Pediatric Surgery

Fetal Surgery Fellowship Training Program

The Division of Pediatric Surgery at Cincinnati Children’s Hospital Medical Center offers a Fetal Surgery Fellowship Training Program.

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Program Demographics

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Name of Host Institution: Cincinnati Children’s Hospital Medical Center

Program Specialty / Subspecialty: Fetal Surgery Fellowship Training Program

Program Mailing Address:
Cincinnati Children’s Hospital Medical Center
MLC 2023
3333 Burnet Ave.
Cincinnati, OH 45229-3039

Program Phone Number: 513-803-9226

Program Fax Number: 513-636-7657

Program Email: foong.yen.lim@cchmc.org

Program Director: Foong-Yen Lim, MD

Alternate Program Contact: Leslie Grube, residency coordinator, Leslie.Grube@cchmc.org

Introduction

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History

This program was approved by the Graduate Medical Education Committee in February 2004. The first trainee began in July 2004.

Duration

One year fetal fellowship plus 2nd year opportunity to obtain a Master's Degree as an incidental component to the training, through the division of pediatric surgery.

Prerequisite Training / Selection Criteria

The trainee would need to have completed at least three years of residency in general surgery, and therefore would be a candidate eligible for application to a pediatric surgical training program. It is also possible that such an individual will have already completed general surgery or a general pediatric surgery residency, and now desires specialty training in fetal surgery.

Goals and Objectives

We have established a fetal surgery training program in which individuals participate in the broad clinical and academic experience now available in fetal surgery with the creation of the Cincinnati Fetal Center. This position could be filled by a general surgery trained individual who comes for a one year fetal surgery experience, and would serve as the fetal surgery fellow, or by a trained pediatric surgeon who desires additional fetal surgery experience.

The goal of this position is to enable the trainee to gain exposure in fetal surgery which will enhance their opportunity for application for a more formal general pediatric surgery fellowship in the future, or if they have already completed training in pediatric general surgery, will enhance their experience in fetal surgery in anticipation of a sub specialization in this area.

Program Certifications

None at this time.

Resources

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Teaching Staff

Pediatric Surgery – Drs. Daniel von Allmen, Maria Alonso, Rebeccah Brown, Roshni Dasgupta, Richard Falcone, Jason Frischer, Victor Garcia, Thomas Inge, Foong-Yen Lim, Jaimie Nathan, Jose Peiro, Beth Rymeski and Gregory Tiao
Obstetrics and Gynecology – Drs. William Polzin, Mounira Habli, and Sammy Tabbah
Genetics – Dr. Robert Hopkin and Dr. Howard Saal
Neonatology – Drs. Beth Haberman and Paul Kingma
Neurosurgery - Drs. Karin Bierbrauer and Charles Stevenson
Cardiology – Drs. Allison Divanovic and James Cnota
Urology – Drs. Paul Noh, Pramod Reddy and Bob Defoor
Radiology – Drs. Beth Kline-Fath, Maria Calvo-Garcia, and Carl Merrow

The training program director will coordinate all aspects of the fellowship training program for the fetal surgery fellow. All of the other listed faculty will be involved in specific training experiences. The surgical faculty will supervise the fetal surgery fellow on all operative cases as well as on inpatient and outpatient care.

Facilities

All training is conducted at the Cincinnati Children’s Hospital Medical Center. The Cincinnati Children’s Hospital Medical Center is a private medical center providing 673 inpatient beds. The hospital is one of the largest children’s care facilities in the United States in several categories: number of beds; number of emergency room visits; and number of operative procedures.

Educational Program – Basic Curriculum

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Clinical and research components

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Clinical and research components: During the training period, this individual will be expected to participate in the Fetal Surgery educational programs, outpatient and inpatient care, routine and complex surgical procedures. The trainee will also be involved in research projects. The trainee may also participate in shared general pediatric surgery clinical and educational experiences with our current pediatric surgery trainees when deemed to be beneficial.

The goal of this fellowship position is to enable the trainee to gain experience in the diagnosis, medical and operative management of a wide spectrum of fetal abnormalities. This experience will first and foremost expand the pool of specialists who will be able to care for these patients. In addition, this experience will permit the practitioner to enhance their expertise in the treatment of fetal problems in anticipation of a sub-specialization in this area.

Trainee’s supervisory and patient care responsibilities

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Trainee’s supervisory and patient care responsibilities: The ultimate responsibility for care of the patients is the attending surgeon. No patient is admitted to the hospital, undergoes a procedure, or has a consultation without the attending surgeon being made fully aware and assuming all responsibility. The fellows interact with the attendings on a daily basis to go over the patient’s progress or to raise any concerns. The attending surgeon is routinely called directly by the fellow. The fellows round with the attendings on all patients. There is frequent communication both at the bedside and in the department regarding patient management decisions.

Procedural requirements

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The operative procedures and skills require at least three years of general surgery training or its equivalent. The trainees will participate in various surgical procedures, including:

Open Fetal Surgery for:

Resection of Congenital lung lesions
Resection of teratomas / tumors
Repair of Spina Bifida

Fetoscopic Surgery for:

Laser treatment of Twin-Twin Transfusion Syndrome (TTTS)
Release of amniotic bands
Treatment of chorioangioma
Release of Bladder Outlet Obstruction (BOO)
Repair of Spina Bifida
Tracheal Occlusion in Congenital Diaphragmatic Hernia (CDH)

Radiofrequency Ablation for:

Twin reversed arterial perfusion sequence (TRAP)

Percutaneous Shunt Placement for:

Fetal pleural effusions
Cystic lung lesions
Bladder outlet obstruction

EXIT Procedures for:

Tumors / teratomas
Congenital High Airway Obstruction Syndrome (CHAOS)
Micrognathia
Severe Congenital Diagphragmatic Hernia (CDH)
Severe Congenital Heart Defects

Didactic components

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Daily

Bedside rounds

Weekly

Tumor Board
UC Surgical Grand Rounds
Pediatric Surgery Grand Rounds
Pediatric Surgery / Radiology Conference
Pediatric Surgery Morbidity and Mortality Conference
Fetal Therapeutic Conference
Fetal Morbidity / Mortality Report

Monthly

Trauma Case Review
Trauma Morbidity and Mortality Conference
Fetal Therapy Grand Rounds

Training progression for a second year

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The core curriculum of the fetal surgery fellowship program may be completed in one year with a second year for selected fellows. The second year allows the fellow to continue to increase expertise in the diagnosis and management of more complex disorders such as fetoscopic diaphragmatic hernia repair and myelomeningocele repairs. In addition, the fellow will gain specific knowledge and experience in clinical and translational research, including preparing a clinical trial, gaining IRB approval and executing the study.

Additional focus will be placed on preparing abstracts and presentations for national meetings, preparing and submitting peer reviewed manuscripts and writing local and national grant applications.

Evaluation

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Fellows are evaluated every six months by the Program Director, and a summary evaluation is conducted at the conclusion of the fellowship. In addition, the sub-specialty residents are expected to provide formal evaluations of the individual faculty members, the program of learning, and the program resources on an annual basis. This information is collated and presented to the faculty in an anonymous fashion.