Fellowship Application - BodyByBariatrics

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Applicant Information

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Education

Medical School

Graduation Year

Residency Program

Residency Completion Date/Expected Completion Date:

Program Director Name

Program Director Contact

Have you transferred between residency programs?

Licensure & Credentials

ECFMG Certificate # (if applicable):

NPI Number:

Florida Medical License # (if held):

Florida Application Status

Not Started
In Progress
Active

DEA Registration # (if held):

Have you ever been convicted of a felony or misdemeanor (other than minor traffic violations)?

No
Yes - Please explain on a separate sheet.

Have you ever had a medical license, DEA registration, or hospital privileges revoked, suspended, or subjected to disciplinary action?

No
Yes - Please explain on a separate sheet.

Board Eligibility

Are you Board Eligible (General Surgery)?

Have you completed the American Board of Surgery Qualifying (Written) Examination?

Operative Experience

Provide your estimated case numbers from residency for the following procedure categories.

Laparoscopic sleeve gastrectomy

Primary

Laparoscopic Roux-En-Y gastric bypass

Primary

Revisional bariatric surgery

Primary

Laparoscopic sleeve gastrectomy

First Assist

Laparoscopic Roux-En-Y gastric bypass

First Assist

Revisional bariatric surgery

First Assist

Laparoscopic sleeve gastrectomy

Notes/Comments

Laparoscopic Roux-En-Y gastric bypass

Notes/Comments

Revisional bariatric surgery

Notes/Comments

Hiatal hernia repair

Primary

Laparoscopic fundoplication

Primary

Upper endoscopy (EGD)

Primary

Hiatal hernia repair

First Assist

Laparoscopic fundoplication

First Assist

Upper endoscopy (EGD)

First Assist

Hiatal hernia repair

Notes/Comments

Laparoscopic fundoplication

Notes/Comments

Upper endoscopy (EGD)

Notes/Comments

Laparoscopic cholecystectomy

Primary

Ventral/incisional hernia repair

Primary

Inguinal hernia repair

Primary

Laparoscopic cholecystectomy

First Assist

Ventral/incisional hernia repair

First Assist

Inguinal hernia repair

First Assist

Laparoscopic cholecystectomy

Notes/Comments

Ventral/incisional hernia repair

Notes/Comments

Inguinal hernia repair

Notes/Comments

Robotic-assisted procedures (any)

Primary

Other bariatric/MIS procedures

Primary

Robotic-assisted procedures (any)

First Assist

Other bariatric/MIS procedures

First Assist

Robotic-assisted procedures (any)

Notes/Comments

Other bariatric/MIS procedures

Notes/Comments

Total Logged Cases (ACGME Case Log) as of Application Date:

Primary

Describe any additional technical skills or surgical simulation training (e.g., FLS certification, robotic training course, SAGES endoscopy):

Video Links

Applicants are encouraged to submit 1–3 unedited operative videos that best demonstrate their technical skills. Preferred cases include laparoscopic procedures, such as bariatric, foregut, or advanced minimally invasive surgery. Videos will be reviewed as part of the technical assessment process and should be fully de-identified in accordance with HIPAA requirements.

Video Link

Short Answer Questions

Why Bariatric Surgery?

Describe the moment or experience that solidified your decision to pursue bariatric surgery. What draws you to the care of the bariatric patient, and how has that interest evolved over residency?

Why BodyByBariatrics?

After reviewing the BodyByBariatrics website and learning about our practice, what specifically excites you about training here? What do you see as the unique advantages of this fellowship compared to a traditional academic bariatric fellowship?

Private Practice & Entrepreneurship

Most surgical training programs do not teach the business of medicine. Do you have any interest in private practice, ASC ownership, or building your own surgical practice? What is your current level of understanding of surgical practice economics, and what do you hope to learn?

Career Vision

Where do you envision your career in 5 years? In 10 years? What type of practice setting do you see yourself in, and what role does this fellowship play in getting you there?

Operative Challenge

Describe the most technically challenging case you have participated in during residency. What made it challenging? What did you do, what did your attending do, and what did you learn?

A Difficult Patient Interaction

Describe a time when you had a difficult interaction with a patient or family member. How did you handle it, and what would you do differently in retrospect?

Feedback & Growth

Describe a piece of critical feedback you received during residency that you initially disagreed with. How did you process it, and did it change your behavior or perspective?

Team & Culture

BodyByBariatrics is a high-energy, high-volume, close-knit team. Describe the work environment in which you do your best work and thrive. What qualities do you bring to a team?

Research Interest

Do you have a specific clinical research question or quality improvement interest related to bariatric surgery? If so, describe it. If not, what area of bariatric surgery do you think deserves more study?

Anything Else?

Is there anything in your background, residency experience, or personal history that you believe the fellowship committee should know to fully evaluate your application? Is there anything in your record you would like to address or provide context for?

gastrectomy Video Surgery

References

Provide contact information for three (3) individuals who will submit letters of recommendation on your behalf. At least two (2) must be attending surgeons who have directly supervised your operative work. All references must submit letters directly to BodyByBariatrics.

Name & Title

Institution

Relationship

Name & Title

Institution

Relationship

Name & Title

Institution

Relationship