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									               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 3rd 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
                      UW Fellow   National Ave.   Percentile

    Abdominal             147           58              98%

       Open AAA            21           13              88%

  Cerebrovascular          45           59              45%

     Peripheral           125           109             67%

      Complex             184           87              97%

      Mesenteric           9             1              97%

          TAA              30            5              98%

        EVAR               70           70              50%
   Total Operations       567           600             45%
         Endovascular Experience 2008-2010
                          UW Fellow      National Ave.   Percentile

           Diagnostic          416            414             57%

           Therapeutic         288            270             62%

           Endografts          70              70             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?

								
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