Vascular Surgery Residency and Fellowship • Residency established with ACGME approval in 2009; fellowship started in 1999. • 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. • First Resident, July 2010 – 1 st graduate: Brigitte Smith, MD, Univ of Wisconsin School of Medicine • Assistant Professor Univ of Utah – 2 nd graduate: Jessica Secor, MD, Boonshoft School of Medicine at Wright State • Private practice Illinois – – – PGY-5 Elena Rinehardt, MD, University of Washington School of Medicine PGY-4 Christopher Mc. Aninch, MD, St Louis University PGY-3 Jason Le, MD Chicago Medical School at Rosalind Franklin University PGY-2 Shruthi Thiagarajasubramanian, MD, MI State College Of Medicine PGY-1 Alexander Leung, MD, Boston University School Of Medicine • 5+2 Fellowship program: matching 1 fellow annually – PGY-6 Peter Bartline, MD, Univ of Utah - General Surgery – PGY-7 Camila Castello, MD, St Luke’s NYC - General Surgery
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 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 for Abbott Vascular: “Asymptomatic Carotid stenosis, stenting versus endarterectomy Trial”, 2004 - present - PI. -Medical Director Aorta. Core Imaging Lab# 08 -01: Evaluation of the GORE Conformable TAG® Thoracic Endoprosthesis for Treatment of Acute Complicated Type B Aortic Dissection (2009 -2017) - PI. NIH R 01 (Terrin, Matsumura, Baxter) Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA 3 CT) • Author of more than 100 -peer reviewed articles, 42 book chapters and editor of 10 books
John R. Hoch, MD • • • 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, 1989 -1991 Research: – PI VA Co-op trial #410 and #498 – Industry sponsored clinical trials – Chair, UW Anticoagulation Taskforce • Clinical Interests: – Complex aortic and visceral artery occlusive disease – Endovascular management of arterial occlusive and aneurysmal disease – Systems approach to VTE prevention – Less invasive management of varicose vein disease
Girma Tefera, MD Professor of Surgery • • Chief of Vascular Surgery, Madison VA Hospital and Vice-Chair Division Vascular Surgery, 2011 -Present • Director, UW Limb Salvage Angioplasty and Carotid Stenting • 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 – FEVAR and complex TEVAR – Ethiopian Medical Education Initiative ( MEPI) as well as Leader of multiple funded health and nutrition projects. – Ethiopian Emergency Medicine Training Initiative – Co-Founder University Wisconsin Global Health Initiative • Medical Director of ACS Operation Giving Back (OGB). OGB is a comprehensive resource that helps surgeons find volunteer opportunities worldwide that match their expertise and interests.
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
Gretchen Schwarze, MD, MPH • • • Associate Professor of Surgery Harvard Medical School, Boston, MA, 1995 JFK School of Government, Boston, MA, MPH 1995 General Surgery Residency at Mass General 2002 Vascular Residency, University of Chicago, 2004 Research and Clinical Interests – KL 2 “Prevention of postoperative conflict about life supporting therapy by improving preoperative communication with older patients” 12 -’ 15 – Greenwald Faculty Scholars Award 08 -’ 14 Advance Directives for High Risk Surgical Patients – NIA 1 R 03 AG 047920 GEMSSTAR: A Communication Tool to Assist Older Adults Making Difficult Surgical Decisions” “ 14 -’ 16 – Developer of the UW Medical School Ethics Curriculum Evaluating tools and processes to help close the gap between what surgeons know and patients understand – Navigating Major Surgery: supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-1502 -27462) – Best Case / Worse Case • Patient Experience Physician Champion UWHC 2012 • Recipient Dean’s Teaching Award 2011
Dai Yamanouchi MD, Ph. D • Associate 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, WI, 2009 -2010 • Research interests: – AHA Scientist Development Grant ‘ 12 -15 • Role Osteoclast-like Cells in AAA – Industry sponsored EVAR clinical trials – National PI Branched TEVAR Trial – Industry Sponsored Research Grant to study the effect of Nano-Bubble – Biomedical Engineering Project to develop Endovascular Devices
Kyla Bennett, MD • Assistant Professor (2015 – present) • Duke University: medical school, general surgery residency and vascular surgery fellowship at Duke University Medical Center. • Clinical focus on aortic, carotid and limb salvage surgery. • Vascular thoracic outlet syndrome interventions and management of venous obstruction. • Research interests include: outcomes and access-to-care disparities, methodology for large database analysis to improve model integrity and pre-hospital management of ruptured AAA and dissections.
Paul Di. Musto, MD • Assistant Professor (2015 -present) • Associate Program Director, residency & fellowship • University of Michigan: undergraduate, medical school, general surgery residency, and vascular surgery fellowship. • Clinical interests focus on aortic disease: including aneurysms, dissections, and occlusive disease. He performs both open and complex endovascular repair of the aorta. • He spent two years during residency studying the molecular biology underlying the gender difference in abdominal aortic aneurysm formation. • Interest in education of medical students, residents and fellows. • Working with Dr. Hoch to develop a simulation curriculum for the vascular trainees.
• Bo Liu, Ph. D, Biochemistry, SUNY Downstate, New York, NY, 1993 • Postdoctoral fellow, Transcription regulation; signal transduction, Memorial Sloan-Kettering Cancer Center, New York, NY, 1996 -1999 • Research: RO 1: understand regulatory mechanisms underlying l functions of vascular smooth muscle cells and how these mechanisms malfunction in vascular diseases – AAA and Restenosis • T 32 NIH-sponsored Vascular Biology Training Grant – Available after PGY 5 year
Vascular Surgery Residency • Provide incremental, progressive training in core surgery (CS) and vascular surgery (VS) during the five year program • Four integrated sites: UW Hospital, Wm. S. Middleton VA Hospital (connected by corridor), Meriter Hospital (5 minute drive) and Transformations (aesthetic center; 10 min drive) • Affiliated Rotations: St Mary’s Hospital, Madison and Theda Clark Hospital, Neenah, WI. – Future site Swedish American Hospital Rockford, Il • Optional research year(s) – after 5 years training or after PGY-2 T-32 funding mechanism
Integrated Residency (0 -5) Year 1 • 10 m Core and 2 m Vascular Year 2 and Year 3 • 7 m Core and 5 m Vascular both years Year 4 and Year 5 • 12 m Vascular each year
Integrated Residency (0 -5) • Core General Surgery: – Surgical Intensive Care 2 months – Emergency General Surgery 2 months – Surgical Trauma 2 months – Night Float (vascular) 2 months – Anesthesia 0. 5 months – Off-site general/vascular 1 month – General Surgery 8. 5 months • Core Surgical subspecialties: – Transplantation 2 months – Plastic Surgery 1 month – Thoracic Surgery 2 months – Cardiac Surgery 1 month 24 months
Integrated Residency (0 -5) PGY 1 -3 Years Vascular Rotations • Vascular Surgery : – UW Vascular – Vascular Lab – Vein Care – VA Vascular 5 months 1 month 2 months • Vascular - related: – Cardiology – Vascular Access – Elective/Research 1 month 12 months
Integrated Residency (0 -5) PGY 4 & 5 Years • Vascular Surgery 24 months • Alternating 3 month rotations with PGY-4, PGY-5 and PGY-7 Fellow – UW Vascular 12 months (6 m/yr) – VA Vascular 6 months (3 m/yr) – On. Service 6 months (3 m/yr) • • • Acute care Endovascular Veins V-lab Research • _______ 24 months – – No conflict between Residents and Fellow; pair fellows &
Core Surgery Training PGY 1 -3 • Provide complete “foundation of the principles and practices of surgery” ACS course • SCORE Curriculum • 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) and ACLS 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 PGY 1 -3 no greater than 1: 3 • Excellent working relationship with general surgery – SCORE curriculum • VSITE PGY 1 -5 • Resident Evaluation by core faculty
Core Surgery Rotations Outside UWHC • Theda Clark Hospital - Neenah, WI (PGY-3; 1 month) – Community general surgery; no residents – Nice mix of open and laparoscopic operations – 4 weeks; weekends off • St Mary’s Hospital - Madison, WI (PGY-3; 2 months) – Community general surgery; no other residents – Mix of general, cardiac surgery and vascular patients • Meriter Hospital (PGY-1 & 3; 2 months) – Community general surgery • VA Hospital General Surgery Service (PGY-1; 1 month)
• Curriculum Integrated Vascular Surgery Rotations – APDVS curriculum on-line with references, both Basic Science and Clinical Curricula – Vascular SCORE – Written Curriculum Goals and Educational Objectives – UCLA/SVS Vascular Review Course in September of PGY 4 – RPVI Exam in PGY 3 year (Division covers cost) – Web-based universal curricula being developed by APDVS • Milestone Driven – Monthly Global (Web-ex online) and Local Journal Clubs
Vascular Conferences • Monday morning 6: 30 to 9: 30 am (excused from OR) – 6: 30 to 7: 15 Indications – 7: 15 to 7: 30 Web-Ex morning sign out – 7: 30 to 8: 30 Basic Science 1/mo; Noninvasive Lab conference 1/mo; Global Journal Club 1/mo; Clinical Research conference 1/mo – 8: 30 to 9: 30 Teaching conference • Faculty sponsored Monthly Journal Club
• • Integrated Vascular Surgery Residents Attendance at Monday conferences required on all rotations; excused from OR and general surgery rotations Divisional support for meetings at which you present Prepare the resident for the design, implementation and conduct of clinical trials Assigned research mentor: – Expected to present at least once at National or Regional vascular meeting during residency – Expected to take at least one research project from concept, through the IRB, data collection, statistical and conceptual analysis and publication
Cardiology Rotation PGY 1 • 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
Non-invasive Vascular Lab Rotation PGY-2 • Daily reading at the University Hospital and West Clinic; 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 RPVI examination during third year of residency • Vascular lab interpretation responsibilities continue in PGY 3 - and 4 years at VA
Venous Disease Rotation PGY-3 • 1 month rotation at Meriter Hospital • Venous clinic at Meriter, UW West Clinic and Transformations • Office-based and hospital operating room-based interventions • Minimally invasive techniques, and the postoperative care of patients with venous disorders • Hands on venous imaging in the vascular labs at West and UWHC • Also participate in vein care during Meriter Hospital core surgery rotations years 1 -3 and when rotating on Onservice rotation PGY 4&5.
Vascular Surgery Elective PGY 3 • 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 or endovascular techniques • 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. • Option for AV Access rotation at Swedish American Hospital, Rockford, IL
University and VA Vascular Rotations PGY 2 and PGY 3 • Junior resident on the UW and VA Vascular teams working with Gen Surg PGY 1 & 3 and Vascular PGY 4 & 5 and fellow. • Experience in endovascular and open interventions • With the input of faculty, develop therapeutic plans, perform endovascular and open interventions and follow up the patients • Responsible for majority of endovascular procedures in the UW Cath lab and VA Hybrid OR under the guidance of vascular surgery faculty when on rotation. • Perform CEA, femoral to popliteal bypass, CFA endarterectomy, EVAR, amputations, extra-anatomic bypass, assist with complex open aortic reconstructions • Participate in weekly VA and UW clinics
Vascular Rotations PGY 4 and PGY 5 • UW Vascular Service (6 months/yr) • • • – 2 three month blocks each of the PGY 4 & 5 years – Gen. Surg PGY-3 (at times vascular PGY 2 or 3) – PGY 1 (shared with VA Vascular Service) – 3 nurse practitioners on the floor (They are awesome!) Seven 7: 30 OR starts Zeego Angio Operating Suite (also at VA) Complex open and Hybrid procedures Endovascular diagnostic and therapeutic interventions in OR and cath lab, staffed by vascular surgery faculty Vascular Clinic at UW West clinic average of ½ day/wk
Vascular Rotations PGY 4 and PGY 5 • VA Vascular Service (3 months/yr) • • • 1 three month block as chief each of the PGY-4 & -5 years Open and endovascular general vascular cases PGY-1 (shared with UW Service) Inpatient VA NP and case managers Clinic on Wednesdays at VA, morning and afternoon – Junior residents on UW service also attend VA clinic – Active faculty teaching in clinic • OR 4 7: 30 am starts • Endovascular experience in new Zeego Hybrid Angio Suite/Operating Room.
Vascular Rotations PGY 4 and PGY 5 • On. Service Rotation (3 months/yr) • 1 three month block as chief each of the PGY-4 & -5 years • Responsible for covering vascular cases at Meriter and new East side Hospital, as well as acute cases UW vascular service • Endovascular and open arterial cases • Vein care • Spine exposures • Endovascular experience in UWHC Zeego Angio Operating Room, UW cath lab, Meriter Cath Lab and VA Zeego Room. • Time for research, vascular lab work and additional vein care opportunities
Vascular Call • PGY 2 & 3 – On core rotations • Every third night call from home • Except 2 months SICU in-house every third night – On vascular rotations • Share back-up call from home for in-house night-float intern with PGY 3 general surgery resident, PGY 4 & 5 and the fellow • PGY 4 & 5 – Call is from home – Backup night-float intern every 3 -4 nights during week – Backup junior residents every fourth weekend in rotation with fellows – The vascular PGY 4, PGY 5 and fellows are on call and have rounding duties every fourth weekend – Weekend Midlevel NP support
Vascular Resident Cases 2011 -2016 UW Resident National Ave. Breast 33 12 Transplant 7 6 Thoracic 21 18 Hernia 45 31 Biliary 28 20 Abd Gen 12 9 Lg Intest 18 15 Sm Intest 7 6 Skin 27 24 Total Major Core Operations 293 205 Total Primary Vascular Operations 869 861 Total Major Vascular 541 472
UW National Vascular Average Resident. UW 2011 -2016 Fellow 20142016 Fellows 2011 -2016 Residents Abdominal Obstructive 23 16 23 15 Open AAA 15 10 23 11 EVAR 73 59 65 60 All Aneurysm 119 89 130 123 Cerebrovascular 48 70 99 82 Peripheral 218 182 392 255 PTA Aorto. Iliac 52 44 67 46 PTA/Stent Fem-Pop 128 99 121 93 Mesenteric 9 4 4 3 TEVAR 14 14 20 17 Open TAA 21 3 17 3 EVAR 63 45 56 49 Total Major Vascular 557 398 541/716* 472/664* * Primary and secondary cases
Programs and Clinical Trials • Limb Salvage Angioplasty Program • Carotid Stent Program (1 post-marketing trials allowing treatment of asymptomatic and symptomatic patients) • Thoracic Endograft Program • Fenestrated EVAR program (>30 cases / year) • Cook: P-branch Endovascular Graft Pivotal Study • BEST CLI Trial • SCAFFOLD CAS Trial; • GORE® TAG® Thoracic Branch Endoprosthesis (TBE Device) • GORE IBE bifurcated iliac trial • Roadster flow reversal cerebral protection carotid stent trial • CREST 2 Trial; CEA vs CAS vs Medical Management
Clinical Research and Critical Thinking • • • Faculty research mentor assigned PGY 1 year (PD acts as Resident advocate) PGY 1: – Present twice in Vascular conference – Case report PGY 2 – Initiate clinical study involving imaging or other topic – Quality Project PGY 3 – Retrospective Review – 1 month research/elective rotation – Quality Improvement paper – Introduction to Clinical Trials Course – Initiate Prospective study PGY 4 – Retrospective paper – Prospective study continues – Should be presenting at regional or national meeting PGY 5 – Complete projects initiated in prior years – Should be presenting at national meeting – After PGY-5 year: T 32 Grant: opportunity to spend -2 years in postgraduate clinical or basic research
New Initiatives • Global Health: Ethiopia – Beginning in January 2017 – The first vascular residency in Africa (outside South Africa) – Faculty from the Univ. of Wisconsin and other invited institutions will rotate every other month to Addis Ababa – Opportunity for PGY-4 Vascular resident to rotate for 1 month when UW faculty present at end of 4 th year. • Simulation Curriculum: #1 goal for Division this year – – Simulation Center UWHC Open skills training: low cost and high-end Active faculty mentoring Mentice Endovascular simulator
80 -Hour Work Week
Questions?
Vascular Imaging Rotation PGY 2 • The PGY-2 vascular resident will rotate for 1 month on the Vascular Imaging Service which includes CT and MR vascular imaging. • 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 • The resident will attend educational conferences in radiology on CT and MR imaging and radiation safety.
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 – March In-service Exam (VSITE) – Quality Improvement Project • Anonymous evaluation of program and faculty via Med. Hub
2016 Vascular Resident Graduate “Defined Categories”
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