Columbia University Medical Center Department of Anesthesiology
 
fellowship in CardiothoraciC ANESTHESIA

Accredited by the ACGME
Number of positions: 7
Duration of training: 12 months
Program Director: Jack Shanewise, MD

Experience provided with

  • Coronary revascularization surgery – on pump and off pump
  • Valve surgery – repair and replacement
  • Adult congenital heart surgery
  • Major aortic surgery – ascending, arch and descending thoracic aorta
  • Procedures including circulatory arrest
  • Heart transplantation – one of the largest programs in the country
  • Ventricular assist device implantation – including investigational devices
  • Minimally invasive and robotic techniques including a large TAVR program
  • Routine thoracic surgery - VATS, pulmonary resections
  • Thoracic epidural insertion
  • Esophageal surgery
  • Tracheal surgery
  • Lung transplantation – one of the largest programs in the country
  • Lung volume reduction surgery (in NIH sponsored trial)
  • Pulmonary thromboendarterectomy surgery
  • Hybrid surgical procedures
  • Catheter based interventions including valve implantation and repair
  • Electrophysiology procedures - pacemakers, ICDs, afib & V tach ablations

Advanced Perioperative TEE Training
Fellowship training in adult cardiothoracic anesthesiology includes training in advanced perioperative transesophageal echocardiography.  All the echocardiography systems used are state of the art including real time 3D imaging.  There is extensive one-on-one hands on training with the cardiothoracic anesthesiology faculty in the OR and using two TEE simulators and further training in the Cardiology echocardiography lab under the supervision of the Cardiology faculty. The primary goal with this experience for our ACTA Fellows is to become proficient in performing, documenting and communicating a comprehensive intraoperative TEE examination on patients undergoing complex cardiac and thoracic surgery. There also is extensive experience using TEE during catheter-based interventional procedures such as valve implantations, valve repairs and paravalvualr leak closures.  Additional TEE experience is gained on patients in the non-cardiac ORs and in the CTICU. All ACTA fellows fulfill the training requirements for NBE certification in advanced perioperative TEE. There is an extensive didactic program for training in TEE, with weekly conferences covering the knowledge base and reviewing interesting and instructive cases. Each fellow is provided with textbooks on TEE and a collection of educational videos and DVDs is available for study. Our fellows have a high pass rate for the TEE certification examination.

Rotations

Cardiothoracic OR
ACTA fellows spend a total of at least seven months on this rotation to gain expertise in providing anesthesia care for patients undergoing all kinds of cardiac and thoracic surgery. They also have days dedicated to perioperative TEE and days in the interventional cardiology and electrophysiology labs. Other daily assignments on this rotation include the CTA consultation service and regular non clinical days to allow completion of an academic project. For the vast majority of cases, the fellow acts as the primary anesthesiologist under the supervision of the faculty member, who usally is responsible for only one case at a time. Later in the fellowship year, ACTA fellows gain experience in teaching by supervising anesthesiology residents on their first CT anesthesia rotation with faculty backup.

Cardiothoracic ICU
All ACTA fellows have a one month rotation in the 21 bed Cardiothoracic ICU at CUMC. During the CTICU rotation the ACTA fellows have the same responsibilities as the fellows in our ACGME accredited Critical Care fellowship program. They actively participate in daily ICU rounds, are directly involved in patient care and are assigned to the CTICU fellows call schedule in the same manner as the critical care fellows. They participate in all the educational activities offered to the critical fellows during that month, but in addition attend the regularly scheduled lectures given to the ACTA fellows. The primary goal for ACTA fellows on this rotation is to develop proficiency in providing critical care for adults with a variety of cardiothoracic critical illnesses, as well as performing diagnostic and therapeutic procedures, acute postoperative management, and advanced life support.

Perfusion
All ACTA fellows spend two weeks working with the perfusionists to gain experience in setting up the bypass machine, managing the extra-corporal circulation, as well as coordinating initiation and discontinuation of cardiopulmonary bypass as part of the cardiac surgical team.

Cardiology echocardiography lab
All ACTA fellows spend two weeks to one month in the Cardiology echocardiography laboratory at CUMC under the supervision of the cardiology faculty gaining experience in transthoracic echocardiography, stress echocardiography, and diagnostic TEE in awake patients. They participate in the analysis and the interpretation of echocardiographic findings and learn to communicate effectively and professionally with the cardiologists, technicians and patients.

Elective Rotations

All ACTA fellows have at least two months of elective rotations during the fellowship year. Elective opportunities include:

Pediatric cardiac anesthesia
Two weeks to one month rotation with pediatric cardiac anesthesia at Children’s Hospital of NY (CHONY), under direct supervision of pediatric anesthesia faculty. The ACTA fellows will be responsible for the perioperative care of the pediatric patient undergoing cardiac surgery including reviewing the underlying pathology, understanding the anesthetic implications, designing and managing an anesthetic plan, assist in placement of invasive cardiac monitors, interpret and communicate hemodynamic parameters, help initiate, manage and discontinue cardiopulmonary bypass.

Pulmonary medicine rotation
Two weeks to one month, in the Pulmonary Medicine Division under direct supervision of Pulmonary Medicine faculty. ACTA fellows will participate in in-patients’ rounds, contribute to the medical management of patients with end-stage lung disease, lung transplant, lung volume reduction. ACTA fellows will also assist in performing and interpreting diagnostic and therapeutic bronchoscopies done by a Pulmonary Medicine attending in the bronchoscopy suite.

Heart failure rotation
Two weeks to one month, with the Heart Failure Division of Cardiology, under direct supervision of Cardiology faculty. During their rotation, ACTA fellows will participate in patient’s rounds, be assigned to the care of in-patients, follow-up on their progress, order, interpret and communicate results of diagnostic tests and perform therapeutic interventions with the assent and supervision of cardiology faculty.

Research
Up to two months of elective time may be devoted to research during the fellowship. Opportunities include working on clinical research, lab based research, and epidemiological studies. Many of the Department of Anesthesiology faculty members are involved in basic research; fellows who are interested in conducting basic research during their ACTA fellowship will find available the physical resources as well as the required mentoring for designing, establishing and conducting their basic science research. The Department of Anesthesiology also fosters and encourages clinical and epidemiologic research. Many adult cardiothoracic anesthesia faculty have extensive experience in the design of clinical research as well as data collection and analysis leading to publications. We also have statistician/IT specialists on the departmental staff. There are research funding opportunities within the department. Other elective rotations tailored to suit the needs of ACTA may be arranged for, as well.

Didactic Program
The ATCA fellowship at Columbia has an extensive didactic program covering the knowledge base of cardiothoracic anesthesiology. There is a weekly fellow conference on perioperative echocardiography and another for non-echo topics. Fellows also attend the department wide weekly grand rounds. There are journal clubs held for the ACTA fellows every other month, some of which take place in a social setting. The ACTA fellows have a continuous quality improvement conference every other month to discuss an issue relevant to cardiothoracic anesthesiology based on a case from the cardiothoracic service. Each fellow will be responsible for organizing and presenting at one of these conferences and will have an ACTA faculty assigned to supervise their presentation. There are ongoing CQI projects for antibiotic administration and intraoperative glucose control that are periodically (about twice a year) surveyed by the departmental CQI coordinator. The results of the surveys are presented to the ACTA fellows, who participate in discussions for further improvement in these areas. ACTA fellows are also encouraged to take advantage of the numerous other relevant conferences available in the medical center including the topics of critical care medicine, cardiac catheterization, cardiology echocardiography, and heart and lung transplantation.

Available Library Resources
ACTA fellows have open access to libraries, online resources and research space at CUMC and NYPH. The Health Science Library is part of the medical center complex and allows open access to the ACTA fellows. The library holdings are extensive and easily accessed. Also, the library provides quiet and spacious reading space. The departmental library is available for the fellows for reading and studying throughout the day and night. The Anesthesiology Library has the capacity for 70 people and has PC computers, Xerox facilities and a LCD projector and screen. In addition, the ACTA fellows share a private office in the cardiac division area (adjacent to the OR) with desk and storage space, 4 PC computers with 2 printers, a flat screen TV and DVD reader. Throughout the campus, fellows have online access for research and literature search. The OR area also has a lounge with an area for reading and eight PC computers.
All ACTA fellows are provided with their own copies of the following textbooks and dvd:

  • Textbook of Clinical Echocardiography – Otto
  • Kaplan’s Cardiac Anesthesia
  • A Practical Approach to TEE – Perrino & Reeves
  • Fundamental Applications of Transesophageal Echocardiography, a Society of Cardiovascular and Anesthesiologists Monograph on DVD, Reeves, Shanewise

Call Responsibilities
ACTA Fellows typically work from 0600 to 1600 days they are doing cases in the OR. They work under the direct supervision of a cardiothoracic anesthesiology faculty, usually on a one on one basis. Unless on call, fellows are free from program duties on Saturday and Sunday, and when they are on vacation. Fellows usually take first call about three times a month, in which they stay until all cardiothoracic cases are finished. In any event, they are relieved by 0700 and have no responsibilities on the day following first call. Fellows take about two second calls a month in which they stay until only one cardiothoracic OR is running, typically about 2100. The day after a second call, the fellow is not assigned to the OR and able to come in at 0800 or later. Call may be taken at home if no cases are ongoing. Lounge areas are available in the anesthesia department to the fellows 24 hours a day. Food is easily accessible 24 hours a day either from the hospital cafeteria until 2300, vending machines, or multiple restaurants which deliver to the hospital.

Meeting Participation
ACTA fellows are given financial support to attend an anesthesia related meeting during their fellowship. Fellows may receive time and financial support to attend additional meetings if peer-reviewed research data is being presented.

Fellowship Application Checklist
Fellowship Application

For more detailed information on the Cardiothoracic Fellowship and to initiate the application process, please e-mail Ms. Monica Roberts at mr2401@cumc.columbia.edu, or call her at 212-342-2210. Our fax number is 212-342-2211, and correspondence can be addressed to:

Jack Shanewise, MD
Division of Cardiothoracic Anesthesiology
Columbia University, College of Physicians and Surgeons
Department of Anesthesiology
P&S Box 46
630 West 168th Street
New York New York 10032

 

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