Montefiore Medical System Moses Division and the Jack D. Weiler Hospital of the Montefiore Medical System
Number of Positions Available: 1
W. Scott Melvin, MD, FACS
Montefiore Medical Center
The University Hospital for Albert Einstein College of Medicine
3400 Bainbridge Ave, 4th floor
Bronx, NY 10467
The program will consist of two six-month rotations at Montefiore Medical System Moses Division and the Jack D. Weiler Hospital of the Montefiore Medical System. Both hospitals 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.
The key elements of the program include autonomy, mentoring, greater responsibility, flexibility, and outcomes measurement.
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) Surgeon Specific Registry (SSR); and 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, open abdominal surgery, acute care, general surgery related to the abdomen and other organ systems, esophago-gastroscopy, and colonoscopy; minimally invasive surgery will also be considered an essential element of the experience. In addition, re-operative surgery is important. Other elements that the TTP Associate would be exposed to will be based on individual needs assessment, and might include ano-rectal basic evaluation, ultrasound, and vascular access including dialysis and chemotherapy.
Program Faculty Clinical Duties/Responsibilities
At each site, the TTP Associate will have primary responsibility for patients that were 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.
The TTP Associate would be required to attend 70 percent of the conferences or participate as a faculty member as noted below.
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.
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.
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 11 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.
Arnold Berlin, MD, FACS
Prashanth Sreeramoju, MBBS, FACS
Tyr Wilbanks, MD, FACS