Accredited by the ACGME
Number of positions: 7
Duration of training: 12 months
Program Director: Jack Shanewise, MD
Advanced Perioperative TransEsophageal Echocardiography Training
Fellowship training in Adult Cardiothoracic Anesthesiology (ACTA) includes training in transesophageal echocardiography (TEE), fulfilling the training requirements for the National Board of Echocardiography (NBE) certification in advanced perioperative TEE. 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. This is accomplished by a combination of didactic teaching, hands-on intraoperative experience, as well as simulation-based practice.
The didactic program is led by Dr Shanewise, an internationally recognized TEE expert. Weekly conferences prepare the fellows for both the clinical experience and for passing the NBE certification exam. These lectures are supplemented by the provided TEE textbooks.
The clinical component consists of extensive intraoperative hands-on experience with direct ACTA faculty guidance. All the echocardiography systems used are state of the art including real time 3D imaging. In addition, perioperative TEE and further 3D TEE experience is provided during elective rotations in the Echocardiography lab with cardiology faculty. Additional perioperative TEE experience is gained in non-cardiac operating rooms, and in the care of patients in the cardiothoracic and surgical intensive care units.
Our fellows have a high pass rate on the NBE certification examination.
ACTA fellows spend a total of seven months in the cardiothoracic OR, gaining expertise in the perioperative management of patients undergoing cardiac, thoracic and aortic surgery as well as patients undergoing interventional cardiac procedures and electrophysiology interventions. Fellows are directly supervised by a group of experienced ACTA faculty, some of whom are also members of the Critical Care Medicine division. Fellows are the primary providers for the majority of the cases. Opportunities for fellows to gain experience in teaching and supervising junior residents are provided during the second half of the academic year.
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
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 – pacemaker insertion, implantable cardioverter defibrillator testing, atrial fibrillation and ventricular tachycardia ablations
Cardiothoracic Intensive Care Unit (CTICU)
ACTA fellows spend a total of 4 weeks in the CTICU. During the CTICU rotation, ACTA fellows have the same responsibilities as the fellows in our ACGME accredited Critical Care Medicine (CCM) 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 CCM fellows. They participate in all the educational activities offered to the CCM fellows during that month. In addition, they attend the regularly scheduled lectures given to the ACTA fellows. The primary goal for ACTA fellows on this rotation is to develop proficiency in the perioperative management of adults with a variety of critical cardiothoracic illnesses. In addition, ACTA fellows gain expertise in performing diagnostic and therapeutic procedures and focused ultrasonographic evaluation. The CTICU rotation provides experience with postoperative management of assist devices, extracorporeal membrane oxygenators and advanced modes of mechanical ventilation.
Elective Rotations and Research
ACTA fellows have a total of two months of elective rotations during their fellowship year.
All ACTA fellows spend two weeks working with the perfusionists to gain better understanding of the cardiopulmonary bypass machine, as well as coordinating initiation and discontinuation of cardiopulmonary bypass. In addition, during this rotation, ACTA fellows gain experience with management of the extracorporeal membrane oxygenators (ECMO) that are placed by CT surgeons and managed by the perfusion team in the different ICU locations throughout the hospital.
Most ACTA fellows choose to spend two weeks in the Invasive and Valvular Echocardiography division of Cardiology, gaining experience in perioperative 2D and 3D TEE for patients undergoing catheter-based valvular replacement or repair.
Fellows who elect a rotation in Pediatric Cardiac Anesthesia spend 2 weeks to one month in the Pediatric Anesthesia division at Children’s Hospital of New York (CHONY), under direct supervision from pediatric anesthesia faculty.
Other elective rotations available include Transfusion Medicine, Pulmonary Medicine, Heart failure, Cardiac Critical Care rotation. In addition, elective rotations can be tailored to the fellow’s interests.
Fellows may choose to dedicate the elective months to research relevant to cardiothoracic practice. The Department of Anesthesiology has several opportunities for fellows who wish to conduct research, with a well-established basic science research infrastructure, resources for epidemiological studies, and opportunities for clinical and educational research.
The didactic program aims to provide fellows with a comprehensive knowledge of topics related to cardiothoracic anesthesia. Our didactic program is multidisciplinary, drawing on the expertise of faculty from other divisions (such as pain, neuroanesthesia, critical care and pediatric) and other departments (such as cardiology and cardiothoracic surgery). Fellows’ lectures are held weekly. In addition, departmental Grand Rounds, Critical Care Rounds and Research meetings are held weekly. The weekly TEE didactic lectures are led by Dr Shanewise. They combine basic TEE knowledge, advanced TEE interpretation, hemodynamic calculations, artifact recognition and review of interesting cases.
Journal club sessions are held every other month, are led by fellows and moderated by ACTA faculty. The purpose of journal club is the critical review of a recently published article, relevant to the practice of cardiothoracic anesthesia, from peer reviewed journals.
Continuous Quality Improvement (CQI) conferences are held every other month, and are prepared and presented by ACTA fellows and moderated by ACTA faculty. CQI conferences serve to review systems problem, identify challenges and areas for improvements, investigate solutions and propose steps for implementation. Several CQI projects completed by ACTA fellows have had an important impact on our practice. Examples of such CQI projects include intraoperative glucose monitoring, antibiotic administration, and orientation of residents on their first ACTA rotation.
ACTA Fellowship at CUMC
ACTA fellowship at CUMC provides fellows with the opportunity of a challenging, stimulating and rewarding experience. The clinical experience and the breadth of procedures and surgeries performed are unsurpassed. The collaborative atmosphere between cardiothoracic anesthesiologists, surgeons and perfusionists allows us to “Put Patients First”. Our perioperative care is the very best, because of the nationally recognized strength of our Critical Care Medicine division.
Because calls during ACTA fellowship are home calls, several of our residents and fellows choose to live close to the CUMC campus, located in the northern part of Manhattan. Public transportation and the subway system make life in NYC easy and locations easily accessible at all times of the day.
Many alumni of the ACTA fellowship have remained in academic practice, and are practicing in different parts of the country. Several have joined the ACTA family as faculty members.
Applying to the Fellowship Program
Individuals interested in the fellowship program must have successfully completed an ACGME –accredited residency training program in Anesthesiology prior to the start of the fellowship.
ACTA fellowship at CUMC is participating in the San Francisco (SF) Match. Applicant registration for the academic year 2017-2018 begins on November 13th, 2015. The application deadline is February 1st, 2016. Interviews at CUMC will be held on several dates in February through early May 2016. The rank list for all participating programs is due on June 6th, 2016 and results of the match will be announced on June 20th, 2016.
To apply to the Adult Cardiothoracic Anesthesiology Fellowship program, please register at: https://www.sfmatch.org. Supplemental application documents should be emailed to the fellowship coordinator.
Supplemental Document Checklist
For more detailed information on the Fellowship Application Process, please e-mail Ms. Roberts at firstname.lastname@example.org, or call her at 212-342-2210. Her mailing address is:
Ms. Monica Roberts
Coordinator, Adult Cardiothoracic Anesthesiology Fellowship Program
Division of Cardiothoracic Anesthesiology
Columbia University Medical Center
Department of Anesthesiology
P&S Box 46
630 West 168th St.
New York, New York 10032
Telephone: (212) 342 2210
Fax: (212) 342 2211