Cleveland Clinic Florida's Department of Colorectal Surgery maintains an average of six to 24 month non-funded research residency positions in colorectal surgery. These positions are available to general or colorectal surgeons who wish to gain additional experience in both the practical and academic aspects of colorectal surgery. There are over 75 ongoing prospective studies with which the residents become immediately involved. special interest areas or other projects may be pursued in addition to those studies already in progress.
Much of the research relates to anorectal physiology, laparoscopy, inflammatory bowel disease, and carcinoma. Recent projects by our research residents have been presented in many prestigious organizations:
- American College of Gastroenterology
- American College of Surgeons
- American Society for Gasrointestinal Endoscopy
- Argentine Surgical Society
- Asian Federation of Coloproctology of Great Britain and Ireland
- Association of Coloproctology of Great Britain and Ireland
- Brazilian Society of Coloproctology
- Central European Society of Coloproctology
- European Association of Endoscopic Surgery
- Florida Gastroenterologic Society
- Florida Society of Colon and Rectal Surgeons
- German Surgical Society
- International Society of University Colon and Rectal Surgeons
- Israeli Surgical Society
- Italian Society of Colorectal Surgeons
- Italian United Coloproctology
- Latin American Association of Colorectal Surgery
- Latin American Society of Endoscopic Surgeons
- Mediterranean Society of Coloproctology
- Northeastern Society of Colon and Rectal Surgeons
- Pan Asian Congress of Coloproctology
- Society of American Gasrointestinal Endoscopic Surgeons
- Society of Laparoendoscopic Surgeons
- Society of Surgical Oncology
- Society for Surgery of the Alimentary Tract
- South Florida Chapter of the American College of Surgeons
- Southern Medical Association
- Southern Surgical Society
- Surgical Research Society (Great Britain)
- Swiss Surgical Society
- Taiwanese Society of Colon and Rectal Surgeons
- The American Society of Colon and Rectal Surgeons
- World Congress of Endoscopic Surgery
- World Congress of Gastroenterology
Over 75 chapters, manuscripts, and abstracts were published by the members of the Department during the last year. A list of recently published projects is available upon request.
One of the primary functions of research residents is to become familiar with the Anorectal Physiology Laboratory and to help perform and interpret the physiologic studies. Research residents thus gain a broad familiarity with the indications for, techniques of, and interpretations of anorectal manometry, rectal compliance, colonic and small bowel transit studies, cinedefecography, anal electromyography, pudendal nerve terminal motor latency assessment, and anorectal ultrasonography. In addition, time is spent working with the biofeedback therapist and learning the techniques of biofeedback therapy.
Research residents are welcome to participate in the clinical aspects of the practice as time permits. There is an exceedingly busy clinical practice with four full time staff colorectal surgeons, Drs. Steven Wexner, Juan Nogueras, Eric Weiss, and Dana Sands. In addition to the clinical residents, research residents, and observers, there are nurse clinicians who assist in patient care and help with much of the day-to-day patient management. This involvement allows the research residents more time for interaction in the operating room, endoscopy suite, office, and physiology lab. In addition, there are several dedicated colorectal clinic nurses, enterostomal therapists, and biofeedback therapists.
Over 150 patients are seen in the office each week and evaluated for a wide gamut of colorectal complaints. Procedures such as rubber band ligation of internal hemorrhoids, excision of thrombosed external hemorrhoids, superficial fistulotomies, incision and drainage of abscesses, incision and drainage of pilonidal abscesses, rectal and perianal biopsies, and fulguration of lesions are performed in the clinic.
In addition, there are over 20 rigid proctoscopies and flexible sigmoidoscopies performed in the clinic setting each week. Over 75 colonoscopies are performed each week, approximately two-thirds of which are therapeutic rather than diagnostic. There are usually over 20 resections performed in the hospital each week including segmental and total abdominal colectomies, low anterior resections, abdominoperineal resections, total proctocolectomies, ileoanal reservoirs, proctopexies for prolapse, small bowel resections, and colostomy and ileostomy related procedures. Many of these procedures are laparoscopically performed.
Over 500 ileoanal pouches and over 500 laparoscopic colectomies have been performed in the last few years. There is also a heavy emphasis on procedures relating to disorders of evacuation such as sphincteroplasty, the artificial bowel sphincter, radiofrequency and sacral nerve stimulation for fecal incontinence, perineal rectosigmoidectomy with levatoroplasty for rectal procidentia, and anoplasty for stenosis. In addition, the standard spectrum of anorectal operations is also performed. Research residents are involved in these procedures so that they become proficient with the indications for, techniques of, and results of these various therapies.
There are a number of formal educational conferences including anorectal physiology conference and an ultrasound conference in which all the studies from the previous few days are reviewed and a treatment outline is made. There is also a core curriculum conference each week at which a single topic in colorectal disease is discussed at length by all of the members of the department. In addition, there are several interdisciplinary conferences, including a colorectal surgery radiology conference which alternates with a colorectal surgery pathology conference. At each of these conferences, either the radiologist or pathologist reviews the interesting studies from the previous two weeks with the staff and residents from each department. Case management conferences are held on a bimonthly basis and consist of a case by case presentation of all scheduled surgical procedures which are then discussed with the staff. These conferences have proven invaluable, not only in terms of an enhanced comprehension of patient management and appreciation for continuity of care, but also in preparation for board examinations.
The Colorectal Surgery Department hosts a monthly Journal Club and a Tumor Conference. To complement the input of the staff from Cleveland Clinic Florida, many of the community colorectal surgeons participate in these conferences. This interaction enables the residents to benefit from additional opinions. There are also a monthly Colorectal Surgery Morbidity and Mortality Conference, and Colorectal Surgery Research Forums.
In addition to the conferences outlined above, standard surgical conferences for the Division of Surgery include Morbidity and Mortality and Grand Rounds. While participation in all of the colorectal surgery conferences is mandatory, participation in the general surgical conferences is optional.
It is expected that the colorectal surgery resident will attend the International Colorectal Disease Symposium in Fort Lauderdale which is held every February. Over 1,000 surgeons and physicians from 65 countries attend this three day course.
Furthermore, multiple annual colorectal laparoscopic surgical courses are coordinated by the Department. Resident participation in these courses is also possible. Lastly, three times each year, the Department hosts visiting professors for one day each. Previous visiting professors have included Drs. Stanley M. Goldberg, Herand Abcarian, David Schoetz, Thomas Dailey, H. Randolph Bailey, Marvin Corman, Indru Khubchandani, Ira Kodner, David Rothenberger, Zane Cohen, David Beck, Phil Gordon, James Fleshman, John Pemberton, Robert Beart, Robert Fry, Lee Smith, Patricia Roberts, Terry Hicks, and Alan G. Thorson.
The visiting professor program is designed to permit full interaction between the visiting professor and the residents. It is anticipated that the resident will submit at least one paper for presentation at the annual meeting of the American Society of Colon and Rectal Surgeons or a similar prestigious national or international meeting. The residents are expected to present at the South Florida Chapter of the American College of Surgeons meeting in May. Each resident is also encouraged to submit work done at CCF for presentation in their own geographic area.
Basically, the research residency year can be tapered to suit one’s needs. Eligible research residents may choose to apply for the clinical residency either at CCFlorida or elsewhere, and others may wish to participate only in the research residency year. Quite a number of non-physiology research projects are currently underway. Other areas of special interest may be addressed. Past research residents have found the environment to be most stimulating and rewarding.
Research Residents / Fellows
Interested candidates should write to Graduate Medical Education for additional information and application forms. After acceptance to the position, contingent upon external funding, the Cleveland Clinic Educational Foundation will assist in providing the necessary forms to obtain the appropriate visa.
Due to the large number of applications received for these few positions, the appointments are made based upon how promptly the application process is completed. Also, due to the amount of paperwork required, it is not uncommon to begin the application process one year to eighteen months prior to the anticipated start date. Delay in completion of the application process, including written confirmation of funding, may result in a later starting date.
Cleveland Clinic Florida
Research and Education