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| Colorectal Surgery Research | ||
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Introduction The Department of Colorectal Surgery at Cleveland Clinic Florida maintains an average of six to 24 month non-funded research residency positions in colorectal surgery. These positions are available to general or colorectal surgeons who wish to gain additional experience in both the practical and academic aspects of colorectal surgery. There are over 75 ongoing prospective studies with which the residents become immediately involved. special interest areas or other projects may be pursued in addition to those studies already in progress. Presentations Much of the research relates to anorectal physiology, laparoscopy, inflammatory bowel disease, and carcinoma. Recent projects by our research residents have been presented in many prestigious organizations:
Over 75 chapters, manuscripts, and abstracts were published by the members of the Department during the past year. A list of recently published projects is available upon request. Resident Functions One of the primary functions of research residents is to become familiar with the Anorectal Physiology Laboratory and to help perform and interpret the physiologic studies. Research residents thus gain a broad familiarity with the indications for, techniques of, and interpretations of anorectal manometry, rectal compliance, colonic and small bowel transit studies, cinedefecography, anal electromyography, pudendal nerve terminal motor latency assessment, and anorectal ultrasonography. In addition, time is spent working with the biofeedback therapist and learning the techniques of biofeedback therapy. Research residents are welcome to participate in the clinical aspects of the practice as time permits. There is an exceedingly busy clinical practice with six full time board-certified staff colorectal surgeons, Drs. Steven Wexner, Juan Nogueras, Eric Weiss, Anthony M. Vernava, III, Jonathan Efron, and Dana Sands. In addition to the clinical residents, research residents, and observers, there are nurse clinicians who assist in patient care and help with much of the day-to-day patient management. This involvement allows the research residents more time for interaction in the operating room, endoscopy suite, office, and physiology lab. In addition, there are several dedicated colorectal clinic nurses, enterostomal therapists, and biofeedback therapists. Clinical Procedures Over 150 patients are seen in the office each week and evaluated for a wide gamut of colorectal complaints. Procedures such as rubber band ligation of internal hemorrhoids, excision of thrombosed external hemorrhoids, superficial fistulotomies, incision and drainage of abscesses, incision and drainage of pilonidal abscesses, rectal and perianal biopsies, and fulguration of lesions are performed in the clinic. In addition, there are over 20 rigid proctoscopies and flexible sigmoidoscopies performed in the clinic setting each week. Over 75 colonoscopies are performed each week, approximately two-thirds of which are therapeutic rather than diagnostic. There are usually over 20 resections performed in the hospital each week including segmental and total abdominal colectomies, low anterior resections, abdominoperineal resections, total proctocolectomies, ileoanal reservoirs, proctopexies for prolapse, small bowel resections, and colostomy and ileostomy related procedures. Many of these procedures are laparoscopically performed. Over 500 ileoanal pouches and over 500 laparoscopic colectomies have been performed in the last few years. There is also a heavy emphasis on procedures relating to disorders of evacuation such as sphincteroplasty, the artificial bowel sphincter, radiofrequency, and sacral nerve simulation for fecal incontinence, perineal rectosigmoidectomy with levatoroplasty for rectal procidentia, and anoplasty for stenosis. In addition, the standard spectrum of anorectal operations is also performed. Research residents are involved in these procedures so that they become proficient with the indications for, techniques of, and results of these various therapies. Conferences There are a number of formal educational conferences including anorectal physiology conference and an ultrasound conference in which all the studies from the previous few days are reviewed and a treatment outline is made. There is also a core curriculum conference each week at which a single topic in colorectal disease is discussed at length by all of the members of the department. In addition, there are several interdisciplinary conferences, including a colorectal surgery radiology conference and a colorectal surgery pathology conference. At each of these conferences, either the radiologist or pathologist reviews the interesting studies from the previous two weeks with the staff and residents from each department. These conferences have proven invaluable, not only in terms of an enhanced comprehension of patient management and appreciation for continuity of care, but also in preparation for board examinations. The Colorectal Surgery Department hosts a monthly Journal Club and a Tumor Conference. To complement the input of the staff from Cleveland Clinic Florida, many of the community colorectal surgeons participate in these conferences. This interaction enables the residents to benefit from additional opinions. There are also monthly Colorectal Surgery Morbidity and Mortality Conferences and Colorectal Surgery Research Forums. With the exception of morbidity and mortality conferences, all conferences are held by video link between Weston and Naples. In addition to the conferences outlined above, standard surgical conferences for the Division of Surgery include Morbidity and Mortality and Grand Rounds and Tumor Board. While participation in all of the colorectal surgery conferences is mandatory, participation in the general surgical conferences is optional. It is expected that the colorectal surgery resident will attend the Annual International Colorectal Disease Symposium in Fort Lauderdale held every February. Over 700 surgeons and physicians from 54 countries attend this three-day course. A sample program is available upon request by contacting:
Furthermore, multiple annual colorectal laparoscopic surgical courses are coordinated by the Department. Resident participation in these courses is also possible. Lastly, three times each year, the Department hosts visiting professors for one day each. Previous visiting professors have included Drs. Stanley M. Goldberg, Herand Abcarian, David Schoetz, Thomas Dailey, H. Randolph Bailey, Marvin Corman, Indru Khubchandani, Ira Kodner, David Rothenberger, Zane Cohen, David Beck, Phil Gordon, James Fleshman, John Pemberton, Anthony Vernava III, M.D., Alan G. Thorson, Douglas Wong, Bruce Wolff, Lester Gottesman, and Steven Stryker. The visiting professor program is designed to permit full interaction between the visiting professor and the residents. It is anticipated that the resident will submit at least one paper for presentation at the annual meeting of the American Society of Colon and Rectal Surgeons or a similar prestigious national or international meeting. The residents are expected to present at the Florida Society of Colon and Rectal Surgeons meeting in September, the Section of Colon and Rectal Surgery of the Southern Medical Association meeting in November, or the South Florida Chapter of the American College of Surgeons meeting in May. Each resident is also encouraged to submit work done at CCF for presentation in their own geographic area. Basically, the research residency year can be tapered to suit one's needs. Eligible research residents may choose to apply for the clinical residency either at CCFlorida or elsewhere, and others may wish to participate only in the research residency year. Many non-physiology research projects are currently underway. Other areas of special interest may be addressed, including prospective coordinated clinical trials, basic science, animal, or cadaver studies, and projects involving cancer or inflammatory bowel disease. Past research residents have found the environment to be most stimulating and rewarding.
To Apply Interested candidates should contact Graduate Medical Education for additional information and application forms. After acceptance to the position, contingent upon external funding, the Cleveland Clinic Educational Foundation will assist in providing the necessary forms to obtain the appropriate visa. Due to the large number of applications received for these few positions, the appointments are made based upon how promptly the application process is completed. Also, due to the amount of paperwork required, it is not uncommon to begin the application process one year prior to the anticipated start date. Delay in completion of the application process, including written confirmation of funding, may result in a later starting date. |
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Colorectal
Surgery
Residency Program Coordinator, Clinical Residency Program 954.978.5236, 800.359.5101 x5236, Fax 954.978.5757 gme@ccf.org |
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