A Complex Biliary Procedure: Chief Resident or Fellow

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A Complex Biliary ProcedureChief Resident or
Fellow?

• Keith D. Lillemoe, M.D.
• Indiana University
• School of Medicine

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Resident or Fellow?

• Framing the Problem
• Fellow Issues
• Resident Issues
• Health Care Issues
• Quality (and other) issues

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Resident or Fellow?

• FELLOW ISSUES
• Increasing Number of Fellowships / Fellows
• - MIS, HPB, Surg Onc
• - More fellows / program
• Why?
• - Man Power Issues
• - Faculty satisfaction
• - Why train a _______ to this procedure?

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Resident or Fellow?

• Resident Issues
• 80 hour work week
• Lack of interest Speciality specific
• Less technical experience
• 1990
  2005
• CBDE 9.8 cases 1.7 cases
• Gastrostomy 9.4 cases 4.7 cases
• Whipple 1.4 cases 4.0 cases
• AAA 7.1 cases 4.5 cases

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Resident or Fellow?

• Health Care Issues
• New Technology
• ERCP, PEG, Endovascular procedures,
• Stereotactic Core Breast biopsy
• Regionalization
• Specialization

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Resident or Fellow?

• Health Care Issues
• New Technology
• ERCP, PEG, Endovascular procedures
• Stereotactic Core Breast biopsy
• Regionalization
• Specialization

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Resident or Fellow?

• Quality (and other) Issues
• Volume / Outcome Relationship
• 1979 2001
• CBDE 47,000 cases 7,700 cases
• Complications 3.4 17.4
• Attending Attitudes

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Resident or Fellow?

• IU HPB Fellowship
• Established 2005
• Match participation
• Curriculum based
• Fellowship Council Accreditation

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Resident or Fellow?

• IU HBP Fellowship
• WHY?
• Increasing volume
• Inadequate coverage
• Legacy

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Resident or Fellow?

• IU HPB Fellowship
• Solution?
• Faculty Assignment / Split Service
• Housestaff Assignment
• Selected x-over
• Service Meetings
• Results?
• Adequate volume fellow and residents
• Improved teaching, ?care
• Unresolved problem - leadership

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Resident or Fellow?

• Recommendation
• Cases Predetermined by Service Assignment
• Monitor Case Volumes / Hours
• Communication / Feedback
• Faculty Expectation / Support