The Colon and Rectal Surgery Residency at Penn State Health Milton S. Hershey Medical Center is a one-year, ACGME-accredited program that admits one resident per year.
During the Colon and Rectal Surgery Residency, clinical exposure to the full range of disease of the colon, rectum and anus is provided. The division has a strong interest in inflammatory bowel disease, and the Inflammatory Bowel Disease Center serves as a regional referral center for all patients with IBD. Furthermore, we offer state-of-the-art sphincter preserving surgery for rectal cancer, and treatment for complex anorectal disease.
The majority of the abdominal cases are performed with minimally invasive access (standard laparoscopy, single site laparoscopy, robotic surgery) and for selective rectal cases Transanal Endoscopic Micro Surgery (TEMS) or Transanal Minimally Invasive Surgery (TAMIS) are used. The expected annual volume for each resident is approximately 200 to 300 abdominal (60 percent or more are laparoscopic, 10% percent of which are robotic) and 150 to 250 anorectal cases.
The fellow will be exposed to more than 35 robotic cases per year. Transanal endoscopic microsurgery and transanal minimally invasive surgery are routinely performed for rectal polyps or early cancers. The service performs both fiber optic and rigid proctosigmoidoscopy and colonoscopy. The resident will have the opportunity to perform 150 to 200 colonoscopies and 100 sigmoidoscopies. Furthermore, the resident is expected to see approximately 500 new patients in clinic; 35 percent of the cases are IBD, 35 percent colorectal cancer, and 30 percent benign diseases (diverticulitis, polyps, anorectal etc.). Our goal is to train individuals to become safe, well rounded specialists in Colon and Rectal Surgery and active members of the American Society of Colorectal Surgery (ASCRS).
We have an active Colon and Rectal Surgery service; learn more about the clinical team here. There is a full complement of residents and medical students on the Colon and Rectal Surgery service. The Colon and Rectal Surgery resident will be part of the team and interact with the residents and medical students on a daily basis. The resident will be expected to assist in and teach the junior residents in the daily care of the patients. He/she will also be expected to provide formal and informal teaching sessions to the residents and medical students on the service. The Colon and Rectal Surgery resident will have no in house call responsibilities. He/she will be expected to share home back-up call to the in-house junior residents with the Chief General Surgery resident assigned to the service. He/she will also be expected to alternate weekend call, including patient rounds, with the Chief General Surgery resident. Three weeks of vacation are provided per year, with an additional five days of CME/education time that may be approved at the discretion of the program director.
There are four General Surgery residents assigned to the service on a rotating basis: a chief resident, a second-year resident, and two interns. In addition to the clinical staff, there is a full-time basic science research staff consisting of one PhD, two postdocs, one resident, one clinical research fellow and three research technicians. The Colon and Rectal Surgery service is divided into two teams. The Blue team consists of Drs. Koltun, Puleo and McKenna, and the White team consists of Drs. Stewart and Messaris. The Colon and Rectal Surgery resident will rotate services every six weeks, alternating with the Chief General Surgery resident, giving him/her six months on each service in total. While on each service, the Colon and Rectal Surgery fellow will be responsible for the daily care of their assigned attendings inpatients, participate in clinic with the assigned attending and assist in the operating room. The resident will spend a total of six months on each rotation. The time on each rotation will be broken up into six-week blocks to easily alternate with the Chief General Surgery resident so that there is no overlap. The General Surgery residents rotate on the Colon and Rectal Surgery service for three months at a time, and will spend six weeks on each rotation. At no time will both the Chief General Surgery resident and the Colon and Rectal Surgery resident be assigned to the same team. The junior residents on the service (R2 and interns) will work with both teams.
General Rotation Schedule
Sample Weekly Schedule
Blue Rotation (Koltun/Puleo/McKenna)
Monday: OR (Koltun/Puleo) Tuesday: Academic Wednesday: Clinic (Koltun/Puleo/McKenna) Thursday: OR (Koltun) Friday: OR (McKenna)
White Rotation (Messaris/Stewart)
Monday: OR (Messaris) Tuesday: OR (Stewart) Wednesday: OR (Stewart/Messaris) Thursday: OR (Messaris) Friday: Clinic (Messaris) Operative cases will be assigned to the Chief General Surgery resident and the Colon and Rectal Surgery resident by service. Certain “index” cases such as sphincter reconstruction and resection of presacral tumors will be assigned to the Colon and Rectal Surgery resident regardless of the team he/she is on. For the academic year 2012/2013, the Colon and Rectal Surgery resident performed 272 abdominal cases, 220 anorectal cases, 450 colonoscopies, and 234 endoscopic surgeries. The Colon and Rectal Surgery service works closely with other services in the hospital, including Gynecologic Oncology, Urology, Oncology, Radiation Oncology, and especially Gastroenterology. Not only do the services coordinate care of the patients but there are several interdisciplinary conferences amongst the groups including but not limited to IBD conference and GI tumor board. In addition representatives from many of these services will provide lectures to the Colon and Rectal resident. Through sharing of patients, lectures, and conference interactions Colon and Rectal resident will gain a broad multidisciplinary approach to the care of patients. In addition to close interaction with other services in the hospital the Colon and Rectal Surgery service maintains a close relationship with the enterostomal therapists. Their assistance in taking care of our patients with ostomies is invaluable. They regularly attend our preoperative conference so that they can be involved in patient care from the beginning.
A number of conferences are available to the Colon and Rectal Surgery resident, many of them mandatory.
Colon and Rectal Surgery Conferences (all required)
Pre-Operative Case Conference
Every Wednesday, 7 to 8 a.m. All the operative cases for the following week are discussed including indications for surgery, work-up, and pathophysiology. Pertinent studies such as colonoscopies, CT scans, barium studies and pathology will be reviewed.
GI Tumor Board
Last Friday of the month, 7 to 8 a.m. Interesting/complex patients with GI cancers (primarily colon and rectal cancers) are presented and discussed in a multidisciplinary conference. In attendance are surgeons, gastroenterologists, pathologists, radiologists, oncologists and radiation oncologists. The cases are presented by the colon and rectal resident and the general surgery residents.
Inflammatory Disease Center
Every Wednesday, 3 to 4 p.m. This is an interesting case conference run by the GI medicine service. On the last Wednesday of every month, a surgical case is presented. The fellow will be responsible for half of these presentations. He/she will also be expected to attend the conference the other weeks when the topic of the case being presented by the GI service is appropriate.
Colon and Rectal Didactic Series
Every Friday, 7 to 8 a.m. The Colon and Rectal Didactic Conference is designed to cover all aspects of colon and rectal surgery. The colon and rectal surgery resident and the chief general surgery resident will be required to give one lecture every three months. Topics will be assigned. There will be lecturers from outside the department to cover the following topics:
- Radiology of the colon and rectum
- CT scans
- Fluoroscopic exams
- Pathology of the colon and rectum
- Cancer and polyps
- IBD and miscellaneous
- GI medicine
- Medical management of IBD
- Medical management of constipation
- Medical treatment of metastatic colorectal cancer
- Radiation for rectal cancer
- Surgical management of liver metastasis
- Anesthesia for colon and rectal surgery
- Aspects of general anesthesia
- Local and regional anesthesia
- Pediatric colon and rectal surgery
- Imperforate anus
- Hirschsprung’s disease
The rest of the conferences will be given by the Colon and Rectal Surgery faculty.
Colon and Rectal Journal Club
Every other month Colon and Rectal Journal Club will be held four times/year (every other month). Two to four current articles relating to colon and rectal surgery will be discussed. The colon and rectal surgery resident and chief general surgery resident on the service will present the articles.
General Surgery Conferences (all required unless otherwise stated)
Morbidity and Mortality
Every Wednesday, 5 to 6 p.m. The colorectal residents will present the morbidity and mortalities from the colon and rectal service at this conference. In addition to providing the details of the case they will be required to discuss the teaching points and present a pertinent literature review.
Every Thursday, 5 to 6 p.m.
One Thursday a month, 7 to 9 a.m. This program is required only when the subject material is appropriate to Colon and Rectal Surgery. Optional for other topics.
Monthly These conferences are organized by the Office of Graduate Medical Education. Learn more about these lectures here.
Colon and Rectal Lab Meeting
Every Friday, 9 to 10 a.m. Ongoing basic science research projects in the Colon and Rectal Lab are discussed.
Surgical Research Seminar
Every Wednesday, noon to 1 p.m. Research being performed in the Department of Surgery is presented.
The Colon and Rectal Surgery Residency uses the Electronic Residency Application Service (ERAS) and the National Resident Matching Program. Further information on the registration and application process can be found on the web sites for these services.
- Application form
- Curriculum vitae
- Three or more letters of recommendation
- Medical school transcript
- USMLE scores for parts I, II and III
- Personal statement
- Medical school dean’s letter
Penn State Health Milton S. Hershey Medical Center Division of Colon and Rectal Surgery 500 University Drive PO Box 850 Hershey, PA 17033
General Contact Information
Phone: 717-531-5164 Fax: 717-531-0646