Transcript Department of Surgery - University of Wisconsin

Vascular Surgery
Residency and Fellowship
• Established with ACGME approval in 2009
• First Resident, July 2010
– PGY-3 Brigitte Smith, MD, University of Wisconsin School of Medicine and
Public Health
– PGY-2 Jessica Secor, MD, Boonshoft School of Medicine at Wright State
– PGY-1 Elena Rinehardt, MD, University of Washington School of Medicine
• Phasing out 5+2 Fellowship program with Integrated Vascular Residency 0-5.
• Designed to produce surgeons who can provide comprehensive care to the
vascular patient and be expected to fully participate in the rapid expansion of the
field of vascular surgery, both clinically and academically.
Vascular Surgery Faculty
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K. 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, MPH - 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
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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
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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
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Professor of Surgery
Program Director, Vascular Residency and Vascular Fellowship
Chief of Vascular Surgery, Madison VA Hospital, 1994 – 2011
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
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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
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Associate Professor of Surgery
Chief of Vascular Surgery, Madison VA Hospital, 2011-Present
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, MPH
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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
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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
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Assistant Professor of Surgery
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
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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
Residency
Goals:
• Provide incremental, progressive training in core surgery
(CS) and vascular surgery (VS) during the five year
program
• 24 months Core Surgery over PGY1-3
• 36 months of Vascular Surgery PGY1-5
• Three integrated sites: UW Hospital, Wm. S. Middleton
VA Hospital (connected by corridor) and Meriter Hospital
(5 minute drive)
Integrated Residency (0-5)
Year 1
• 10m Core and 2m Vascular
Year 2 and Year 3
• 7m Core and 5m Vascular both years
Year 4 and Year 5
• 12m Vascular
Will add one resident each year and phase out 5+2 fellowship
Integrated Residency (0-5)
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Core General Surgery:
– General Surgery
– Acute Care Surgery
– Critical Care
– Surgical Trauma
– General Vascular
– Night Float
Core Surgical subspecialties:
– Transplantation
– Cardiac Surgery
– Thoracic Surgery
– Plastic Surgery
7.5 months
2 months
1 month
1.5 months
3 month
2 months
3 months
1 month
2 months
1 month
24 months
Integrated Residency (0-5)
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Vascular Surgery:
– UW Vascular
– Endovascular
– Vascular Lab
– Vein Care
Vascular -related:
– Cardiology
– Interventional Nephrology
– Neurology/Stroke
– Elective
– Vascular Imaging
24 months (an additional 2 months as Core)
5 months
1 month
1 month
1 month
1 month
1 month
1 month
1 month
36 months
PGY1
PGY2
PGY3
PGY 4
PGY5
2
UW Vascular
Vein Care
UW Vascular
UW Vascular
4
(Core)
Night Float
(Vascular)
Endovascular
Surgery Service
Surgery Service
6
Transplant
Surgery
(Core)
Thoracic
(Vascular)
(Vascular)
8
(Core)
(Core)
(Vascular)
Open and
Endovascular
Open and
Endovascular
10
Stroke Service
Vascular Lab
General Surgery
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14
(Vascular)
(Vascular)
(Core)
UW General
Surgery
Endovascular
Meriter General
Surgery
16
(Core)
(Vascular)
(Core)
18
VA General
Surgery
20
(Core)
22
Cardiology
Consult
24
(Vascular)
26
Night Float
12 mo Vascular
12 mo Vascular
Weeks
Cardiac Surgery
(Core)
Endovascular
SICU
(Core)
(Vascular)
Interventional
Nephrology
Acute Care
Surgery
(Core)
28
(Core)
(Vascular)
30
Meriter General
Surgery
Endovascular
Elective
32
(Core)
(Vascular)
(Vascular)
34
Thoracic
36
(Core)
Acute Care
Surgery
VA Vascular
38
Transplantation
(Core)
(Vascular)
40
(Core)
General Surgery
UW General
Vascular
42
Plastics
(Core)
(Core)
44
(Core)
46
UW General
Surgery
Trauma Surgery
48
(Core)
50
UW General
Surgery
(Core)
52
Totals
10 mo Core
2 mo Vascular
(Core)
Transplant Surgery
MR/CT Imaging
(Core)
(Vascular)
7mo Core
5 mo Vascular
7 mo Core
5mo Vascular
Core Surgery Training PGY 1-3
• Provide complete foundation of the principles and practices of
surgery
• Similar training experiences as categorical general surgery residents
• Core Surgery Technical Skills Lab
• Instrument identification, knot-tying and suturing
• Management and repair of central lines and enteric feeding tubes
• Wisconsin Elements of Laparoscopic Surgery (WELS)
• Advanced Trauma Life Support (ATLS)
• Laparatomy and bowel anastomosis
• Principles of Ultrasound – FAST and line placement
• Principles of vascular anastomosis
Core Surgery Training PGY 1-3
• Specialized conferences e.g. Trauma
• Call during PGY1-3 no greater than 1:3
• Excellent working relationship with general surgery
– SCORE curriculum
• ABSITE PGY1,2 VSITE PGY 1-5
• Resident Evaluation by core faculty
Core Surgery and
Non-Department of Surgery Faculty
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Stroke Neurology (Matthew Jensen)
Cardiology and Interventional (Georgio Gimelli)
MR/CT imaging (Thomas Grist)
Cardiothoracic Surgery (Takushi Kohmoto)
Thoracic Surgery (Jim Maloney)
Vascular Access Intervention (Alex Yevzlin)
VA General Surgery (Sharon Weber)
Trauma and Acute Care Surgery (Ann O’Rourke)
Transplantation (Anthony D’Alessandro)
SICU (Ann O’Rourke)
Plastic Surgery (Michael Bentz)
Vascular Surgery Rotations
Develop Excellence In:
• Routine and complex open vascular surgery
• Diagnostic arteriorgraphy
• Endovascular intervention of aneurysmal and occlusive
disease
• Interpretation of non-invasive vascular laboratory studies and
their limitations
• Clinical research with faculty mentor(s)
Integrated Vascular
Surgery Rotations
• The resident must progressively demonstrate the knowledge and technical
ability for the clinical management of diseases of arteries and veins as they
progress from the PGY-1 year through the PGY-5 year
• We will develop the teaching and administrative capabilities of the vascular
resident as a fundamental goal to produce individuals with the knowledge
and superior skills necessary to manage patients with vascular disease
• Develop a pattern of continual education to keep abreast of the
developments and improvements in our field to maintain delivery of state
of the art care
• The vascular resident will receive adequate didactic and experiential
exposure and training in the conception, design, conduct, regulatory
monitoring, safety, analysis and reporting of clinical research trials to
advance our understanding of vascular disease itself and how to manage
patients afflicted with vascular disease
Integrated Vascular
Surgery Rotations
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The resident will show competency in all 6 core competencies for each rotation (Patient
Care, Medical Knowledge, Professionalism, Interpersonal and Communication, Systemsbased Practice and Practice –based Learning)
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This residency will prepare the resident to function as an independent expert
practitioner of vascular surgery and endovascular care at the high level of performance
expected of a board certified specialist
Curriculum
– APDVS curriculum on-line with references, both Basic Science and Clinical Curricula*
– Written Curriculum Goals and Educational Objectives
– September UCLA Vascular Review Course in PGY4 year
– RVT or RPVI Exam in PGY3 year
– Web-based universal curricula being developed by APDVS
– Wednesday Teaching Conference, Monday Basic Science and Didactic Lectures,
Thursday Indications Conference
– Monthly Global (Web_ex online) and Local Journal Clubs
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Integrated Vascular
Surgery Rotations
• Attendance required on all rotations
• Divisional support for meetings at which you present
• Prepare the resident for the design, implementation, and conduc
of clinical trials
• Assigned research mentor
• PGY 4 & 5 present at Surgery Grand Rounds each year
Cardiology Rotation PGY1
• A focused exposure to consultative cardiovascular medicine,
echocardiography and nuclear myocardial perfusion imaging
stress testing.
• 2 weeks with the UW Hospital Cardiology Consult Service, and
spending 1 week each reading studies in the UW Hospital
Echocardiography Laboratory and Nuclear Cardiology Laboratory.
• Will function on each service in a role equivalent to a first year
cardiovascular medicine fellow
Neurology/Stroke PGY1
• Rapid and appropriate triage, diagnosis, and management of
acute stroke patients in a variety of clinical settings
• Appropriate clinical care of neurological and medical issues in
these patients after the acute phase
• Good coordination of care between the various services involved
in the care of these patients.
• One month on the combined UWHC/VAH service which consists
of a vascular neurology faculty member, a neurology or
neurosurgery resident, and medical students.
• The vascular surgery resident would join the team in addition to a
neurology or neurosurgery resident, and receive direct
supervision and teaching from the vascular neurology attending
Non-invasive Vascular Lab
Rotation PGY2
• Daily reading at the VA and at the University Hospital; no
night call
• Daily hands-on participation in UW vascular lab with time
spent in UW West clinic and VA vascular labs
• Didactic lectures on CD from SVS/APDVS
• Gain a complete understanding of the indications,
interpretation and limitations of each test.
• Prepared to pass ARDMS examination during third year of
residency
Endovascular Rotations PGY2 and
PGY3
• 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 Angio suite and OR under the guidance of vascular surgery
faculty.
• Participate in weekly VA and UW clinics
• Initial exposure during PGY1 UW vascular rotation
• PGY4 and PGY5 continue to perform endovascular cases as
part of the daily care of UW vascular service patients
Venous Disease Rotation PGY3
• 1 month rotation at Meriter Hospital
• Venous clinic at Meriter, UW West, and Transformations
• Office-based and hospital operating room-based
interventions
• Minimally invasive techniques, and the postoperative care
of patients with venous disorders
Interventional Nephrology PGY2
• Demonstrate an understanding of the general principles outlined in
the Dialysis Outcomes Quality Initiative for Vascular Access (DOQI).
• Demonstrate basic understanding of the pathophysiology of
arteriovenous access failure .
• Demonstrate basic understanding of the pathophysiology of
renovascular disease failure including the typical clinical
presentation, noninvasive renovascular evaluation and indications,
outcomes and complications or renal artery PTA and stenting.
• One month rotation in the cardiac catheterization laboratory, with
the resident working side-by-side and under the supervision of the
attending interventional nephrology faculty.
• The rotation will include time in clinics as well as in the peripheral
catherization lab at the UWHC and the IR suite of the Wm. S.
Middleton VA Hospital in Madison.
Vascular Imaging Rotation
PGY2
• Demonstrate an understanding of the principles and practice of
modern vascular cross sectional imaging using computed tomography
and magnetic resonance imaging.
• Understand principles of radiation safety
• Understand the roles of CTA, MRA and MRV in the evaluation of
vascular pathology
• The PGY-2 vascular resident will rotate for 1 month on the Vascular
Imaging Service which includes CT and MR vascular imaging.
• The supervising faculty will include vascular radiologists with
expertise in vascular CT and MR imaging.
• The resident will attend educational conferences in radiology on CT
and MR imaging and radiation safety.
Vascular Surgery Elective
PGY3
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To allow the resident one month of elective time in the third year to conduct vascular
research or pursue additional training in open vascular procedures, endovascular
techniques at Theda Clark Medical Center in Neenah, WI.
The PGY-3 resident will work with the Program Director and Chair of the Division of
Vascular Surgery to identify programs of interest either within the University of
Wisconsin system, or elsewhere in the United States.
Rotating at another institution will allow the resident to compare differences in how
vascular care is provided and how different systems function.
Such an elective would allow the resident to be exposed to procedures not currently
performed at the University of Wisconsin, such as fenestrated or branched aortic
endografts.
Another option would be for the resident to travel abroad, in order to gain insight into
global health issues. Institutional involvement with international centers of vascular
care has the potential to provide our residents with valuable opportunities for crosscultural exchange of knowledge and experience.
Cardiac Surgery Rotation PGY2
• 1 month Rotation on the University Cardiac surgery
rotation with CT Residents
• The vascular resident participates in the pre- and postoperative management of patients on the Cardiac service
• The PGY-2 will be responsible in managing pre- and postoperative cardiac surgery patients
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Pericardial window
Thoracotomy and Median sternotomy
Cardiac canulation for cardiopulmonary bypass
First assist on coronary artery bypass and valve replacement
UW Vascular Rotation Clinical
Responsibilities
• Vascular PGY5 and PGY4
– GenSurg PGY3 (at times vascular PGY3)
– PGY 1 usually 2 interns
– 2 nurse practitioners on the floor
• OR 6-7 7:30 starts
• New Zeego Angio Operating Suite
• Open general vascular, complex open and hybrid
procedures
• Endovascular diagnostic and therapeutic interventions in
OR and cath lab, staffed by vascular surgery faculty
• Vascular Clinic Wednesdays at VA and UW
UW Vascular Service
• Call is from Home:
– 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 PG3
when they are on first call
– The vascular PGY4 and PGY5 are on call and have
rounding duties every other weekend
– When the PG3 is on weekend first call, the faculty will
not call in the vascular senior resident except for
“index” cases, allowing greater vascular exposure for
the PG3…New Weekend Midlevel
VA Vascular Service
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General Surgery PG4, PG1, PG3 and VA NP
Clinic on Wednesdays at VA
OR 4 7:30am starts
Endovascular experience in OR, OEC 9800. New
construction of Zeego Angio Operating Room to be
finished 2012.
• The PGY4 vascular resident will act as a consultant for the
general surgery PGY4, and will be responsible for some
percutaneous and open VA endovascular cases.
• Vascular PGY2 and PGY3 residents on Endovascular
rotation will perform some cases at the VA
Resident Evaluation
• Resident performance evaluation
– Faculty at end of each Rotation
– Semi-annual Review
– 360 evaluation by nursing (floor and OR), cath lab
personnel, NP’s and support staff
– February In-service Exam (VSITE)
– Quality Improvement Project
• Anonymous evaluation of program and faculty by
computer input
Routine and Complex Open Vascular
Surgery Cases Vascular Fellow 2009-2011
UW Fellow
Abdominal
National Ave.
Percentile
86
55
90%
Open AAA
19
12
92%
Cerebrovascular
41
57
35%
Peripheral
93
99
45%
Complex
114
86
80%
Mesenteric
9
1
97%
TEVAR
19
12
80%
Open TAA
8
3
88%
EVAR
108
74
82%
Total Operations
(Primary and
Secondary)
1117
1130
49%
Fellow Endovascular Experience 2009-2011
UW Fellow
National Ave.
Percentile
Diagnostic
440
381
72%
Therapeutic
236
269
48%
Endografts
108
74
82%
• Limb Salvage Angioplasty Program
• Carotid Stent Program (3 post-marketing trials allowing treatment of
asymptomatic and symptomatic patients with critical ICA stenosis)
• Thoracic Endograft Program (Fenestrated program beginning in 2012)
• Site for Gore Tag Clinical Trials TEVAR for Trauma, Dissection, TAA
• ACT I, FREEDOOM and CHOICE Carotid Stent trials
• Plasmin Acute Ischemia Trial
• Drug Eluding Balloon SFA PTA Trial
Clinical Research and Critical Thinking
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Faculty mentor assigned PGY1 year
– Resident advocate
PGY1:
– Present once in Vascular conference
– Case report or retrospective review article
PGY2
– Initiate clinical study involving imaging
– Attend AAS Fundamentals of Surgical Research Course
PGY3
– Retrospective Review
– Quality Improvement paper
– Introduction to Clinical Trials Course
– Initiate Prospective study
PGY4
– Retrospective paper
– Prospective study continues
– Should be presenting at regional or national meeting
PGY5
– Complete projects initiated in prior years
– Should be presenting at national meeting
80-Hour Work Week
Questions?
Integrated Vascular Residency
Rotations
Integrated Vascular Residency
Rotations