The fellow will be provided a diverse exposure to complex abdominal wall pathology in both an academic referral center as well as an affiliate community hospital. The fellowship consists of three abdominal wall core faculty at the primary academic site, Oregon Health and Science University, (OHSU) as well as exposure to a community based complex abdominal wall practice at Adventist Health Portland. (1-2 days per month). There is an opportunity to work with other MIS faculty at Hillsboro Medical Center who perform a variety of hernia, flexible endoscopy, foregut and bariatrics. All faculty perform advanced laparoscopic and robotic surgery. Fellows will be expected to complete a rotation at all three sites as part of their fellowship. In addition to surgical management, our abdominal wall team utilizes chemical component separation as an adjunct for select complex reconstructions. Due to complex surgical needs, frequent collaboration occurs with surgeons within surgical oncology, colorectal surgery, urology, vascular surgery, and pediatric surgery.
The fellow is appointed as an Instructor within the Department of Surgery. Clinical responsibilities include all aspects of care of the Abdominal Wall Reconstruction patients from initial clinic evaluation through post-operative visits.
The fellow has the full attending privileges at the institution and is expected to take monthly general surgery call, with faculty oversight, as part of their educational experience (fellows are expected to take AWRS call at AHP, HMC and OHSU for the duration of their rotation at that location).
Didactics - weekly educational sessions with attendings, medical students and resident learners, and mid-level providers on an MIS, bariatric, or abdominal wall topic. Attendings, fellows and other trainees participate in an educational conference with rotating lecture, case conference and journal club content.
Simulation - both training and teaching opportunities for the fellow exist throughout the on-campus experience as well as outside courses. Recent fellows have enjoyed opportunities for preserved and perfused cadaver dissections and robotic lab education.
Surgical – apprenticeship style training with surgical preceptors, providing graduated autonomy over the course of the year of training.
Outpatient - clinic experience on average of 1 day per week. Commonly encountered problems include recurrent ventral and inguinal hernias, inguinodynia, infected mesh and mesh related GI fistulae. In addition to patient optimization, additional emphasis is placed on interpretation of cross-sectional imaging and operative planning.
Inpatient duties are shared with House staff and an Advanced practice Provider. There is an expectation to cross cover call for the MIS service in a 1 in 3 fashion between the Abdominal Wall/MIS fellow, Bariatric/MIS fellow and a chief surgical resident. These services are run in parallel, with the opportunity to cross cover overflow surgical volume.
Outline of the aim training program hopes to achieve
The fellowship program hopes to develop well rounded fellows with the ability to diagnose and treat a variety of initial and complex recurrent abdominal wall pathology. Graduating fellows should expect to be proficient in the management of complex ventral and inguinal pathology, mesh excision, management of mesh related GI fistulae. Fellows will be able to perform open, laparoscopic, and robotic surgical management.
Unique characteristics
The abdominal core practice at OHSU has decades long history of managing complex hernias in Oregon, as well as patients referred from neighboring states. Patients present with normal, abnormal, standardly surgically modified, and aberrantly surgically modified anatomy – allowing for the fellow to diagnosis and manage abdominal wall reconstructions at various levels of complexity. Due to the institution’s robust IBD center and GU oncology programs, there are a large volume of parastomal (bowel ostomies and urostomies) hernia. Patients choosing to have their care here are co-managed by the colorectal or urology services alongside the hernia service, allowing for multidisciplinary collaboration in complex cases. Additionally, the bread-and-butter cases provide experience in open, TEP, TAPP, and IPUM cases. In complex cases, open, laparoscopic, and robotic platforms are used, allowing the fellow to understand patient selection for each intervention and experience which skills translate or require modification across platforms and varying techniques.
Type of fellow, the program is helping to train
This program is seeking fellows with an enthusiasm for abdominal wall surgery at various levels of complexity. The fellows should be driven to optimize patient care and outcomes, participating in research and QI projects. They should be willing to collaborate in a multidisciplinary setting across surgical and medical subspecialities as well as with nursing and midlevel providers. The fellow should desire to be a teacher and leader to the junior residents and medical students, guiding the future generation of abdominal wall surgeons. The fellow should overall be a physician of upright character who practices ethically and empathetically in their current and future practice.
Teaching responsibilities include lectures and demonstration of abdominal wall anatomy and reconstructive techniques to residents, medical students, and PA students, both in a conference setting as well as intraoperatively. The opportunity exists to serve as a “Teaching Assistant” during cases later in the fellowship.
A wide array of clinical trials, translational and outcomes studies are active within the hernia practice. Fellows are presented opportunities for research and educational activities. It is expected that fellows will participate in at least one project and submit an abstract to a surgical conference. Our program can be a period of substantial growth toward an academic or private practice surgical career, and our faculty will work with you to help you develop your CV to help you achieve your career goals.
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