Curriculum

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Two trainees had a discussion while sitting at a table.

The intent of our Abdominal Transplant and Hepatopancreatobiliary Surgery Fellowship is to produce proficient and competent physicians. That means knowing the operations and performing them.

All staff aim to serially progress you through each transplant operation until you can complete the operation on your own. Of course, each fellow progresses at their rate, but our job as educators is to understand this and give more responsibility and autonomy as you become ready for it.

Clinical training

During the two years of clinical training in the Abdominal Transplant and Hepatopancreatobiliary Surgery Fellowship, you will spend the first year focusing on kidney and multi-organ transplantation along with a month and a half on liver and three months in HPB. The second year is focused on liver transplantation as well as laparoscopic donor nephrectomies with continued time on kidney transplantation and three more months in HPB.

During the donor service, time is built into the schedule for you to complete research and education on top of clinical training.

Rotation schedule

Rotation	Length
Kidney/Pancreas Transplant Service	26-27 weeks
Liver Transplant Service	22 weeks
Donor Service	25-26 weeks
HPB Service	24-26 weeks

Rotation descriptions

Kidney-pancreas transplant service

The goal of this rotation is to provide experience in kidney transplantation (recipients of both living and deceased donors) and pancreas transplantation (recipients of deceased donors). The major emphasis of this rotation is surgical experience as well as the postoperative management of these patients and their complications.

You will become familiar with:

Pre-transplant evaluation of potential recipients
Operative planning • Immunosuppressive management
Medical complications of transplant recipients

Unique aspects of the kidney transplant program at Mayo Clinic's campus in Rochester, Minnesota, include:

Positive crossmatch and ABO-incompatible kidney transplantation
Pediatric transplantation

In addition, you will have experience with one of the largest volumes of living donor kidney transplant programs in the country.

Liver transplant service

The goal of this rotation is to provide significant experience with liver transplantation, including:

Pre- and post-operative management of adult and pediatric recipients
Deceased donor whole organ liver transplantation
Deceased donor split organ liver transplantation
Living donor liver transplantation
Pediatric liver transplantation

You will also become familiar with common medical issues in liver transplant patients, such as:

Management of hyponatremia
Spontaneous bacterial peritonitis
Intractable ascites
Addiction issues
Fulminant hepatic failure

Lastly, you are exposed to innovative treatments, including:

Transplantation for extrahepatic cholangiocarcinoma
Domino transplantation for amyloid

Donor service

The goal of this rotation is to provide experience with multi-organ abdominal procurements and living-donor nephrectomy. You also gain additional experience with hemodialysis access and will have time to dedicate to research during this rotation.

HPB service

The goal of this rotation is to provide you with exposure to a wide spectrum of procedures, from resident-level operations to advanced, complex operations designed for advanced fellows who are competent in complicated hepato-pancreatico-biliary (HPB) and upper gastrointestinal surgery.

In large part, the rotation focuses on HPB, though it also involves gastric and some esophageal surgery, major oncologic-type abdominal procedures, and some colon and rectal surgery. While this is not primarily a laparoscopic fellowship, there is considerable laparoscopy involved in your clinical training.

You are fully responsible for patient management on clinical rotations.

Didactic training

What does a typical day or week look like for trainees?

In July, you will meet with the program director to determine goals for the number of patients of each type you should see in clinic.

What is the call schedule like during on-service rotations?

You will share call with our inpatient APP team as well as general surgery residents.

How does your program support residents while on-call?

Surgical consultants are readily available 24 hours per day, and you are encouraged to involve them should any patient care issues surface. We work closely with our medical colleagues, and a hepatologist and nephrologist are on call 24 hours per day. These staff may be contacted in the event of uncertainty regarding the medical management of our patients. Most patient care issues are handled long before consultants perceive a difficulty.

How are didactics conducted?

Both virtual and in-person options are available for all didactic meetings and conferences.

How are didactics balanced with clinical responsibility?

The Abdominal Transplant and Hepatopancreatobiliary Surgery fellowship has a strong didactic program.

In July, you will meet with the program director to determine goals for the number of patients of each type you should see in clinic. You will share call with our inpatient APP team as well as general surgery residents. Surgical consultants are readily available 24 hours per day, and you are encouraged to involve them should any patient care issues surface. We work closely with our medical colleagues, and a hepatologist and nephrologist are on call 24 hours per day. These staff may be contacted in the event of uncertainty regarding the medical management of our patients. Most patient care issues are handled long before consultants perceive a difficulty. Both virtual and in-person options are available for all didactic meetings and conferences.

Conferences

The Abdominal Transplant and Hepatopancreatobiliary Surgery Fellowship has a strong didactic program with many meetings, including:

Morbidity and Mortality. Monthly Transplant Center and HPB conferences where interns, residents, fellows, and specialty staff discuss one or two cases led by a fellow, with expert commentary from various fellows and staff.
Transplant Grand Rounds. Weekly Transplant Center conference where all staff, fellows, residents, and other guests attend, with a variety of intramural and invited expert speakers.
Abdominal Transplant Fellows Education Conference. Weekly educational conference that is specifically geared toward surgical fellows that involves transplant hepatology, transplant nephrology, and surgical staff.
HPB Education Conference. Weekly educational conference that is specifically geared toward hepatopancreatobiliary (HPB) fellows that involves a lecture in the field of HPB.
AHPBA HPB Fellows Grand Rounds. Monthly conference where all staff, fellows, residents, and other guests attend, with a variety of intramural and invited expert speakers.
Journal Club. Monthly Abdominal Transplant and HPB conferences where interns, residents, fellows, and specialty staff discuss a variety of journal articles related to aspects of transplantation and hepatopancreatobiliary surgery.
Deceased Donor Review. Biweekly meeting where abdominal transplant staff discuss past deceased donor surgeries.

Additional didactic opportunities include Surgery Grand Rounds and innumerable basic science lectures complementing the Mayo Clinic academic atmosphere.

Call frequency

Fellows at Mayo Clinic are considered trainees and comply with all regulations regarding trainees, including the 80-hour workweek as stipulated by Mayo Clinic School of Graduate Medical Education (MCSGME) and the Accreditation Council for Graduate Medical Education (ACGME).

You will take call approximately every other weekend following the ASTS Managed Time Policy.

Procedures

To receive a certificate of completion from the ASTS, the trainee must complete the following number of procedures during the two-year clinical fellowship:

Transplant	Procedures
Total transplant volume	50
Liver transplant	45
Living donor nephrectomy	12
Pancreas transplant	10
Pancreas back table prep	10
Pancreas procurement	10

To receive a certificate of completion from the AHPBA, the trainee must complete the following number of procedures during the two-year clinical fellowship:

Transplant	Procedures
Major operative cases	100
Fellow act in role of primary surgeon	70
Major - Liver	25
Major - Complex biliary	15
Major - Pancreas	25

Research opportunities

Your research opportunities at Mayo Clinic are outstanding. You are encouraged to participate in research projects with the consulting staff during the Donor Service rotations.

The research experience includes opportunities for research in:

Endothelial cell biology
Immunology
Artificial liver support devices
Cholangiocarcinoma
Transplantation obesity
Other basic research projects in all facets of transplantation.
Biliary diseases
Hepatobiliary and pancreatic disorders

Research is a core value for a well-rounded academic surgeon.

Additional training opportunities

As a fellow at Mayo Clinic, you'll have access to robust clinical, educational, and research resources. You'll find support both inside and outside of the campus to promote physical and mental wellness and ensure your work/life balance. Many prominent professors visit Mayo Clinic each year and present their work during lectures and participate in hospital rounds. You are encouraged to take full advantage of these opportunities.

Teaching opportunities

Residents and other trainees are always rotating on the transplant service, and you will have the opportunity to provide teaching to residents and to junior fellows. It is our firm belief that teaching relevant subject matter helps trainees transform into experts. Teaching is done routinely on rounds and in didactic settings. You are encouraged to lead teaching sessions, and staff are always present to assist.

Evaluation

To ensure that you acquire adequate knowledge and develop your technical skills, performance is monitored carefully throughout the Abdominal Transplant and Hepatopancreatobiliary Surgery Fellowship. You are evaluated formally by all surgical faculty members. As per ASTS guidelines, your operative and non-operative milestones will be assessed every six months. In addition, quarterly meetings will be held with the program director. You will also evaluate the faculty regularly to ensure that educational needs are being met. The HPB fellowship program director will also meet with you at the end of each HPB rotation.

Mentorship

Faculty members generally have an open-door policy. Daily interaction between staff and fellows is encouraged. Upon graduation, most fellows can name several staff members who strongly influenced their development and career choice.

Patient population

There is no denying that the transplant patient population is one that can be complex and challenging clinically. The key is to have appropriate mentorship, so you feel comfortable as you grow your knowledge of transplant. We encourage you to contact staff with any questions, day, or night.