American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Montefiore Medical Center

Montefiore Medical System Moses Division and the Jack D. Weiler Hospital of the Montefiore Medical System 
Bronx, NY

Number of Positions Available: 1

Contact Information

TTP Chief

W. Scott Melvin, MD, FACS
wsmelvin@montefiore.org

Senior Associates

Vance L. Smith, MD, MBA, MS, FACS
Moses Campus (general surgery and critical care)
vsmith@montefiore.org

Prashanth Sreeramoju, MBBS, FACS
Weiler Campus (general surgery)
psreeram@montefiore.org

Jenny J. Choi, MD, FACS
Moses Campus (MIS and endoscopy)
jechoi@montefiore.org

Additional Information

Montefiore Medical Center
The University Hospital for Albert Einstein College of Medicine
3400 Bainbridge Ave, 4th floor
Bronx, NY 10467
718-902-4058
Fax: 718-882-6141

Website

www.montefiore.org/general-surgery

Program Highlights

The TTP Program at Montefiore is a 13-month appointment to the department of surgery. It will consist of a 9.5-month rotation at the Moses Division and 3.5 monthstwo six-month rotations at Montefiore Medical System Moses Division and 3.5 months at the Weiler Hospital Campus. Both centers are active teaching units of the Albert Einstein College of Medicine and part of the integrated Medical Center. Both are tertiary care centers offering open heart surgery, full-time teaching programs, and critical care programs. The Weiler campus is a busy program and 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 postresidency, general surgery experience with broad clinical experience, including surgical autonomy, with focus on mastery of skills necessary for the TTP Associate to transition from residency to surgical practice, including independent operating, practice management, and patient care in the inpatient and outpatient settings.

Program Description

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

Objectives

  1. Demonstrate ability to conduct independent pre- and postoperative 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) Surgeon 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 abdominal wall surgery, open abdominal and minimally invasive surgery, emergency general surgery cases related to the abdomen and other organ systems, endoscopy, and airway access. Other elements that the TTP 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

At each site, the TTP Associate will have primary responsibility for patients that are admitted to his or her service. During the initial three months, there will be regular oversight of patient care responsibilities. In addition, the TTP Associate will staff a clinic. The TTP Associate will be assigned to the Hospital Quality Assurance Committee at the respective hospital to which he or she is assigned. He or she will attend the Medical Staff Administrative Committee and the Leadership Council for Clinical Quality, Safety, and Satisfaction with the TTP 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 site attending and selected intraoperative mentoring; 
  • Level III: Assistance and consultation directed by the TTP Associate. 

Supervision of the TTP 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 and M cases, or monthly reviews.

Conferences

The TTP 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 TTP Associate will be required to give Grand Rounds on the required project on practice-based learning. 

Professor Conference

The Assistant Program Director coordinates board review conference for the PGY3 residents. The TTP Associate will give two of these conferences. The TTP Associate will present a seminar of his or her transition to practice and lead a discussion concerning this experience. The Acute Care Surgery Service holds weekly journal club/case conference. The TTP Associate will lead the resident discussion of the selected topics once per month during their appointment.

Morbidity & Mortality

This conference is organized weekly by a PGY5 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 13 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 TTP Chief will complete the final evaluation in conjunction with the site directors.