Structure of Training
The vascular training programs are divided into four rotations for each year of fellowship and for the PGY-4 and PGY-5 years of the vascular residency: the University Vascular Service, the Endovascular/Emergency Vascular Surgery (Onservice) rotation and the VA Vascular Service. During the first year of fellowship the fourth rotation will be at Swedish American Hospital in Rockford, IL doing community vascular surgery with the UW faculty who practice there. In the second year of fellowship, the trainee will do two rotations on the University Vascular Service.
The University Vascular Service consists of three inpatient nurse practitioners, one or two interns, a PGY-3 general surgery resident, either a vascular PGY-2 or PGY-3 resident (eight months of the year), and two senior vascular residents/fellows. The two senior vascular residents and the two fellows each spend six months on the University Vascular Service. This service manages elective arterial open and endovascular surgery at UWHC. Patients with all manner of vascular disease are managed on this service including our patients with thoracoabdominal aneurysms and patients requiring open complex repairs or requiring TEVAR, FEVAR or EVAR. We work in a Zeego hybrid OR five days a week and the service has seven 7:30 a.m. starts every week. Senior residents and fellows attend clinic for one day every other week; the clinic day rotates so that residents/fellows gain experience with all attending staff.
Each fellow will rotate for three months each year on the Endovascular/Emergency Vascular Surgery Rotation as will the PGY-4 and PGY-5 vascular residents. The trainees on this rotation manage all acute vascular care cases at the University, Veteran’s and Meriter hospitals. When on the service, they will share the junior residents on the University Service but be primarily responsible for these patients. The fellow/resident assigned to lead the Onservice Rotation will also work with outpatients in the cath labs at UWHC and Meriter hospitals where the majority of our percutaneous endovascular care is performed. The vascular surgeons in our hospital system perform over 90% of all peripheral endovascular interventions. We manage a region-wide endovascular limb salvage program. Cath lab endovascular interventions are also performed by the residents/fellows assigned to the University Service, but the Onservice resident will have priority to perform these cases unless they are managing emergencies or they are performing vein procedures. While assigned to the Onservice Rotation, fellow/residents will also attend one-half day per week of vein care clinic and perform outpatient vein procedures on average one day per week. The fellows will also use their time on this service to work in the noninvasive vascular lab.
Fellows will rotate for three months each year on the VA Vascular Service as will the PGY-4 and PGY-5 vascular residents. There will be a junior resident assisting them as well as the inpatient nurse practitioner. We have a Zeego Hybrid Angio OR at the VA and all operating rooms were remodeled in 2014. We operate starting at 7:30 a.m. every weekday except Wednesday. Wednesday is our VA clinic day, staffed by a rotating vascular surgery attending. VA clinic is attended by the senior resident or fellow assigned to the VA as well as any vascular junior residents rotating on the University Service and the general surgery PGY-3 and intern assigned to the University Service. We are fortunate to have a RN case manager and two nurse practitioners on our VA Service. We manage patients with arterial occlusive disease at the VA Hospital by both open and endovascular procedures. Endovascular procedures are performed in the VA hybrid Angio OR suite including EVAR, TEVAR, FEVAR and percutaneous management of peripheral, renal and carotid occlusive disease. All manner of open procedures are performed at the VA including carotid and CFA endarterectomy, aortic reconstruction for occlusive and aneurysmal disease, extra-anatomic bypasses and infrainguinal and infrageniculate bypasses.
Differences between Fellowship Training and Vascular Residency Training
The two years of fellowship training mirrors the final two years of our integrated vascular residency with some exceptions. The integrated senior residents will have fulfilled their minimal case volume requirement for endovascular cases and for interpretation of noninvasive lab studies by the start of their PGY-4 year. In contrast, the majority of first-year fellows will have limited exposure to percutaneous procedures and a limited understanding of the role of the noninvasive vascular lab in the practice of vascular care. Therefore the first-year vascular fellow will begin fellowship on the Onservice rotation for three months. The fellow will participate in fewer major cases during this initial three-month period compared to vascular residents as they will need to focus on developing beginning catheter-based skills, while gaining knowledge in the vascular lab and being exposed to vein care. The two senior vascular residents assigned to the University Service will cover emergency cases for the first-year fellow during their initial Onservice rotation so that the fellow will have enough time for these activities. The first-year fellow when Onservice will be responsible for the pre and postoperative care of patients undergoing endovascular diagnostic and interventional procedures at UWHC and Meriter Hospital. The first-year fellow will build on their initial exposure to endovascular care during that first three months on the Onservice rotation when they rotate to the VA and University Services. During that initial Onservice rotation the first-year vascular fellow will complete a didactic module outlining the role of the vascular lab and its limitations.
The Division of Vascular Surgery will sponsor the vascular fellow to take the Registered Physician Vascular Interpretation (RPVI) Exam by the end of their second year. While on the Onservice rotation the first-year fellow spends one month learning the pre and postoperative care of patients with vein disease at our vein clinic and performs endovenous ablation procedures, microphlebectomy, and ultrasound-guided foam sclerotherapy at Meriter Hospital in Madison. During the second year of fellowship, depending on their endovascular skill sets, fellows can use the Onservice rotation to again focus on work in the cath labs and have the vascular residents cover emergencies, however this may not be necessary. Additionally, UW has acquired Swedish American Hospital in Rockford, IL. Three vascular surgery faculty are dedicated exclusively to this community based practice. The first year fellow will spend one three month rotation working with these faculty to gain an appreciation for community vascular surgical practice.
The first-year vascular fellow will be assigned a faculty mentor at the start of their training. The fellow will design a mentored clinical research project(s) and develop critical thinking skills during their time here. The vascular fellows are expected to develop their teaching skills working with junior residents and medical students during their two years of clinical training. Many of our trainees have received medical student teaching awards.
Call responsibility consists of approximately every fourth night of second call from home during the week; the two vascular fellows and senior vascular residents (PGY-4 and PGY-5) share every fourth weekend call from home. The first-year vascular fellow and the PGY-4 vascular resident will attend the UCLA Vascular Surgery Review Course to obtain additional didactic basic science teaching. The second year vascular fellow and the PGY-5 vascular resident will attend the Midwest Vascular Mock Oral Boards at the annual meeting. Please feel free to contact Program Director Dr. John Hoch or Associate Program Director Dr. Paul DiMusto directly if you have any questions.