Requirements for Application:
The objective of our transplant surgery fellowship training program is to develop proficiency in the surgical and medical management of patients with end-stage organ diseases amenable to transplantation. We require that candidates for this training must have satisfactorily completed a surgical residency that satisfies the educational requirements for certification by the medical council of India
Organization of the transplant fellowship rotations:
The Liver Transplant fellowship at CLBS is a 1 year fellowship that involves clinical rotations in all fields of liver transplantation.
Currently, there are 6-7 fellows at one time. The clinical fellows rotate Every week between the Donor, Recipient, ward, ICU works along with pediatric rotation. During these rotations, the fellows cover all transplant procedures, manage patients in the intensive care units and the floor, see consults, and attend the pre-transplant and post-transplant clinics. The fellows gain experience in both recipient and living donor evaluations and patient selection. They acquire extensive knowledge in donor procurements, liver transplantation, and pediatric transplantation, also a significant amount of non-transplant surgery that involves both the fellow and senior resident, GI surgical procedures, hepatobiliary procedures, and general surgery on transplant patients. The transplant fellow participates in, and eventually independently performs, procurements of liver grafts and recipient hepatectomies. They are fully trained in ICU management of donor management.
Liver rotation - covers all liver transplants, all hepatobilliary cases, perform all recipient operations when on first call. The liver fellow will cover all liver pre-transplant evaluation and post-transplant clinics and hepatobiliary patients.
They will assist with all transplants, as feasible, with second call fellow and senior resident available for backup and donors.
The call schedule follows the recommendations of the Indian medical council for fellow work hours. There is a weekly schedule with rotating weekend coverage with a primary and secondary call fellow.
Weekend calls are rotated among fellows. Every duty night is compensated with a post duty off.
All fellows are allowed to attend national conferences, particularly if work is accepted for presentation.
The attendings and fellows for both Nephrology and Hepatology are very involved in both the pre and post clinics of our transplant patients, and the inpatient care, but it is the surgeons and transplant fellows who “run” the service, with the nephrologists, diabetologists, and hepatologists serving as consultants. There is frequent communication between the nephrologists and hepatologists and our transplant fellows to formulate a plan for those awaiting transplantation, and the management of the post-transplant patients. Immunosuppression management is done on inpatient rounds with the transplant surgery attendings.
Interaction with transplant coordinators, nurse practitioners, physician assistants: There are 3 inpatient transplant coordinators that cover the service 7 days a week, 3 pre-transplant and 3 post-transplant liver coordinators.
These coordinators are involved in a significant amount of the care and planning of our transplant patients and work side-by-side with our transplant fellows in the clinics, on the clinical transplant floor, in the ICU, and on call, to deal with day to day issues, transfers, emergency room visits, immunosuppression management, and follow-up with referring physicians.
The transplant fellow’s surgical responsibilities grow as their experience grows. In the first days to weeks, they will first assist on liver transplants..
In liver, they will be begin as first assistant, but depending on skill and experience, they are usually the primary surgeon on straight-forward liver transplants by the middle or end of their first year. An attending surgeon is almost always present for the entire liver transplant.
All procedures must be recorded on the case logs which are reviewed every 6 months by the Program Director.
Transplant conferences: The fellowship begins with a 2 day orientation to CLBS, Apollo hospitals and transplant service. The academic schedule program is regular with weekly audit on Mondays, research meets on Tuesdays pre transplant discussion on Wednesdays, scientific discussion addressing all issues on liver transplantation on Fridays.