Description

The Surgical Nutrition Team is a surgeon-led multidisciplinary team which includes clinical pharmacists, registered dietitians, advanced nurse practitioners, fellows and resident trainees.  Surgical and supportive care for patients with complex gastrointestinal anatomy is provided along with inpatient consultation for enteral and parenteral nutrition (PN) support, outpatient management of PN, intravenous fluids, and enteral nutrition (EN). The Surgical Nutrition Team specializes in intestinal rehabilitation of short bowel syndrome, treatment of bariatric surgery complications, surgical repair of enterocutaneous and entero-atmospheric fistulae, management of complicated wounds and advanced daily customized PN and enteral therapies. The median daily inpatient census is 15 patients (range 11-21), median monthly consultations are 20 (range 14-32), median monthly operative case volume is 8 (range 6-17), and median monthly clinic census is 42 (range 15-99), including telemedicine clinic visits. Due to our case mix, surgical critical care is an integral part of the management of our patients and consults and the team is led by two critical care board-certified surgeons with expertise in managing critically ill surgical and trauma patients. The service receives consultations from all over the United States as well as the Caribbean and follows patients who live at a distance using telemedicine technology. Dr. Byers is both certified by the American Board of Surgery with added Qualifications in Critical Care, as well as the National Board of Nutritional Support.

Physicians who have completed at least three years of general surgery residency training are eligible to apply for the Surgical Nutrition Fellowship. The Fellowship currently accepts 2 candidates each year.

 Goals and Learning Objectives

 At the conclusion of this fellowship, participants will be able to…

Perform a comprehensive nutritional assessment of malnourished and catabolic patients on the ward and in the intensive care unit and prescribe a customized enteral and/or parenteral nutritional plan.

Prescribe a detailed step-up approach for nutrition support and intestinal rehabilitation for patients with intestinal failure along the continuum of care from critical illness to stabilization to discharge and at home.  This may include medications, “nutraceuticals” (nutritional pharmaceuticals), specialized diets, enteral nutrition (EN), and parenteral nutrition (PN).

Evaluate patients in the home setting and prescribe customized parenteral and enteral nutrition prescriptions based on their nutritional and metabolic needs and their intestinal function.

Perform comprehensive evaluations of patients with enterocutaneous fistulae including sepsis control, wound management, bowel mapping techniques, nutritional evaluation and support, innovative enteral access approaches, and preoperative evaluation for repair. Perform vascular, advanced enteral and peritoneal access and competently manage serious post-operative complications.

Perform a comprehensive evaluation of candidacy for a patient desiring intestinal/multivisceral transplant.

Develop operative expertise in complex abdominal operations including repair of entero-cutaneous fistulae, restoration of intestinal continuity, excision of infected mesh and abdominal wall reconstruction.

-Apply and sit for the board exam to become a Certified Nutritional Support Practitioner.

Requirements

 Duties and Responsibilities

1.To become integrated into the Surgical Nutrition team and attend and direct daily inpatient rounds on the Surgical Nutrition service for admitted and consulted patients at Jackson Memorial Hospital/Ryder Trauma Center and U Health Tower.

2. Entrustment of roles and responsibilities of the Fellow will be granted on an individualized basis using graded autonomy.

3. Fellows will assist in the operating room for all surgical nutrition cases at their level, such as venous access, enteral access (endoscopic, laparoscopic, or open gastrostomy/jejunostomy), fistulograms, peritoneal dialysis catheters and major abdominal procedures including washouts, drainages, abdominal wall reconstructions and enterolysis for enterocutaneous fistulae repairs.

4. The Surgical Nutrition team has 3 to 3 1/2 half-days of clinic each week and the Fellow will be assigned to assist the faculty in one clinic session weekly. The clinical mentors will provide opportunity for the Fellow to evaluate new consultations for malnutrition and to actively manage patients with intestinal failure and insufficiency in the home setting. Our goal is for you to become an independent practitioner who can manage these patients over the long term.

 Education and Research

1.The one-year didactic curriculum will be derived from the ASPEN Adult Nutrition Support Core Curriculum, with the expectation that the Fellow will take the Certified Nutrition Support Clinician ® (CNSC) exam during the spring season test offering. The Fellow will be expected to obtain trainee level membership to the American Society of Parenteral and Enteral Nutrition.  The funding for the text, ASAPEN membership, exam course and fees can be covered by a stipend added to the trainee salary by Jackson Memorial Health System.  

2. The fellow will be fully funded to attend the annual ASPEN Nutrition Science and Practice Conference.

3. Fellow will be assigned to prepare a monthly presentation on an intestinal failure topic and oversee the presentation of a difficult case monthly by an intern.

4. The Intestinal Failure Fellow will be assigned to develop and execute a quality improvement project over the course of the year.

5. Fellows are encouraged to be involved in any of our multicenter trials involving innovations in pharmacotherapy and nutritional devices.

6. All fellows are assessed for central venous access competency and are mentored to become facile with temporary and long-term central line access.  

7. There is an extensive data base of consults and short bowel patients and fellows are encouraged to perform clinical investigations and present at local and national meetings.  

5. The fellow will have the opportunity to gain expertise in surgical endoscopy and can work with the Laparo-Endoscopic Service and in the Simulation Lab to gain competency.  

Please send the following documents, we will send you the application upon receipt of your email.

*Personal Statement

*LORs-3

*USMLE step 1,2 and 3

*ECFMG Certificate

*ABSITE

*Picture

*MD diploma