Surgical Critical Care and Acute Care Surgery Fellowship

• Trauma/critical care (9 months) - Resuscitative and post-op management of complex surgical diseases related to general surgery and trauma
• Electives in trauma/critical care (3 months) - Management of complex critical illness such as pediatric surgical care, neurocritical care, burns, etc.
• Emergency and elective surgery (12 months)

Total: 24 months

Training in the Division of Trauma, Emergency Surgery and Surgical Critical Care

• Trauma
• Emergency non-trauma surgery
• Thoracic
• Vascular
• Hepatobiliary/pancreatic
• Endoscopy
• Bedside surgical procedures program
• Orthopaedic surgery (concurrent)
• Neurological surgery (concurrent)
• Thoracic (concurrent)
• Vascular (concurrent)
• Hepatobiliary/pancreatic surgery (concurrent)

Burn surgery and pediatric surgery are recommended. Others would include:

• Endoscopy
• Imaging
• Intervention radiology
• Plastic surgery
• Or, maximize time in above rotations

Total: 15 months

The goals of this rotation are to provide a broad exposure to:

• Operative techniques and technical skills related to early management of orthopedic injuries
• Practical orthopedic experience appropriate for a career in acute care surgery
• The evaluation and management of patients with urgent/emergent orthopedic injuries

Upon completion of this rotation the fellow will have attained the following medical skills and knowledge:

• Ability to describe meaning of damage control orthopedics
• Compare and contrast the risks/benefits of early vs delayed fixation of orthopedic fractures
• Compare and contrast treatment of severe pelvic fracture management options
• Demonstrate ability to interpret radiologic imaging studies of orthopedic injuries
• Demonstrate competent placement of pelvic binder
• Demonstrate familiarity with traction, splints/casts, irrigation and debridement of fractures and external fixation
• Demonstrate how to perform 4 compartment fasciotomy of the leg
• Describe management of nerve and tendon injuries
• Describe the diagnosis and treatment options for spine fractures and spinal cord injuries

Additionally, the fellow will be able to demonstrate compassionate, appropriate and effective patient care for the treatment of health problems and the promotion of health in the setting of the provision of surgical care in the following areas as they pertain to orthopedic trauma:

• Infectious Disease: Evaluate and treat infectious complications of orthopedic trauma
• Musculoskeletal System: Interpretation of musculoskeletal imaging in orthopedic trauma. The Fellows will participate as Surgeon or First Assistant in orthopedic trauma procedures to gain experience in fracture reduction and repair
• Neurological System: Diagnose and manage neurological complications associated with spine trauma

The goals of this rotation are to provide a broad exposure to:

• Operative techniques and an opportunity to develop technical skills related to early management of brain injuries
• Practical orthopedic experience appropriate for a career in acute care surgery
• The evaluation and management of patients with urgent/emergent brain and spine injuries

Upon completion of this rotation the fellow will have attained the following medical skills and knowledge:

• Compare and contrast the methods to treat traumatic brain injury, including decompressive craniectomy and decompressive spine surgery
• Demonstrate competency in interpretation of brain and spine radiographic imaging
• Describe and demonstrate familiarity with indications and technique for burr holes and craniectomy
• Describe the indications and technique for placing an intra-cranial pressure monitor
• Describe the non-surgical options for treatment of brain and spinal cord injuries

Additionally, the fellow will be able to demonstrate compassionate, appropriate and effective patient care for the treatment of health problems and the promotion of health in the setting of the provision of surgical care in the following areas as they pertain to neurologic trauma:

• Infectious Disease: Evaluate and treat infectious complications of neurotrauma
• Musculoskeletal System: Interpretation of spine imaging in trauma. The Fellows will participate as Surgeon or First Assistant in spine/TBI procedures to gain experience in spine fixation and operative decompression of brain and spine
• Neurologic System: diagnosis and treatment of traumatic brain and spine trauma

Upon completion of this rotation, fellows must provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health in the setting of the provision of surgical care. Specifically, fellows are expected to demonstrate proficiency in the following ACGME-based core competencies:

• Circulatory System: Use and interpretation of invasive and non-invasive assessment tools such as peripheral Doppler evaluation and Duplex scanning of arterial and venous systems, arteriography (including CT Angiography). Interpretation of chest imaging for vascular disease. The fellows will participate as surgeon or first assistant in vascular procedures to gain experience in exposure of the vessels of the chest, abdomen, pelvis and extremities
• Endocrine System: Evaluate and manage endocrine conditions requiring thoracic or vascular exposure techniques (mediastinal goiter, adrenal tumor)
• Gastrointestinal System: Evaluate and manage vascular conditions affecting the mesenteric circulation (occlusive mesenteric insufficiency, visceral artery aneurysm). Carry out operative approaches to esophageal resection, including open and video-assisted thoracoscopic surgery (VATS) techniques
• Hematologic System: Understand and apply principles for anticoagulation as practiced in treatment of vascular surgery patients. Diagnose and manage hematologic complications of vascular surgery (heparin-induced thrombocytopenia). Diagnose and manage post-operative bleeding
• Infectious Disease: Evaluate and treat infectious complications of thoracic and vascular surgery (graft infection, aortoenteric fistula, aspiration pneumonia, empyema)
• Monitoring/Bioengineering: Use and calibration of invasive and non-invasive monitors used in vascular and thoracic surgery (continuous intra-operative EEG monitoring, carotid artery stump pressure, intra-operative Doppler ultrasound, esophageal manometry)
• Neurological System: Diagnose and manage neurological complications associated with vascular and thoracic surgery, including stroke, delirium and spinal cord ischemia
• Nutritional System: Assess nutritional goals in vascular and thoracic surgery patients. Manage nutritional support using enteral and parenteral routes. Assess response to nutritional support and adjust nutritional goals accordingly
• Renal System: Manage fluid and electrolyte balance in vascular and thoracic surgery patients. Understand and apply the principles of diuretic therapy in lung disease
• Respiratory: Evaluate and manage lung cancer. Apply diagnostic tools to determine resectability of thoracic tumors (exercise capacity, maximal VO2, ventilation/perfusion scan). Diagnose and manage respiratory insufficiency. Diagnose and manage pneumothorax with chest tubes. Carry out open and VATS approaches to pulmonary resection

• Bedside surgical procedures program
• Complex emergency general surgery
• Hepatobiliary/pancreatic surgery

The goals of this rotation are to provide a broad exposure to:

• Operative techniques for hepatobiliary and pancreatic surgery
• Practical surgical experience in preparation for a career in acute care surgery

Upon completion of this rotation the fellow will have attained the following medical skills and knowledge:

• Compare and contrast the methods for achieving hemostasis of a bleeding liver
• Compare and contrast the methods for treating a pancreatic lesion
• Describe the methods for damage control techniques for hepaticopancreatic injury and emergencies
• How to mobilize the liver and pancreas

Upon completion of this rotation, fellows must provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health in the setting of the provision of surgical care as they pertain to hepatobiliary and pancreatic disease:

• Circulatory System: Interpretation of abdominal imaging for hepatobiliary and pancreatic disease. The fellows will participate as surgeon or first assistant in hepatobiliary/pancreatic procurements/transplant procedures to gain experience in exposure of the vessels of the liver and pancreas
• Gastrointestinal System: Evaluate and manage conditions affecting the liver and pancreas function during both pre-operative and post-operative phases
• Hematologic System: Understand and apply principles for anticoagulation as practiced in treatment of coagulopathies related to liver dysfunction
• Infectious Disease: Evaluate and treat infectious complications of liver and pancreatic surgery
• Neurological System: Diagnose and manage neurological complications associated with liver or pancreatic dysfunction

• Extended ortho/neurosurgical rotations
• Pre-hospital/med-flight
• South Africa
• Vascular/thoracic
• One-month rotation