From Residency to Fellowship: Two Fellows’ Journeys

This column aims to educate individuals and organizations about the importance of the work that the Foundation for Surgical Fellowships is doing to ensure the funding that leads to the innovative training for surgeons to apply the principles of advanced surgical techniques in patient care.  

This month: From Residency to Fellowship: Two Fellows’ Journeys

by Matthew O. Hubbard, MD, and Caitlin Halbert, DO, MS

Dr. Matthew Hubbard is currently working to complete a Bariatric Fellowship under the direction of Ronald H. Clements, MD, at Vanderbilt University in Nashville, Tennessee. Dr. Halbert is currently working to complete a Bariatric Fellowship under the direction of Aurora D. Pryor, MD, at Stony Brook University Medical Center, Stony Brook, New York.

Funding: No funding was provided for this article

Financial Disclosures: The authors report no conflicts of interest relevant to the content of this article.

Bariatric Times. 2014;11(12):24–25.

Entry #1: Matthew O. Hubbard, MD

“As the calendar flips a page and October begins, I have now completed one quarter of my year-long fellowship in Minimally Invasive Surgery (with a Bariatric focus). When I started this fellowship, I was inundated with many logistical challenges that come with starting any new job, and I was reminded of how my General Surgery residency began. There is the ever-present desire to provide excellent patient care, but on top of those responsibilities, a new fellow working at a new institution has other responsibilities. For instance, I had to become familiar with an electronic medical record (EMR) and ordering system, complete numerous new-hire requirements, such as the tuberculosis (TB) skin tests and respirator fit testing, and, not least of all, move to a new city. I was met with all of the challenges that come with picking up your life and starting over somewhere else. Two of the most important a new fellow must take when when starting a fellowship is 1) learn to become part of the well-oiled machine of the bariatric surgery department and 2) get to know and learn to work with the attending physicians who are well-established, as they will be your mentors as you take the next leap into practice.

During residency, an intern knows that she or he will have five (or more) years to earn the trust and friendship of their attendings, but a fellow must focus on hitting the ground running and actively foster the valuable personal and professional friendships that come from a surgical fellowship. I have felt extremely fortunate at my new institution. From Day 1, I have been treated as a colleague by the surgical attendings and not as a work horse. The attention paid to my progress in the operating room and the clinic has been flattering, and I have also has reaped tremendous benefits in terms of performance.

I believe that my general surgery training was excellent during my residency, but due to the highly complex nature of the many sub-disciplines to which a resident is exposed, I believe that the ability to perform at the level of a specialized general surgeon after residency would be very difficult to achieve without a fellowship. Further, since I was trained at an academic residency in a university setting, many of my attendings were fellowship trained and were able to perform at a level of competence that would marvel many chief residents. I knew that to reach the clinical and surgical excellence that I witnessed during residency I would need to hone my own skills in a fellowship.

The biggest change that I have experienced during my fellowship compared to residency has come in the highly focused approach toward my knowledge and skills. Every day I perform surgeries that I have been performing since Day 1 of my fellowship. My operative experience has been intense, with over 60 cases in bariatrics alone, on top of many complex laparoscopic cases. Each case seems to build on the previous day’s work. Recently, during a Roux-en-Y gastric bypass (RYGB) procedure, we focused on how I passed the needle during intra-corporeal suture closure of the jejuno-jejunostomy. I did not have to wait a few days, or until the following week to put these techniques to work. Later that day, we performed the same procedure on a different patient and I was able to put these teaching points into practice.

I can see my own improvement in the operating room growing on a daily basis. I am working with the same staff members who have increasing trust in my abilities and keep looking toward the next step on which I need to work. Since the number of attendings that I work with is much smaller than a general surgery resident’s experience, the familiarity and trust are built much more quickly and the attention to improvement allows for a much faster pace of technical advancement. Achieving the same proficiency as those training me does not seem as challenging as it did during residency. My goals for becoming an excellent surgeon by the time I enter practice are well within my grasp due to the increased focus and attention that fellowship training provides, and I could not imagine a scenario where I would be able to achieve such marked improvement in a similar time frame.”

Entry #2: Caitlin A. Halbert, DO, MS

“Deciding to pursue an MIS/Bariatric fellowship was certainly not easy for me. While professionally, it seemed an obvious choice, I was leaving my husband and family and moving states away for a year. Within days of coming to Stony Brook University in New York, I realize that my experience will be well worth the sacrifice.

The transition to fellowship was infinitely easier than going from medical school to internship. I was warmly welcomed and quickly integrated into the Stony Brook Bariatric team. The residents, nurse practitioners, dietitians, and administrative staff have already become my new family, united in the care of a grateful patient population.

As the weeks pass by, I recognize that this is much different than residency. I am studying the art of bariatric and advanced MIS surgery. I realize that despite having been exposed to a great deal of bariatric surgery in residency, I am learning something new every day about the variations within the procedures and new innovative techniques.

Having the opportunity to train at Stony Brook University with two remarkable role models, Dr. Pryor and Dr. Telem, is humbling. My education extends beyond the operating room, learning about how to build a practice and maintain a fellowship program, and even balance a busy career with a personal life. I am very thankful to the Foundation of Surgical Fellowships for the funding that allows for such an amazing opportunity to enrich my career.”

Tags: bariatric surgery

Category: Past Articles, Spotlight on Surgical Fellowships