MIS Fellowship Overview

The goal of MultiCare’s MIS Fellowship is to provide fellows with the training and education necessary to develop and enhance techniques and clinical skills in the preoperative and postoperative management of advanced foregut, colorectal, bariatric and solid organ surgery, with a major emphasis on minimally invasive techniques and emerging technology.

The fellowship offers a broad clinical experience, which may be tailored to the goals of the individual fellow. Our objective is to offer the fellow comprehensive surgical experience and exposure to minimally invasive applications for treating the following conditions and diseases:

Upon completion of the Minimally Invasive Surgery (MIS) Fellowship, the fellow will have the skills and tools needed to pursue a career in private practice or academic surgery.

Clinical and operative experience

Fellows will gain clinical and operative experience at MultiCare hospitals in the South Sound region. This primarily involves Tacoma General Hospital but may also include Allenmore Hospital, Auburn Medical Center, Covington Medical Center and Good Samaritan Hospital. These hospitals are equipped with da Vinci robots and endoscopic equipment allowing for advanced minimally invasive surgeries and are most commonly used by our surgical teams for their most complex cases. Additionally, the nursing and technical staff at these facilities have proficiency in supporting the surgeons in their daily work. We expect the fellow to participate fully in surgeries, quality improvement and inter-disciplinary education in these hospitals.

The experience will be provided under the supervision of four primary surgeons representing the subspecialties of colorectal surgery, foregut surgery and bariatric surgery. The team is led by Program Director Laila Rashidi, MD, and Associate Program Director James Sebesta, MD. Each surgeon is fellowship-trained, clinically active and has demonstrated skills in research and scholarly activity.

Operative Experience

Early during the training period, the fellow will act as the assistant surgeon. As skill increases the fellow will graduate to the role of primary surgeon under supervision.

The fellow will become familiar with robotic-assisted surgery through the use of robotic training equipment, followed by assisting faculty with their cases. As the fellow gains appropriate knowledge, skills and experience they will perform operations as primary surgeon using the robot.

Clinical Experience

The clinic experience is a key element of the fellowship. Preoperative decision making and surgical planning will contribute to forming the fellow’s judgment. These cases will be supervised by faculty and clinical decisions will be informed by the attending’s experience. Planning for surgical cases will occur collaboratively.

Postoperative experience is also crucial to the development of a surgeon. A deep understanding of normal and abnormal postoperative courses will enable the fellow to quickly identify complications and intervene. All patients requiring an unexpected return to the OR will be reviewed by the fellow and faculty. The fellow may also be asked to present these cases to the Peer Review Committee of the medical staff.

Fellows will have supervision in the clinic, however given that the fellow has already completed a surgical residency and is board-eligible or board-certified, clinic supervision will typically be indirect. Particularly complex or atypical cases may have direct supervision by faculty to support optimal patient outcomes.

Research

The fellow is expected to actively engage in research through the fellowship and will be given ample opportunity to initiate clinical research and quality outcome projects. The fellow is required to complete the MultiCare Institutional Review Board (IRB) Certification for Investigator Training during the first month of fellowship.

The division of minimally invasive surgery actively collaborates with Swedish Medical Center. In addition, research is conducted in collaboration with the MultiCare Institute for Research & Innovation (MIRI), which supports the organization through grant management, a librarian, biostatisticians and limited funding. The fellow will have full access to the MIRI team in the development of their scholarly activity.

Scientific abstracts are recommended to be submitted for oral or poster presentation to the following societies’ annual meetings:

• Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
• Society of Laparoendoscopic Surgeons (SLS)
• American Society of Colon & Rectal Surgeons (ASCRS)
• Northwest Society of Colon & Rectal Surgeons (NWSCRS)
• American College of Surgeons (ACS)
• American Society for Metabolic & Bariatric Surgery (ASMBS)
• Digestive Disease Week® (DDW)
• Minimally Invasive Robotic Association (MIRA)

It is expected that the fellow ensure that abstracts eventually lead to manuscript publication in peer-reviewed journals.

Requirements

All fellows will, by the completion of their fellowship, be highly competent and:

• Demonstrate surgical proficiency with advanced laparoscopic and robotic techniques
• Complete robotic training as required by the medical staff
• Submit a manuscript or abstract for presentation at a meeting of a relevant professional society
• Perform effective teaching of medical students and/or residents
• Participate in quality improvement efforts of the department

Salary, vacation and conferences

Fellows are commensurate as a PGY-6 with health and dental insurance for the fellow and his/her family, as well as other standard benefits for MultiCare. Malpractice insurance is provided by MultiCare on an occurrence basis.

In addition, the fellow will be eligible for two weeks of vacation, one week of CME with a CME stipend and one week of practice search.