As additional postgraduate training in Colorectal Surgery is designed to lead to Board certification in Colon and Rectal Surgery, and as the American Board of Colon and Rectal Surgeons is a free-standing board separate from the American Board of Surgery, training programs in Colorectal Surgery are technically residencies. However, the terms “residency” and “fellowship”, and “resident” and “fellow”, are often used interchangeably in this particular setting.
The Southern Illinois University Program in Colorectal Surgeryis a collaborative educational program involving academic and private colorectal surgeons who joined together in a program designed to provide excellent postgraduate training in the current practice of colorectal surgery. The catchment area for the Southern Illinois University Program in Colorectal Surgery encompasses the southern two-thirds of Illinois and includes both urban and rural populations. The breadth of pathology seen by surgeons in the SIU Colorectal Program covers the entire spectrum of colorectal disease, from basic uncomplicated anorectal and colorectal problems in otherwise healthy people to complex and complicated anorectal and colorectal problems in people with multiple medical comorbidities. The surgical faculty enjoys a good working relationship with other subspecialties who often participate in management of complex cases, including but not limited to: urology, gynecology, plastic surgery, radiation and medical oncology, gastroenterology, orthopaedics, and enterostomal therapy/wound management. The Colorectal Surgery attending surgeons have trained at a number of different programs, allowing a breadth of experience for the trainee’s benefit.
The SIU Colorectal Surgery Program utilizes two inpatient facilities and two outpatient facilities. The inpatient facilities allow the Colorectal Surgery resident to gain experience with working within two distinct healthcare systems – a private nonprofit healthcare system as well as a church-owned healthcare system. Each inpatient facility is part of a larger regional healthcare system which incorporates inpatient and outpatient care elements. The culture within each system is also distinctly different. Experience with both will equip the Colorectal Surgery resident with skills that will aid his/her transition into a practice setting. Similarly, the two outpatient settings are distinctly different – one is an academic clinic setting, and the other a private office setting, and experience with both will allow the Colorectal Surgery resident to feel more comfortable when settling into the type of practice s/he chooses after completion of training.
Of note: there is a hospital-provided shuttle between the two hospitals which runs every ten minutes from 6 AM until 6:30 PM, decreasing the burden of having two inpatient sites. The shuttle ride between hospitals takes approximately three minutes door-to-door. The two outpatient settings are two blocks apart, placed on either side of the major inpatient facility.
The Colorectal Surgery resident will participate in all index colorectal operative cases as appropriate for his/her training and time management. The resident will also have the opportunity to be involved in all urgent/emergent index cases, as this is an integral part of the subspecialty.
The resident will have one to two half-day sessions of colonoscopy on a weekly basis. Colonoscopy block times for the Colorectal Surgery faculty are spread throughout the week, ensuring that operative cases will not diminish the availability of endoscopic experience for the resident. Indications for colonoscopy are recorded, as well as the procedure(s) performed, including polypectomy, stent placement, laser recanalization, bleeding control, reduction of volvulus, or decompression.
Outpatient clinic experience/Pelvic floor evaluation
The resident will have one to two half-day sessions of outpatient clinic, including pelvic floor lab experience, on a weekly basis. Office or clinic sessions for the Colorectal Surgery faculty are spread throughout the week, ensuring that operative cases will not diminish the availability of outpatient experience for the resident. Colorectal surgeons commonly perform significant outpatient management of colorectal and anorectal complaints, and this experience is quite important within the training program. For that reason diagnoses encountered and managed in the outpatient setting will be recorded, both for the resident’s portfolio as well as the program’s records.
Colorectal Surgery Service Structure
Acting as the leader of the Colorectal Surgery team, the CRS resident will be involved in every aspect of care as patients move through the healthcare system, including: outpatient evaluation in two different settings (academic clinic and private office); arranging for evaluation services such as laboratory and radiology services; decisions regarding least costly yet medically appropriate care for under- and uninsured patients; explanation of therapy alternatives to patients and families, making clear the risk-benefit ratio for the individual patient; working with fellow healthcare providers in other specialties to deliver high quality, safe patient care as a multidisciplinary team; and arranging for discharge when ready to an appropriate facility. Not every patient will require every step outlined here, and the CRS resident may not be involved in every step of every patient’s progress through the healthcare system. However, the CRS resident will perform every step mentioned here on a number of occasions.
The Colorectal Surgery resident will not take in-house call. S/he will take after-hours calls for all faculty colorectal surgeons (excluding the one day in seven free of clinical duties), assess the concern, and contact the responsible faculty member. The Colorectal surgery service has in-house junior surgery residents as well who will work closely with the Colorectal Surgery resident in evaluation of inpatient consults, patients seen in the emergency department, or inpatients on the Colorectal Surgery service. If a patient requires operative intervention, the Colorectal Surgery resident will be expected to participate, unless it is his/her day off. Concerns regarding inpatients will usually be assessed by the in-house general surgery resident, who will contact the Colorectal Surgery resident for discussion. The Colorectal Surgery resident will evaluate the concern and contact the Colorectal Surgery faculty member as appropriate. The Colorectal Surgery resident will not exceed 80 duty hours per week, with four weeks averaged. The Colorectal Surgery resident will have a ten hour rest period between duty periods. Moonlighting will not be permitted.
Formal teaching rounds occur every Monday morning at 0700 with the faculty, resident staff, medical students, and nurses in attendance. Cases are discussed in detail, along with evaluation and management options. Bedside rounds occur daily, and combine working rounds with teaching rounds.
Exposure in the basic sciences occurs in multidisciplinary settings, such as when pathologists present microscopic slides for review at Tumor Board, or in Core Conferences dealing with anatomy and physiology, biochemistry applications of anesthesia, physiologic and anatomic effects of adjuvant therapies, and also during discussions of translational research projects.
Faculty members direct and participate in a number of research endeavors, which include faculty from other areas such as Surgical Oncology, basic science research, Surgical Education, Gastroenterology, Radiation Oncology, Medical Oncology, and Infectious Disease.
The resident’s responsibilities include:
1. Medical Knowledge: working to acquire the necessary medical knowledge for the practice of Colorectal Surgery.
2. Patient Care: management of the Colorectal Surgery Service, which encompasses the patients at the two hospitals included in the program. Performance of inpatient and outpatient procedures as appropriate to skill level. Evaluation and assessment of inpatients and outpatients referred to Colorectal Surgery.
3. Practice Based Learning: Show ability for meaningful self-assessment and selection of realistic, achievable performance and improvement goals to foster life-long learning; demonstrate skill in use of information technology; demonstrate ability to analyze and improve practice or patient care; develop teaching skills needed to educate patients, families, students, and others.
4. Interpersonal skills and communication: Communicate effectively with patients and families; work well as leader and member of healthcare team; maintain medical records on a timely basis.
5. Professionalism: Develop and display commitment to carrying out professional responsibilities and to ethical principles. Conduct self in a professional manner.
6. Systems based Practice: display ability to work effectively in various healthcare delivery settings with coordination of patient care, concern for risk-benefit analysis, and serve as advocate for patient safety and quality care.