Montefiore Medical Center

Bronx, NY

Number of Positions Offered: 2

Mastery in Surgery Chief

Vance L, Smith, MD, MBA, FACS, director, acute care surgery
VSMITH@montefiore.org

Senior Associates

W. Scott Melvin, MD, FACS, vice chair and chief, general surgery
WSMELVIN@montefiore.org

David Weithorn, MD, acute care surgery, minimally invasive & robotic surgery
daweitho@montefiore.org

Michele Siciliano, MD, FACS, acute care surgery & surgical critical care
msiciliano@montefiore.org

Additional Information

Montefiore Medical Center
The University Hospital for Albert Einstein College of Medicine
3400 Bainbridge Ave, 4^th Floor
Bronx, NY 10467
(718) 902-4058
(718) 882-6141

Website

www.montefiore.org/general-surgery

The Mastery in Surgery program is a 12-month appointment to the Department of Surgery, Montefiore Medical Center, Moses campus, of The Albert Einstein College of Medicine. Most of the year will be at the Moses Division, with limited time spent at our community hospital (Wakefield) and ambulatory surgery center (Hutchison Ambulatory Center). Montefiore is a tertiary care center offering cardiothoracic surgery, hematologic and solid organ transplantation, cancer care, emergency general surgery, medical and surgical critical care services, and full-time teaching programs. The Moses Division has an extremely busy emergency room, staffed by an acute care surgeon 24 hours a day. The goal of the program will be to provide a post residency, general surgery experience with broad clinical experience, including surgical autonomy, with focus on mastery of skills necessary for the Mastery Associate to transition from residency to surgical practice, including independent operating, practice management, and patient care in the inpatient and outpatient settings.

The key elements of the program include autonomy, mentoring, greater responsibility, flexibility, and outcomes measurement.

Objectives

1. Demonstrate ability to conduct independent pre- and post-operative patient care.
2. Gain the experience needed for the independent conduct of surgical operations and procedures including endoscopy (EGD and colonoscopy).
3. Master the elements of professionalism essential for the best surgical care including teamwork, communication (both verbal and written), ethics, risk management and citizenship.
4. Begin the process of practice-based learning through use of the American College of Surgeons (ACS) Surgery Specific Registry (SSR).
5. Understand the essential business elements of surgical practice coding, timely correspondence and closure of encounters, contract negotiations, and reimbursement strategies.

The program will provide experience in bread-and-butter general surgery, abdominal wall surgery, open and minimally invasive (laparoscopic and robotic) surgery, emergency general surgery cases related to the abdomen and other organ systems, endoscopy and airway access. Other elements that the Associate would be exposed to will be based on individual needs assessment, and may include anorectal basic evaluation, ultrasound, and vascular access including dialysis and chemotherapy catheters.

Program Faculty Clinical Duties/Responsibilities

The Mastery Associate will have primary responsibility for patients that are admitted to the ACS service. During the initial three months, there will be close oversight of patient care responsibilities. In later stages of the year, the Associate will staff his/her own general surgery clinic. He or she will be assigned to the Department of Surgery Quality Improvement Committee, with the Mastery in Surgery Chief.

Levels of supervision are graduated throughout the program and are defined as follows:

• Level I: All cases reviewed prior to surgery and one-on-one supervision during the operation.
• Level II: Preoperative discussion with the mentorship attending with selective intraoperative mentoring.
• Level III: Independent practice, with assistance and consultation directed by the Associate.

Supervision of the Associate’s practice will be at Level I in the first three months, Level II in the second block of three months, and Level III in the final six months. The faculty may decide to change the level of supervision required based on prospective reviews of the case log, M&M cases, or monthly reviews.

Conferences

The Mastery in Surgery Associate would be required to attend 70 percent of the conferences or participate as a faculty member as noted below:

Grand Rounds

Grand Rounds is organized by a committee consisting of the Program Director, Assistant Program Director, and Chief Residents. The Associate will be required to give Grand Rounds on the required project on practice-based learning.

ACS/General Surgery Journal Club

The Acute Care Surgery Service holds a bi-monthly journal club/case conference. The Associate will, with the help of the Assistant Program Director, help oversee topics and articles chosen, and lead the discussion and presentation of the articles.

Morbidity & Mortality

This conference is organized weekly by the Division Chief and M&M PGY-5 resident. Weekly cases are submitted for presentation by the PGY2-5 residents on each service. Senior residents present cases to peers, medical students, and faculty.

Successful completion of the program includes: Completion of 12 months of clinical duties and achievement of Level III supervision as determined by practice performance assessments and evaluations; meet ongoing performance of evaluation standards; satisfactory completion of prospective SSR (this will require 90 percent of cases to be recorded at the final evaluation point); appropriate coding documentation and billing in 80 percent of cases as assessed by the compliance officer QE passing score; 70 percent conference and committee attendance; and completion of teaching assignments. The Mastery in Surgery Chief will complete the final evaluation in conjunction with faculty and program associates.