate in assigned conferences and present clinical cases when necessary. Additionally, fellows spend 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 are observed, managed and discussed within this one-year experience.
Approximately 250 patients are available to be seen in the office each week. During clinic and office hours, a one-to-one teaching ratio is maintained with a fellow and an experienced colorectal surgeon. New and established patients are assessed with the attending surgeon. Since fellows also participate in inpatient care, they have the opportunity to follow patients before, during and after surgery. Anoscopy, rigid and flexible sigmoidoscopy, sclerotherapy, infrared photocoagulation, rubber-band ligation of hemorrhoids and minor, office-based anorectal procedures are performed.
More than 60 endoscopic procedures are performed weekly, including sigmoidoscopy, colonoscopy and pouchoscopy. In the endoscopy suite, fellows learn the basics of gastrointestinal endoscopy and then perform diagnostic procedures. As the year progresses and personal competence is demonstrated, fellows learn and perform colonoscopic polypectomy and other therapeutic endoscopic techniques.
About 20 abdominal and anorectal surgeries are performed in the operating room each week, and the entire spectrum of colorectal surgical procedures is available to fellows. Specialized cases, including, but not limited to, rectovaginal fistulas, sphincter repairs, rectal prolapse surgery, and ileal/colonic pouches are available to fellows, regardless of their rotation.
In the anorectal physiology lab, fellows learn and personally perform anorectal manometry, pudendal nerve studies, anorectal biofeedback and anorectal ultrasound. These activities are performed under the guidance of other Cedars-Sinai attending physicians, all of whom are recognized experts in their fields of interest. This experience teaches the important role of these diagnostic tests in the clinical management of patients with colorectal diseases. Fellows also learn from expert nurses the art and science of enterostomal therapy.
A typical week for colorectal surgery fellows begins Monday morning with assisting and performing diagnostic and therapeutic colonoscopies. On Monday afternoons, fellows spend time in the anorectal physiology lab performing manometry, biofeedback, pudendal nerve studies, and anorectal ultrasound. Tuesdays are spent in the operating room assisting and performing a variet of colorectal surgical procedures. On Wednesday mornings, fellows perform colonoscopies. On Wednesday afternoons, they are in a private office setting with one of the attending staff. Thursdays and Fridays are spent in the operating room.
Clinical conferences, seminars, a journal club and one-on-one instruction are important parts of the Cedars-Sinai Colon and Rectal Surgery Fellowship.
Fellows actively participate in:
- A weekly one-hour inflammatory bowel disease clinical conference involving colorectal surgeons and the gastroenterology staff. Clinical cases are presented to optimize medical and surgical management of these diseases. Fellows are expected to present and discuss cases at these conferences.
- A weekly one-hour colorectal surgery clinical conference 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 addressed. Fellows are expected to present and discuss cases at these conferences. The last conference of each month is a journal club, at which journals aimed at gastrointestinal disease are discussed. The primary journal will be Diseases of the Colon and Rectum.
- A weekly one-hour course dedicated to reviewing core subjects. This course is based on the American Society of Colon and Rectal Surgeons textbook Colon and Rectal Surgery. Fellows review and present roughly one chapter every two weeks; the entire book is covered during the year.
- A weekly review of the Colon and Rectal Surgery Self Assessment Program. Fellows review five questions weekly.
- A monthly colorectal surgery morbidity and mortality conference. Fellows are expected to participate and present cases of the attending colorectal staff.
- A monthly multidisciplinary colorectal cancer tumor board. Fellows are expected to participate and present cases of the attending colorectal staff.
- A weekly general surgery clinical conference, addressing the diagnostic workups and therapeutic approaches to a number of diseases, including those of the colon and rectum. Fellows are expected to actively participate, and it is mandatory for fellows to lecture at this conference once a year.
Fellows' opportunities in clinical and basic research are outstanding. Fellows are encouraged to pursue a number of research projects and publish at least two research papers during the year. They are sponsored to attend the yearly national American Society of Colon and Rectal Surgeons meeting and all meetings of the Southern California Society of Colon and Rectal Surgeons. Other national or regional meetings will be sponsored if fellows have a paper accepted for presentation.
Surgical training in Singapore has been recently integrated into the Cedars-Sinai Colon and Rectal Surgery Fellowship. This unique experience enables a global exchange of the art and science of modern colorectal surgery. Fellows, along with the program director, participate in a weeklong, all-expense-paid academic, research and clinical interchange with colorectal surgeons at National University Hospital. This part of the program promotes and encourages collaboration in clinical and academic colorectal surgery.