Vascular Surgery Residency and Fellowship

• • An ACGME-approved Vascular Surgery Fellowship (5+2) – Established in 1999 as an ACGME-approved 1-year clinical fellowship – RRC approval to move to 2-year program (2006-2008) – All fellows have passed their Board exams on the first attempt – 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 Phasing out 5+2 program with Integrated Vascular 0-5.

Vascular Surgery Faculty

• • • • • • • • • Craig Kent, MD – Chairman, Department of Surgery Jon Matsumura, MD - Chief, Division of Vascular Surgery John Hoch, MD - Residency Program Director Charles Acher, MD - complex open aortic surgery Girma Tefera, MD - endovascular leader Gretchen Schwarze, MD - surgical ethicist William Turnipseed, MD - chronic compartment syndrome Dai Yamanouchi, MD, PhD - clinician and basic science research Bo Liu, PhD - basic vascular research

K. 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

Jon Matsumura, MD

• • • • • • • Professor and Chief, Division of Vascular Surgery Residency, Northwestern University, 1988-1995 Vascular Fellowship, Northwestern University, 1995-1996 President, Midwestern Vascular Surgery Society, 2009-2010 Chair, SVS Clinical Research Committee, 2007-2009 PI or site PI on 18 industry sponsored Grants – PI: WL Gore: "Thoracic Aneurysm Graft Corelab", (2001-2009) – National PI: WL Gore: "Phase II Clinical Trial of the Bifurcated Excluder Endograft for Treatment of Infrarenal Aortic Aneurysms” – International PI: Cook, Inc: “Zenith Thoracic TAA Endovascular Graft” - National Co-PI forAbbott Vascular: “Asymptomatic Carotid stenosis, stenting versus endarterectomy Trial”, 2004- present Author of more than 70-peer reviewed articles, 34 book chapters and editor of 9 books

• • • • • • •

John R. Hoch, MD

Professor of Surgery Program Director, Vascular Residency and Fellowship Chief of Vascular Surgery, Madison VA Hospital, 1994 – present Residency, Thomas Jefferson University, Philadelphia, PA, 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 and Education Research – Chair, UW Anticoagulation Taskforce Clinical Interests: – Complex aortic and visceral artery occlusive disease – Endovascular management of arterial occlusive and aneurysmal disease – Less invasive management of varicose vein disease

• • • • • •

Charles W. Acher, MD

Professor of Surgery Director, Thoracoabdominal Aneurysm Program Residency, University of Wisconsin, Madison, WI, 1973-1978 Fellowship, 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

• • • • • •

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, WI, 1999-2000 Research and Clinical Interests – Carotid stenting – Limb salvage angioplasty – Endovascular aortic stent grafts and angioplasty of peripheral arteries Ethiopian Surgical Education Grant

Gretchen Schwarze, MD

• • • • • • Assistant Professor of Surgery Harvard Medical School, Boston, MA, 1995 JFK School of Government, Boston, MA, 1995 General Surgery Residency at Mass General, Boston, MA, 2002 Vascular Residency, University of Chicago, 2004 Research and Clinical Interests – Surgical ethics research – Developer of the UW Medical School Ethics Curriculum – Endovascular specialist – Surgical education

William Turnipseed, MD

• • • • • • Professor of Surgery Former 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 1974-75 Clinical and Research interests – Thoracic outlet syndrome management – Management of chronic compartment syndrome

• • • • • • •

Dai Yamanouchi MD, PhD

Clinical Assistant Professor ‘10 Surgical Residency, Saiseikai Maebashi Hospital, Japan, 2001-2002 Research Fellowship, Nagoya University Graduate School of Medicine, Japan, 2003-2004 Clinical Fellowship in Vascular Surgery, Nagoya University Hospital, Japan, 2004-2007 Research Fellowship, Weill Cornell Medical College, New York, NY, 2007-2008 Fellowship in Advanced Endovascular Surgery, University of Wisconsin Madison, Madison, WI, 2009-2010 Research interests: – pathogenesis of AAA – restenosis after angioplasty including balloon angioplasty and stent placement – Development of novel materials for vascular bypass graft – Gene delivery methods for patients with peripheral arterial disease

• • • • •

Bo Liu, PhD

MS, Biology, Beijing University, Beijing, China, 1986 PhD, Biochemistry, SUNY Downstate, New York, NY, 1993 Postdoctoral fellow, Signal transduction; protein degradation, Columbia University, New York, NY, 1994-1996 Postdoctoral fellow, Transcription regulation; signal transduction, Memorial Sloan-Kettering Cancer Center, New York, NY, 1996-1999 Research: RO1: understand the regulatory mechanisms underlying \normal functions of vascular smooth muscle cells (SMCs) and how these regulatory mechanisms malfunction in vascular diseases – AAA – Restenosis

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

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_Pages/New_Curriculum/Clinical/Clinical_Curriculum_INDEX.html

Curriculum

• • • • • • APDVS curriculum on-line with references Written curriculum goals and educational objectives September UCLA Vascular Review Course, first-year fellow Selected topics presented weekly by residents , faculty, and invited speakers at Vascular Conf.

Files with selected references in hard copy filed in resident’s office VSEP/VSAP exam in Fall to direct your reading; Vascular Surgery Inservice Exam in February.

Structure of First Year

• • • • • • Daily rounds UW Vascular Service, part of the team actively involved in patient care Non-invasive vascular lab Diagnostic arteriography and endovascular interventions Venous disease rotation Arterio-venous access rotation Clinical research and critical thinking

Non-invasive Vascular Lab

• • • • • Daily reading at the VA and on a rotational basis at the University Hospital – Likely phased out by 2012 – Change to reference cases review format, ie less service One-half day, twice per week, hands-on in the lab for a 3 month block Didactic lectures on CD from SVS/APDVS Gain a complete understanding of the indications, interpretation and limitations of each test.

Prepared to pass ARDMS RPVI examination during second year of fellowship

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, VA OR Angio and IR suites Participate in weekly VA clinic and Indications conferences

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

Arterio-Venous Access Clinic

• • • Preoperative and postoperative care of patients requiring complex venous access surgery AV access endovascular procedures with Dr. Alex Yevzlin, interventional nephrologist Janet Bellingham, MD provides transplant access clinic PRN

Clinical Research and Critical Thinking

• • • • • • The first-year fellow will be enrolled into classes in our Institute for Clinical and Translational Research: – Advanced Short Course Clinical Research – Scientific Writing workshop Prepare the resident for the design, implementation, and conduct of clinical trials Assigned research mentor Division will cover meeting costs for presentation Weekly didactic lectures Monthly Journal Club

• •

Vascular Services

UW Vascular Service – 2 Vascular fellows, PG3, PG1 and 2 nurse practitioners – OR #6 7:30am starts (2 starts alternating between Tuesday and Thursday) – Clinic offsite: ½ day per week for second-year, rotating days VA Vascular Service – General Surgery PG4, PG1, PG3 and VA NP – Clinic on Wednesdays at VA; first-year fellow – OR #4 7:30am starts – Endovascular experience in OR, OEC 9800 and IR. New Operating Room VA angio suite to open VA vascular Call covered by general surgery residents

• • • •

Call

Fellow call is “second call” from home; UW only.

– Fellows rotate every other weekend; every 3 rd during week – PG3 assigned to UW vascular service shares second call with fellows. When the PG3 is on weekend first call, the faculty will not call in the fellow except for “index” cases.

First call for UW Vascular Service by intern assigned to Sunday to Friday night float for vascular. PG1 and PG3 assigned to vascular for day shift, takes call Saturdays 8:30am- 10:30pm and Sunday 8:30am to 6pm; PA or PG3 covers first call Saturday nights Trauma/ED night float team covers ED admissions

• • • • • •

Clinical Coverage in First Year

First-year vascular fellow rounds with the University Service daily Daily responsibility in cath lab (415 diagnostic and 288 endovascular interventions) but also >200 open cases in the first year Cover of clinical services when second-year vascular fellow or the VA PG4 out on vacation (6 weeks) VA Vascular Clinic, organize and attend – The first-year vascular fellow will act as a consultant for the PG4, and will be responsible for many percutaneous cases in VA IR suite and VA EVAR cases and Carotid stents.

Optional participation in basic science vascular lab/meetings Noninvasive lab

Second Year of Training

• Second-year vascular fellow runs UW vascular service; general surgery PG4 runs the VA vascular service.

UW Service – Vascular fellows, PG3, PG1 and 2 nurse practitioners – UW West Clinic ½ day per week; VA clinic when available – OR #6 7:30am starts (2 on Tuesday and Thursday alternating) – Endovascular experience in operating room and in cath lab (Wednesday mornings) – New UW Endovascular OR

Conferences / Teaching

• Weekly Wednesday Teaching Conference – 30-minute didactic lecture by vascular and guest faculty members – PG4 and PG3 give one didactic lecture during 10-wk rotation – Vascular fellows each give a didactic lecture about every 8 wks – Morbidity/Mortality Weekly – 1-2 interesting cases if time allows • Weekly Thursday Vascular Indications Conference – Preoperative presentation of patients requiring endovascular and open procedures, review of non-invasive studies – Two vascular fellows and VA PG4 present cases with faculty.

Conferences / Teaching

• • • • • Weekly Monday AM Conference – Basic science didactic lecture bi-monthly – Monthly clinical research conference – Clinical curriculum / competencies talks Monthly local Journal Club Monthly global Journal Club (Web-Ex) Summer Core Competencies Lectures Monthly M&M Vascular case presentation before Grand Rounds

Conferences / Teaching

• • • • • • Surgery Grand Rounds – Each vascular fellow is assigned one Grand Rounds per year Third and fourth-year medical students rotate on service as 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 Purchase your lead at start of first year

Resident Evaluation

• • Fellow performance evaluation – Semi-annual – Faculty – 360 evaluation by nursing (floor and OR), cath lab personnel, NPs and support staff – February Inservice Exam (VSITE) – Quality Improvement Project Anonymous evaluation of fellows, residents, program and faculty by computer input (MEDHUB)

Routine and Complex Open Vascular Surgery Cases 2008-2010

Abdominal Open AAA Cerebrovascular Peripheral Complex Mesenteric TAA EVAR

Total Operations UW Fellow

147 21 45 125 184 9 30 70

567 National Ave.

58 13 59 109 87 1 5 70

600 Percentile

98% 88% 45% 67% 97% 97% 98% 50%

45%

Endovascular Experience 2008-2010

Diagnostic Therapeutic Endografts

UW Fellow

416 288 70

National Ave.

414 270 70

Percentile

57% 62% 50%

• • • • • Limb Salvage Angioplasty Program Carotid Stent Program Thoracic Endograft Program Site for Gore Tag Clinical Trials TEVAR for Trauma, Dissection, TAA ACT I and CHOICE Carotid Stent trials

80-Hour Work Week

Questions?