Colon and Rectal Surgery Training Program

Policies and Procedures Manual

Overall Program Goals and Objectives

1. The overall goal of the University of Pennsylvania Colon and Rectal Surgery Residency Program is to produce a well-rounded colon & rectal surgeon with clinical competence in the care of lower gastrointestinal disease.
2. At the completion of the fellowship, the trainee will have factual knowledge and technical skills with respect to preoperative evaluation, operative management and postoperative care of patients with lower gastrointestinal disease. This includes knowledge and/or technical competence regarding:
1. Anatomy, physiology, and embryology pertinent to the practice of colon & rectal surgery.
2. Anorectal physiology testing (anorectal manometry and pudendal nerve motor latency testing), including patient selection, interpretation of results, and clinical application.
3. Endoscopy (both diagnostic and therapeutic) of the colon, rectum and anus, including anoscopy, rigid proctosigmoidoscopy, flexible sigmoidoscopy, and colonoscopy, including patient selection, patient preparation, and the prevention and management of complications.
4. Endoanal and endorectal ultrasound, including patient selection, interpretation of results and clinical application of results.
5. Interpretation and clinical application of radiographic studies of the colon, rectum, and anus, including plain abdominal x-rays, bowel transit studies, contrast enemas, ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine studies, PET scan, and fluorodefecography.
6. Pre-operative evaluation and management, including initial evaluation, pre-operative risk assessment, bowel preparation, and proper patient selection.
7. Post-operative management, including post-operative analgesia, fluid management, and diet.
8. Prevention and management of post-operative complications.
9. Benign anorectal disease, including hemorrhoids, fissure-in-ano, abscess, fistula-in-ano, rectovaginal fistula, perianal dermatoses, pruritus ani, and hidradenitis.
10. Pilonidal disease, including surgical options for simple, complex, and recurrent disease.
11. Sexually transmitted diseases of the anorectum, including management of simple and complex condyloma accuminatum, anal dysplasia, and other anorectal manifestations of HIV infection.
12. Lower gastrointestinal hemorrhage.
13. Benign disease of the colon, including diverticular disease, volvulus, constipation, and various forms of colitides.
14. Trauma of the colon, rectum, and anus, including management of rectal foreign bodies.
15. Epidemiology, etiology, and molecular basis of colon and rectal cancer.
16. Evaluation and surgical management of polyposis syndromes.
17. Evaluation, staging, and surgical management of colon and rectal cancer.
18. Hereditary non-polyposis colon cancer, including risk assessment, surgical management, and proper use of genetic counseling.
19. Neoadjuvant and adjuvant therapy for colon and rectal cancer.
20. Management of locally advanced and recurrent colon and rectal cancer.
21. Anal cancer, including surgical and non-surgical treatment
22. Presacral tumors.
23. Medical and surgical management of inflammatory bowel disease, including ulcerative colitis, Crohn’s disease, and indeterminate colitis.
24. Intestinal stomas, including indications, surgical techniques, and management of stoma-related complications.
25. Fecal incontinence and rectal prolapse.
26. Evaluation and management of pelvic floor disorders and obstructed defecation.
27. Endometriosis as it applies to colon and rectal disease.
28. Laparoscopy for colon and rectal disease, including indications and contraindications. The resident will be technically competent to perform laparoscopic surgery, as appropriate, for diseases of the colon and rectum at the completion of training.
29. Recognition of gross and microscopic features of key colon and rectal pathologies and histologies.
30. A basic understanding of pediatric diseases of the colon, rectum, and anus, including Hirschsprung’s disease and anorectal malformations.
3. Additionally, the resident will have an understanding of health care economics, ethical considerations, and medicolegal considerations. Upon completion of the residency, the resident will be prepared to play an active role in the socioeconomic and political climate that has an impact on the care that he/she is are able to provide to patients.
4. The resident will develop the presentation skills that will allow him/her to deliver an effective medical presentation, and will also refine his/her skills in critically appraising current medical literature.
5. In an effort to broaden the resident’s exposure and improve his/her educational opportunities, the resident will rotate through three clinical sites in the University of Pennsylvania Health System:
1. Pennsylvania Hospital (PAH)
• Joshua Bleier, M.D. on-site director
2. Hospital of the University of Pennsylvania (HUP)
• Najjia Mahmoud, M.D. – on-site director
3. Penn Presbyterian Medical Center (PPMC)
• Skandan Shanmugan, M.D. – on-site director
4. In addition, Joshua Bleier, M.D. will serve in a supervisory role at both PAH and HUP.
5. And Cary Aarons, M.D. will serve in a supervisory role at both HUP and PPMC.
6. The resident’s typical weekly schedule is as follows:

1. Flexibility in the schedule will be allowed in order for the resident to maximize educational experiences.
2. The resident will take call from home for the colon & rectal surgery service at PAH on Monday through Thursday from 5PM to 7AM and every third weekend.
3. The resident will record duty hours and will remain in compliance with ACGME –mandated duty hour restrictions.
7. Responsibilities of the faculty members include:
1. Direct supervision of the resident in the outpatient clinic, in the operating room, and in the inpatient setting.
2. Participation in the educational activities of the division, including didactic lectures, journal club, and multi-disciplinary conferences.
3. Regular evaluation of the resident, providing him/her with feedback in areas of strong performance and also in areas where the resident may not be performing as expected where he/she should more strongly focus educational efforts.
4. Providing assistance/guidance to the resident in research efforts.
8. Individual educational goals and objectives, based on the ACGME core competencies, are in place for each of the three clinical sites.
9. The resident will be expected to comply with all Graduate Medical Education policies of the University of Pennsylvania Health System. These are available for review here.
1. Additionally, individual divisional policies, which are listed in the Divisional Policy & Procedures Manual, will be adhered to.
2. Failure to comply with polices & procedures as described may result in disciplinary action at the divisional, departmental, or institutional level.

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