Educational Program
During the first year of training, the fellow will participate in all weekly academic transplant and selected general surgery educational conferences. The fellow will also:
- Rotate through the Human Leukocyte Antigen (HLA)/Immunogenetics Laboratory until familiar with transplant histocompatibility and immunogenetics
- Rotate through the Wake Forest Institute for Regenerative Medicine (WFIRM) to become familiar with new bench technology and applications of stem cell transplantation
- Be responsible in part for medical student and surgical house staff education
- Assist the transplant pharmacists in maintaining quality and performance improvement directives
- Assist the data coordinators in tracking, verifying and updating the transplant database and initiating new studies
- Assist in transplant nurse coordination and nurse practitioner education
- View and participate in interpretation of allograft biopsies at least weekly
- Assist in ensuring that clinical protocols and critical pathways are being implemented and followed
- Assist the transplant surgeons in the implementation, organization and maintenance of new technology under development at the medical center
Fellows will have direct contact with attending staff on a daily basis to further enhance their educational experience. Fellows will also be responsible for participating in a Journal Club and will have supervised reading assignments from selected transplant textbooks and journals.
During the second year of training, the fellow will assist in:
- study conception and design
- data acquisition and analysis
- data interpretation
- drafting of abstracts and manuscripts
- critical revisions
- presentations at local/regional/national/international meetings
Our fellows have participated in numerous clinical projects including:
- Presentations at the annual American Transplant Congress meeting
- The annual Winter Symposium of the American Society of Transplant Surgeons
- Transplant fellow meetings
The fellow is also be a member of our core research group that reviews and determines our participation in new studies (both internal and external). The fellow will be asked to present at our weekly didactic Transplant Conference at least semi-annually and will be invited to generate/participate in one new clinical research project at least every six months. The fellow will complete all required modules of the ASTS Academic Universe prior to completion of training.
Expected Surgical Volumes upon Completion of Training
Within a two-year training period, the transplant surgery fellow would be expected to participate in a minimum of:
- 200-250 kidney transplants
- 20-30 pancreas transplants
- 50 laparoscopic donor nephrectomies
- 50 multiple organ procurements
- 50 dialysis access procedures
Didactic Components
The fellow is expected to attend:
- All transplant educational conferences
- Weekly patient selection committee meetings
- Inpatient and outpatient work meetings
- Living donor and research meetings
- The Pediatric Transplant Conference
- Other conferences and meetings as necessary
Transplantation-Related Conferences Offered
- General Surgery
- Abdominal Organ Transplantation Program
- Nephrology
- Pathology
- Wake Forest Institute of Regenerative Medicine
Clinical Program
The clinical program is focused equally on pre-, peri- and post-transplant care both in the inpatient and outpatient settings.
The fellowship is a blend of:
- Critical and primary care
- Medical and surgical care
- Pediatric and geriatric care
- Inpatient and outpatient care
- Acute and chronic care
The training program exposes the fellow to the full continuum of care from initial referral of the patient to the transplant center to placement on or maintenance of the waiting list to the transplant event to short-term and then long-term medical and surgical care of the transplant patient.
In the first year, the fellow will learn primarily how to evaluate and care for patients from a medical and surgical perspective in a supervised fashion with a focus predominantly in deceased donor kidney transplantation and dialysis access.
In the second year, the fellow will become more autonomous with graded responsibility based on progression of their knowledge base and clinical skills with a focus on:
- Living donor kidney transplantation
- Pancreas transplantation
- Multi-organ retrieval procedures
Fellows Responsibilities
Supervisory Responsibilities
The fellow is responsible for teaching and supervising medical students and surgery residents. They will also participate in teaching advanced practice providers and nurse coordinators.
Patient Care Responsibilities
Under faculty and staff supervision, the transplant fellow is in charge of preoperative and postoperative management of transplant recipients. All acute transplant patients admitted to the hospital are under the direct care of the transplant surgeons, including intensive care unit patients, so the fellow is involved in the daily care of these individuals.
Fellows are expected to participate in the outpatient evaluation of candidates for transplantation as well as post-transplant management. The transplant fellow will become adept in the long-term follow-up of transplant patients and in dealing with the sequela that may develop from long-term immunosuppression in this unique patient population.
Postgraduate Year (PGY) Levels and Progression in Responsibilities
The transplant fellow will function as a PGY-6 or higher and be responsible for teaching and supervising medical students and surgical house staff. The transplant fellow will have the academic rank of assistant instructor and have clinical billing privileges and full faculty benefits including 4 weeks of vacation per year.
Evaluation
The trainee's performance is evaluated by the transplant surgery attending faculty on an ongoing basis; any deficiencies are identified and addressed, and corrective action is implemented as needed. Routine debriefing between transplant attending and fellow is also performed following transplants and other surgical procedures.
The fellow will provide documentation of educational (for example, attendance at conferences, Human Leukocyte Antigen (HLA)/Immunogenetics Lab, Wake Forest Institute of Regenerative Medicine, biopsy review), teaching and academic (for example, abstract development, manuscript submission or clinical projects) activities.
In addition, the fellow will maintain a surgical log, which will be reviewed quarterly by the Program Director and will be recorded by the fellow on the ASTS surgical log website. The fellow will undergo formal biannual evaluation by the Program Director with written documentation of the proceedings. This will include review of written evaluations from faculty and staff and assessment of satisfactory progression towards established performance milestones. Fellow milestone reports will be submitted to ASTS as required.