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The MIS/Bariatric Surgery Fellowship which is now the Bariatric Fellowship at Tufts Medical Center began in 2002. At that time there were two faculty surgeons, Dr. Scott Shikora (past Director and past president of ASMBS) and Dr. Michael Tarnoff who together had performed the first laparoscopic gastric bypass in New England, as well as the first LAGB procedure in New England. Dr. Tarnoff is in an adjunct clinical position, where he remains on staff but divides his time. Dr. Julie Kim, the current program director, completed her MIS/Bariatric Fellowship training at Tufts Medical Center in 2003 and Dr. Sajani Shah, completed her MIS/Bariatric Fellowship training at Tufts Medical Center in 2008 at which time she joined the faculty. A fifth surgeon who completed her MIS/Bariatric Fellowship training at Tufts Medical Center in 2009 will also be joining the faculty, summer 2011 after having practiced out of state. The Bariatric program at Tufts Medical Center became fully laparoscopic in 2002 and remains one of the oldest, largest, high volume academic centers in New England. All program faculty are dedicated to Bariatric Surgery and the education and training of one to two clinical Bariatric Fellow(s) per year.
The Weight and Wellness Center at Tufts Medical Center (previously known as the Obesity Consult Center) was started in 1985 by Dr. Randy Reinhold with both an in house behavioral and dietary component. The multidisciplinary infrastructure with concomitant medical weight loss program has always been a unique aspect of our bariatric program which was highlighted by the Scientific American Frontiers program in 2 separate shows as a model laparoscopic multidisciplinary Bariatric program.
The Bariatric Fellowship volume includes: primary restrictive and malabsorptive cases, laparoscopic revisional cases, IRB approved research procedures, as well as the full spectrum of supplemental procedures such as lap assisted ERCPs in post bypass patients, diagnostic laparoscopies for internal hernias, laparoscopic RYGBP reversal procedures sufficient to train a Bariatric Fellow(s) as well as provide cases for general surgery residents that also rotate and operate with the Bariatric Faculty. The Fellow also participates in teaching procedures, particularly in the latter portion of the fellowship. We are a tertiary referral center for complex bariatric patients and accept all Bariatric patients in need (those who have had remote surgery, surgery abroad, or any acute complication regardless of who or where the surgery was performed). We provide second opinions and consistently approach complex procedures such as leaks, obstructions, and resections of marginal ulcers via a laparoscopic approach. We are involved in new technologies and are the principle center for the VBLOC trial that will begin this summer.
We are, and have always been, a very “hands on” program. All faculty members perform the standard procedures utilizing similar operative techniques and equipment as well as utilizing universal Bariatric peri-operative and post-operative pathways which are under continuous evaluation and review. This allows for a very streamlined approach and quicker learning curve for both our residents and Fellows in terms of operative competency as well as peri-operative and post operative care issues. Although the fellow is given autonomy and encouraged to develop independent thought and function, the staff surgeons are very involved in the care of the Bariatric patients. We encourage discussion regarding the clinical assessment and treatment plan of a patient and will continue to “push” each Fellow further as the year progresses in regards to options, risks and benefits and try to instill a sense of “ownership” while providing a buffer of 24 hour supervision as all faculty members are dedicated to patient care, are available and responsive to any and all urgent issues. All patients are seen by both Fellow and staff at minimum of 2 times a day. Rounds are usually performed as a “team” 3 days a week with inclusion of physician extenders such as our PA and members of our multidisciplinary team (RDs and behavioral staff). Safety, attention to detail, excellent surgical skills and excellent patient care is what we hope to teach each and every Fellow we train. Fellows also participate in pre-operative patient preparation as well as post-operative follow-up as a member of the aftercare team. The Fellow will have an independent clinic for both pre-op patients and post-op patients.
New to the fellowship for 2011-2012 will be the addition of several outreach sites to accommodate additional surgical volume that include: MetroWest Medical Center, Natick, MA, Signature Healthcare Brockton, MA and Mount Auburn Hospital located in Cambridge, Ma, as part of a dedicated community hospital rotation.
Our faculty was involved directly or as a contributing member of the ASMBS Obesity Compendium- a comprehensive web based multimedia reference. We incorporate the recommended ASMBS core curriculum topics into a structured education program. We have successfully trained 7 Bariatric Fellows who are now all in full time practice. All graduating fellows were involved in clinical research that resulted in speaking engagements, presentations at national and international meetings.
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