Educational Philosophy and Goals
The goals of the Yale postgraduate residency program in General Vascular Surgery encompass the training of vascular surgeons/scientists. Our primary objective is to produce individuals with superior skills in the management of patients with vascular disease. Fundamental to this goal is our commitment to developing the teaching and administrative capabilities of our fellows. As a reflection of our academic mission and our belief that scholarship underscores clinical excellence, we will offer our fellows a broad experience in clinical (and in some cases laboratory) research concerning pertinent issues in vascular surgery, medicine, and biology.
Objectives and Curriculum
The two teaching hospitals that will form the basis for the vascular surgery fellowship are Yale-New Haven Hospital (YNHH) and the VA Connecticut Healthcare, West Haven (VA). The core surgical program which supports this fellowship is the Yale General Surgery Residency. This program provides rotations in vascular surgery to all general surgery residents at the PGY-1 through PGY-5 levels. There is great opportunity at both hospitals for clinical training and research involvement at the fellow level. This involvement will certainly enhance, rather than detract from, the overall vascular surgery educational environment available to general surgery trainees.
The Yale Vascular Surgery Fellowship is a 2 year educational program. The rotations are divided between Yale-New Haven Hospital and the VA Hospital. In each rotation, the continuity of patient care is afforded through preoperative evaluations, intra-operative participation, and postoperative management in related hospitals. Longer term follow up care is provided in attending clinics at the Yale Physician’s Building and at the VA Specialty Clinic. It is anticipated that the fellow will attend and participate in regional and national vascular meetings and will complete at least one research project, clinical or basic science.
At YNHH the 2005-2007 clinical fellow was involved in 502cases with a wide variety of routine and complex vascular reconstructions including 111 aneurysms, 98 carotids, 84 reconstructions for peripheral occlusive disease, and 6 visceral reconstructions. By the first third of the second year, the fellow participated in 23 aortic endografts, 62 endovascular interventions and 106 endovascular diagnostic procedures. Training in endovascular surgery occurs during both years of VS resident training but the bulk of activity for the VS resident is during the 2nd year. Since 2002, there has been a formal affiliation between the Interventional Radiology group and the Vascular Surgery Service. In addition, we have a PV faculty member (Dr. Bart Muhs) who had formal training in endovascular procedures during his VS training as well as an additional year of post-fellowship experience. He was a Marco Polo Fellow and spent six months in Utrecht, Netherlands, training on fenestrated aortic grafts. He works two full days in the IR suites.
The VS resident is therefore trained in catheter and guidewire skills by both IR and VS faculty. They learn to perform diagnostic angiography, angioplasty and stenting of appropriate lesions and repair of abdominal aortic aneurysms with stent-graft. These procedures are done both in the IR suites and OR by both interventional radiologists and vascular surgeons. Both VS residents are intimately involved in the pre-operative planning of the procedures, including indications, imaging assessment, measurement of aortic characteristics and selection of appropriate device. At least one of the VS residents is scrubbed for aneurysm or carotid procedures and is involved in catheter selection, guidewire advancement, device deployment, and confirmatory angiography. They are both involved in the post-operative follow-up of the patients with regards to the interpretation of follow-up CT scans and the detection of endo-leaks in aneurysm patients.
The overall aim is to provide clinically-focused, excellent training of one fellow each year. It is also the expectation of the program that a significant portion of clinical trainees will pursue a career in academic vascular surgery, armed with the clinical, teaching, research, and leadership skills to be successful.
Fellow Clinical Responsibilities
The vascular service is configured so that the VS resident and GS Chief residents are not on the same service and therefore, do not have any overlapping responsibility on the same patients. The Vascular Service at Yale-New Haven Hospital consists of the first-year VS resident, a PGY- 3, a PGY-2, a PGY-1 level GS residents and two Physicians Assistants. The Vascular Service at the VA consists of the 2nd year VS resident, a PGY 4, and a PGY-1 level GS resident. The GS residents obtain the major portion of their PV experience as PGY 4 at the VA, PGY 4 and 5 at Bridgeport Hospital and as PGY-3 at YNHH. GS PGY-5’s run the Vascular Surgery Service at Bridgeport Hospital. They direct PGY-2’s and PGY-l’s. The VS resident and the GS PGY-5’s at their respective assigned hospitals are responsible for organizing and running their respective services, assigning junior residents and medical students, reviewing patient workups, pre- and postoperative patient care, organizing rounds and teaching conferences, and communicating with consultants, attending surgeons and patients’ families. They perform the major cases and supervise the junior housestaff in the more minor cases. The rotations for the GS PGY-3 at YNHH and PGY 4 at the VA are intended to enable the resident to obtain extensive operative experience, increase independent responsibility to the level of chief resident, to attain mature and sound surgical judgment, and to acquire the necessary technical skills. The weekly educational conferences for the students, residents and attendings are the shared responsibility of the clinical fellow, with the second-year fellow responsible for the Teaching Conference and the clinical fellow for M&M and Preoperative Conference.
Conferences are held on Monday mornings from 6:30 to 8:00 at Yale-New Haven Hospital. The 2nd year VS resident (at the VA) is the administrative resident and is required to attend these conferences. Both 1st and 2nd year VS residents are highly encouraged to attend Surgery Grand Rounds at YNHH on Wednesday morning. The OR in both the VA and YNHH are not staffed by VS residents during this time. In addition, once a month on Tuesday morning from 7:00 to 7:30, both VS residents are required to attend a faculty meeting to discuss the clinical service and any issues that may have arisen.
The clinical fellow will run daily teaching rounds at YNHH with the residents and students, as well as discussions of vascular issues with third and fourth year medical students. The clinical fellow will participate in all quality assurance and administrative meetings and will present at least one nursing inservice each month.
Bauer Sumpio, M.D., Ph.D.
Chief, Vascular Surgery
Yale University School of Medicine
333 Cedar Street, FMB 137
PO Box 208062
New Haven, Connecticut 06520-8062