Training Manual

Post Fellowship Training in HPB Surgery

The ANZHPBA will seek applications from eligible Post Fellowship Trainees for training in HPB Surgery each year in February. Applicants MUST be citizens or permanent residents of Australia and New Zealand.

Applicant Guidelines

2020 - Application Requirements

Successful applicants will need to be able to attend interviews on Saturday June 6th in Melbourne.

An application fee of $450 is payable upon acceptance of your application.

Applications close midnight, Sunday March 29th 2020.

Post Fellowship Training in HPB Surgery

The ANZHPBA’s Post Fellowship Training Program is for Hepatic-Pancreatic and Biliary surgeons. It is a RACS accredited PFET program. The program consists of two years education and training following completion of a general surgery fellowship. A compulsory portion of the program will include clinical research. A successful Fellowship in HPB surgery will involve satisfactory completion of the curriculum requirements, completion of research requirements, minimum of twenty four months clinical training, successful case load achievement, assessment, and final exam. Successful applicants will be assigned to an accredited hospital unit.

To be eligible to apply, applicants should have FRACS or sitting FRACS exam in May 2019. Any exam fails will not be offered an interview.

For further information please contact the Executive Officer at anzhpba@gmail.com

Applicants should submit a CV, an outline of career plans and nominate four references, one must be Head of Unit, (with email addresses and mobile phone numbers), to Leanne Rogers, Executive Officer ANZHPBA, P.O. Box 374, Belair S.A. 5052, or email anzhpba@gmail.com

Hospital Units Seeking Accreditation

Hospital Units can seek accreditation at any stage. Applications must address all required hospital criteria as detailed in the “ANZHPBA Fellowship in HPB Surgery” document. Please post your application to:

Chairman, ANZHPBA Training Committee
P.O. Box 374
Belair SA 5052

ANZHPBA Accredited Hospital Units

 

 

 

 

 

 

 

 

Auckland City Hospital HPB Fellowship

Auckland City Hospital (ACH) is a tertiary referral hospital based in Grafton, Auckland. It is the largest hospital in New Zealand with some 750 in patient beds. The Hepatopancreaticobiliary (HPB) unit works within the HPB/Upper gastrointestinal (UGI) unit that is part of the Department of General Surgery. The HPB and UGI unit specialises in the management of patients with both benign and malignant liver, biliary, pancreatic and upper gastrointestinal disease, including bariatric surgery. Our aim is to provide a national service for New Zealanders, to optimise the evaluation and treatment of patients with relevant benign and malignant conditions and to provide an environment for clinical excellence, research and teaching in this area. The Unit coordinates the efforts of Medical & Radiation Oncology, Interventional and Diagnostic Radiology, Gastroenterology and Endoscopy and Hepatology. Additionally, through an association with the New Zealand Transplant Unit patients may be referred for hepatic, renal or pancreatic transplantation.

The HPB/Upper GI Unit is led by 5 Consultants that is divided into two streams.

Team: Johnston, Ram, Bartlett

Team: Windsor, Beban

Fellows, Registrars and House staff will be assigned to each team and will be responsible for the management of patients under those teams’ consultants’. The areas of special expertise for the surgeons is as follows:-

Mr Adam Bartlett, MB, ChB, PhD, FRACS
adamb@adhb.govt.nz
021 241 4647

• Liver
• Pancreatic
• Biliary
• Transplant

Mr Grant Beban
gbeban@adhb.govt.nz
021938 385

• General Surgery
• Gastro-oesophageal disease
• Bariatric

Mr Peter Johnston
pjohnston@adhb.govt.nz
021 403 423

• Liver
• Pancreatic
• Biliary
• Gastro-oesophageal disease
• Transplant

Mr Rishi Ram
Rishir@adhb.govt.nz
021 522 289

• General Surgery
• Laparoscopic groin hernia repair & ventral hernia repair
• Gallbladder disease

Professor John Windsor
j.windsor@auckland.ac.nz
021 901 930

• Pancreatic disease
• Biliary diseases
• Gastro-oesophageal diseases

A Fellow will be attached to each team usually for a period of twelve months and depending upon their training requirements will spend variable time on each team. The fellow usually holds a FRACS or equivalent, and the position is accredited by ANZHPBA for post-fellowship training in HPB Surgery. On average there are 7.5 half-day operating sessions per week and 2 half-day outpatient sessions per week. There are two HPB related multidisciplinary meetings (MDM) each week – a general HPB MDM on Wednesday midday and a HCC MDM on Tuesday morning, the later of which is run through the NZLTU. The fellow is required to contribute to the general surgical on call roster after hours on a 1:X basis. There is also an opportunity to assist after hours with acute HPB cases and with transplant related activities.

Within each stream there is a registrar and a House Surgeon. The registrar, usually SET trainee, changes over at 6 months and spends three months in each team. House Surgeons will remain with one team for the duration of their three month run. The medical staff in the Unit are also assisted by Karen Lukies, Clinical Nurse Specialist.

The HPB unit is a busy team. On average one would expect that over the 12-month attachment that they would be exposed to 200 major cases, of which the expected HPB exposure is-

• Liver resections: 80
• Complex biliary cases: 30
• Surgical shunts: 5
• Pancreatic operations: 50

Should you require further information please feel free to contact Mr Adam Bartlett, by adamb@adhb.govt.nz or mobile 021 241 4647.

 

 

 

 

 

 

Hepato-Pancreato-Biliary and Transplant Unit
Austin Hospital Victoria

The Austin Hospital is a tertiary referral centre in Heidelberg Victoria with approximately 500 beds. The unit includes the Victorian Liver Transplant Unit. Staffing includes seven surgeons, two fellows, 3 registrars and 3 interns.

Activities of the unit comprise elective operating sessions five days per week, HPB and general surgery emergency on call and on call for organ retrieval and liver transplantation. There is also a surgical ERCP list per week available for fellowship training.

The approximate annual numbers include: 60 adult and paediatric liver transplantation cases; 80 multi organ retrievals, 40 liver resections, 30 pancreas resections and 150 ERCP’s performed within the unit. Opportunities exist for both clinical and basic science research enrolment for higher degrees.

Number of Fellows: 1/year. One year fellowship.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 6 supervising surgeons – Rob Padbury, Tom Wilson, John Chen, Mark Brooke-Smith, Lilian Kow, Susan Gan.

Unit Activity: 2-3 operating sessions spread over a week; One half-day outpatient session per week. Involvement with Private HPB cases in adjacent and nearby hospitals. Also involved with liver transplantation activity. 5 of the consultants perform and supervise ERCP. 2 Surgeons are also employed at the Royal Adelaide Hopsital.

On-call: Acute surgery unit admitting all general surgery patients. The unit is on call one in three, with the fellow covering the registrar half of the time. There is flexibility with the other units fellows and registrars involved in the acute care of the HPB patients and vice versa.

Team structure: One fellow. One registrar. One Resident Medical Officer. Two interns.

Operative case-load in 12 month:
Liver resections: 30-40 per year
Pancreatic operations: 15-20 per year
Liver Transplantation: 20-25 per year

Areas of interest: Major liver and pancreatic caseload. Laparoscopic liver resections. Laparoscopic pancreatic procedures. Percutaneous pancreatic necrosectomy. Liver Transplantation. ERCP.

Employment arrangement: Employed by Southern Area Health Service (SA Health) as 1 year temporary full-time employee. Benefits include superannuation, payment for overtime, paid recreational and professional development leave.

Teaching
In addition to weekly clinical meetings there are monthly journal club meetings discussing relevant and topical clinical issues.

Adelaide: Adelaide is the capital of South Australia and has a population of around 1.8 million. The city is easy to navigate and there are plentiful good restaurants in the city and suburbs. The world class wine districts of the Barossa Valley, McClaren Vale, the Clare Valley and the Coonawarra are within easy driving distance. The Flinders Medical Centre is a quaternary referral hospital associated with Flinders University with 580 beds, and the adjacent Flinders Private hospital has 130 beds. Extensive recent redevelopment is now complete with new theatre suites and day surgery facilities, a new cancer centre and research facilities.

Further information contacts: Mark Brooke-Smith (Supervising surgeon), Rob Padbury (Divisional director and past president of ANZHPBA) on 08 8204 4253 or via gisurgerysecretary@health.sa.gov.au

 

 

 

 

 

 

 

 

MONASH MEDICAL CENTRE: DEPARTMENT OF UPPER GI AND HPB SURGERY

Overview:
Monash is a tertiary referral and university-affiliated teaching hospital with 640 beds located in Clayton, in South Eastern Melbourne. The unit consists of 3 streams- HPB service, OG service and Acute Surgical service. The unit performs a range of complex hepatobiliary, pancreatic and oesophago-gastric surgery for benign and malignant disease. Advanced laparoscopic surgery including hepatic, pancreatic, gastric and oesophageal resections, fundoplications, hernia repair and bariatric surgery are also performed.

Number of Fellows: 1/year. 12 month position.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Team Structure: There are 12 supervising consultants.
HPB- Roger Berry, Kaye Bowers, Dan Croagh, Mark Cullinan, Dean Spilias
UGI- Paul Cashin, Arun Dhir, Zdenek Dubrava, Jane Ghadiri, John Gribben, Liang Low, Niyaz Nyqash
There is one registrar and 2 interns on each of the HPB and UGI streams and 3 registrars, 1 resident and 2 interns on the Acute Surgical service.
The unit is supported by a surgical liaison nurse, quality improvement and data manager and cancer care nurse.

Unit Activity: The unit is very busy providing both elective and acute surgical inpatient services plus outpatient services. There are 8-9 UGI/HPB theatre lists per week plus a dedicated afternoon ASU Operating Theatre 6 days a week. The fellow also regularly assists with HPB  surgical  procedures  in the private sector.

On-call: The fellow participates in the consultant on call roster covering 1 weekday per week and 1:7 weekends.

Operative case-load: Over the 12 month attachment the expected caseload would be
• Pancreatic resections- 30
• Liver resections- 50
• Complex biliary procedures- 20

Endoscopy: Training in endoscopy including ERCP and EUS is potentially available. The Fellow should be accredited in upper gastrointestinal endoscopy  by the Conjoint Committee  of the RACS and GESA prior to obtaining  hands-on ERCP training. Approximate case-load per year performed by surgical endoscopists is
ERCP 150
EUS 250

Teaching: Key teaching activities include a weekly multidisciplinary cancer meeting, weekly clinical meeting, fortnightly HPB radiology meeting, weekly gastroenterology meeting and monthly journal club.

Research: Extensive research opportunities exist in both clinical and basic sciences. There are also opportunities at the completion of the fellowship year for research leading to higher degrees for those with an interest.

Training not offered: No transplant experience.

Further information contact: Mr Roger Berry ph (03) 85730001 email roger.berry@surgicalconsulting.com.au

Nepean Upper GI/HPB Unit
ANZHPBA Fellowship Nepean Hospital, Kingswood, Sydney, Australia.

Overview
Nepean Hospital is a busy tertiary hospital in Penrith in Sydney’s western suburbs. The Upper GI unit is a mixed unit encompassing both HPB surgery, upper GI/oesophago-gastric surgery, ERCP and general surgery.  There are 5 surgeons on the unit. There is one fellow who works for all consultants on the unit.
One surgeon has a predominantly HPB workload, one hepatic surgeon, two with a mixed practice of both oesophago-gastric and pancreatic surgery, and the 5th who has a predominantly oesophago-gastric and bariatric focus. All surgeons on the unit also have a mix of general surgery in their practice and contribute to the Acute Surgical Unit roster. The team also includes at SET trainee registrar, an unaccredited registrar and 2 junior medical officers.

Workload
In terms of HPB workload the unit performs approximately 15-20 pancreatic resections per year. The unit also performs approximately 40 hepatic resections per year, including many trisectionectomies, re-do resections, second and third stage resections, as well as laparoscopic resections, microwave ablations and complex benign biliary surgery.
The unit also provides the ERCP service for the hospital performing around 300 ERCPs per year combining elective and emergency procedures in addition to other therapeutic endoscopy including oesopgageal and duodenal stents. The trainee would be encouraged to undertake ERCP training while attached to the unit.
The oesophago-gastric workload involves approximately 10-15 oesophago-gastric resections on top of approximately 40 major procedures for benign disease.

The trainee is also expected to contribute to the fellow on call roster for acute surgery, and be involved in acute surgical emergencies admitted under the unit, or requiring sub-speciality involvement.

Operative Experience
The Fellow will be involved in all public operating lists throughout the 12 month appointment. This involves on average 3 full operating days per week, plus 2 half day ERCP lists and additional endoscopy lists. The expectation is that the fellow would be primary operator in around 50% of major resection cases, depending on the level of experience of the individual. The fellow is also expected to supervise and train the SET trainee registrar on the team in appropriate surgical cases.

Multidisciplinary Interaction
The unit is also involved in a robust MDT process allowing discussion of these patients and further learning opportunities. This is a weekly meeting to discuss all Upper GI malignancies involving the 5 Upper GI surgeons, medical oncologists, radiation oncologists, radiologists, nuclear medicine physicians and palliative care physicians.
There is a monthly departmental audit/M&M meeting which the trainee will be involved in, with the assistance of the SET trainee. The unit also presents all activity data, and morbidity and mortality statistics on a quarterly basis at a unit journal club, where topical articles are also reviewed and discussed.

Education and Training
The fellow attends all departmental and unit meetings, and may be involved in presentations at monthly journal club meetings within the hospital. Attendance and presentation at the quarterly ANZHPBA journal clubs is also encouraged.
Administration facilities are available with access to an office, computer, internet access and printer.
The unit has strong ties with Sydney Medical School, and opportunities for conjoint appointment are available, with associated clinical teaching roles.
Research opportunities are available within the unit. The unit has strong links with Sydney Medical School and the Whiteley-Martin Research Centre, and the fellow can expect to be involved in research projects within the unit. The opportunity to supervise junior trainees in their research projects is also encouraged.

Contact
Should you require further information please feel free to contact the ANZHPBA supervisor for the hospital Dr Andrew Ling via email at andrew.ling@health.nsw.gov.au.

North Shore Hospital

Unit Timetable: Two full day operating lists per week (Monday and Tuesday); one Multidisciplinary clinic (Wednesday); one full day for research available (Thursday); 2 MDMs per week (Wednesday and Friday mornings (7.30-8.30am), journal club, audit and teaching (Friday morning).

On-call: Fellows particulate in general surgical on call roster at a consultant level with other 3 fellows 1:4 Fridays. Patients admitted under fellow, full access to dedicated acute theatre provided as well as registrar and house surgeon support. Fellow has back up of consultant on weekend call. Fellow sees all in hospital upper GI and HPB consults.

Team structure: One fellow, two registrars – 1 Senior (SET 5) and one junior (SET 1). 2 house surgeons, 1 clinical nurse specialist, 1 research nurse.

Operative case-load in 12 month:
• 250 major cases (80% as primary operator or supervisor).
• Liver resections: 35
• Pancreatic operations: 40
• Pancreaticoduodenectomy: 15
• Distal pancreatectomy: 10
• Complex biliary cases: 15
• Oesopahagectomy: 10
• Gastrectomy: 20
• Cholecystectomy: 70-100

Endoscopy: Potential for training in advanced upper GI endoscopy including EUS, EMR and ERCP.

Research: The unit is actively engaged in clinical research including outcome research, biobanking and clinical trials. All fellows are encouraged to complete at least one research project during the attachment.
Employment arrangement: Employed by Waitemata District Health Board as 1 year full-time employee including paid recreational and professional development leave.

Auckland: Auckland is a city of 1.5 million people and North Shore Hospital is located in the northern part of the city. The hospital has 650 in-patient beds, 14 operating theatres, an emergency department, a 50 bed Assesment and Diagnostic Uniit, Intensive Care and High Dependency Units, an Elective Surgery Centre, Coronary care, maternity and special care baby unit as well as full endoscopy and radiology (both diagnostic and interventional) services. The hospital catchment is currently 597,500 making it the largest single catchment in New Zealand.

The north shore of Auckland is a safe, family friendly place to live with sophisticated urban areas, beautiful beaches and pleasant rural get-aways close by.

The aim of the Upper Gastrointestinal Unit is to provide excellent training in a great environment for first year fellows to help make the transition from fellow to surgical consultant.

Further information contacts: Jonathan Koea (Unit Head), jonathn.koea@waitematadhb.govt.nz; Michael Rodgers, Michael.rodgers@waitematadhb.govt.nz

Prince of Wales Hospital Upper GI/HPB Unit
ANZHPBA/ANZGOSA Fellowship Prince of Wales Hospital, Randwick, Sydney, Australia

Overview
Prince of Wales Hospital is a busy tertiary hospital in Sydney’s eastern suburbs with a strong focus on cancer services. The Upper GI unit is a mixed unit encompassing both HPB surgery and upper GI/oesophago-gastric surgery. There are 4 surgeons on the unit. There is one fellow who works for all consultants on the unit.
One surgeon has a predominantly HPB/transplant workload, two with a mixed practice of both oesophago-gastric and HPB surgery, and the 4th who has a predominantly oesophago-gastric and bariatric focus.
The team also includes at SET trainee registrar, a resident medical officer, and an intern.

Workload
In terms of HPB workload the unit performs approximately 50 pancreatic resections per year including both venous and arterial resection and reconstruction. The unit also performs approximately 80 hepatic resections per year, including many trisectionectomies, re-do resections, second and third stage resections, as well as laparoscopic resections and microwave ablations.
The oesophago-gastric workload involves approximately 10-15 oesophago-gastric resections on top of approximately 40 major procedures for benign disease.
There is further opportunity to be involved in approximately 20 renal transplantations performed each year, with a mixture of living related and cadaveric donors, and both adult and paediatric recipients.
The unit is involved in the care of patients in both Prince of Wales Public and Prince of Wales Private Hospitals.

Operative Experience
The Fellow is involved in all public operating lists, and most private lists throughout the 12 month appointment. This involves on average 5 full operating days per week, with involvement in between 200-300 major cases. The expectation would be that the fellow would be primary operator in around 50% of these cases, depending on the level of experience of the individual. The fellow is also expected to supervise and train the SET trainee registrar on the team in appropriate surgical cases.
The fellow is also expected to take second call on behalf of the unit consultants for weekend call shifts, and be involved in acute surgical emergencies admitted under the unit.

Multidisciplinary Interaction
The unit is also involved in a robust MDT process allowing discussion of these patients and further learning opportunities. This is a weekly meeting to discuss all gastrointestinal malignancies involving Upper GI and colorectal surgical specialists, medical oncologists, radiation oncologists, radiologists, pathologists and palliative care physicians.
There is also a monthly departmental audit meeting with associated journal club. The unit presents all activity data, and morbidity and mortality statistics on a bi-monthly basis.

Perioperative Evaluation
The unit runs a weekly public outpatient clinic which has a wide referral base. This encompasses both simple general surgical presentations, and complex upper GI and HPB referrals. Post operative and long term follow up patients also attend this clinic. The clinic provides opportunity for the pre-operative assessment and work up of upper GI/HPB malignancies under the supervision of the involved consultants.

Education and Training
The fellow attends all departmental and unit meetings, and may be involved in presentations at monthly journal club meetings within the hospital. Attendance at quarterly ANZHPBA journal clubs is also encouraged.
Administration facilities are available with access to an office, computer, internet access and printer.
The unit has strong ties with the University of NSW Medical Faculty, and opportunities for conjoint appointment are available, with associated clinical teaching roles.
Research opportunities are available within the unit, and the fellow can expect to be involved in presentations at national and international conferences, as well as in publication of projects completed during the fellowship year.

Contact
Should you require further information please feel free to contact the ANZHPBA/ANZGOSA supervisor for the hospital Dr Koroush Haghighi via email at surgeon@koroushhaghighi.com.au

 

 

 

 

 

 

 

 

 

 

Royal Adelaide Hospital (RAH)
Hepato-Pancreato-Biliary (HPB) Surgery Unit

The RAH is South Australia’s largest accredited teaching hospital. It has well-advanced training in a range of specialty areas. The General Surgical Service is comprised of sub-specialised HPB, Colorectal, Upper Gastointestinal and Breast/ Endocrine Surgery Units. All units support a General Acute Surgery Unit (ASU).

Centre for Digestive Diseases (CDD):
The gastrointestinal General Surgical units work closely with the Gastroenterology and Clinical Hepatology Units, so forming a Centre for Digestive Diseases. This facilitates combined endoscopic training , clinical research projects and clinical meetings.

Consultant staff:
The consultant surgeons currently attached to the HPB Surgery Unit include : Chris Worthley (Head of Unit), Paul Dolan, CP Tan and Eu Ling Neo. John Chen and Mark Brooke-Smith are seconded to the RAH from the Flinders Medical Centre (FMC).

Unit activities:
Clinically, the HPB Surgery Unit provides Acute Inpatient and Outpatient services. There are two all-day operating lists and a weekly surgical ERCP list. The gastroenterologists provide a further 3 ERCP lists each week, including an endoscopic ultrasound service. Each General Sugery unit is rostered for ASU duty an average of 1 day in 4. There is a dedicated ASU Operating Theatre available daily from 0900-1600 hours. The HPB Surgery Fellow has a weekly outpatient clinic which includes mainly patients with HPB problems. Patients with undifferentiated General Surgical problems are spread across the General Surgical service.

HPB Surgery Unit Activity:
In 2012 the Unit performed 370 major operations. These included 17 pancreatic resections (15 Whipple’s), 10 other pancreatic procedures, 19 major liver resections and 8 other hepatic procedures. There were 216 cholecystectomies and 16 bile duct operations.
HPB consultative support is provided to the other General Surgical units.
There is an option to assist with HPB surgical procedures in the private sector, when not committed to the RAH.

Surgical ERCP service:
Approximately 200 inpatients per year on the HPB Surgery Unit undergo ERCP-related procedures along with a similar number of outpatients. The HPB Fellow is able to attend the weekly surgical ERCP list. (They will not however be able to become accredited in ERCP during a 1 year attachment to the Unit.) The Fellow should be accredited in upper gastrointestinal endoscopy by the Conjoint Committee of the RACS and GESA prior to obtaining hands-on ERCP training.

Major Trauma:
The RAH is a Level 1 Major Trauma hospital which includes a commensurate volume of patients with major HPB Trauma.

MDT’s and Surgical Audit:
The HPB Surgery Unit runs a weekly MDT meeting and also participates in a fortnightly Hepatoma MDT and weekly Colorectal MDT. The HPB Unit has a web-based semi-automated Surgical Audit database which can also be a useful tool for clinical research projects and presentations.

Liver Transplantation:
Several surgeons on the unit are affiliated with the SA Liver Transplantation Unit. Livers are implanted at FMC, but many donor livers are harvested at the RAH and many potential liver transplant patients are sourced from the RAH patient population.

Tutorials:
There is a quarterly South Australian ANZHPB Trainee journal club and also a quarterly journal club at the HPB/Upper GI/Bariatric Surgery dinner meetings.

Trainee Medical Officer staffing on HPB Surgery Unit:
HPB Fellow- 1 ANZHPBA post-fellowship training position (1 year attachment).
Accredited SET 3-5 General Surgical trainee – 1 position.
Interns/ RMO’s – 2-3 positions (variable).

Royal Brisbane HPB Fellowship

Number of Fellows: 1/year. One year fellowship.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 4 supervising surgeons – Richard Bryant, George Hopkins, Les Nathanson, Nick O’Rourke.

Unit Activity: Average of 5.25 half-day operating sessions spread over a 4-week cycle; Average of 2 half-day outpatient sessions per week.

On-call: Acute surgery unit admitting all general surgery patients. One 24 hour period/week and one weekend (48 hours)/month. Often required to assist other surgical teams with Upper GI/HPB emergencies during working hours, especially difficult cholecystectomy and bile duct stones.

Team structure: One fellows. Two registrars – 1 Senior (SET 5) and one junior (SET 1). 3-4 interns/residents.

Operative case-load in 12 month: 400 major cases (96% as primary operator or supervisor).
Liver resections: 35
Open liver resection: 20
Laparoscopic liver resection: 15
Pancreatic operations: 20
Pancreaticoduodenectomy: 10
Other pancreatic operations (distal pancreatectomy, necrosectomy): 10
Complex biliary cases: 10

Areas of interest: Laparoscopic surgery exposure particularly laparoscopic liver and pancreas resection, laparoscopic hiatus hernia surgery, laparoscopic bile duct surgery and revisional bariatric surgery (including Roux-en-Y gastric bypass).

Training not offered: No transplant experience. No ERCP experience.

Employment arrangement: Employed by Queensland health as 1 year temporary full-time employee. Benefits include superannuation, payment for overtime, paid recreational and professional development leave.

Brisbane: Brisbane is the capital of Queensland and the third largest city in Australia with a population of around 2 million. The city is cosmopolitan, multi-cultural and sophisticated. To the North and South are pristine beaches. The Royal Brisbane hospital has 950 beds and serves as a tertiary referral for areas as far as Cairns (1800km North). The Hospital is recently renovated with modern laparoscopic operating suites and a fantastic working environment.

Further information contacts: Nick O’Rourke (Supervising surgeon) nickoadmin@wesley.com.au; Jerome Laurence (Fellow 2012) jm_laurence@yahoo.co.uk).

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.

Royal Prince Alfred Hospital, CAMPERDOWN, SYDNEY, NSW
HPB and Transplant at RPAH:
Royal Prince Alfred Hospital is a Tertiary referral Hospital associated with the University of Sydney. Fellows predominantly work in the Department of Upper GIT surgery with five specialist surgeons. There is a predominantly HPB focus to the Department with four of five surgeons performing hepatic surgery, and all performing pancreatic and biliary surgery. There are operating lists running every weekday (9.5 sessions per week). The unit also partakes in the general surgery and trauma roster. Apart from the HPB Fellow, there is currently a SET trainee, a surgical senior resident and three interns covering the service. Two surgeons perform ERCP, making it one of the few centres able to provide ERCP training to surgeons. There is a large workload of advanced HPB surgery, utilising the more aggressive approaches to oncological clearance including; vascular reconstruction, portal vein embolisation, 2-stage hepatectomies and isolated hypothermic liver perfusion. Three out of 12 months are spent working as the transplant surgery fellow, with exposure to Liver and kidney transplantation and donor surgery. There are good opportunities for clinical research, and fellows can participate in the Master of Surgery offered through the University of Sydney. The fellow position at RPAH is ideally suited to a second year fellow, who is already proficient in routine resections and management of gallstone disease, so that they can fully benefit from exposure to advanced techniques.

TAN TOCK SENG HOSITAL
SINGAPORE HPB Fellowship

Number of Fellows: 1/year. One year clinical fellowship.

Minimum requirements: FRACS or equivalent.
Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 3 supervising surgeons –
Mr. Winston Woon, FRACS
Mr. Low Jee Keem, MD, FRCS(UK)
Mr. Sameer Junnarkar, MD, FRCS(UK)

Unit Activity:
Operating sessions: 3 full day lists / week
Endoscopy sessions: 1 full day list / week
Clinic sessions (for fellow): 1/ week
HPB multidisciplinary meeting: 1/week
GI tumor board: 1/week

On-call:

General Surgical On call:
Two registrars, four medical officers and three house officers – all on site. Consultant on call – off site.
Fellow would be expected to do on-calls as a senior registrar with Consultant cover.
We are an acute surgery unit and admit all general surgery patients.
One 24 hour period/week

HPB on call:
HPB team provides 24/7 complete and comprehensive cover for the hospital.
Fellow may be escalated to independent HPB calls depending on level of seniority and training adjudged.

Team structure:
3 Consultants
1 Fellow
3 Registrars (1 Senior and 2 Junior)
4 Medical Officers
3 House Officers
1 HPB nurse clinician

Supporting services (all 24/7):
Gastroenterology service
ERCP/ EUS/ FNA etc
Interventional radiology service
PTC, RFA, TACE etc
Diagnostic radiology service including CT and MR scans

Operative case-load of HPB unit in 12 month:

Liver resections: >50
Open liver resection: 40
Laparoscopic liver resection: 10
Pancreatic operations: >35
Pancreaticoduodenectomy: 25
Other pancreatic operations (distal laparoscopic pancreatectomy etc): 10
Complex biliary operations: 15-25

Areas of interest:

Laparoscopic surgery exposure, particularly laparoscopic liver, pancreas and bile duct surgery.

Others – Laparoscopic Hernia Surgery

Training not offered:
No transplant experience.
No ERCP experience.

Employment arrangement:
Employed by Tan Tock Seng Hospital as 1 year temporary full-time employee.
Extra benefits include payment for emergency on call duty, annual/training leave, conference support and others.

Singapore:
Singapore is an island city country with a population of around 5 million. The city is multi-cultural, extremely safe, clean and modern.
Singapore is one of the best places in Asia to live, work and play. It offers the best of shopping and dining. Tan Tock Seng Hospital is a 1400 bed tertiary university affiliated hospital. The hospital has all the world class modern laparoscopic operating suites and a fantastic working environment.

Further information contacts:
Mr. Winston Woon (Fellowship programme director)
Email: Winston_Woon@ttsh.com.sg

 

 

 

 

 

 

 

The Alfred Hospital: Department of HPB Surgery

Overview:
The Alfred is a tertiary referral and university-affiliated teaching hospital with 640 beds located in Prahran, in the inner south east of Melbourne. The Alfred has one of Australia’s busiest emergency and trauma centres, the state’s largest Intensive Care Unit and is home to multiple state-wide services.

The unit provides an HPB service as well as an Acute General Surgical and Trauma Surgical service. A range of complex hepatobiliary and pancreatic procedures for benign and malignant disease, including advanced laparoscopic surgery are performed.

Number of Fellows: 1/year. 12 month position.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Team Structure: There are 4 supervising consultants. Marty Smith, Charles Pilgrim, Kaye Bowers and Val Usatoff. There is 1 registrar, 1 resident and 1 intern on the unit
Unit Activity: The unit provides both elective and acute surgical inpatient services plus outpatient services.

The unit averages 4-5 HPB theatre lists, plus 1 acute surgical/trauma list per week. There is also an opportunity for the fellow to assist with HPB surgical procedures in the private sector.
HPB outpatient clinics are run weekly and are attended by all unit staff.

On-call: The fellow participates in the consultant acute general and trauma surgery on call roster covering 1 weekday evening per week and approximately 1:5 weekends.

Operative case-load: Over the 12 month attachment the expected caseload would be in excess of 200 majors with a mix of hepatobiliary, pancreatic, general surgical and trauma cases.

Teaching: Key teaching activities include a weekly morbidity and mortality meeting, weekly multidisciplinary cancer meeting, weekly clinical meeting, and weekly gastroenterology/HCC meeting.

Research: Extensive research opportunities exist in both clinical and basic sciences. There are also opportunities at the completion of the fellowship year for research leading to higher degrees for those with an interest.
Training not offered: No transplant experience. No ERCP/EUS experience.

Further information contact: Ms Kaye Bowers ph (03) 85730022, email kaye.bowers@monash.edu

Westmead Hospital is one of the major teaching hospitals of the University of Sydney.
At Westmead Hospital, the Hepato-biliary/Gastro-intestinal service comprises five Consultant Surgeons, one Fellow, two trainee Registrars and two Residents. We also have a Clinical Nurse Consultant. We work closely with the Gastro-enterology service at Westmead Hospital which has a large workload which includes 1000 ERCP’s per year and more than 300 endoscopic ultrasound assessments. There is strong interventional radiology support. We as a group are mainly interested in the treatment of hepato-biliary and upper gastrointestinal oncology, but we also run a co-ordinated gallbladder service for the hospital and we provide a large amount of general surgery on-call. The Fellow’s position is an outstanding opportunity to have exposure to a large amount of complex hepato-biliary and upper gastro-intestinal surgery as well as acute general surgery over a 12 month period. We perform as a group in the public hospital somewhere between 50 -75 liver resections a year, 25-30 major pancreatic resections and approximately 300 laparoscopic cholecystectomies per year. We also operate on about 30 gastro-oesophageal cancers per year and we have a strong interest in the management of neuroendocrine tumours. Westmead Hospital is the national Pancreas transplant service and for those fellows who are interested there is the opportunity to have exposure to solid organ pancreas transplantation and renal transplantation as well as about 50 multi-organ retrieval procedures per year. The Unit has a major academic involvement and all five Consultants have an appointment with the University of Sydney and are actively involved in undergraduate and postgraduate teaching as well as supervision of higher degrees. Fellows would be expected to participate in publications and presentations during the year. Further information can be obtained from the Head of Department, Associate Professor Arthur Richardson at arthurr@arthurrichardson.com.au.