Vascular Surgery Fellowship

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Vascular Surgery Fellowship

• Established 1999 as an ACGME-approved one-year
  clinical fellowship
• Primary certificate approved in 2006, mandating
  minimum two years of training
• RRC approval to move to two-year program
  (2006-2008)
• First Year
• acquiring endovascular skills
• learning the science and the clinical application
  of the non-invasive vascular laboratory
• mentored experience in clinical research
• Second Year
• inpatient and outpatient care utilizing
  traditional open vascular surgery and
  endovascular techniques

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Vascular Surgery Faculty

• Craig Kent, Chairman, Department of Surgery
• William Turnipseed, Section Chief
• John Hoch, Residency Program Director
• Charles Acher, complex aortic surgery
• Girma Tefera, endovascular leader
• Gretchen Schwarze, surgical ethicist
• Matthew Mell, public health researcher

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Craig Kent, MD

• A.R. Curreri Professor, Chairman, Department of
  Surgery
• Residency UCSF, 1981-1986
• Vascular Fellowship Brigham Women's Hospital,
  1986-1988
• Chief, Combined Columbia and Cornell Division of
  Vascular Surgery, New York Presbyterian Hospital,
  1997-2008
• President Society For Vascular Surgery, 2006-2007
• Member, Vascular Surgery Board of American Board
  of Surgery, 2008-2012
• PI on more than 45 Industry Sponsored Clinical
  trials
• PI or co-investigator on 4 active NIH grants
• Author of 233 manuscripts and 44 book chapters

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William Turnipseed, MD

• Professor of Surgery
• Chief Section of Vascular Surgery
• MD, Emory University, Atlanta, Ga., 1969
• Residency, NIH Academic Trainee, Ohio State
  University Hospitals, 1969-1974
• Fellowship, Peripheral Vascular Surgery, Ohio
  State University Hospitals, 1974-75
• Clinical and Research interests
• Thoracic outlet syndrome management
• Management of chronic compartment syndrome
• Stepping down as section chief, 2009

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Charles Acher, MD

• Professor of Surgery
• Director, Thoracoabdominal Aneurysm Program
• Residency, University of Wisconsin, Madison,
  Wis., 1973-1978
• Fellow, GI and Peripheral Vascular Surgery,
  Gloucestershire Royal Hospital, Gloucester,
  England, 1978-1980
• Peripheral Vascular Fellow, Baylor College of
  Medicine, 1982-1983
• Clinical and Research interests
• Prevention of ischemic spinal cord injury in
  repair of TAAs
• Management of Complex Aortic and Visceral artery
  disease
• Repair of Aortic Arch and Thoracoabdominal
  Aneurysms by open and endovascular techniques

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John R. Hoch, MD

• Professor of Surgery
• Program Director Vascular Residency, 1999 -
  present
• Chief Vascular Surgery, VA Hospital, 1994
  present
• Residency, Thomas Jefferson University,
  Philadelphia, Penn., 1983-1989
• Fellow, Vascular Surgery, University of
  Missouri-Columbia, Columbia, Mo., 1989-1991
• Research
• PI VA Co-op trial 410 and 498
• Industry sponsored clinical trials
• Translational research
• Clinical Interests
• Complex aortic and visceral artery occlusive
  disease
• Endovascular management of arterial occlusive and
  aneurysmal disease
• Less invasive management of varicose vein disease

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Girma Tefera, MD

• Associate Professor of Surgery
• Director, UW Limb Salvage Angioplasty and Carotid
  Stenting Program
• Residency in General Surgery, Howard University
  Hospital, Washington, D.C., 1994-1999
• Fellowship in Vascular Surgery, University of
  Wisconsin Hospital and Clinics, Madison, Wis.,
  1999-2000
• Research and Clinical Interests
• Carotid stenting
• Limb salvage angioplasty
• Endovascular aortic stent grafts and angioplasty
  of peripheral arteries
• Thoacoabdominal aneurysm repair by open and
  endovascular means
• Developer and Manager of Vascular Surgery
  Database

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Gretchen Schwarze, MD

• Assistant Professor of Surgery
• MD, Harvard Medical School, 1995
• John F. Kennedy School of Government, 1995
• Mass General, General Surgery Residency,
• 2002
• University of Chicago Vascular Residency,
• 2004
• Research and Clinical Interests
• Surgical ethics research
• Developer of the UW School of Medicine and Public
  Health Ethics Curriculum
• Endovascular specialist
• Surgical education

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Matthew Mell, MD

• Assistant Professor of Surgery
• General Surgery, Stanford, 1987-1992
• Transplant, Stanford, 1992-1993
• Senior Surgeon, The Permanente Medical Group,
  Hayward, Calif. 1993-2005
• Vascular Residency, University of Wisconsin,
  2005-2006
• Director, third- and fourth-year medical student
  rotations in vascular surgery
• Clinical and Research Interests
• Complex aortic disease and its management by open
  and endovascular techniques
• Public Health and Vascular Disease research
• Surgical education

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Vascular Surgery Fellowship Goals

• Develop Excellence in
• Routine and complex open vascular surgery
• Diagnostic arteriography
• Endovascular intervention of aneurysmal and
  occlusive disease
• Interpretation of non-invasive vascular
  laboratory studies and their limitations
• Clinical research project with faculty mentor

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Vascular Surgery Fellowship Goals

• Competency in the basic science and clinical
  curriculum
• Competency as a teacher
• Compliance with the 80-hour work week
• Management of the weekly teaching and indication
  conferences and monthly Journal Club

http//apdvs.vascularweb.org/APDVS_Contribution_P
ages/New_Curriculum/Clinical/Clinical_Curriculum_I
NDEX.html
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Curriculum

• APDVS curriculum online with references
• Written Curriculum Goals and Educational
  Objectives
• September UCLA Vascular Review Course, first year
• Selected topics presented weekly by residents,
  faculty, and invited speakers at Vascular
  Conference
• Files with selected references in hard copy filed
  in residents office
• VSEP exam in Fall to direct your reading
  Vascular Surgery Inservice Exam in February.

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Structure of First Year

• Daily rounds
• Non-invasive vascular lab
• Diagnostic arteriography and endovascular
  interventions
• Venous disease rotation
• Arterio-venous access rotation
• Clinical research and critical thinking

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Non-invasive Vascular Lab

• Daily reading at the VA and on a rotational basis
  at the University Hospital
• One-half day per week hands-on in the lab first
  six months
• Didactic lectures on CD
• Gain a complete understanding of the indications,
  interpretation and limitations of each test
• Prepared to pass ARDMS examination during second
  year of residency

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Endovascular Interventions

• Preoperative evaluation of the patient
• Developing a therapeutic plan of endovascular
  intervention, in consultation and input of the
  faculty
• Performance of the endovascular intervention, and
  follow up of the patient
• Responsible for endovascular procedures in the UW
  Cath lab, and VA OR.
• Participate in weekly VA clinic and indications
  conferences and monthly endovascular QA
  conferences quarterly city-wide endovascular
  forum dinner meeting

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Venous Disease Rotation

• One month rotation at Meriter Hospital
• Rotate into venous clinic
• Office-based and hospital operating room-based
  interventions
• Minimally invasive techniques, and the
  postoperative care of patients with venous
  disorders

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Arterio-Venous Access Clinic

• Pre-operative and post operative care of patients
  requiring complex venous access surgery
• AV access endovascular procedures with Dr. Alex
  Yevzlin, interventional nephrologists
• Yolanda Beckers clinic PRN

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Clinical Research and Critical Thinking

• The first-year resident will be enrolled in two
  classes
• 1. Biostatistics and Medical Informatics
• 2. Introduction To Clinical Trials
• Prepare the resident for the design,
  implementation, and conduct of clinical trials
• Assigned research mentor
• Database manager
• Section will cover meeting costs for presentation
• Weekly didactic lecture, monthly Journal Club

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Clinical Coverage in First Year

• Call is from home, backing up an intern who is on
  in-house first call
• Approximately every third night during the week
  and every other weekend call and rounding
  responsibilities
• First-year vascular fellow rounds with the UW
  Hospital Service daily
• Cover of clinical services when second-year
  vascular resident or the VA PGY-4 out on vacation
  (6 weeks)
• Optional participation in basic science vascular
  lab/meetings
• The first-year vascular fellow will act as a
  consultant for the PGY-4, and will be responsible
  for many percutaneous and open VA endovascular
  cases if scheduling permits.

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Second Year of Training

• Second-year vascular fellow runs UW vascular
  service general surgery PGY-4 runs the VA
  vascular service.
• UW Service
• PGY-3, PGY-1 and two nurse practitioners
• Clinic on Wednesdays at VA Dr. Kent has clinic
  Monday afternoons in the UW Hospital
• OR 5, 730 a.m. starts (two on Tuesday)
• Endovascular experience in operating room and
  periodically in cath lab (Wednesday mornings)

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Second Year of Training

• VA Service
• General Surgery PGY-4, PGY-1, PGY-3 and VA NP
• Clinic on Wednesdays at VA
• OR 4, 730 a.m. starts
• Endovascular experience in OR, OEC 9800. New
  construction of an Operating Room VA angio suite
  to begin Fall 2009.
• The first-year vascular fellow will act as a
  consultant for the PGY-4, and will be responsible
  for most percutaneous and open VA endovascular
  cases.

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Second Year of Training

• Call
• Approximately every third night from home during
  the week, backing up the intern who is in house.
  The general surgery night float admits vascular
  patients from the ER.
• The vascular faculty member on call backs up the
  PGY-3 when they are on first call
• The vascular fellows are on call and have
  rounding duties every other weekend
• When the PGY-3 is on weekend first call, the
  faculty will not call in the fellow except for
  index cases, allowing greater vascular exposure
  for the PGY-3

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Conferences / Teaching

• Weekly Wednesday Teaching Conference
• 30-minute didactic lecture by vascular and guest
  faculty members
• PGY-4 and PGY-3 give one didactic lecture during
  10-week rotation
• Vascular fellows each give a didactic lecture
  every eight weeks
• Morbidity/Mortality Weekly
• 1-2 interesting cases if time allows
• Weekly Thursday Vascular Indications Conference
• Pre-operative presentation of patients requiring
  endovascular and open procedures
• Two vascular fellows and VA PGY-4 present with
  faculty.
• Monthly Journal Club
• Monthly Endovascular QA
• Quarterly City-wide Endovascular Forum

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Conferences / Teaching

• Grand Rounds
• Each vascular fellow is assigned one grand rounds
  presentation per year
• All third-year medical students rotate in VA
  Clinic
• Additional third-year medical students complete a
  two-week rotations and fourth-years do month long
  electives
• Attend SVS meeting second year attend any
  meeting at which you are presenting
• First-year resident attends UCLA Vascular Basic
  Science Review Conference
• Summer Core Competency Lectures

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Resident Evaluation

• Fellow performance evaluation
• Every four months
• Faculty
• 360-degree evaluation by nursing (floor and OR),
  cath lab personnel, NPs and support staff
• February Inservice Exam (VSITE)
• Quality Improvement Project
• Anonymous evaluation of program and faculty by
  computer input

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Routine and complex open vascular surgery cases
2007-2008

• UW Fellow
  Natl Average Percentile
• Abdominal 167 65
  98
• Open AAA 44
  16 98
• Cerebrovascular 37 54 22
• Peripheral 100 101
  58
• Complex 200 85 97
• Mesenterics 5 4
  64
• TAA 35 5
  96
• Endografts 106
  71 81
• Total Open 504
  305 93

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Endovascular Experience

• UW Fellow
  Natl Average Percentage
• Diagnostic 82 (615) 95
  (382) 50
• Therapeutic 239 (487) 151 (255)
  80
• Endografts 76 (106) 55
  (71) 80
• First number is primary recorded procedure, the
  number ( ) is secondary recorded procedures
  (Both are recorded for the RRC for Surgery)
• Limb Salvage Angioplasty Program
• Carotid Stenting Program
• Thoracic Endograft Program

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80-Hour Work Week
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Questions?