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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

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Vascular Surgery Fellowship

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  1. 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 Vascular Surgery Fellowship

  2. 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 Vascular Surgery Faculty

  3. 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

  4. 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 William Turnipseed, MD

  5. 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 Charles Acher, MD

  6. 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 John R. Hoch, MD

  7. 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 Girma Tefera, MD

  8. 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 Gretchen Schwarze, MD

  9. 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

  10. 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 Vascular Surgery Fellowship Goals

  11. 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 Vascular Surgery Fellowship Goals *http://apdvs.vascularweb.org/APDVS_Contribution_Pages/New_Curriculum/Clinical/Clinical_Curriculum_INDEX.html

  12. 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 resident’s office VSEP exam in Fall to direct your reading; Vascular Surgery Inservice Exam in February. Curriculum

  13. Daily rounds Non-invasive vascular lab Diagnostic arteriography and endovascular interventions Venous disease rotation Arterio-venous access rotation Clinical research and critical thinking Structure of First Year

  14. 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

  15. 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 Q&A conferences; quarterly city-wide endovascular forum dinner meeting

  16. 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

  17. 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 Becker’s clinic PRN

  18. 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

  19. 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.

  20. 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, 7:30 a.m. starts (two on Tuesday) Endovascular experience in operating room and periodically in cath lab (Wednesday mornings) Second Year of Training

  21. VA Service General Surgery PGY-4, PGY-1, PGY-3 and VA NP Clinic on Wednesdays at VA OR #4, 7:30 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. Second Year of Training

  22. 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

  23. 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 Q&A Quarterly City-wide Endovascular Forum Conferences / Teaching

  24. 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 Conferences / Teaching

  25. 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

  26. UW FellowNat’l AveragePercentile 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% Routine and complex open vascular surgery cases 2007-2008

  27. UW FellowNat’l AveragePercentage 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 Endovascular Experience

  28. 80-Hour Work Week

  29. Questions?

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