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Royal North Shore Hospital

Overview

The HPB Unit is part of the Upper GI Surgery Unit at Royal North Shore Hospital. The unit has three surgeons with a predominant focus on HPB surgery. Approximately 60 liver resections and >100 pancreatic resections are performed annually. This is a busy clinical rotation with a particular focus on major liver and pancreatic surgery. The Unit undertakes a range of complex open and laparoscopic HPB and General Surgical procedures. The HPB Fellow is attached to three HPB consultants only. There is a separate Oesophago-Gastric Fellow working with two Upper GI surgeons whose main focus is Oesophago-Gastric and Obesity Surgery. In addition, there are two full time HPB research fellows, one of who oversees the research activities of the unit. The HPB Unit looks after patients in Royal North Shore Hospital (public hospital) and North Shore Private Hospital.

Anticipated Operative Experience

The Fellow participates in all public hospital and many private hospital operating lists throughout the 12 month appointment. They can expect to be involved in more than 200 major HPB cases during the rotation including exposure to a large number of liver and pancreatic resections. In at least 50% of cases the Fellow will be the principal operator. The HPB Fellow also takes second call as a junior consultant for all acute gastrointestinal emergencies admitted under the HPB Unit. At the end of the year, the Fellow would have had enough exposure to complex HPB surgery to confidently perform those procedures independently.

Multidisciplinary Interaction

There are regular clinical meetings involving interaction with multidisciplinary specialists. These include a dedicated HPB radiology meeting each week, a weekly gastroenterology meeting (gastroenterologists, surgeons and radiologists), a weekly unit audit meeting (surgeons, junior medical staff, and nursing staff), a second weekly HPB MDT meeting (surgeons, medical oncologists, radiation oncologists, radiologists) and a monthly surgical Grand Rounds (sub-speciality surgical groups, medical students, junior medical staff, and nursing staff). These meetings involve structured presentations of selected cases and the HPB Fellow is expected to participate and present on a regular basis.

Perioperative Evaluation

There are two formal public outpatient clinics at Royal North Shore Hospital. These include a wound clinic and a pancreatic exocrine deficiency clinic. Also, as required, the Fellow can participate in the liver and pancreatic cancer clinics conducted out of the private consulting rooms of the HPB surgeons. This will involve participation in preoperative evaluation and assessment and treatment planning.

Training Program

The HPB Fellow attends all clinical and teaching meetings as appropriate within the Division of Surgery. The surgical Grand Rounds involves alternating between a journal club format and didactic lectures on Upper GI, Colorectal, Vascular and Endocrine surgical issues.

Members of the Upper GI Surgical Team include:

  • HPB Clinical Fellow
  • HPB Research Fellows (x 2)
  • Oesophago-Gastric Fellow
  • SET 3 General Surgical Registrar
  • SET 1 General Surgical Registrar
  • Resident Medical Officer
  • Intern

The clinical workload of the Unit is such that the HPB Fellow and the Oesophago-Gastric Fellow participate in all major Upper GI surgical cases at Royal North Shore Hospital as well as many in the private hospitals. The General Surgical Registrars (SET trainees) only work at RNSH but can still expect to do more than 100 major cases and in 30% of these cases they will be the principal operator during any 6 month rotation.

Funding for this Position

The Fellow is part funded (0.5 FTE) salary from Royal North Shore Hospital with the remainder of the salary made up from private assisting and supplemented from an Upper GI Surgical trust fund.

Education Facilities Available for the HPB Fellow

The HPB Fellow is provided with a workstation, computer, internet access and a printer within the Upper GI Surgical Department. The HPB Fellow also has basic administrative support and is allocated a defined amount of time each week (1.5 days) to undertake clinical or laboratory-based research. The HPB Fellow has full access to the Royal North Shore Hospital library as well as to the University of Sydney library which provides an extensive electronic literature database access.

Director of the HPB Program/Mentors

The Director of the HPB Fellowship Program is Prof Thomas J Hugh, a board member of the ANZHPBA. All consultants within the HPB surgery unit have higher degrees and have a major interest in both clinical and laboratory-based research. All consultants regularly present and participate in National surgical meetings. They also regularly publish in the field of HPB surgery. There are formal prospective liver and pancreatic databases within the unit as well as a dedicated Data Manager. The HPB Fellow is able to use these resources for clinical research. The HPB Fellow's progress will be carefully monitored and formally evaluated during the appointment. There will be 3 monthly feedback sessions with the program director.

Support from the Institution

Royal North Shore Hospital and the Northern Sydney Area Health Service are fully supportive of both the HPB Fellow and the Oesophago-Gastric Fellow positions. In recognition of the contribution these senior trainees make to our hospital they are provided with substantial base funding.

Research Training

The HPB unit runs a monthly research meeting with over 50 active participants including two PhD students and numerous MD students from the University of Sydney. We publish 10-15 clinical and basic science papers per year and have active collaborative relationships with several laboratories. The clinical fellow will be expected to conduct a limited number of clinical research projects while the research fellow will take the bulk of the research responsibility.

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