Vascular Surgery Residency

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Vascular Surgery Residency

• Established 1999 as an ACGME-approved one-year
  clinical residency
• Primary certificate approved 2/2006, mandating
  minimum 2 years training
• RRC approval to move to 2-year program
  (2007-2009)
• 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

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Vascular Surgery Faculty

• William Turnipseed, Section Chief
• John Hoch, Residency Program Director
• Charles Acher, complex aortic surgery
• Girma Tefera, endovascular leader
• Gretchen Schwartze, surgical ethicist
• Matthew Mell, public health researcher

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William Turnipseed

• Professor of Surgery
• Chief Section of Vascular Surgery
• M.D., 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
• Minilaparotomy Aortic surgery
• Thoracic outlet syndrome management
• Management of chronic compartment syndrome
• Management of aortic and prosthetic graft
  infections

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Charles Acher

• Professor of Surgery
• Director Thoracoabdominal Aneurysm Program
• Residency, University of Wisconsin, Madison, WI,
  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

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John R Hoch

• Professor of Surgery
• Program Director Vascular Residency, 1999 -
  present
• Chief Vascular Surgery, VA Hospital 1994
  present
• Residency, Thomas Jefferson University,
  Philadelphia, PA, 1983-1989
• Fellow, Vascular Surgery, University of
  Missouri-Columbia, Columbia, MO, 1989-1991
• Research
• VA Merit Review TGF-beta and intimal hyperplasia
• NIH RO1 Estradiol and Gene Expression in intimal
  hyperplasia
• PI VA Co-op trial 410 and 498
• Clinical Interests
• Complex aortic and visceral artery occlusive
  disease
• Repair of thoracoabdominal aneurysms
• Endovascular management of arterial occlusive and
  aneurysmal disease
• Less invasive management of varicose vein disease

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Girma Tefera

• 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
• Thoacoabdominal aneurysm repair by open and
  endovascular means
• Developer and Manager section of vascular surgery
  database

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Gretchen Schwarze, MD

• Colby college 90
• Harvard Med School 95
• JFK School of government 95
• Mass General GS residency 02
• Univ. Chicago Vascular Residency 04
• Assistant Professor of Surgery
• Research and Clinical Interests
• Surgical ethics research
• Endovascular interventions
• Vein care
• Surgical education

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Matthew Mell

• Assistant Professor of Surgery
• General Surgery, Stanford 1987-1992
• Transplant, Stanford 1992-1993
• Senior Surgeon, The Permanente Medical Group,
  Hayward, CA 1993-2005
• Vascular Residency, Univ. WI 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

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Vascular Surgery Residency 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

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Vascular Surgery Residency 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_P
ages/New_Curriculum/Clinical/Clinical_Curriculum_I
NDEX.html
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Curriculum

• APDVS curriculum on-line 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 Conf.
• Files with selected references in hard copy filed
  in residents office
• VSEP exam in winter to direct your reading

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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

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Non-invasive Vascular Lab

• Daily reading at the VA and every third week at
  UW
• One day per week hands-on in the lab
• Didactic lectures on CD
• Gain a complete understanding of the indications,
  interpretation and limitations of each test.
• Prepared to pass ARDMS examination

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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 angio suite and VA OR.
• Participate in VA clinic, Indications and monthly
  endovascular QA conferences

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Venous Disease Rotation

• 1 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

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Arterio-Venous Access Clinic

• Pre-operative and post operative care of patients
  requiring complex venous access surgery
• Yolanda Beckers clinic PRN

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Clinical Research and Critical Thinking

• The first year resident will be enrolled into 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

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Clinical Coverage in First Year

• Every third night and weekend call and rounding
  responsibilities
• First year vascular resident rounds with the
  University Service daily
• Cover of clinical services when 2nd year resident
  or PG4 out on vacation (6 weeks)
• Optional participation in basic science vascular
  lab/meetings

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Second Year of Training

• 2nd year vascular resident runs UW vascular
  service general surgery PG4 runs the VA vascular
  service.
• UW Service
• PG3, PG1 and 2 nurse practitioners
• Clinic on Wednesdays at UW West Clinic or VA
• OR Five 730am starts (2 on Tuesday)
• Endovascular experience in operating room and
  periodically in cath lab

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Second Year of Training

• VA Service
• General Surgery PG4, PG1, PG3 and VA NP
• Clinic on Wednesdays at VA
• OR 4 730am starts
• Endovascular experience in OR OEC 9800 and in IR
  suite
• The first year vascular resident will act as a
  consultant for the PG4, and will be responsible
  for all percutaneous and open VA endovascular
  cases.

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Second Year of Training

• Call
• Every third night from home, back up intern or
  PG3 who is in house
• Every third weekend, rotating with 1rst year
  vascular resident and PG4 general surgery
  resident

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Conferences / Teaching

• Weekly Wednesday Teaching Conference
• PG5 and PG3 give 1 didactic lecture during 10 wk
  rotation
• Vascular residents each give a didactic lecture
  every 5-6 wks
• 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 residents and VA PG4 present.
• Monthly Journal Club
• Monthly Endovascular QA
• Quarterly City-wide Endovascular Forum

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Conferences / Teaching

• Grand Rounds
• Vascular resident is assigned 1 grand rounds year
• All third year medical students rotate in VA
  Clinic
• Additional med3s do 2 week rotations and med4s
  do month long electives
• Attend SVS meeting 2nd year attend any meeting
  at which you are presenting
• First year resident attends UCLA Vascular
  Teaching Conference

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Resident Evaluation

• Quarterly resident evaluation
• Faculty
• 360 evaluation by nursing (floor and OR), cath
  lab personnel, NPs and support staff
• February Inservice Exam (VSITE)
• Anonymous evaluation of program and faculty by
  computer input

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Routine and complex open vascular surgery cases
2006-2007

• PG6
  PG7 2 Year Experience
• Abdominal 24 80 104
• Cerebrovascular 11 33
  44
• Peripheral 29 62
  91
• Complex 7 41 48
  
• Mesenterics 1 16
  17
• TAA 1 20 21
• Endografts 25 37
  62
• Total Open 65 269
  334

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Endovascular Experience

• PG6 PG7
  Combined Natl Ave
• Diagnostic 58 (291) 48 (170) 106 (461)
  108 (306)
• Therapeutic 145 (146) 132 (59) 277 (205)
  113 (92)
• Endografts 25 37 62
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• Limb Salvage Angioplasty Program
• Carotid Stenting Program
• Thoracic Endograft Program

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80 Hour Work Week
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Questions?