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Program Goal: To prepare fellows for independent practice through training with sleeve gastrectomy, Roux-en-Y gastric bypass, revisional procedures, advanced foregut surgery, and eTEP abdominal wall repair.
The Birthplace of Bariatric Surgery
The University of Iowa is the birthplace of obesity surgery. Dr. Edward Mason — the “Father of Bariatric Surgery”— conceived and performed the first gastric bypass at the University of Iowa in 1965.
The bariatric surgery fellowship program at University of Iowa Health Care was first accredited by the Fellowship Council in 2008. In addition, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) have repeatedly recognized UI Health Care as an accredited comprehensive center.
Surgical Techniques
The program utilizes the sleeve gastrectomy and roux-en-y gastric bypass in roughly equal proportions. In addition to primary weight loss operation there is exposure to revisional weight loss surgery patients from work-up to a redo procedure. There is a robust experience in advanced foregut cases including paraesophageal hernia repairs, laparoscopic Heller myotomies, POEM and cutting-edge anti-reflux procedures.
The fellow also has an opportunity to perform a variety of open and laparoscopic abdominal wall procedures including eTEP approaches. Finally, each fellow is trained in the interpretation of esophageal function testing including pH testing and esophageal manometry.
On average, 70% of the case mix is bariatric surgery and 30% predominantly foregut procedures. Research within our program focuses primarily on outcomes and translational science. All fellows are encouraged to participate in research while at UI Health Care including protocol development, abstract submission, presenting their data and submitting manuscripts.
Curriculum
Fellow Duties
The fellow is responsible to record their work hours daily to ensure they remain compliant with the duty hour requirements set by ACGME. The normal work week for the fellow is approximately 60 hours per week. The fellow does take call to cover the service, but the Minimally Invasive Bariatric Surgery Fellow does not take in-house call.
The fellow is an active participant in clinic 2 days per week. If there are emergency cases during clinic then the fellow is excused from clinic. The fellow will also respond to consults for in-house patients. Clinical support for the fellow consists of nurse clinicians, physician assistants, and physician extenders. In regard to fellowship oversight, the fellow can obtain support from the program coordinator.
Facilities
Primary Program Site is at the University of Iowa Hospitals and Clinics which consists of 860 hospital beds, 30 Main OR rooms, 12 ambulatory surgery rooms, 8 children's hospital OR rooms, and 36 SNICU beds.
Typical Rotations
There are no specific rotations throughout the year, but rather opportunities for the fellow to tailor to the fellow’s year to include cases that are meet the goals of the fellow outlined at the start of the year.
Opportunities for Additional Training
The fellow typically attends a SAGES Endoscopy course as well as other society-sponsored events that are professionally or clinically relevant. There is also support for attendance at the annual meeting for SAGES or ASMBS.
Conference and Teaching Program
The conference and teaching program schedule consists of the following:
- Bariatric Case Conference – Monday
- Surgical Audit (Morbidity and Mortality) Conference – Tuesday
- Department of Surgery Grand Rounds – Tuesday
- Quarterly bariatric meetings to review clinical outcomes
The fellow is expected to attend all conferences apart from the Bariatric Case Conference. For Bariatric Case Conference the fellow is the active lead and is to review the following weeks cases and lead review of articles making up part of the curriculum. Additionally, the fellow is responsible to present the Bariatric M&M cases selected for presentation each week for the Surgical Audit (Morbidity and Mortality) Conference.
Research
The fellowship estimates roughly 15% of the fellow’s time to be in research with the remaining 85% being clinical. Research support in the form of statistical assistance is available to fellows along with general surgery residents with dedicated time in the lab, as well as medical students assisting in data collection.