Hepatopancreatobiliary (HPB) Surgery Fellowship

Program Objectives

1. To teach the fellow the clinical evaluation of HPB tumors and diseases within a multidisciplinary team including  gastroenterology, medical and radiation oncology, and interventional radiology.

2. To teach the fellow the breadth of operative techniques within HPB surgery, specifically including:

a. pancreatic neoplasms
b. liver tumors, including primary and metastatic disease
c. chronic pancreatitis (e.g., pancreaticojejunostomy)
d. complications of acute pancreatitis, including necrosectomy (minimally invasive and open) and cystenterostomy
e. complex biliary surgery, including complications of stone disease and biliary reconstruction after bile duct injury

3. To give special emphasis to minimally invasive HPB surgery, including laparoscopic liver surgery, laparoscopic left pancreatectomy and enucleation, and minimally invasive surgery for pancreatitis (laparoscopic transgastric cystgastrostomy and necrosectomy and minimally invasive retroperitoneal pancreatectomy (MIRP))

4. To provide the fellow opportunities to serve in a teaching role in the OR and on the ward. The fellow is expected to participate in teaching rounds and will be an important contributor to the education of our general surgery residents and medical students.

5. To provide the fellow with opportunities and support for scholarly activities.

To help achieve these objectives, the fellow is expected to participate in the following educational activities (as permitted by fellow’s rotation schedule):

1. Weekly SUMC HPB/Surg Onc pre-operative case conference
2. Weekly SUMC Liver Tumor Board
3. Weekly SUMC General Surgery Morbidity and Mortality conference
4. Weekly pancreatic disease multidisciplinary conference (conference with GI pancreatologists and interventional endoscopists to discuss challenging clinical cases)
5. Bi-weekly HPB didactic lecture

While rotating at SUMC, the fellow is expected to take a leadership role in the biweekly HPB conference. This teaching conference takes the form of a discussion of important themes and controversies within a specific subject area (rather than a patient/case-based format) following an assigned reading list. Topics include but are not limited to:

· Essential Hepatic and Biliary Anatomy for the Surgeon
· Imaging of the Liver, Bile Ducts and Pancreas
· Interventional Radiology in Hepatobiliary Surgery
· Liver resection in Cirrhotics
· Ampullary Cancer
· Colorectal Liver Metastases
· Non-Colorectal Liver Metastases
· Surgical Techniques of Open Cholecystectomy
· Surgical Techniques for Bilioenteric Bypass
· Hilar Cholangiocarcinoma
· Hepatic Ablation: Cryotherapy and RFA

Goals

The goal of the HPB fellowship is to provide the fellow with the experience necessary for him/her to provide comprehensive, state-of-the-art medical and surgical care to patients with surgical diseases/disorders of the liver, pancreas, biliary tract and duodenum. This will include the ability to investigate, diagnose, recommend appropriate treatment options, perform operative procedures, and provide the pre- peri- and late postoperative care.

The primary goals for the fellow can be broken down as follows:

· Master the perioperative assessment and risk stratification of patients requiring major surgery
· Gain additional experience in the day-to-day management of very complex inpatients after major abdominal surgery as the primary decision maker for routine inpatient care
· Gain additional understanding in the principles of preoperative HPB cancer evaluation and staging
· Gain experience with the multi-modality treatment of HPB cancer and the role of surgery in the context of other anti-cancer therapies
· Refine surgical skills, performing complex UGI and HPB operations via both the open and laparoscopic approaches—these cases routinely include Whipple pancreaticoduodenectomy, liver resections, biliary reconstructions, laparoscopic distal pancreatectomy, etc.

Faculty

At Stanford University on the HPB/Surg Onc Services, the HPB fellow works predominantly with four surgeons: Dr. Jeffrey Norton (Section Chief of Surgical Oncology), Dr. Brendan VisserDr. George Poultsides, and Dr. Monica Dua. Dr. Visser serves as the fellowship director and Dr. Dua as the assistant program director. This is a preceptor model, so at any given time the fellow works with one of the faculty members very closely in the OR, clinic, and on the ward.

Research Component/Clinical Procedural and Patient Care Responsibilities

The fellow is expected to participate in the clinical research mission of the HPB Section. The fellow meets with the program director within the first month of the fellowship to delineate clinical research opportunities and available projects. Two months of each year of the fellowship will be free of routine clinical responsibilities to have the time and energy necessary to ensure successful completion of the identified research project(s). The fellow is expected to attend the AHPBA meeting each year and is strongly encouraged to submit one or more abstracts for consideration.

The fellow participates in the outpatient clinics of each faculty member (1 day/week) during each rotation (mentor model, working with one faculty member at a time). This includes new patient consultations, perioperative care, and long term follow-up (e.g., cancer surveillance).

Prerequisite Training/Selection Criteria

Citizenship and Visa Requirements:
US Citizens,  US Permanent Residents (Green Card),  Canadian Citizens, Canadian Permanent Residents,  Non U.S. Citizens eligible for/with planned J-1 Visa during their fellowship (For U.S. Fellowship Programs).

Medical School Requirement:
We accept graduates of U.S. or Canadian Medical Schools and Foreign Medical Schools only if ECFMG Certified.

Examinations and Certifications:
Applicants must have passed the USMLE/COMLEX Step 1, 2, & 3 exams, had at least 1 year of prior training in an ACGME accredited residency or fellowship (or Canadian equivalent),  are ABS or Canadian Board Eligible or Certified, and hold a General Surgery specialty certificate from a Board or College outside of U.S. or Canada at the beginning of the fellowship

Licensure Requirements and Information: Incoming Fellows:
1. Must have completed 1 year of prior training in an ACGME accredited (or Canadian equivalent),  residency or fellowship program in the United States.
2. International Medical School Graduates (IMGs) must complete certification from the Educational Commission for Foreign Medical Graduates (ECFMG) and Step 3 of United States License Examination (USMLE).
3. Are expected to obtain an unrestricted California license prior to starting at Stanford University Medical Center.

How To Apply

Applications must be submitted via The Fellowship Council

Important Dates

Application Opens: December 4, 2017

Deadline to Apply: February 13, 2018

Interview Dates: March 30, 2018 and April 11, 2018

Match Process Date: June 12, 2018

Fellowship Begins: August 1, 2019

Accreditation

The Stanford HPB Fellowship Program is accredited by The Fellowship Council and AHPBA

HPB Fellowship

Contact

Jurna Flaris
Fellowship Coordinator
650-723-3826
stanfordhpb@stanford.edu