Overview

Number of Positions: 4 — 5

Length of Training: 12 months (18-24 months available for individuals interested in pursuing a career in academic medicine)

Surgical Procedures:

• Routine cardiac surgery (CABG, Valve repair/replacement)
• Off-pump CABG
• Cardiac/lung transplantation
• Ventricular assist device implantation
• Robotic cardiac and thoracic surgery
• Routine thoracic surgery
• Lung volume reduction (participating in a NIH-sponsored trial)
• Procedures requiring circulatory arrest
• EP Lab procedures

Focus of Training:

Transesophageal Echocardiography (TEE)

• Dedicated non-clinical time for TEE training
• Extensive didactic TEE program
• Each fellow given their own TEE textbooks
  
• TEE Video and CD ROM collection
• State of the art TEE equipment
• High pass rate ON TEE Certification exam

• Excellent variety of clinical cases
• Each fellow given their own Cardiac Anesthesia textbooks
  
  - Textbook of Clinical Echocardiography ---- Otto ----
  - Cardiac Anesthesia ---- Kaplan
  - Ultrasound Physics ---- Edelman
  - Practical Approach ---- Perrino
  - Basic Echocardiography "An Illustrative Guide" ---- Mark
  Harry (The Iowa Heart Center)
  
  
• Reasonable work/call schedule
• Exposure to cardiac pediatric anesthesia
• Exposure to cardiac critical care medicine

• Wide variety of clinical and basic science research opportunities
• Dedicated non-clinical time for research
• Meaningful opportunities to design and implement a study
• Opportunity to present study results at a national meeting
• Necessary facilities provided (e.g. office space, computer)
• Seed funding available for projects
  

Individualized Tracks in Cardiac Anesthesia

The Department of Anesthesiology, Division of Cardiothoracic Anesthesia, has four to five fellowship positions available, for a twelve-month period. Training may be extended to two years for applicants interested in pursuing a career in academic medicine, of which 6 months may be taken in the CA3 year if desired - making the fellowship duration 18 months.

Training and Experience includes:

• Surgical Procedures
  
• Transesophageal Echocardiography (TEE)
• Clinical variety of services
  
• Research
  
• Strong program electives
  
• Excellent clinical environment
  

The Department of Anesthesiology offers fellowship positions in Cardiothoracic Anesthesia, in three tracks: Clinical, Clinical / Research, and Research / Clinical (see table below). After three months of fellowship experience, fellows may act in the OR providing direct patient care themselves but in addition, act as “Senior Fellows” on certain days (see table).

The Clinical Track is recommended for applicants who do not plan to be involved in any academic activities in the future and prefer a career in private practice. This track includes extensive training in all aspects of adult cardiothoracic anesthesiology and Trans Esophageal Echocardiography (TEE). We also offer training in transthoracic echocardiography using a new miniature hand held device.

The Clinical / Research track is recommended for applicants who are undecided about pursuing a career in academic medicine, or those that desire a blend of research and clinical activity. The senior fellows are given a choice of an on-going project. A written manuscript and presentation to the faculty and their peers is required.

The Research / Clinical track is recommended for applicants who wish to pursue a career in academic medicine. Fellows will be expected to develop, complete and present a research project at a national meeting, and participate in the publication of a manuscript. Research participation in on-going projects is encouraged as a more certain avenue to success.

Fellows can act in the OR to provide patient care directly themselves (OR days) or act as senior fellows (senior fellow days) in conjunction with a resident and attending.

Operating Room (OR) days entail provision of anesthesia under the supervision of a faculty attending anesthesiologist. Fellows act as the primary care anesthesiologist, under the supervision of the faculty attending anesthesiologist on those days assigned to the OR. On some days, fellows act as “senior fellows”, usually after three months of starting the fellowship period. Senior Fellows may, under the supervision and direction of the faculty attending anesthesiologists, contribute to the education of residents during Senior Fellow clinical days and also provide patient care at a more senior level. This introduces the Senior Fellow to a more active participation in teaching responsibilities within an academic institution.

Senior Fellow Responsibilities include:

• Choice of a case the night before the operation. Review the case with the faculty attending.
  
• Prepare the anesthetic plan
  
• Interview the patient
  
• Discuss the anesthetic plan with the faculty attending and the resident.
  
• Under the supervision of the faculty attending anesthesiologist:
  
  - Induction
  - Pre -cardiopulmonary bypass management
  - Separation from cardiopulmonary bypass
  - Post-cardiopulmonary bypass management
  - Execute the anesthetic plan
  - Perform the intraoperative echocardiographic exam
  

Conference Days

Attendance of departmental educational lectures, sessions, journal club, and workshops in perioperative TEEs. This is available to fellows on all three tracks (See table).

Nonclinical Days

Fellows may work on research projects. One to two days may be used as library days, particularly for those on the clinical track fellowship, who have chosen not to pursue a clinical research project (See table).

On Call Responsibilities

First Call (followed by day off)
One day per week
One weekend per month
Second call one day per week

Surgical Procedures

Routine cardiac Surgery
Off pump CABG
Cardiac/Lung Transplantation
Ventricular Assist Device Implantation
Robotic Cardiac and Thoracic Surgery
Lung Volume Reduction Surgery
Procedures requiring circulatory arrest
Adult Congenital Heart Disease

Transesophageal Echocardiography (TEE)

Extensive didactic TEE program, with textbooks provided.
TEE video and CD ROM collection available.
High scoring percentage on certification exam of the SCA.

Perioperative Echocardiography Training

The adult Perioperative Echocardiography Training Program is an integral part of the Cardiothoracic fellowship. The transesophegeal echocardiograh (TEE) consists of intraoperative TEE training, didactic lectures, workshops, as well as conferences with the Cardiology department.

During intraoperative TEE training, fellows are taught how to safely place a TEE probe, operate the ultrasound machine, and perform a full TEE exam. The cardiac surgical caseload during the fellowship training offers ample opportunity for trainees to gain extensive intraoperative TEE experience by the completion of their fellowship. Transthoracic echo training using a novel small portable device is also available.

The didactic lectures are designed to help fellows gain an understanding of the principles of echocardiography, as well as the indications and contraindications of perioperative TEE. Topics covered during the lecture series include physics of ultrasonography, M-mode 2D, Doppler flow, pulse wave, continuous wave, qualitative and quantitative echocardiography.

The goal of our Cardiothoracic fellowship program is to train fellows in the proper perioperative management of cardiothoracic patients as well as train them to be advanced perioperative echocardiographers. The fellows are given the following four textbooks by the department to enhance their TEE experience training:

• Textbook of Clinical Echocardiography by Catherine M. Otto
  
• Understanding Ultrasound Physics by Sidney K Edelman
  
• A Pratical Approach to Transesophogeal Echocardiography by Albert C. Perrino, JR.
  
• Cardiac Anesthesia by A. Joel et al
• A Practical Guide to Echocardiography and Cardiac Doppler Ultrasound, by A. Ibrahim and MD Jawad
  

In addition, all fellows are encouraged to take the examination in Perioperative TEE given by SCA/ASE. The fellows are given time off to take the exam. Fellows who take and pass the Perioperative TEE exam are reimbursed for the cost of the exam.

Electives

Cardiac Pediatric Anesthesia (Catheterization Laboratory and OR exposure)
Cardiac Critical Care
Clinical Cardio/Pulmonary Perfusion Bypass Techniques
Cardiology Echocardiography Lab

Meeting Participation

Up to one week to attend an anesthesia meeting
Additional time and funding to present research data
Seed funding for research projects

For further information, write or contact:

Jack Shanewise, M.D.
Division of Cardiothoracic Anesthesiology
Columbia University, College of Physicians and Surgeons
Department of Anesthesiology
P&S Box 46
630 West 168th St.
New York New York 10032
Telephone: 212 -342-2210
Fax: 212-342-2211
Email: jss2128@columbia.edu