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Mini-Fellowships
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 Mini-Fellowship Program
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Overview
Minimally invasive or laparoscopic surgery is a rapidly evolving advanced discipline that has experienced significant growth and demand in the past 10 years. Competency for a minimally invasive thoracic and foregut surgeon requires training that involves acquisition of both technique related skills, and the cognitive principles of thoracic surgery. Currently, few if any surgical residency programs provide adequate training in this focused discipline to enable a surgeon to achieve any level of baseline competency. Short 2-3 day introductory post-graduate courses or even weeklong observational preceptorships are valuable but are woefully inadequate for most inexperienced surgeons seeking preparative training for operative and clinical practice. A one-year fellowship with an emphasis on laparoscopic thoracic and foregut surgery supervised by and expert in the field is the ideal training modality available presently that provides training to achieve not only baseline competency but also proficiency. However, few yearlong fellowship opportunities exist to meet present demand, and furthermore, most cardiothoracic surgeons already in practice are unable to forfeit a year of surgical practice to complete a full year-fellowship. Currently no alternative training opportunities exist, other than one-year fellowships, that bridge the gap between introductory training courses and actual clinical practice. Many surgeons, thus, choose to “go it alone” without adequate training and consequently endure an arduous learning curve that results in unacceptably high complication rates. The “Mini Fellowship”, comprising a 6 week to 3 month “hands on” training experience, is intended to bridge that gap. The “Mini Fellowship” provides the essential training for a practicing surgeon to achieve baseline competency (and not necessarily proficiency) in laparoscopic surgery in order to begin safe clinical and operative practice.
Goal of Mini-Fellowship
The goal of the mini-fellowship in minimally invasive thoracic and foregut surgery at the University of Pittsburgh is to provide a focused and concentrated 6-week to 3-month training experience under the direction of experienced surgeons for qualified surgeons who wish to begin a clinical program in minimally invasive thoracic and foregut surgery. Upon completion, the trainee should be able to perform specific minimally invasive thoracic and foregut operations safely and have a basic understanding of preoperative and postoperative management concepts.
Qualifications/Prerequisites
Surgeons applying for the mini-fellowship should have completed an ACGME approved residency in General Surgery and must be Board Certified (or Board eligible) in Cardiothoracic Surgery by the American Board of Surgery. Experience in advanced laparoscopy including but not limited to laparoscopic fundoplication, colectomy, splenectomy, and hernia repair is required. Experience in laparoscopic suturing techniques and flexible endoscopy is highly recommended. Prior experience in open thoracic surgery is required. Prior completion of a laparoscopic fellowship is desirable but not required.
Application
Surgeons meeting the above qualifications and requirements may apply and will be accepted into the program at the program directors discretion based on the applicant’s ability to meet the above requirements. The University of Pittsburgh does not discriminate on the basis of age, sex, race, or religion. After completing the application form and submitting a CV, the applicant will be notified with in 4-6 weeks whether he or she has been accepted and when the mini-fellowship program will begin. The duration of the mini-fellowship is at the discretion of the program director and will be determined prior to beginning the program.
Administrative Prerequisites
Prior to beginning the fellowship, applicants must apply for and receive privileges to practice medicine at the specific UPMC hospitals where minimally invasive thoracic and foregut surgery is performed. These include but are not limited to Presbyterian Hospital and Shadyside Hospital. In general, a Pennsylvania State medical license is required for privileging. Obtaining a Pennsylvania license may take 3 months or more. Privileging is determined by separate hospital privileging boards. In addition, applicants must have medical malpractice coverage for the duration of their training experience.
Program Description
All fellows will be under the direct supervision of Dr. James Luketich and associate faculty who have all completed a fellowship in advanced laparoscopy with extensive experience in minimally invasive thoracic and foregut surgery. The hands-on program will involve experience in all major aspects of thoracic and foregut surgery including operative experience, inpatient clinical management, and outpatient clinical management. Fellows will be required to document their experience in each of these fundamental areas. Weekly mandatory conferences will provide the fellows with the opportunity to explore and discuss challenging patient problems that may involve preoperative assessment, intraoperative decision-making, or postoperative care. Textbook reading focusing on the essentials of thoracic and foregut surgery will be required. Animal laboratory experience is available on an optional basis.
Mini-Fellow Patient Care Responsibilities
Fellows will be required to participate in patient care activities commonly performed by house staff and fellows. These include daily patient rounds and in-patient management, outpatient clinic evaluations, hospital admission and discharge dictations. On occasion, fellows will be required to take on “on-call “ duties not to exceed 2 nights per week.
Mini-Fellowship Completion
Successful completion of the mini-fellowship will be determined by the program director. Documentation of satisfactory completion will be rendered within the specified time of completion of the program in the form of a certificate. Successful completion of the training program does not infer or imply competency to perform laparoscopic thoracic and foregut surgery nor does it ensure that privileges to perform laparoscopic thoracic and foregut surgery are granted. Procedure specific privileges are determined at the discretion of individual hospitals.
Credentialing and Certification
Upon successful completion, fellows will receive a certificate that acknowledges completion of the training program. Accompanying the certificate will be documentation of the fellow’s clinical experience. Although fellows are free to use the certificate as a vehicle to achieve credentialing or privileges, it does not infer or imply competency to perform advanced minimally invasive thoracic and foregut surgery.
Post Fellowship Support/Guidance
Following completion of the fellowship, Dr. Luketich and/or associates will provide informal guidance via telephone, email, or teleconferencing relating to the practice of minimally invasive thoracic and foregut surgery.
Post Fellowship Mentoring
Following completion of the fellowship, Dr. Luketich and/or associates, on invitation and based on availability, will agree to visit the fellow at his/her hospital in order to observe and mentor him/her while performing minimally invasive thoracic and foregut surgery. Mentoring at the fellow’s hospital is intended to be a helpful adjunct to the fellowship but is optional and is not considered part of the formal fellowship training. Expenses to cover post fellowship mentoring will be charged separately and are not included in fellowship training costs.
Costs
The all-inclusive tuition for the 6-week to 3-month training fellowship is determined in advance of the fellowship dependent on the length of the training program. This cost does include all administrative costs incurred by the Department of Surgery and Dr. Luketich’s office and all other costs associated with actual teaching and training. Certificates of completion will be granted after the entire balance has been received. The Fellow and/or sponsoring institution will be responsible for all personal expenses related to living expenses and travel during the fellowship-training period. These include but are not limited to air travel, local travel, room, board, and miscellaneous expenses. Whenever possible, Dr. Luketich’s office staff will provide guidance in selecting and securing local accommodations.
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