The clinical year is divided between rotations at the University of Maryland Medical Center and Mercy Hospital. These two institutions have dedicated Vascular Surgery teaching services. On both services the vascular fellow is the senior trainee on a service that is supported by junior-level general surgical residents.
University and Mercy have independent clinical activities, but all major clinical conferences are held jointly. Instruction at both hospitals is provided by the full-time academic teaching faculty.
The clinical curriculum includes:
- Performance of all forms of non-cardiac vascular surgical, vascular trauma, and endovascular procedures.
- Refinement of inpatient management skills for pre- and post-operative patients on the Vascular Surgery Service.
- Outpatient evaluation of patients with known or suspected vascular disorders.
- Didactic conference and lecture programs.
- Teaching general surgical residents and medical students.
- Instruction in techniques of preparation of graphic materials for conferences, presentations and publications.
- Clinical research.
- Expansion of skills in the field of noninvasive vascular testing, including clinical applications and understanding of technological and physiological limitations and interpretations.
- Instruction on the development of evidenced-based treatments, quality outcomes assessments, practice guidelines, and other practice management skills, as a part of the University of Maryland Division of Vascular Surgery quality improvement team.
The vascular fellow performs all categories of major non-cardiac vascular surgical procedures under the direct supervision of the attending staff.
- The Division of Vascular Surgery (DVS) treats complex patients from the local community and also receives referral of complex vascular cases from practitioners throughout the state of Maryland and the surrounding geographic region. The DVS also participates in the specialty care of vascular trauma cases seen at the Maryland Shock Trauma Center, the nation's busiest trauma unit.
- Mercy Medical Center is an inner-city, community based, comprehensive acute-care hospital. The Mercy Vascular Center has a large clinical vascular surgery service with significant experience in endovascular procedures.
Vascular fellows in our program have generally performed 250-275 major open surgical procedures during their clinical year. Surgical case totals are generally balanced with regard to case mix (e.g. carotid, aortic, extremities), but our cases tend to be at the high end of complexity. A typical clinical year would be expected to include:
- 50 carotid endarterectomies
- 15 repairs of suprarenal and thoracoabdominal aortic aneurysms
- 15-20 visceral artery reconstructions
- 40 aortic reconstructions for occlusive or aneurysmal disease
- 60 infrainguinal vascular reconstructions
Dialysis access procedures are obtained during the Mercy Hospital rotation.
- During the clinical year the vascular fellow performs diagnostic angiography, as well as peripheral and visceral angioplasty and stenting. The operating room is fully equipped with the latest imaging technology and endovascular equipment.
- During the clinical year the vascular fellow performs a substantial number of aortic endograft procedures in the operating room. Aortic and peripheral stent graft procedures are performed routinely at all of our training sites. Trainees have experience with all approved endograft and stent graft devices available. The Division will also be involved in future clinical trials involving endograft treatments in both the infrarenal and thoracic aorta.
- Members of the teaching faculty are qualified to perform carotid interventions and the Division is a leader in the ongoing stages of the CREST trial.
- Upon completion of the training program, the vascular fellow will have both the skills and experience to qualify for independent performance of all approved percutaneous interventions and aortic endografting based upon all current established credentialing guidelines.
The vascular fellow serves as a supervisory resident in the clinical management of all inpatients on the teaching Vascular Surgery service at all institutions. The vascular fellow is assisted by a second and/or first year general surgical resident on both services (UMMC, Mercy). Daily work/teaching rounds are made with the attending staff to plan diagnostic and therapeutic strategies for all patients. It is anticipated that throughout the year, the vascular fellow will assume an increasing degree of responsibility for perioperative patient management decisions.
The vascular fellowwill attend the weekly outpatient Vascular Surgery Clinic at UMMC and the Mercy Vascular Center during the period of his/her rotation at each institution. The resident will directly examine and evaluate patients and confer with the attending staff to plan further diagnostic evaluation and treatment. During the clinical rotation at UMMC the vascular fellow may also attend daily outpatient sessions held on a rotating basis by each staff member to see referral patients.
There is a monthly clinical curriculum didactic lecture and quarterly talks by visiting experts. The clinical fellow is responsible for choosing case presentations for the weekly main Vascular Conference, and coordinating preparation of educational materials for discussion. The clinical fellow also has primary responsibility for the weekly Preoperative Conference, where each patient scheduled for surgery is reviewed in detail. The preliminary fellow is responsible for planning the bi-weekly Vascular Lab Conference and the monthly Journal Club.
All fellows have office space in the Division of Vascular Surgery academic suite with full computer support for access to electronic patient records, the radiology PACS system, web-based literature research, and internet services. There is a Division of Vascular Surgery library with books, journals, and there are extensive reprint files of past and current literature.
Support for Academic and Scholarly Activities
The Division supports travel and expenses for fellows to present scholarly material to meetings of all major vascular societies. The clinical fellow is routinely allowed to attend board review courses that are offered annually.
On call responsibilities are shared among the fellows and conform to current ACGME guidelines. Long-range pagers are provided and call may be taken from home. Call-room facilities are provided if necessary. The DVS office has a fully equipped kitchen. Fellows have a total of 2 weeks of vacation time each year.