Transcript Hoch Template - Department of Surgery, University of

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
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acquiring endovascular skills
learning the science and the clinical application of the non-invasive
vascular laboratory
mentored experience in clinical research
 Second Year
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inpatient and outpatient care utilizing traditional open vascular surgery
and endovascular techniques
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
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, 20062007
 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
William Turnipseed, MD
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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
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
John R. Hoch, MD
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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
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., 19992000
 Research and Clinical Interests
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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
Gretchen Schwarze, MD
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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
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Surgical ethics research
Developer of the UW School of Medicine and Public Health Ethics
Curriculum
Endovascular specialist
Surgical education
Matthew Mell, MD
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Assistant Professor of Surgery
General Surgery, Stanford, 1987-1992
Transplant, Stanford, 1992-1993
Senior Surgeon, The Permanente
Medical Group, Hayward, Calif. 19932005
Vascular Residency, University of
Wisconsin, 2005-2006
Director, third- and fourth-year medical
student rotations in vascular surgery
Clinical and Research Interests
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Complex aortic disease and its management
by open and endovascular techniques
Public Health and Vascular Disease research
Surgical education
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 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.
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
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
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
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
 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
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
Clinical Coverage in First Year
 Call is from home, backing up an intern who is on inhouse 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.
Second Year of Training
 Second-year vascular fellow runs UW vascular
service; general surgery PGY-4 runs the VA vascular
service.
 UW Service
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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
 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
 Call:
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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
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 Q&A
 Quarterly City-wide Endovascular Forum
Conferences / Teaching
 Grand Rounds
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Each vascular fellow is assigned one grand rounds
presentation per year
 All third-year medical students rotate in VA Clinic
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Additional third-year medical students complete a twoweek 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
Resident Evaluation
 Fellow performance evaluation
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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
Routine and complex open vascular surgery cases
2007-2008
UW Fellow
 Abdominal
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Open AAA
 Cerebrovascular
 Peripheral
 Complex
 Mesenterics
 TAA
 Endografts
 Total Open
Nat’l Average
Percentile
167
65
98%
44
16
98%
54
101
85
4
5
71
305
22%
58%
97%
64%
96%
81%
93%
37
100
200
5
35
106
504
Endovascular Experience
UW Fellow
Percentage
 Diagnostic
 Therapeutic
 Endografts
82 (615)
239 (487)
76 (106)
Nat’l Average
95 (382)
151 (255)
55 (71)
50%
80%
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
80-Hour Work Week
Questions?