Adult Cardiothoracic Anesthesiology Fellowship
Fellowship is advanced graduate medical education beyond a core residency program for physicians who desire to enter more specialized practice. Fellowship-trained physicians serve the public by providing subspecialty care, which may also include core medical care, acting as a community resource for expertise in their field, creating and integrating new knowledge into practice, and educating future generations of physicians. Graduate medical education values the strength that a diverse group of physicians brings to medical care.
Fellows who have completed residency are able to practice independently in their core specialty. The prior medical experience and expertise of fellows distinguish them from physicians entering into residency training. The fellow’s care of patients within the subspecialty is undertaken with appropriate faculty supervision and conditional independence. Faculty members serve as role models of excellence, compassion, professionalism, and scholarship. The fellow develops deep medical knowledge, patient care skills, and expertise applicable to their focused area of practice. Fellowship is an intensive program of subspecialty clinical and didactic education that focuses on the multidisciplinary care of patients. Fellowship education is often physically, emotionally, and intellectually demanding, and occurs in a variety of clinical learning environments committed to graduate medical education and the well-being of patients, residents, fellows, faculty members, students, and all members of the health care team.
In addition to clinical education, many fellowship programs advance fellows’ skills as physician-scientists. While the ability to create new knowledge within medicine is not exclusive to fellowship-educated physicians, the fellowship experience expands a physician’s abilities to pursue hypothesis-driven scientific inquiry that results in contributions to the medical literature and patient care. Beyond the clinical subspecialty expertise achieved, fellows develop mentored relationships built on an infrastructure that promotes collaborative research.
Adult cardiothoracic anesthesiology is devoted to the pre-operative, intraoperative, and post-operative care of adult patients undergoing cardiothoracic surgery and related invasive procedures. The majority of the clinical education involves caring for patients in the operating room, other anesthetizing locations, and intensive care units, and includes experience providing anesthesia for cardiac, non-cardiac thoracic, and intrathoracic vascular surgical procedures, as well as for non-operative diagnostic and interventional cardiac and thoracic procedures. Adult CTA Fellows at the University of Minnesota will also have meaningful opportunities to pursue research and quality improvement opportunities, educational and teaching opportunities, and wellness opportunities with a focus on time and energy management.
As per ACGME requirements, applicants for the fellowship must have successfully completed an ACGME accredited residency in anesthesiology or RCPSC/CFPC (Royal College of Physicians and Surgeons of Canada/College of Family Physicians of Canada) accredited training in Canada. In rare cases, an “exceptionally qualified applicant” who has not completed an accredited residency may be considered after assessment by the program director and fellowship selection committee of the applicant’s suitability to enter the program, based on:
- Prior training and review of the summative evaluations of training in the core specialty.
- Review and approval of the applicant’s exceptional qualifications by the GMEC or a subcommittee of the GMEC
- Satisfactory completion of the United States Medical Licensing Examination (USMLE) Steps 1, 2, and, if the applicant is eligible, 3.
- For an international graduate, verification of Educational Commission for Foreign Medical Graduates (ECFMG) certification.
The following documents need to be submitted to the SF Match Centralized Application Service:
- Centralized Application Service (CAS) Application for Adult Cardiothoracic Anesthesiology fellowships provided at the SF Match website
- Three (3) letters of recommendation to SF Match
- Distribution list of programs
- Registration payment and fees
- Healthy, well-rounded culture for learning with focus on clinical excellence, education, research and wellbeing
- Opportunities to experience the perioperative clinical care of patients with advanced and end-stage heart and lung failure
- A clinical, research and quality improvement focus on Enhanced Recovery after Cardiac Surgery, Right Heart Failure and Bloodless Cardiac Surgery
- Collegial relationship with cardiac surgical staff and perfusionists
- Progressive approach to time and energy management with at least one academic day per week
- Ample didactic opportunities outside the operating room including cutting-edge local, regional and national conferences
- Unique elective opportunities
Duration & Rotation Schedule
The adult CTA fellowship is a one-year commitment and from August to August. Other start dates are negotiable. Adult CTA fellows spend a total of approximately 37 weeks in cardiothoracic operating rooms at the University of Minnesota or the Minneapolis Veterans Affairs Hospital. This does not include dedicated time to focus on intraoperative transesophageal echocardiography and perfusion. CTA fellows will also spend a total of 4 weeks in a freestanding cardiothoracic intensive care unit (CTICU), and 4 weeks on elective rotations (see options below). While on clinical rotations in the cardiothoracic operating rooms, CTA fellows are expected to finish cardiac cases scheduled in their assigned rooms for that day. In the event that a cardiac case ends between 18:00 and 21:00, fellows will have a full 10 uninterrupted hours without clinical responsibilities, and resume clinical responsibilities the following day at 07:00. In the event that a cardiac case ends after 21:00, fellows will not be expected to have any clinical responsibilities the entire following day, and resume clinical responsibilities the following day after that at 07:00. While at the University of Minnesota, CTA fellows will take call for 1 week at a time. The call week will begin Monday morning at 7a and end on the next Monday morning at 7a. Following a week of call, fellows will have the following Monday off.
While on call, CTA fellows are expected to participate in the following complex cardiac case types:
- Type I aortic dissection repair
- Thoracic aortic aneurysm repair
- Acutely decompensating infective endocarditis
- Heart transplantation
- Emergent ventricular assist device placement
- Lung transplantation
- Low LVEF (<20%) CABG
- Ischemic VSD, papillary rupture or acute MR
Teaching & Didactics
CTA fellows will have the opportunity to attend case conference twice a week (Tuesdays and Thursdays) to discuss the management of complex cardiac and thoracic patients including pre-operative patient evaluation and optimization of clinical status prior to the cardiothoracic procedure, interpretation of cardiovascular and pulmonary diagnostic test data, respiratory monitoring, pharmacological and mechanical hemodynamic support, ventilatory management and peri-operative pain management. Fellows will be able to demonstrate competence in the following:
- Providing anesthesia care for patients undergoing cardiac surgery with and without extracorporeal circulation.
- Providing anesthesia care for patients undergoing thoracic surgery, including operations on the lung, esophagus, and thoracic aorta.
- In advanced-level peri-operative TEE.
- In management of cardiopulmonary bypass (CPB).
Fellows will be able to independently manage intra-aortic balloon counter-pulsation and be actively involved in the management of other extracorporeal circulatory assist devices.
Fellows will be able to demonstrate knowledge of how cardiothoracic diseases affect the administration of anesthesia and life support to adult cardiothoracic patients with a focus on:
- Pathophysiology, pharmacology, and clinical management of patients with cardiomyopathy, heart failure, cardiac tamponade, ischemic heart disease, acquired and congenital valvular heart disease, congenital heart disease, electrophysiologic disturbances, and neoplastic and infectious cardiac diseases.
- Pathophysiology, pharmacology, and clinical management of patients with pleural, bronchopulmonary, neoplastic, infectious, and inflammatory diseases of the lung.
- Pharmacology, and clinical management of patients with thoracic vascular, tracheal, esophageal, and mediastinal disease.
- Non-invasive cardiovascular evaluation including electrocardiography, transthoracic echocardiography, TEE, stress testing, and cardiovascular imaging, cardiac catheterization procedures.
- Diagnostic interpretation of invasive cardiac catheterization procedures, including angioplasty, stenting, and transcatheter laser and mechanical ablations.
- Diagnostic interpretation of non-invasive pulmonary evaluation, including pulmonary function tests, blood gas and acid-base analysis, oximetry, capnography, and pulmonary imaging.
Adult CTA fellows will participate in ongoing CTA divisional research and quality improvement projects, participate in scientific writing, editing and presentation, and complete our Collaborative Institutional Training Initiative (CITI) Program with a focus on research ethics and compliance. As such adult CTA fellows at the University of Minnesota will also gain expertise in research methodology and statistical analysis, quality assurance and improvement, the fundamentals of research design and conduct, the interpretation and presentation of data, and scientific writing, medical ethical and legal issues, and practice management. Adult CTA fellows will receive training on time and energy management as well as participation in an 8-week course on Wellbeing and Resilience for Health Professionals through the Center for Spirituality and Healing at the University of Minnesota.
Out adult CTA fellows will also gain insight by to attending monthly morbidity and mortality conferences, weekly grand rounds, quarterly cardiac journal club, and research meetings every other month. Once a year, the CTA fellows will have the opportunity to attend an advanced Hemodynamics Animal Lab, Right Ventricular Dysfunction Symposium, the Society of Cardiothoracic Anesthesiologists (SCA) Annual ECHO Meeting, SCA National Meeting, the Lillehei Heart Conference, the Bakken Symposium, the Minneapolis Structural Heart Meeting all at the expense of the department.
To participate in these extra-clinical opportunities in a meaningful way, each adult CTA fellow will receive one academic day per week, in addition to post-call days. Academic days can be used to complete original research, didactic preparation, resident mentoring, manuscript review and departmental/hospital committee work.
Adult CTA fellows are expected to play a significant role in the leadership and mentoring of anesthesia residents rotating through our cardiothoracic division. Responsibilities will include resident orientation the week prior to starting to review rotation expectations, basic cardiac room set-up, and the didactic curriculum. CTA fellows will also be available for a weekly check-in and end-of-the-rotation feedback.
The following elective opportunities are available to fellows:
- Congenital cardiac anesthesiology
- Adult or pediatric cardiac catheterization and/or electrophysiology laboratory
- Adult or pediatric cardiac imaging with cardiology
- Mobile VA ECMO Service
- Virtual Heart Laboratory