Description

Candidates who are eligible for the University of Chicago non-ACGME cardiothoracic transplantation surgery fellowship must be ECFMG certified, be eligible for licensing in the state of Illinois, have successfully completed the equivalent of a US general surgery residency, have some thoracic surgery training and have a desire to pursue a career in cardiothoracic transplant surgery. Please complete an application using this link and email to Zainab.Aslam@bsd.uchicago.edu

 PROGRAM DEMOGRAPHICS

Host institution: The University of Chicago

Program subspecialty: Cardiothoracic Transplantation Surgery

Program Address: Section of Cardiac Surgery

5841 S. Maryland Avenue

MC5040

Chicago, IL 60637

Telephone: (773) 834-3707

Facsimile: 773-702-4187

Program e-mail: Zainab.Aslam@bsd.uchicago.edu

Program Director: Valluvan Jeevanandam, MD

Alternate program contact: Zainab Aslam

INTRODUCTION

History

The University of Chicago has a long tradition of training surgeons in cardiothoracic surgery. Our Fellowship in Cardiothoracic Transplantation Surgery began in 2015 and has offered surgeons with the interest in cardiothoracic transplantation surgery the opportunity to get an additional 12-24 months of training at University of Chicago Medicine based on the high number of heart and lung transplants performed annually.

Duration

The program is 12-24 months in duration and includes advanced experiences for trainees’ appropriate for their degree of experience, year (s) of training, and record of achieving competencies appropriate for their year(s) of training. Curriculum will be designed by the program director with input from section faculty.

Prerequisite training/selection criteria

Candidate trainees must: have completed medical school, have completed the equivalent of an ACGME- approved residency in cardiothoracic surgery, be focused and dedicated to cardiothoracic surgery as a career, have the ability to be licensed in the state of Illinois (permanent or temporary); provide appropriate letters of recommendation from their training program director and/or other mentors; be in good mental and physical health; have no criminal record; and be able to work collaboratively with other physicians and staff associated with the cardiothoracic service.

Goals and objectives for training

The goals of our program are aligned with the ACGME competencies for fellow education demonstrating increased cardiothoracic transplantation expertise in all aspects of patient care, medical knowledge; practice based learning and improvement, interpersonal communication skills, systems based practice, and professionalism. The fellow will be exposed to the full spectrum of cardiothoracic transplant surgery services, including both heart and lung transplantation.

Program certification

Both the heart and lung transplant programs have successfully completed the CMS Transplant Certification process. Additionally, our mechanical circulatory assist (MCS) / VAD program is joint commission certified.

Facilities

Training takes place at the University of Chicago Medicine). The University of Chicago Medicine campus has 575 beds spread across an adult and a children’s hospital, 28 operating rooms (4 devoted to cardiac, vascular, and thoracic surgery), 22 dedicated ICU beds, a cardiac catheterization laboratory, an adjacent medical library, and a 525,000 square foot outpatient building that is linked to both the adult and the pediatric hospitals.

EDUCATIONAL PROGRAM – BASIC CURRICULUM

Clinical and research components

There are no planned research components to this training experience. The entirety of the experience is clinically based. There are opportunities for trainees to participate in clinical research activities, but such participation is not a requirement for successful completion of training.

Participant’s supervisory and patient care responsibilities

CT transplant fellow clinical responsibilities include patient evaluation (preoperative diagnosis and selection of patients for surgery), performing operations, and postoperative patient care. The cardiac and thoracic surgery transplant faculty, each of whom has an academic appointment at The University of Chicago, guides and advises the CT transplant fellows in these duties and responsibilities. Depending on the CT transplant fellow’s level training, individual level of accomplishment and experience, he/she will either first assist the attending surgeon or serve as the operating surgeon with the attending surgeon serving as the first assistant. The CT transplant fellow will supervise activities of general surgery residents, medical students, cardiothoracic physician assistants, and cardiothoracic nurse practitioners in their shared care of the cardiothoracic patients.

Procedural requirements

The program is designed so that the trainee will perform more than the minimum number of procedures required by the United Network in Organ Sharing (UNOS) to be qualify as a transplant surgeon for heart and lung transplantation.

During the first year, the fellow will function as an integral member of the multidisciplinary team. In addition, he/she will learn the fundamentals of surgical management of heart and lung transplantation.

The second year will include continuity of practice experience. Under the guidance of the program director and supervising faculty, the fellow will be exposed to a broader range of heart and lung disorders in various complexities.

Didactic components

Available didactic components, defined as mandatory or elective, are listed below:

EVALUATION

The fellowship in cardiothoracic transplantation surgery at the University of Chicago has incorporated the ACGME six competencies into its evaluation process. An evaluation form is completed quarterly by attending surgeons on the CT transplant fellow’s rotation for that quarter using MedHub (Appendix A). At the end of each quarter, all of the evaluations are reviewed by the Program Director and Program Coordinator. Every 6 months, a more formal review of the fellow is performed.

When appropriate, corrective counseling and/or a remedial plan of study are provided. The individual and consensus evaluations are available for review by the fellow at any time.

FELLOW RESPONSIBILITIES

 Goals for outpatient fellow responsibilities are:

Patient Care:

The fellow should be able to:

• obtain a comprehensive, yet focused history and physical examination
• interpret available diagnostic studies and defends ordering of further provide a differential diagnosis.
• design a treatment plan for each patient
• assess operative risks
• assess the patient’s postoperative condition and manage issues such as complications and functional status
• design an appropriate follow-up plan, both short-term (return to daily activities and work) as well as long-term (to assess outcome and, where appropriate, recurrence of disease)

Medical Knowledge:

The fellow interprets, analyzes, and applies evidence-based scientific knowledge to the perioperative care of patients seen in the outpatient setting. This will include published medical information in scientific journals, chapters, reviews and on the internet.

Practice-Based Learning and Improvement:

The fellow enhances their scientific knowledge by accessing scientific journals, books and the internet to supplement their knowledge base with regard to diagnostic studies, treatment planning, and postoperative care and long-term follow-up.

Interpersonal Communication Skills: 

• The fellow initially observes then becomes an active participant in:
• The initial communication with patients and their families.
• Explaining diagnostic testing and treatment planning.
• Explaining therapeutic options.
• Explaining surgical procedures in lay format.
• Explaining risks and complications of surgical procedures.
• Obtaining informed consent.
• Explaining pathologic findings and directing appropriate multi-modality treatment.
• Appropriately documenting and communicating with referring and parallel care physicians.

Professionalism:

The fellow exhibits a commitment to continuity of care, the highest standards of ethical behavior, and sensitivity to age, gender, race, and culture of patients. The fellow exhibits at all times appropriate professional behavior including sensitivity to age, gender, race and culture of other health care professionals both in and outside of their working environment.

Systems-Based Practice:

The fellow demonstrates:

• High quality cost-effective patient care
• Knowledge of risk benefit analysis in determining the appropriate treatment for patients
• An understanding of the role of different specialists and other health care professionals in overall patient management
• The fellow will demonstrate the ability to interface and select consultative services appropriate to preoperative, perioperative, and postoperative care of the transplant patient
• The fellow will demonstrate the ability to interface and select appropriate ancillary health services for effective perioperative care of the surgical patient
• The fellow should demonstrate an understanding of the administrative and financial components of the outpatient visit
• The fellow should demonstrate the ability to communicate and interface with the referring physician

PREOPERATIVE ASSESSMENT AND POSTOPERATIVE CARE

The preoperative assessment and postoperative care of transplant patients are integral parts of the fellow’s experience and responsibility.

It is frequently necessary to perform consults on inpatients that may require urgent surgery or other interventions. It is the responsibility of the fellow to perform or supervise the initial consultation on such patients. This includes performing a focused history and physical examination, reviewing radiographic and other diagnostic studies, and recommending any additional tests that are necessary. The fellow will then make recommendations for the suitable surgical therapy for these patients.

On the day of surgery, the advanced fellow in cooperation with physician assistants, will verify patient identity, confirm that informed consent has been obtained, verify the planned operative procedure and site, and manage surgical aspects of the patient’s care prior to the beginning of the actual operation. In the immediate postoperative period, the fellow supervises the writing of postoperative orders.

Managing the postoperative care of the transplant patient is a vital part of the educational experience. Virtually all heart and lung transplant patients are managed by the cardiothoracic surgical services during the early postoperative period when important medical and surgical problems often arise. Care by the primary surgical service continues when patients are transferred from the intensive care unit or the postoperative anesthesia care unit to the regular patient floors. The advanced fellow is expected to make rounds on all patients at least daily and to participate directly in their management.

The fellow directs all aspects of patient care under the active guidance of the attending faculty, who are available for consultation and assistance on a 24-hour basis. General surgery residents and experienced cardiothoracic physician extenders are immediately responsible for patient care under the direct supervision of the fellow. The CT transplant fellow is responsible for directly attending to patient care issues when the level of care requires his/her presence and intervention.

PROGRESSION OF TRAINING

The training is accompanied by incremental levels of responsibility being accorded to the advanced fellow. Within the first year, such responsibilities include organization of educational endeavors, supervision of quality improvement activities, while the second year concentrates more on independence in preoperative and postoperative management of patients, and performance of increasingly complex cases as the operating surgeon. We believe it is in the best interests of our patients that the CT transplant fellow does not perform operations independently and without the direct supervision of an attending faculty member. This policy requires that the faculty member also be present (and usually scrubbed) for the critical portions of all cases.