ACGME Accredited Cardiothoracic Anesthesia Fellowship

Introduction

Excellence in education, patient care, and research are the principles upon which the department of Anesthesiology at the University of California San Diego was founded.

The Focus of the ACGME accredited Cardiothoracic Anesthesiology Fellowship is to provide a nurturing environment in which to acquire the knowledge and develop the technical skills necessary to provide superb clinical care and cultivate high quality research. This fellowship provides an incredibly rich academic experience that produces well trained and qualified CT Anesthesiologists fellows who will become facile in the perioperative management of patients undergoing complex procedures such as off pump CABG, aortic reconstruction, Mitral, Aortic and Tricuspid valve work, Ventricular Assist Devices, Heart Transplants, Congenital Heart Surgery, Pneumonectomies and Minimally Invasive Cardiac surgery. Our perioperative TEE service performs approximately 600 exams per year, providing ample opportunities to become an expert at image acquisition and interpretation. The fellowship is set up as a one- to two-year specialized training program designed to allow the individual maximal exposure to the clinical, research, administrative, and teaching opportunities best suited to his or her own interests and ultimate career goals. Clinical experience is the focus of the first fellowship year, with involvement in clinical research. The optional second fellowship year is available to fellows interested in basic or clinical research and pursuit of academic career.

Goals and Objectives

The Cardiothoracic Anesthesiology Fellowship curriculum provides 12 months of training dedicated to mastering the principles, practices, and techniques of cardiothoracic anesthesia, adhering to the guidelines outlined by the Department of Anesthesiology, UCSD School of Medicine and the ACGME. The training will consist of at least six months in the main operating room providing anesthesia to patients undergoing cardiac procedures, one month of thoracic anesthesia, one month in surgical intensive care unit providing perioperative care for cardiac and thoracic surgery patients, two month dedicated to transesophageal echocardiography (TEE) and two month of electives.

The core 6-month main operating room cardiac anesthesia training will be divided among UCSD, San Diego VA and Sharp Memorial hospitals. All locations will share the same educational goals and objectives. Each institution, however, will provide a distinct teaching milieu. UCSD Jacobs Medical Center will offer unique experience in advanced cardiothoracic cases, such as Pulmonary Thromboendarterectomy (PTE). San Diego VA hospital will offer an older patient population with its own challenges. At the VA hospital fellows will assume the role of a senior fellow; they will under the supervision and direction of the faculty attending anesthesiologists contribute to the education of the residents. Sharp Memorial hospital rotation will introduce the fellows to cardiac anesthesia in the private practice setting. Fellows will act as the primary anesthesiologists, under the supervision of the faculty attending anesthesiologist. TEE experience at all locations will adhere to the same educational standard. Attending anesthesiologists involved in TEE teaching, all have formal training in cardiothoracic anesthesia or TEE certification.

Upon completion of the one-year program, the cardiothoracic anesthesiology fellow will have:

  • Acquired the knowledge, judgment, and skills requisite with recognition as a consultant anesthesiologist with subspecialty expertise in Cardiothoracic Anesthesia.
  • Developed specialized expertise in the performance and interpretation of perioperative transesophageal echocardiography with the specific goal of attaining the American Board of Echocardiography's Certification in Perioperative TEE at completion of fellowship training.
  • Participated actively in clinical and/or basic research with the goal of acquiring skills needed to identify important clinical questions, to critically evaluate published literature, and to design studies to answer questions according to sound scientific methods.

Elective Rotations: The fellowship offers a variety of electives for fellows to choose from:

  • Congenital (Pediatric): The congenital (pediatric) cardiac surgery elective rotation at Rady’s children hospital fellows will be providing anesthesia for pediatric patients requiring CPB for cardiac surgical procedure, cardiac catheterization and cardiac electrophysiologic diagnostic/therapeutic procedures, and surgical treatment for cardiac arrhythmias.
  • Pulmonology: Fellows will gain familiarity with the pulmonary vascular imaging modalities used in the work-up of patients with pulmonary hypertension. Overview of pulmonary hemodynamics from right heart catheterization and its importance in the evaluation and management of Chronic thromboembolic Pulmonary hypertension (CTEPH) patients.
  • Cardiac Electrophysiology: Fellows will get involved in the evaluation, diagnosis and management of cardiac arrhythmias, including noninvasive and invasive diagnostic and therapeutic electrophysiologic techniques, and cardiac implanted electronic device (CIED) implantation.
    Perfusion: Fellows will acquire expertise in the management of cardiopulmonary bypass during cardiac surgery.
  • Research: Fellows will develop experience in research pertaining to cardiovascular anesthesia. They will acquire skills in the development, planning, organization, collection of data, and presentation of a research project.

Number of Positions: Three accredited spots

Surgical Procedures:

  • Routine cardiac surgery (CABG, Valve repair/replacement)
  • Minimally invasive valve surgery
  • Off-pump CABG
  • Pulmonary Thromboendarterectomy (involving deep hypothermic circulatory arrest)
  • Lung and Heart transplantation
  • Ventricular assist device implantation
  • Minimally invasive, Robotic and Transcatheter (TAVR) valvular surgery (including Coronary Sinus Catheter placement experience)
  • General thoracic surgery including lung resection, lung volume reduction surgery for emphysema, and esophageal surgery
  • Major Aortic Surgery including procedures requiring circulatory arrest
  • Surgery of the great vessels of the chest including aneurysms

Clinical Education:

  • Large variety of clinical cases as described above
  • Transesophageal Echocardiography education
  • Monthly didactic TEE lecture series
  • Echo weekly Review Sessions - these typically are 1-2 hour echocardiography sessions that begin with a brief mini-lecture/discussion on a particular echo related topic followed by a review of TEEs with emphasis on the daily topic.
  • Extensive teaching library with digital case reviews, CD-ROMs, and TEE textbooks
  • New echocardiographic equipment, including Live 3D as well as offline 3D evaluation
  • New TTE/TEE simulator

Cardiac Education:

  • Monthly case conference session with fellows and faculty
  • Monthly cardiac lecture series with faculty from other disciplines
  • Opportunity to participate in departmental workshops at the UCSD Update conference in San Diego
  • Perfusion workshops with hands on training on the bypass machine.
  • Monthly joint journal club conference with UCSD cardiothoracic surgeons, Sharp Memorial cardiac anesthesiologists and surgeons, Navy Hospital cardiac anesthesiologists and surgeons.
  • Dedicated non-clinical time for scholarly activities.

Paid conferences and cardiac text books:

  • Dedicated time and paid fees for the annual UCSD Perioperative Transesophageal Echocardiography Review Course
  • Dedicated time and paid fees for the Society of Cardiovascular Anesthesiologists Annual Meeting
  • Each fellow provided the following Cardiac Anesthesia textbooks.
  • Kaplan's Cardiac Anesthesia
  • Perrino's Practical Approach to Transesophageal Echocardiography

Research

Established cardiovascular physiology research laboratory with significant opportunity for fellow involvement. The optional second fellowship year is available to fellows interested in basic or clinical research and pursuit of academic career.

Cardiovascular Physiology Research Laboratory

The cardiovascular physiology research laboratory at UC San Diego/VA San Diego Medical Center performs novel basic science inquiry into mechanisms of myocardial ischemia-reperfusion injury, cardiac remodeling and heart failure. A focus of the laboratory involves the study of volatile and opioid anesthetics as they relate to ischemia-reperfusion injury. The laboratory uses state of the art physiological monitoring, molecular biology, primary cell culture, transgenic animals, gene therapy, immunohistochemistry and electron microscopy to address novel mechanisms for cardiac injury and remodeling. The laboratory with its principal investigator David M. Roth, PhD, MD, and co-investigators, Piyush M. Patel, MD, Hemal H. Patel, PhD and Yasuo Tsutsumi, MD, PhD within the Department of Anesthesiology have several collaborations with other clinical and research departments at UC San Diego including the Division of Cardiology, the Department of Pharmacology, and Department of Cellular and Molecular Medicine and the UC San Diego Cancer Center. The laboratory and its investigators are funded by the National Institutes of Health, The Veterans Administration and the American Heart Association.

  • Current clinical trials
  • Opportunity to design and execute research studies

Eligibility Criteria:

Candidates for admission to University of California San Diego cardiothoracic anesthesia fellowship must have the following criteria:
  • Completed a core residency program within the United States or Canada.
  • Graduated from a 4-year ACGME accredited core Anesthesiology Residency Program.
  • Satisfactory residency performance, as evidenced by recommendation letters and performance evaluations.
    ABA Board-Certified or candidate status.
  • Three letters of references.
  • Integrity, motivation, and overall interest in cardiac anesthesiology as a subspecialty.
  • The accepted applicant must hold a full and unrestricted license in the State of California to practice medicine.
  • We do not discriminate with regard to sex, race, age, and religion, color, national origin, disability or veteran status.
  • Applications and CV’s will be accepted from November 1st, 2015 - April 30th, 2016. Interviews will be scheduled from late February through mid May.
  • Graduates of schools outside of the United States or Canada must meet all of the following qualifications:
    • Completed a 4-year ACGME accredited core Anesthesiology Residency Program.
    • Must have a currently valid ECFMG certificate.
    • Must hold a full and unrestricted license in the State of California to practice medicine.
    • Must hold a Permanent Residency in the United States.

Appointment is contingent upon:

  • Satisfactory criminal background check
  • Full compliance with the licensure regulations of the Medical Board of California and federal immigration laws.

Application process:

The application period runs from November through April. If applying after April 30th, please contact the program directly. Applicants should register through SF Match in order to apply to the program as well as arrange rank lists. This year we will be using the Central Application Service (CAS) offered through SF Match. Please follow the directions on sfmatch.org to complete the application process. In addition to the SF Match application please submit the following additional information:

1. Personal Statement
2. Current Curriculum Vitae (CV)

For further information contact:

Cardiac Anesthesiology Fellowship Program
Email: cardiacfellowship@ucsd.edu
Phone: 858-657-7413
Fax: 858-657-6073