Colon and Rectal Surgery

The Fellowship in Colon and Rectal Surgery is a one-year program based at Saint Francis Hospital and Medical Center (SFHMC). SFHMC is a major urban tertiary referral center and teaching facility for the University of Connecticut School of Medicine. All major subspecialties are represented at the medical center. Subspecialty programs compliment Fellowship programs in general surgery and internal medicine. This fellow training program offers the fully trained general surgeon an opportunity to acquire specialized training in the treatment of the diseases of the colon, rectum, and anus. An in-depth exposure is offered in the medical and surgical management of patients in both the outpatient and inpatient setting. The fellow is exposed to a broad spectrum of benign and malignant colon and rectal pathologies. The fellow is expected to master the material as outlined in the core curriculum goals. Teaching responsibilities are shared between all teaching staff. The fellow spends time with each faculty member as dictated by the core curriculum and by the personal interests of the fellow. Dedicated time is reserved for didactic sessions and clinic (refer to conference schedule).

The colon and rectal surgery fellow is in charge of the colon and rectal service at SFHMC. This includes care of inpatients on the colon and rectal service, performing consultations, running an outpatient colon and rectal surgery clinic and teaching general surgery fellows and medical students. All activities are under direct and constant supervision of the faculty of the Division of Colon and Rectal Surgery. Additional clinical experience is obtained at Manchester Memorial Hospital (ECHN) and in the private offices of Colon and Rectal Surgeons of Greater Hartford.

Daily responsibilities of the fellow include consultation and evaluation of all admitted patients to the Colon and Rectal Service. A typical inpatient census on the Colon and Rectal Service ranges from 8 to 16 patients. The colon and rectal fellow provides consultations requested by other services and evaluation of patients in the emergency room. The fellow makes daily morning rounds, writes progress notes, orders appropriate labs and investigations, follows up on the care plan, performs surgery and is responsible for all aspects of preoperative care and postoperative care of the patients. A second year general surgery fellow is assigned to the colon and rectal service and shares in some of these responsibilities under the direction of the colon and rectal staff and fellow. Colon and rectal surgery teaching staff are assigned daily to supervise and provide hospital care of the inpatients and provide ongoing clinical teaching to the fellows.

The fellow performs therapeutic and diagnostic endoscopy, transrectal ultrasound and pelvic floor physiological testing. Colonoscopy is performed daily in the mornings at SFHMC. Colonoscopies are performed each day and are available to the fellow. Surgery is performed in the outpatient ambulatory surgery center and in the main operative suites of participating institutions. Operative are selected by the fellow to minimize conflict in the operative schedule and thus maximizing the fellow’s exposure to a broad range of cases. Clinic surgical cases are scheduled during regular operative days staffed by attendings. Follow-up after discharge is provided in the Colon and Rectal Surgery Clinic or in the private offices of Colon and Rectal Surgeons of Greater Hartford. All activity is under the direct and constant supervision of the teaching staff.

The fellow is on call every third weekend. At that time he is responsible for rounding on inpatients at St Francis with the attending staff. The fellow is then available to help with any surgical cases performed that weekend. There is no in-house call. The fellow is not asked to cover telephone calls. No in-hospital call is required by the colon and rectal surgery fellow during the week. Night coverage is provided by the general surgery service at SFHMC. The members of Colon and Rectal Surgeons of Greater Hartford (the faculty) provide night and day call coverage at ECHN hospitals.

Advanced specialty training includes diagnostic and therapeutic sigmoidoscopy and colonoscopy. Pelvic floor and colonic physiology evaluation by anal manometry, MRI and transit time are available at SFHMC and transrectal ultrasound is performed by the fellow in the offices of Colon and Rectal Surgeons of Greater Hartford. Training in radiology is provided by the teaching staff, at teaching conferences and by the department of radiology during teaching rounds. At Colon and Rectal Surgery Case Discussion & X-Ray Rounds (see conference schedule), radiology studies are reviewed with attention to salient teaching points.

Robust training in laparoscopic surgical techniques is provided by approximately 100 laparoscopic cases with teaching staff and by two laboratory sessions at national teaching animal labs at Ethicon or Covidien teaching centers. Laparoscopic simulator sessions are available for fellows with no previous laparoscopic experience at SFHMC. All teaching staff regularly performs laparoscopic surgery colon and rectal surgery. The staff now provide experience with robotic assisted colon resection.

A certified enterostomal therapist provides enterostomal therapy training in formal teaching sessions and on an ongoing basis through daily clinical problem solving in cooperation with the colon and rectal surgery fellow. Fellows are familiarized with stoma products, stoma care, problem solving and wound care.

Research activity is mandatory and each fellow is expected to submit an abstract. A presentation at local and regional meetings is mandatory. Manuscript must be submitted prior to completion of the fellowship.

Fellows are evaluated quarterly in a written format. Currently, a web-based evaluation system is used. Categories of evaluation include patient care and status, fund of medical knowledge, personal and ethical attributes. Ongoing “live” evaluation is given by the program director on a daily basis when appropriate. For example, content of oral presentations and didactic sessions are assessed by the program director and the fellow is given immediate analysis. A final evaluation and exit interview provide feedback to the program director.

The goal of the program is to provide educational experiences as needed in order for their fellows to demonstrate sufficient professional ability at the completion of this Fellowship to practice competently and independently in the field of Colon and Rectal Surgery.  

A structured teaching didactic schedule is established incorporating a series of teaching conferences. The weekly schedule of conferences follows.

Colon and Rectal Surgery Fellow Schedule & Conferences  

 

  • Monday 4:30 pm Research Conference (Monthly, third Monday)
  • Monday 5:30 pm Fellow Lecture to Fellows (Monthly, third Monday)
  • Monday 6:00 pm Colorectal M&M (Monthly, third Monday)
  • Tuesday 8:00 pm Journal Club (Monthly, first Tuesday)
  • Tuesday 9:00 pm Cases Conference (Monthly, first Tuesday)
  • Wednesday 7:00 am Surgery M&M weekly, (first Wednesday dedicated to colorectal
  • Friday 7:00 am-11:00 protected time
  • Friday 11:00 am weekly walk rounds
  • Friday 11:30 am weekly Attending didactic lecture
  • Friday 12:30 pm clinic
  • Gastrointestinal Radiology Teaching Conference Monthly, Monday 8 am
  • Tumor Board Tuesday 12:00 pm

How to Apply

Interested 5th year surgical postgraduates, who are board eligible for the American Board of Surgery examination, may apply through the National Residency Matching Program (NRMP) utilizing the Electronic Residency Application System (ERAS).