1. Educating the Rural Surgeon
The MIMIS Fellowship
Educating the Rural Surgeon
Paul Severson, MD, FACS
Howard McCollister, MD, FACS
Timothy LeMieur, MD, FACS
Shawn Roberts, MD

2. Disclosures Paul Severson, MD MIMIS Fellowship
Stryker Endoscopy: International Advisory Council
MIMIS Fellowship
Covidien: unrestricted educational grant to MIMIS
MIMIS Fellowship Faculty:
Paid consultants for rural hospitals
Surgical education - proctors

3. Sunrise on Serpent Lake Crosby, Minnesota

4. The MIMIS Fellowship The first rural fellowship
The first fellowship in a “critical access” rural hospital
Cuyuna Regional Medical Center, Crosby, Minnesota
The first fellowship to be triple accredited in the United States and Canada
MIS + Bariatric + Flexible Endosurgery

5. The MIMIS Fellowship The first rural fellowship
The first fellowship in a “critical access” rural hospital
Cuyuna Regional Medical Center, Crosby, Minnesota
The first fellowship to be triple accredited in the United States and Canada
MIS + Bariatric + Flexible Endosurgery

8. The MIMIS Fellowship The first rural fellowship
The first fellowship in a “critical access” rural hospital
Cuyuna Regional Medical Center, Crosby, Minnesota
The first fellowship to be triple accredited in the United States and Canada
MIS + Bariatric + Flexible Endosurgery

9. Background – Surgical Education
MIMIS – Minnesota Institute for Minimally Invasive Surgery
Created by our rural surgical group in 2002 to reflect our mission
History of educating regional surgeons in advanced laparoscopy and endoscopy since 1995
Laparoscopic Burch bladder neck suspension (urinary incontinence in women)
Laparoscopic Nissen fundoplication
Endoscopy training (FP Residents, surgeons in private practice)
Additional courses offered after forming MIMIS
Bariatric mini-fellowships
Trivex faculty for varicose vein surgery
Stapled hemorrhoidopexy regional training center

10. Background – Surgical Education
MIMIS – Minnesota Institute for Minimally Invasive Surgery
Created by our rural surgical group in 2002 to reflect our mission
History of educating regional surgeons in advanced laparoscopy and endoscopy since 1995
Laparoscopic Burch bladder neck suspension (urinary incontinence in women)
Laparoscopic Nissen fundoplication
Endoscopy training (FP Residents, surgeons in private practice)
Additional courses offered after forming MIMIS
Bariatric mini-fellowships
Trivex faculty for varicose vein surgery
Stapled hemorrhoidopexy regional training center

11. Background – Surgical Education
MIMIS – Minnesota Institute for Minimally Invasive Surgery
Created by our rural surgical group in 2002 to reflect our mission
History of educating regional surgeons in advanced laparoscopy and endoscopy since 1995
Laparoscopic Burch bladder neck suspension (urinary incontinence in women)
Laparoscopic Nissen fundoplication
Endoscopy training (FP Residents, surgeons in private practice)
Additional courses offered after forming MIMIS
Bariatric mini-fellowships
Trivex faculty for varicose vein surgery
Stapled hemorrhoidopexy regional training center

12. Background – Surgical Education
Regional Surgical Leadership
Upper Midwest Bariatric Forum (Severson, McCollister)
Founded by MIMIS in cooperation with UM and Mayo
Hitchcock Surgical Society Presidents (Severson, LeMieur)
Minnesota Surgical Society leadership (Severson, McCollister, LeMieur)
Minnesota Trauma Task Force (Severson, LeMieur, Roberts)
National leadership opportunities emerge
SAGES Program Committee – rural liaison (Severson)
Fellowship Council Program Directors (Severson)
Global education efforts are recognized
Severson and McCollister develop courses in Laparoscopy and Endoscopy for surgeons in Pignon, Haiti – 13 years and running
ACS Executive Director Dr. Tom Russell visits Pignon, awards granted
Severson appointed to Global Health Education Committee at UM
Incorporation of global health into medical school curriculum

13. Background – Surgical Education
Regional Surgical Leadership
Upper Midwest Bariatric Forum (Severson, McCollister)
Founded by MIMIS in cooperation with UM and Mayo
Hitchcock Surgical Society Presidents (Severson, LeMieur)
Minnesota Surgical Society leadership (Severson, McCollister, LeMieur)
Minnesota Trauma Task Force (Severson, LeMieur, Roberts)
National leadership opportunities emerge
SAGES Program Committee – rural liaison (Severson)
Fellowship Council Program Directors (Severson)
Global education efforts are recognized
Severson and McCollister develop courses in Laparoscopy and Endoscopy for surgeons in Pignon, Haiti – 13 years and running
ACS Executive Director Dr. Tom Russell visits Pignon, awards granted
Severson appointed to Global Health Education Committee at UM
Incorporation of global health into medical school curriculum

14. Background – Surgical Education
Regional Surgical Leadership
Upper Midwest Bariatric Forum (Severson, McCollister)
Founded by MIMIS in cooperation with UM and Mayo
Hitchcock Surgical Society Presidents (Severson, LeMieur)
Minnesota Surgical Society leadership (Severson, McCollister, LeMieur)
Minnesota Trauma Task Force (Severson, LeMieur, Roberts)
National leadership opportunities emerge
SAGES Program Committee – rural liaison (Severson)
Fellowship Council Program Directors (Severson)
Global education efforts are recognized
Severson and McCollister develop courses in Laparoscopy and Endoscopy for surgeons in Pignon, Haiti – 13 years and running
ACS Executive Director Dr. Tom Russell visits Pignon, awards granted
Severson appointed to Global Health Education Committee at UM
Incorporation of global health into medical school curriculum

15. Dr. Paul Severson proctors Haiti’s surgery professors

16. The Ride Across Haiti 2008

17. Dr. Howard McCollister teaches laparoscopy to Haitian surgeons

18. Dr. Howard McCollister

19. Dr. Tim LeMieur MIMIS faculty

20. Dr. Shawn Roberts Our first fellow MIMIS faculty

21. Educating the Rural Surgeon
So why develop a fellowship?

22. The Problem with Surgical Education
Many residency programs poorly prepare graduates
Endoscopy
Gastroenterology control
Limited exposure to therapeutic “endosurgery”
Lack of commitment to endoscopy despite directives
Advanced laparoscopy
Failure to develop “the laparoscopic mentality”
Faculty still learning – residents don’t get enough experience
Bariatric surgery
Failure to recognize obesity as America’s #1 health problem
Surgery is currently the only and most effective treatment
Failure to accept bariatric surgery as “mainstream” general surgery

23. The Problem with Surgical Education
Many residency programs poorly prepare graduates
Endoscopy
Gastroenterology control
Limited exposure to therapeutic “endosurgery”
Lack of commitment to endoscopy despite directives
Advanced laparoscopy
Failure to develop “the laparoscopic mentality”
Faculty still learning – residents don’t get enough experience
Bariatric surgery
Failure to recognize obesity as America’s #1 health problem
Surgery is currently the only and most effective treatment
Failure to accept bariatric surgery as “mainstream” general surgery

24. The Problem with Surgical Education
Many residency programs poorly prepare graduates
Endoscopy
Gastroenterology control
Limited exposure to therapeutic “endosurgery”
Lack of commitment to endoscopy despite directives
Advanced laparoscopy
Failure to develop “the laparoscopic mentality”
Faculty still learning – residents don’t get enough experience
Bariatric surgery
Failure to recognize obesity as America’s #1 health problem
Surgery is currently the only and most effective treatment
Failure to accept bariatric surgery as “mainstream” general surgery

25. The Problem with Surgical Education
Many residency programs poorly prepare graduates
Endoscopy
Gastroenterology control
Limited exposure to therapeutic “endosurgery”
Lack of commitment to endoscopy despite directives
Advanced laparoscopy
Failure to develop “the laparoscopic mentality”
Faculty still learning – residents don’t get enough experience
Bariatric surgery
Failure to recognize obesity as America’s #1 health problem
Surgery is currently the only and most effective treatment
Failure to accept bariatric surgery as “mainstream” general surgery

26. The Problem with Surgical Education
Rural surgeons need to be broadly trained
Endoscopy – therapeutic dilations, polypectomy, bleeds, ablations
Advanced laparoscopy – lap Nissen, colon, hernia
Gynecology – lap hysterectomy, lap ectopic pg, C-sections
Orthopedics – fractures and hand
ENT – tubes and tonsils
General Surgery residencies are not providing adequate training to prepare the surgeon for rural America
Fellowships are needed until residencies do the job
Even then, additional education is needed due to narrow training focus both in residency AND in fellowships
Cooperstown surgery residency training is a model for success
(JACS 2003, Reynolds)

27. The Problem with Surgical Education
Rural surgeons need to be broadly trained
Endoscopy – therapeutic dilations, polypectomy, bleeds, ablations
Advanced laparoscopy – lap Nissen, colon, hernia
Gynecology – lap hysterectomy, lap ectopic pg, C-sections
Orthopedics – fractures and hand
ENT – tubes and tonsils
General Surgery residencies are not providing adequate training to prepare the surgeon for rural America
Fellowships are needed until residencies do the job
Even then, additional education is needed due to narrow training focus both in residency AND in fellowships
Cooperstown surgery residency training is a model for success
(JACS 2003, Reynolds)

28. The Problem with Surgical Education
Rural surgeons need to be broadly trained
Endoscopy – therapeutic dilations, polypectomy, bleeds, ablations
Advanced laparoscopy – lap Nissen, colon, hernia
Gynecology – lap hysterectomy, lap ectopic pg, C-sections
Orthopedics – fractures and hand
ENT – tubes and tonsils
General Surgery residencies are not providing adequate training to prepare the surgeon for rural America
Fellowships are needed until residencies do the job
Even then, additional education is needed due to narrow training focus both in residency AND in fellowships
Cooperstown surgery residency training is a model for success
(JACS 2003, Reynolds)

29. The Problem with Surgical Education
Urban surgeons have limited themselves to very few procedures
Primarily gallbladder and hernia - maybe breast, maybe trauma
No colo-rectal
No endoscopy
There is an ever increasing divergence between the urban and rural surgical repertoire
We need to educate rural surgeons to expand their capabilities
Revenue from procedures lost to regional centers is needed to keep our rural hospitals healthy (43% of rural hospital revenue is surgical)
Educating the practicing rural surgeon in advanced laparoscopy and endoscopy is almost impossible without proctoring relationships

30. The Problem with Surgical Education
Urban surgeons have limited themselves to very few procedures
Primarily gallbladder and hernia - maybe breast, maybe trauma
No colo-rectal
No endoscopy
There is an ever increasing divergence between the urban and rural surgical repertoire
We need to educate rural surgeons to expand their capabilities
Revenue from procedures lost to regional centers is needed to keep our rural hospitals healthy (43% of rural hospital revenue is surgical)
Educating the practicing rural surgeon in advanced laparoscopy and endoscopy is almost impossible without proctoring relationships

31. The Problem with Surgical Education
Urban surgeons have limited themselves to very few procedures
Primarily gallbladder and hernia - maybe breast, maybe trauma
No colo-rectal
No endoscopy
There is an ever increasing divergence between the urban and rural surgical repertoire
We need to educate rural surgeons to expand their capabilities
Revenue from procedures lost to regional centers is needed to keep our rural hospitals healthy (43% of rural hospital revenue is surgical)
Educating the practicing rural surgeon in advanced laparoscopy and endoscopy is almost impossible without proctoring relationships

32. The Problem with Surgical Education
Current educational models are inadequate
Weekend courses, major meetings
Cadaver labs, inanimate labs, “hands-on” training
Invitations to observe at tertiary centers
Patient safety and proper credentialing are not possible without numerous cases monitored by an experienced proctor
MIMIS surgeons provide long-term consulting relationships with rural hospitals to solve their problems
Advanced laparoscopy
Endoscopy
Surgical education for all the physicians
Administrative support, systems based protocols, credentialing

33. The Problem with Surgical Education
Current educational models are inadequate
Weekend courses, major meetings
Cadaver labs, inanimate labs, “hands-on” training
Invitations to observe at tertiary centers
Patient safety and proper credentialing are not possible without numerous cases monitored by an experienced proctor
MIMIS surgeons provide long-term consulting relationships with rural hospitals to solve their problems
Advanced laparoscopy
Endoscopy
Surgical education for all the physicians
Administrative support, systems based protocols, credentialing

34. The Problem with Surgical Education
Current educational models are inadequate
Weekend courses, major meetings
Cadaver labs, inanimate labs, “hands-on” training
Invitations to observe at tertiary centers
Patient safety and proper credentialing are not possible without numerous cases monitored by an experienced proctor
MIMIS surgeons provide long-term consulting relationships with rural hospitals to solve their problems
Advanced laparoscopy
Endoscopy
Surgical education for all the physicians
Administrative support, systems based protocols, credentialing

35. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in MIS, Bariatric, and Flexible Endosurgery in December, 2007
The first program to achieve triple accreditation in the US and Canada

36. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in MIS, Bariatric, and Flexible Endosurgery in December, 2007
The first program to achieve triple accreditation in the US and Canada

37. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in MIS, Bariatric, and Flexible Endosurgery in December, 2007
The first program to achieve triple accreditation in the US and Canada

38. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in MIS, Bariatric, and Flexible Endosurgery in December, 2007
The first program to achieve triple accreditation in the US and Canada

39. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in MIS, Bariatric, and Flexible Endosurgery in December, 2007
The first program to achieve triple accreditation in the US and Canada

40. The MIMIS Fellowship
We were encouraged by the Fellowship Council to join in the effort to educate at the fellowship level (Dr. Dan Smith )
3 years to develop MIMIS, investigate fellowships, and prepare
Hired Dr. Shawn Roberts as new partner and “test” fellow, 2004
Applied to Fellowship Council for MIS fellowship in 2005
Entered the match in 2006 as a new program “pending accreditation”
Granted full 3 year accreditation in December, 2007 in MIS, Bariatric, and Flexible Endosurgery
The first program to achieve triple accreditation in the US and Canada

41. Fellowship Council www.fellowshipcouncil.org History
2001: “MIS Fellowship Council” established
“to advance high quality surgical education in MIS, GI, HPB, and bariatric surgery”
2003: SSAT, SAGES, AHPBA join together to organize fellowships for GI, MIS, and HPB surgery
Non-ACGME accredited fellowships
First match (NRMP) held for 60 programs, 90 applicants
2005: ASBS joins to support bariatric surgery fellowships
Name changes to “Fellowship Council”
2008: Fellowship Council holds its own match
130 programs, 217 applicants (165 US, 15 Canada, 37 Foreign)

42. Fellowship Council www.fellowshipcouncil.org
The Fellowship Council has accredited 107 fellowships:
Minimally Invasive Surgery (26)
Bariatric (12), and MIS/Bariatric (51)
Flexible Endoscopy (3), and MIS/Flex Endo (3)
Hepato-Pancreato-Biliary (7)
MIS/Colorectal (4)
and
MIS/Bariatric/Flexible Endosurgery (1)*
*The MIMIS Fellowship

43. Fellowship Council www.fellowshipcouncil.org
Notable programs that did not match
Penn State
University of Miami
Brigham and Women’s (0 of 2)
Cleveland Clinic (research fellow)
University of Iowa
Fresno Bariatrics
Columbia/Cornell (1 of 2)
New York Hospital Queens
SUNY Brooklyn
University of Illinois Chicago
So how does a private practice program in a critical access hospital in rural Minnesota match excellent candidates year after year after year?

44. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

45. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

46. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

47. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

48. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

49. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

50. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

51. The MIMIS Fellowship Survey of fellows – Why MIMIS?
More cases in a lot less time (864 total Endo, 329 OR)
Large endoscopic experience, preparation for NOS
GI Lab – expertise in pH and manometry, PillCam
Opportunity to join faculty in teaching MIS surgery in Haiti
Respect for the fellow as a surgeon, autonomy
Excellent quality of life in the rural setting
Favorable call schedule
No research abuse

52. The MIMIS Fellowship The MIMIS Fellows
Matched Dr. Michael Black, our #1 on the rank order list
August 1, 2007 – August 1, 2008
Practicing MIS/Flex Endo rural surgery (Appleton, Wisconsin)
Matched Dr. Jeremy Joyner, our #1 on the rank order list
August 1, 2008 – August 1, 2009 (our current fellow)
Returning to Americus, Georgia to join his father in rural
General Surgery practice as MIS/Flex Endo specialist
Matched Dr. Karen McFarlane, our #1 on the rank order list
August 1, 2009 – August 1, 2010 (our next fellow)
From inner city New York, interested in the underserved and global education volunteerism

53. The MIMIS Fellowship The MIMIS Fellows
Matched Dr. Michael Black, our #1 on the rank order list
August 1, 2007 – August 1, 2008
Practicing MIS/Flex Endo rural surgery (Appleton, Wisconsin)
Matched Dr. Jeremy Joyner, our #1 on the rank order list
August 1, 2008 – August 1, 2009 (our current fellow)
Returning to Americus, Georgia to join his father in rural
General Surgery practice as MIS/Flex Endo specialist
Matched Dr. Karen McFarlane, our #1 on the rank order list
August 1, 2009 – August 1, 2010 (our next fellow)
From inner city New York, interested in the underserved and global education volunteerism

54. The MIMIS Fellowship The MIMIS Fellows
Matched Dr. Michael Black, our #1 on the rank order list
August 1, 2007 – August 1, 2008
Practicing MIS/Flex Endo rural surgery (Appleton, Wisconsin)
Matched Dr. Jeremy Joyner, our #1 on the rank order list
August 1, 2008 – August 1, 2009 (our current fellow)
Returning to Americus, Georgia to join his father in rural
General Surgery practice as MIS/Flex Endo specialist
Matched Dr. Karen McFarlane, our #1 on the rank order list
August 1, 2009 – August 1, 2010 (our next fellow)
From inner city New York, interested in the underserved and global education volunteerism

55. MIMIS Fellows Dr. Michael Black and Dr. Jeremy Joyner

56. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

57. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

58. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

59. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

60. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

61. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

62. Educating the Rural Surgeon
Conclusions
The rural surgeon needs to be trained in modern techniques of laparoscopy, endoscopy and bariatric surgery
The rural surgeon frequently needs a broad scope of training that might include common procedures from other specialties
Residency programs do not adequately prepare the graduate surgeon for the needs of the rural patients they serve
Fellowship training programs are needed to help address these training deficiencies
MIMIS has demonstrated initial success with its fellowship
The impact of this training will need to be measured to determine its value and applicability
Similar training opportunities are sought after by graduate surgeons and we believe are needed in rural America
We encourage others to join us in the effort!

63. www.mimismn.org www.mimis-obesity.com www.fellowshipcouncil.org
The MIMIS Fellowship
Educating the Rural Surgeon