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Educational Goals and Objectives

Robert B. Rutherford Fellowship in Vascular Surgery


 Patient Care

Goal
Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of vascular problems. Fellows are expected to:
Competencies
Demonstrate willingness to assume responsibility for the clinical evaluation of all vascular patients, including history, physical examination, medical management (pharmacotherapy and risk factor reduction), and surgical management.
Objectives:
  1. Conduct a comprehensive patient centered vascular interview, focusing on vascular issues.
  2. Identify the risk factors that might influence the patient's ability to tolerate a surgical procedure.
  3. Perform a competent complete vascular physical examination with evaluation of pulses, bruits, and possible aneurysms, including ankle/brachial index.
  4. Discuss treatment options, risks and potential complications with patients having vascular disease.
  5. Interpret arteriograms and noninvasive vascular studies.
  6. Assist in the performance of vascular operations.
  7. Manage the post-operative care of vascular patients, identify and manage complications.
  8. Maintain adequate records including history, physical exam, lab tests and notes indicating progress of treatment.
  9. Demonstrate ability to work with medico-legal problems in the hospital setting
  10. Oversee work of the junior resident on service.
  11. Be available to the patient and staff, and supervisors when needed.
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 Medical Knowledge

 
Goal
Medical knowledge is gained over a continuum of increasing understanding that occurs at an individual rate. The fellow will gain progressive knowledge of diagnosis, management, treatment options (surgical and non-surgical), long term prognosis, post operative results, complications, patient risk and cost considerations associated with:
 
Cerebrovascular disease:
1.      symptomatic and asymptomatic carotid disease
2.      vertebrobasilar disease
3.      carotid body tumors
 
Upper extremity occlusive disease:
  1. thoracic outlet syndrome
  2. Raynaud’s syndrome (primary and secondary)
 
Aneurysm disease:
  1. dissection versus rupture
  2. thoracoabdominal and suprarenal aneurysms
  3. ruptured versus elective aneurysm AAA repairs
  4. management of small abdominal aortic aneurysms
  5. inflammatory aneurysms
  6. infected grafts and mycotic aneurysms
  7. splanchnic aneurysms
  8. iliac, femoral and popliteal aneurysms
  9. aortoiliac occlusive disease
  10. transluminal angioplasty
  11. reconstructive procedures
  12. extra anatomic reconstruction indications and techniques, ie: ax-fem, fem-fem
  13. interventional radiographic approaches
 
Lower extremity occlusive disease, chronic:
  1. medical management
  2. autogenous venous bypass
i.                    above knee, below knee
ii.                  in-situ, reversed
  1. artificial material bypass
  2. transluminal angioplasty
  3. popliteal entrapment syndrome
 
 Lower extremity occlusive disease, acute:
  1. embolic occlusion
  2. thrombosis
  3. hypercoagulable states
  4. fibrinolytic therapy
  5. balloon catheter embolectomy
 
 
Vascular trauma:
  1. penetrating injuries
i.                    aorta and arch vessels
ii.                  extremity vessels
  1. blunt trauma
i.                    associated with fractures of extremities
ii.                  thoracic aorta
iii.                compartment syndrome
 
Mesenteric vascular disease:
  1. renovascular
  2. chronic splanchnic occlusive disease
  3. acute splanchnic occlusive disease
 
Angioaccess:
  1. methods of access
  2. techniques of arterio-venous shunts/fistula
  3. various devices used for angioaccess
 
Venous disease:
  1. varicose veins
  2. management of deep venous thrombosis
  3. venous thrombectomy
  4. post phlebitic syndrome
  5. venous stasis change and ulceration
  6. effort thrombosis
  7. medical and surgical treatment of acute PE
  8. IVC filter use
 
 
 
 
 
 
Fellows are expected to:
Competencies
Demonstrate a clear understanding of the pathophysiology of the formation and natural history of arterial and venous disorders, including: atherosclerosis, intimal hyperplasia, non-atherosclerotic arterial disorders, acute and chronic venous and lymphatic diseases, and end-organ disorders.
Demonstrate a clear understanding of the indications and techniques for open surgical treatment of vascular disorders, including: congenital, occlusive, traumatic, aneurysmal, and inflammatory  disease involving arteries of the cerebrovascular system: carotid artery and branches, upper extremity arteries, intrathoracic arch branches, aortic arch, descending thoracic aorta, abdominal aorta, visceral and renal arteries, pelvic and lower extremity arteries and venous system of the neck, chest, abdomen, pelvis and upper and lower extremities.
Demonstrate a clear understanding of the indications and techniques for endovascular intervention, including: balloon angioplasty, stenting, and dis-obliteration procedures of all vessels (excluding intracranial and coronary arteries), thoracic and abdominal aortic and peripheral vascular endograft placement, thrombolysis, and other endovascular adjuncts for vascular reconstruction.
 
Objectives:
  1. Demonstrate the ability to order appropriately, interpret accurately and efficiently use the information from laboratory tests, non-invasive vascular lab studies (Duplex ultrasound scanning, Doppler testing, plethysmography), vascular imaging studies (magnetic resonance imaging, computed tomography angiography, contrast angiography and venography, intravascular ultrasonography) other diagnostic procedures and consultations.
  2. Make accurate vascular diagnosis.
  3. Evaluate the need for hospitalization or intervention.
  4. Formulate a treatment plan and implement it through personal effort or appropriate referral.
  5. Demonstrate ability to take medical and surgical care of patient and use consultation from other medical specialists.
  6. Demonstrate ability to evaluate and treat concomitant chronic medical problems.
  7. Demonstrate ability to recognize and manage a medical crisis.
  8. Demonstrate detailed knowledge of the risks, complications, side effects and benefits of invasive endovascular and open surgical treatment of vascular disorders.
  9. Demonstrate ability to safely and competently perform invasive vascular and endovascular procedures for treatment of vascular disorders.
  10. Demonstrate the ability to manage perioperative care for patients with vascular disorders, including recognition and appropriate treatment of complications.
  11. Demonstrate the ability to provide intensive care for patients with vascular disorders, including use of vasoactive medications, artificial ventilation and invasive hemodynamic monitoring, including arterial, central venous, and pulmonary artery catheters.
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 Practice Based Learning and Improvement:

Goal
Fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Fellows are expected to develop skills and habits to be able to:
Competencies

Exhibit self-directed learning.

Demonstrate improvement in clinical management of patients by continually improving vascular-related knowledge and skills during the residency.

Identify strengths, deficiencies and limits in one’s knowledge and expertise.

Set learning and improvement goals.

Incorporate formative evaluation feedback into daily practice.

Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems.

Use information technology to optimize learning.

Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a fellow’s teaching abilities by faculty and/or learners.

 
Objectives

Demonstrate ability to use information technology to manage information, access online medical information and support self-learning.

Set learning and improvement goals for self based on feedback and evaluation from vascular faculty.

Demonstrate a personal plan for continuing medical education after residency, including review of the general medical literature and that specific to vascular surgery.

Seek, achieve and maintain board certification in vascular surgery.

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 Systems Based Practice:

Goal
Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Fellows are expected to:
Competencies
  1. Demonstrate understanding of medical delivery systems as they relate to both inpatient and outpatient resources.
  2. Work effectively in various health care delivery settings and systems relevant to their clinical specialty
  3. Coordinate patient care within the health care system relevant to vascular surgery.
  4. Arrange for postoperative care and follow-up for amputees.
  5. Incorporate considerations of cost awareness and risk-benefit analysis in patient care.
  6. Advocate for quality patient care and optimal patient care systems
  7. Work in interprofessional teams to enhance patient safety and improve patient care quality.
  8. Participate in identifying systems errors and in implementing potential systems solutions.
 
Objectives
  1. Coordinate the care the vascular patient prior to hospitalization including scheduling pre-operative studies and consults, arranging for vascular imaging studies and scheduling the date for surgery.
  2. Manage the patient post-operatively including communicating between consulting services, ancillary staff, and discharge planners.
Demonstrate the ability to integrate knowledge of new medical evidence into practice decisions/actions.
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 Professionalism:

Goal
Fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Fellows are expected to:
Competencies
  1. Demonstrate compassion, integrity, and respect for others.
  2. Exhibit competency in working with patients regarding advanced directives, DNR status, futility, and withholding/withdrawing therapy.
  3. Demonstrate responsiveness to patient needs that supersedes self-interest.
  4. Demonstrate respect for patient privacy and autonomy.
  5. Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
  6. Identify and assist with the psychological stress of patients with chronic vascular disease as it affects their personal life, their family life, and their socioeconomic environment.
 
Objectives
  1. A caring and respectful attitude to vascular patients, their families, colleagues and other health care professionals.
  2. The attitude of being a learner and teacher, able to ask and respond to questions.
  3. Willingness to consider and evaluate criticism and peer review of one’s professional work.
  4. Sensitivity to and tolerance towards different opinions and attitudes.

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 Interpersonal and Communication Skills:

Goal
Fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Fellows are expected to:
Competencies
  1. Establish rapport with patients and their families.
  2. Perform a patient-centered medical interview, focusing on vascular issues.
  3. Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds.
  4. Engage patients in shared decision-making, and participate in family discussions.
  5. Discuss patient’s fears regarding loss of life or limb.
  6. Discuss patient’s fear of amputation and the impact of an amputation on self-image and mobility.
  7. Communicate effectively with physicians, other health professionals, and health related agencies in a manner that promotes care coordination.
  8. Work effectively as a member of leader of a health care team or other professional group.
  9. Act in a consultative role to other physicians and health professionals.
  10. Maintain comprehensive, timely, and legible medical records.
 
Objectives
  1. Articulate a complete and efficient plan for diagnosis of vascular disorders, based upon medical knowledge, history and physical exam.
  2. Demonstrate the ability to communicate effectively and professionally with patients, families, referring physicians and staff.
  3. Demonstrate the ability to request appropriate consultation from other medical specialities specialists for patients with vascular disorders.
  4. Demonstrate the ability to provide effective vascular consultation to other physicians and providers.
  5. Demonstrate the ability to interact effectively and professionally with hospital staff and other health care professionals.
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