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Vascular Surgery Fellowship at UCLA Division of Vascular Surgery

The primary goal of the UCLA Vascular Surgery residency program is to prepare the trainee to function as a specialist in vascular disease managment, including the prevention, diagnosis, and treatment of vascular disease; treatment encompasses medical, open and endovascular surgery. A competent resident must have a dedication to self-study and lifelong learning. The residency experience is designed to promote a fundamental understanding of vascular disease that encourages professional growth as a practitioner of vascular medicine, vascular surgery, and endovascular therapy.

Competency-based Objectives for Both Years 1 and 2

PATIENT CARE

  1. Efficiently complete and direct patient care activities.
  2. Demonstrate the ability to gather essential and accurate patient information.
  3. Develop appropriate diagnostic workups of vascular disease with a full understanding of the tests to be ordered
  4. Be able to develop a differential diagnosis and management plan.
  5. Be able to provide a preoperative and postoperative care plan.
  6. Make informed decisions about diagnostic and therapeutic interventions.
  7. Develop competence in performing standard and complex endovascular and open vascular surgery procedures in elective and emergent situations.
  8. Be able to perform non-reconstructive vascular procedures, including venous ablative, angioaccess, and thoracic outlet

MEDICAL KNOWLEDGE & SKILLS

  1. Arterial and venous patho-physiology
  2. Arterial and venous surgical anatomy
  3. Identification and management of risk factors of atherosclerotic vascular disease.
  4. Develop a differential diagnosis of vascular problems.
  5. Perfect decision-making concerning alternatives of non-operative and operative intervention for vascular disease in the ambulatory setting.
  6. Understanding non-atherosclerotic vascular disease evaluation and management.
  7. Diagnose and treat neurogenic and vascular thoracic outlet syndromes.
  8. Have a knowledge of the pre- and postoperative care required of the patient undergoing vascular procedures
  9. Provide general preoperative cardiac, pulmonary and renal risk assessment.
  10. Interpret diagnostic vascular studies, including duplex, physiologic testing, angiograms, CTA and MRA/MRV.
  11. Perform standard noninvasive vascular tests, including physiologic and duplex scans.
  12. Understand treatment options for vascular diseases, including endovascular therapeutics.
  13. Perform endovascular procedures using catheters and guide-wires, including angiography and endovascular therapeutic interventions
  14. Understand the equipment used in vascular surgery procedures including suture, graft materials, and instrumentation.
  15. Be able to perform arterial and venous surgical exposures
  16. Understand the management of vascular surgery complications

PRACTICE BASED LEARNING

  1. Pursue a personal program of self-study and professional growth with guidance from the teaching faculty and program director. An understanding of the etiology, pathogenesis, patho-physiology, diagnosis and management of vascular disorders will promote sound surgical judgment, which relies on knowledge and rational thinking.
  2. Develop ability to analyze critically the vascular literature in order to practice evidence-based medicine.
  3. Complete a research project on selected topic in vascular surgery and conduct the research while a resident at UCLA
  4. Participate and assist in organization of daily rounds, preop conference, vascular lab conference, morbidity and mortality conference, journal club and research conference.
  5. Carry out patient management decisions in consultation with attending staff.
  6. Participate in general surgery resident and medical student teaching.

PROFESSIONALISM

  1. Provide compassionate patient care, maintaining the highest moral and ethical values with a professional attitude.
  2. Be sensitive to the needs and feelings of the patient's family members, allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students
  3. Demonstrate respect, compassion, and integrity in the care of patients on a daily basis.
  4. Show sensitivity to patient's culture, age, gender and disabilities.
  5. Interact professionally with referring physicians, consulting physicians, and other physician providers.

INTERPERSONAL RELATIONSHIPS AND COMMUNICATION

  1. Create and sustain a therapeutic and ethically sound relationship with patients.
  2. Work collaboratively with the ANP's and nurses in the wound care clinic and risk factor modification clinic
  3. Work effectively with other members of the medical team, including allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students
  4. Maintain professional interactions with other health care providers and hospital staff.
  5. Provide leadership and organization of the vascular surgery clinical services.
  6. Develop good communication skills.

SYSTEMS BASED PRACTICE

  1. Understand how the health care organization affects a vascular surgery practice.
  2. Demonstrate cost effective health care.
  3. Know how to partner with health care managers and allied health personnel to improve health care.
  4. Follow established practices, procedures, and policies of the Department of Surgery and Division of Vascular Surgery.
  5. Complete medical records, operative notes,and other patient care related documentation in a timely, accurate,and succinct manner.
  6. Understand principles of Vascular Surgery division quality assurance program.

These goals are fostered in an environment of progressively graded clinical and operative experience and responsibility. Within the limits of variability found in a clinical practice, an equivalent experience will be afforded each resident under the guidance and supervision of qualified teaching staff. The resident will exercise increasingly mature surgical judgment and operative and endovascular skills which prepares him/her to provide independent care to patients with vascular disease. The faculty of the UCLA Division of Vascular Surgery makes the final assessment of whether these objectives are being achieved.

Special Objectives for Year 1 VASCULAR LABORATORY

The goal of vascular laboratory education is to impart the knowledge necessary to correctly interpret physiologic and ultrasound vascular studies and the technical skills necessary to perform these studies.

PATIENT CARE

  1. Demonstrate the ability to gather essential patient information prior to performing a vascular lab study.
  2. Make informed decisions about the limitations and accuracy of noninvasive ultrasound and physiologic vascular studies.
  3. Acquire skills for selected noninvasive ultrasound and physiologic vascular studies.

MEDICAL KNOWLEDGE & SKILLS

  1. Knowledge of the physics of blood flow.
  2. Interpretation of extremity arterial and venous physiologic studies.
  3. Interpretation of carotid, renal, visceral, aortic and extremity arterial duplex studies using video-imaging review.
  4. Interpretation of vena cava and venous duplex studies using video-imaging review.
  5. Knowledge of technical skills required for diagnostic scanning.
  6. Understand the indications, accuracy and diagnostic utility of specific noninvasive vascular tests.
  7. Knowledge of statistical analysis used to assess the accuracy of vascular studies, including receiver operator curves, kappa statistic, specificity, sensitivity, positive predictive value, negative predictive value and accuracy.

PRACTICE BASED LEARNING

  1. Pursue a personal program of self-study and professional growth with guidance from the teaching staff and vascular lab medical and technical directors. An understanding of the etiology, pathogenesis, pathophysiology of vascular disorders is necessary to perform and interpret noninvasive ultrasound and physiologic vascular studies.
  2. Participate and assist in organization of vascular lab quality assurance.
  3. Participate in general surgery resident and medical student teaching concerning noninvasive vascular studies.

SYSTEMS BASED PRACTICE

  1. Understand how an effective, efficient vascular laboratory is organized.
  2. Demonstrate knowledge of the costs of the various vascular studies as well as the equipment and disposables required for those studies.
  3. Recognize the importance of allied health care personnel (clerical and technical staff) to a properly functioning vascular laboratory
  4. Follow established practices, procedures, and policies of the UCLA Vascular Laboratory.
  5. Complete vascular laboratory documentation and medical records promptly.
  6. Understand principles of UCLA Vascular Laboratory quality assurance practices.
  7. Demonstrate the knowledge required to implement and coordinate a vascular laboratory quality assurance program.

Special Objectives for Year 1 ENDOVASCULAR THERAPEUTICS

The goal of the endovascular therapy rotation is to provide the resident with a comprehensive experience in the performance and interpretation of diagnostic angiograms and to acquire the necessary skills to be a safe practitioner of endovascular therapeutics:

PATIENT CARE

  1. Demonstrate the ability to gather essential and accurate patient information necessary for safe endovascular interventions.
  2. Make informed decisions about diagnostic and therapeutic endovascular interventions.
  3. Efficiently complete and direct patient care activities related to endovascular therapy.
  4. Acquire clinical and technical skills necessary to correctly guide endovascular therapy including an understanding of the differential diagnosis, management plan, the necessary endovascular procedures and the preoperative and postoperative care required both short and long term.

MEDICAL KNOWLEDGE & SKILLS

  1. Attend a two-day course that focuses on endovascular knowledge and skills.
  2. Principles of radiation safety, including the concepts of time, distance, and shielding in limiting patient and staff radiation exposures.
  3. Knowledge of digital subtraction angiography and post processing methods of image enhancement.
  4. Techniques of endovascular intervention, including balloon angioplasty, intravascular stent, stent-graft placement, thrombolysis, transcatheter occlusion, and intravascular foreign body retrieval.
  5. Indications for diagnostic angiography and endovascular intervention.
  6. Results and limitations of endovascular therapies.
  7. Experience with percutaneous arterial and venous access, including femoral, brachial, and popliteal punctures, both retrograde and antegrade.
  8. Knowledge of intravascular contrast agents; iodinated contrast, carbon dioxide, gadolinium, including dosage, use and complications.
  9. Knowledge of endovascular instruments: catheters, guidewires, catheter-mounted balloons, balloon-expandable and self-expanding intravascular stents, stent-grafts, infusion catheters, embolization coils, and snares.
  10. Experience and proficiency in selective catheterization.
  11. Diagnostic angiography of the cerebral, abdominal and extremity vessels, including autobiography and demography.
  12. Performance of endovascular aortic aneurysm repair.
  13. Use of closure devices at vascular access sites.
  14. Knowledge of the complications of vascular access and endovascular interventions, and experience with management of complications.

PRACTICE BASED LEARNING

  1. Conduct a personal program of self-study in endovascular therapy with guidance from the teaching staff and director of endovascular therapies. This includes attending endovascular symposia, textbook review and journal reading such that an understanding of endovascular diagnosis and management of vascular disorders emerges. This allows for sound judgment concerning the application and limitations of endovascular therapy.
  2. Develop ability to critically analyze the endovascular literature in order to practice evidence-based medicine.
  3. Organize with attending input pre-procedure and post-procedure care of patients undergoing endovascular procedures.
  4. Present and discuss endovascular patient management at preop vascular conference, attending rounds and morbidity and mortality conference.

INTERPERSONAL RELATIONSHIPS AND COMMUNICATION

  1. Work effectively with angiographic health care personnel (nurses, clerical, technical staff).
  2. Provide leadership and organization of patient's receiving endovascular interventions.
  3. Provide patients with clear informed consent regarding endovascular procedures.

SYSTEMS BASED PRACTICE

  1. Understand the organization of the OR endovascular suite.
  2. Demonstrate cost effective endovascular care by being knowledgeable in the costs of endovascular devices and pharmaceuticals.
  3. Know how to partner with angiography directors, nurses and technologists in order to provide optimal delivery of endovascular care.
  4. Follow established practices, procedures, and policies of the Department of Surgery and Division of Vascular Surgery concerning endovascular therapy.
  5. Understand principles of endovascular therapy and quality assurance practices

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Special Objectives for Year 2 OPEN VASCULAR SURGERY

The goal of the year 2 rotation is for the Vascular Surgery resident to master open vascular surgery procedures in an academic university hospital setting.

PATIENT CARE

  1. Learn to provide consultation services for the vascular surgery division at UCLA medical center
  2. Receive referrals from cardiologists, pulmonologists, internists, interventional radiologists, and primary care providers and participate in the clinical decisions concerning operative and endovascular therapy.
  3. Demonstrate the necessary clinical skills to evaluate a patient with vascular disease with a full understanding of the tests to be ordered, the differential diagnosis, the management plan, the necessary vascular surgical procedures and the preoperative and postoperative care required both short and long term.
  4. Initiate appropriate diagnostic workup specific vascular diseases utilizing noninvasive and invasive diagnostic technologies.

MEDICAL KNOWLEDGE & SKILLS

  1. Understand preoperative considerations in cardiac, pulmonary and renal risk assessment.
  2. Know the benefits and limitations of open procedures.
  3. Perform open extremity bypasses, aortic aneurysm repairs, and carotid/extracranial procedures.
  4. Perform quaternary, tertiary referral complex vascular procedures such as redo limb bypasses and carotid procedures, juxta, supra and thoracoabdominal aneurysms, renal and visceral revascularization.
  5. Demonstrate mastery of the skills to perform intraoperative duplex scanning and angiography.
  6. Understand the pros and cons of prosthetic and autogenous grafts, suture materials, and vascular surgery instrumentation.
  7. Perform hybrid stent graft/revascularization procedures for thoracoabdominal and thoracic aneurysms.
  8. Manage postoperative cardiac, pulmonary and renal systems; and anticoagulation.
  9. Demonstrate the ability to monitor postoperatively various vascular reconstructions
  10. Evaluate the patient requiring AV access.
  11. Perform AV access procedures.
  12. Manage postoperative complications of open vascular procedures
  13. Evaluate and manage patients with traumatic vascular injuries
  14. Understand the indications for arteriography in blunt and penetrating arterial injuries.
  15. Diagnose and manage compartment syndrome
  16. Diagnose and manage extremity vascular injuries associated with orthopedic and neurologic injuries.
  17. Diagnose and manage non-atherosclerotic vascular disease such as Takayasu's disease, arterial thrombosis and embolism, intra-arterial drug injections, and mycotic aneurysms
  18. Diagnosis and management of extracranial vascular disease including stroke, transient cerebral ischemia, reversible ischemic neurologic deficits and crescendo TIAs.
  19. Know the techniques of extremity bypass surgery including the use of cephalic, basilic, greater and lesser saphenous veins.
  20. Understand the exposures in complex vascular procedures, such as redo carotid and extremity revascularization; suprarenal, thoracoabdominal aneurysms.

PRACTICE BASED LEARNING

  1. Pursue a personal program of self-study and professional growth with guidance from the teaching staff and program director. An understanding of the etiology, pathogenesis, pathophysiology, diagnosis and management of vascular disorders is absolutely necessary. This will allow for sound surgical judgment, which relies on knowledge, rational thinking and the surgical literature.
  2. Demonstrate the ability to analyze critically the vascular literature in order to practice evidence-based medicine.
  3. Participate and assist in organization of daily rounds, vascular surgery preop conference, morbidity and mortality conference, journal club and the basic science curriculum.
  4. Carry out patient management decisions in consultation with attending staff.
  5. 3. Participate in general surgery resident and medical student teaching.

PROFESSIONALISM

  1. Participate in compassionate patient care maintaining the highest moral and ethical values with a professional attitude. The resident should be sensitive to the needs and feelings of others, including the patient's family members, allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students.
  2. Demonstrate respect, compassion and integrity in the care of patients on a daily basis
  3. Show sensitivity to patient's culture, age, gender and disabilities
  4. Interact professionally with referring physicians, consulting physicians and other physician providers.

INTERPERSONAL RELATIONSHIPS AND COMMUNICATION

  1. Create and sustain a therapeutic and ethically sound relationship with patients.
  2. Work effectively with other members of the medical team including allied health care personnel (nurses, clerical staff, etc.), fellow residents, and medical students.
  3. Maintain professional interactions with other health care providers and hospital staff.
  4. Provide leadership and organization of the Vascular Surgery service.
  5. Develop appropriate judgment and good communication skills.

PROFESSIONALISM

  1. Understand how the health care organization of an academic medical center affects a Vascular Surgery practice.
  2. Demonstrate cost effective health care.
  3. Know how to partner with health care managers and allied health personnel to improve health care.
  4. Follow established practices, procedures, and policies of the Department of Surgery and Division of Vascular Surgery
  5. Complete medical records, operative notes, and other patient care related documentation in a timely, accurate and succinct manner.
  6. Understand principles of UCLA quality assurance practices.

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