Vascular Surgery Residency and Fellowship Residency established with ACGME approval in 2009; fellowship started in Designed to produce surgeons who can provide comprehensive care to the vascular patient and be expected to fully participate in the rapid expansion of the field of vascular surgery, both clinically and academically. First Resident, July 2010 –1 st graduate: Brigitte Smith, MD, University of Wisconsin School of Medicine –2 nd graduate: Jessica Secor, MD, Boonshoft School of Medicine at Wright State –PGY-5 Elena Rinehardt, MD, University of Washington School of Medicine –PGY-4 Christopher McAninch, MD, St Louis University –PGY-3 Jason Le, MD Chicago Medical School at Rosalind Franklin University –PGY-2 Shruthi Thiagarajasubramanian, MD, MI State College Of Medicine –PGY-1 Alexander Leung, MD, Boston University School Of Medicine 5+2 Fellowship program continues: matching 1 fellow every year –Operative case volume has increased 30% in the past 4 years. –New faculty hiring, further increasing case volume –Week end call improved to every fourth from every other for PGY4 & PGY5’s – PGY-6 Peter Bartline, MD, Univ of Utah - General Surgery – PGY-7 Camila Castello, MD, St Luke’s NYC - General Surgery

K. Craig Kent, MD A.R. Curreri Professor Chairman, Department of Surgery Residency, UCSF Vascular Fellowship, Brigham & Women's Hospital, Chief, Combined Columbia and Cornell Division of Vascular Surgery, New York Presbyterian Hospital President Society for Vascular Surgery, Member, Vascular Surgery Board of American Board of Surgery, PI on more than 45 Industry Sponsored Clinical trials PI or co-investigator on 4 active NIH grants Author of > 250 manuscripts and 44 book chapters

Jon Matsumura, MD Professor and Chief, Division of Vascular Surgery Residency, Northwestern University, Vascular Fellowship, Northwestern University, President, Midwestern Vascular Surgery Society, Chair, SVS Clinical Research Committee, PI or site PI on 18 industry sponsored Grants –PI: WL Gore: "Thoracic Aneurysm Graft Corelab", ( ) –National PI: WL Gore: "Phase II Clinical Trial of the Bifurcated Excluder Endograft for Treatment of Infrarenal Aortic Aneurysms” –International PI: Cook, Inc: “Zenith Thoracic TAA Endovascular Graft” - National Co-PI forAbbott Vascular: “Asymptomatic Carotid stenosis, stenting versus endarterectomy Trial”, present Author of more than 80-peer reviewed articles, 34 book chapters and editor of 9 books

John R. Hoch, MD Professor of Surgery Program Director, Vascular Residency and Vascular Fellowship Chief of Vascular Surgery, Madison VA Hospital, 1994 – 2011 Residency, Thomas Jefferson University, Philadelphia, PA, Fellow, Vascular Surgery, University of Missouri-Columbia, Research: –PI VA Co-op trial #410 and #498 –Industry sponsored clinical trials –Chair, UW Anticoagulation Taskforce Clinical Interests: –Complex aortic and visceral artery occlusive disease –Endovascular management of arterial occlusive and aneurysmal disease –Systems approach to VTE prevention –Less invasive management of varicose vein disease

Charles W. Acher, MD Professor of Surgery Director, Thoracoabdominal Aneurysm Program Residency, University of Wisconsin, Madison, WI, Fellowship, GI and Peripheral Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, England, Peripheral Vascular Fellow, Baylor College of Medicine, Clinical and Research interests –Prevention of ischemic spinal cord injury in repair of TAAs –Management of Complex Aortic and Visceral artery disease –Repair of Aortic Arch and Thoracoabdominal Aneurysms by open and endovascular techniques

Girma Tefera, MD Professor of Surgery Chief of Vascular Surgery, Madison VA Hospital and Vice-Chair Division Vascular Surgery, 2011-Present Director, UW Limb Salvage Angioplasty and Carotid Stenting Residency in General Surgery, Howard University Hospital, Washington, D.C., Fellowship in Vascular Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, Research and Clinical Interests –Carotid stenting, Limb salvage angioplasty –FEVAR and complex TEVAR –Ethiopian Surgical Education Grant as well as Leader of multiple funded health and nutrition projects. Co-Founder University Wisconsin Global Health Initiative Medical Director of ACS Operation Giving Back (OGB). OGB is a comprehensive resource that helps surgeons find volunteer opportunities worldwide that match their expertise and interests.

Gretchen Schwarze, MD, MPH Associate Professor of Surgery Harvard Medical School, Boston, MA, 1995 JFK School of Government, Boston, MA, MPH 1995 General Surgery Residency at Mass General, Boston, MA, 2002 Vascular Residency, University of Chicago, 2004 Research and Clinical Interests –KL2 “Prevention of postoperative conflict about life supporting therapy by improving preoperative communication with older patients” 12-’15 –Greenwald Faculty Scholars Award 08-’14 Advance Directives for High Risk Surgical Patients –Developer of the UW Medical School Ethics Curriculum Patient Experience Physician Champion UWHC 2012 Recipient Dean’s Teaching Award 2011

Dai Yamanouchi MD, PhD Assistant Professor of Surgery Surgical Residency, Saiseikai Maebashi Hospital, Japan, Research Fellowship, Nagoya University Graduate School of Medicine, Japan, Clinical Fellowship in Vascular Surgery, Nagoya University Hospital, Japan, Research Fellowship, Weill Cornell Medical College, New York, NY, Fellowship in Advanced Endovascular Surgery, University of Wisconsin-Madison, Madison, WI, Research interests: –AHA Scientist Development Grant ‘12-15 Role Osteoclast-like Cells in AAA –Industry sponsored EVAR clinical trials –National PI Branched TEVAR Trial –Gene delivery methods for patients with peripheral arterial disease

Kyla Bennett, MD Assistant Professor (2015 – present) Duke University: medical school, general surgery residency and vascular surgery fellowship at Duke University Medical Center. Clinical focus on aortic, carotid and limb salvage surgery. Vascular thoracic outlet syndrome interventions and management of venous obstruction. Research interests include: outcomes and access-to-care disparities, methodology for large database analysis to improve model integrity and pre-hospital management of ruptured AAA and dissections.

Paul DiMusto, MD Assistant Professor (2015-present) University of Michigan: undergraduate, medical school, general surgery residency, and vascular surgery fellowship at the University of Michigan. Clinical interests focus on aortic disease: including aneurysms, dissections, and occlusive disease. He performs both open and complex endovascular repair of the aorta. He spent two years during residency studying the molecular biology underlying the gender difference in abdominal aortic aneurysm formation. Interest in education of medical students, residents and fellows. Working with Dr. Hoch to develop a simulation curriculum for the vascular trainees.

Bo Liu, PhD PhD, Biochemistry, SUNY Downstate, New York, NY, 1993 Postdoctoral fellow, Transcription regulation; signal transduction, Memorial Sloan-Kettering Cancer Center, New York, NY, Research: RO1: understand regulatory mechanisms underlying l functions of vascular smooth muscle cells and how these mechanisms malfunction in vascular diseases –AAA and Restenosis T32 NIH-sponsored Vascular Biology Training Grant (with Dr Kent and Matsumura) –Available after PGY5 year Lian Wang Guo. PhD

Vascular Surgery Residency Provide incremental, progressive training in core surgery (CS) and vascular surgery (VS) during the five year program Four integrated sites: UW Hospital, Wm. S. Middleton VA Hospital (connected by corridor), Meriter Hospital (5 minute drive) and Transformations (aesthetic center; 10 min drive) Affiliated Rotations: St Mary’s Hospital, Madison and Theda Clark Hospital, Neenah, WI. Optional research year(s) –after 5 years training or after PGY-2 T-32 funding mechanism

Integrated Residency (0-5) Year 1 10m Core and 2m Vascular Year 2 and Year 3 7m Core and 5m Vascular both years Year 4 and Year 5 12m Vascular each year

Integrated Residency (0-5) Core General Surgery: –Surgical Intensive Care2 months –Emergency General Surgery2 months –Surgical Trauma2 months –Night Float (vascular)2 months –Anesthesia0.5 months –Off-site general/vascular1 month –General Surgery8.5 months Core Surgical subspecialties: –Transplantation2 months –Plastic Surgery1 month –Thoracic Surgery2 months –Cardiac Surgery1 month 24 month s

Integrated Residency (0-5) PGY 1-3 Years Vascular Rotations Vascular Surgery : –UW Vascular6 months –Vascular Lab1 month –Vein Care1 month Vascular - related: –Cardiology1 month –Vascular Access 1 month –Vascular Imaging1 month –Elective/Research training1 month 12 months

Integrated Residency (0-5) PGY 4 & 5 Years Vascular Surgery 24 months Alternating 3 month rotations with PGY-4, PGY-5 and PGY-7 Fellow –UW Vascular12 months (6m/yr) –VA Vascular6 months (3m/yr) –UW OnService6 months (3m/yr) Acute care Endovascular Veins V-lab Research______________ 24 months – – No conflict between Residents and Fellow

Core Surgery Training PGY 1-3 Provide complete “foundation of the principles and practices of surgery” ACS course SCORE Curriculum Similar training experiences as categorical general surgery residents –Core Surgery Technical Skills Lab –Instrument identification, knot-tying and suturing –Management and repair of central lines and enteric feeding tubes –Wisconsin Elements of Laparoscopic Surgery (WELS) –Advanced Trauma Life Support (ATLS) and ACLS –Laparatomy and bowel anastomosis –Principles of Ultrasound – FAST and line placement –Principles of vascular anastomosis

Core Surgery Training PGY 1-3 Specialized conferences e.g. Trauma Call during PGY1-3 no greater than 1:3 Excellent working relationship with general surgery –SCORE curriculum VSITE PGY 1-5 Resident Evaluation by core faculty

Core Surgery Rotations Outside UWHC Theda Clark Hospital - Neenah, WI (PGY-3; 1 month) –Community general surgery; no residents –Nice mix of open and laparoscopic operations –4 weeks; weekends off St Mary’s Hospital - Madison, WI (PGY3; 2 months) –Community general surgery; no other residents –Mix of general, cardiac surgery and vascular patients Meriter Hospital (PGY-1 & 2; 2 months) –Community general surgery VA Hospital General Surgery Service (PGY-1; 1 month)

Integrated Vascular Surgery Rotations Curriculum –APDVS curriculum on-line with references, both Basic Science and Clinical Curricula –Vascular SCORE –Written Curriculum Goals and Educational Objectives –UCLA/SVS Vascular Review Course in September of PGY4 –RPVI Exam in PGY3 year (Division covers cost) –Web-based universal curricula being developed by APDVS Milestone Driven –Monthly Global (Web-ex online) and Local Journal Clubs

Vascular Conferences Monday morning 6:30 to 9:30 am (excused from OR) –6:30 to 7:15 Indications –7:15 to 7:30 Web-Ex morning sign out –7:30 to 8:30 Basic Science 1/mo; Noninvasive Lab conference 1/mo; Global Journal Club 1/mo; Clinical Research conference 1/mo –8:30 to 9:30 Teaching conference Faculty sponsored Monthly Journal Club

Integrated Vascular Surgery Residents Attendance at Monday conferences required on all rotations; excused from OR and general surgery rotations Divisional support for meetings at which you present Prepare the resident for the design, implementation and conduct of clinical trials Assigned research mentor: –Expected to present at least once at National or Regional vascular meeting during residency –Expected to take at least one research project from concept, through the IRB, data collection, statistical and conceptual analysis and publication Present at Surgery Grand Rounds at least once

Cardiology Rotation PGY1 A focused exposure to consultative cardiovascular medicine, echocardiography and nuclear myocardial perfusion imaging stress testing. 2 weeks with the UW Hospital Cardiology Consult Service, and spending 1 week each reading studies in the UW Hospital Echocardiography Laboratory and Nuclear Cardiology Laboratory. Will function on each service in a role equivalent to a first year cardiovascular medicine fellow

Non-invasive Vascular Lab Rotation PGY-2 Daily reading at the VA and at the University Hospital; no night call Daily hands-on participation in UW vascular lab with time spent in UW West clinic and VA vascular labs Didactic lectures on CD from SVS/APDVS Gain a complete understanding of the indications, interpretation and limitations of each test. Prepared to pass ARDMS RPVI examination during third year of residency Shared vascular lab studies interpretation also in PGY3-5 years when on VA vascular rotations Vascular lab interpretation responsibilities continue in PGY3 and 4 years at VA

Vascular Imaging Rotation PGY2 The PGY-2 vascular resident will rotate for 1 month on the Vascular Imaging Service which includes CT and MR vascular imaging. Demonstrate an understanding of the principles and practice of modern vascular cross sectional imaging using computed tomography and magnetic resonance imaging. Understand principles of radiation safety The resident will attend educational conferences in radiology on CT and MR imaging and radiation safety.

Venous Disease Rotation PGY3 1 month rotation at Meriter Hospital Venous clinic at Meriter, UW West Clinic and Transformations Office-based and hospital operating room-based interventions Minimally invasive techniques, and the postoperative care of patients with venous disorders Hands on venous imaging in the vascular labs at West and UWHC Also participate in vein care during Meriter Hospital core surgery rotations years 1-3 and when rotating on Onservice rotation PGY 4&5.

Vascular Surgery Elective PGY3 To allow the resident one month of elective time in the third year to conduct vascular research or pursue additional training in open vascular procedures or endovascular techniques The PGY-3 resident will work with the Program Director and Chair of the Division of Vascular Surgery to identify programs of interest either within the University of Wisconsin system, or elsewhere in the United States. Option for AV Access rotation at Swedish American Hospital, Rockford, IL

University and VA Vascular Rotations PGY2 and PGY3 Junior resident on the UW and VA Vascular teams working with Gen Surg PGY1 & 3 and Vascular PGY4 & 5 and fellow. Experience in endovascular and open interventions With the input of faculty, develop therapeutic plans, perform endovascular and open interventions and follow up the patients Responsible for majority of endovascular procedures in the UW Cath lab and VA Hybrid OR under the guidance of vascular surgery faculty when on rotation. Perform CEA, femoral to popliteal bypass, CFA endarterectomy, EVAR, amputations, extra-anatomic bypass, assist with complex open aortic reconstructions Participate in weekly VA and UW clinics

Vascular Rotations PGY4 and PGY5 UW Vascular Service (6 months/yr) –2 two month blocks as chief each of the PGY4 & 5 years –GenSurg PGY3 (at times vascular PGY2 or 3) –PGY 1 (shared with VA Vascular Service) –3 nurse practitioners on the floor (They are awesome!) Seven 7:30 OR starts Zeego Angio Operating Suite (also at VA) Complex open and Hybrid procedures Endovascular diagnostic and therapeutic interventions in OR and cath lab, staffed by vascular surgery faculty Vascular Clinic at UW West clinic average of ½ day/wk

Vascular Rotations PGY4 and PGY5 VA Vascular Service (3 months/yr) 2 two month blocks as chief each of the PGY-4 & -5 years Open and endovascular general vascular cases PGY-1 (shared with UW Service) Inpatient VA NP and case managers Clinic on Wednesdays at VA, morning and afternoon –Junior residents on UW service also attend VA clinic –Active faculty teaching in clinic OR 4 7:30am starts Endovascular experience in new Zeego Hybrid Angio Suite/Operating Room.

Vascular Rotations PGY4 and PGY5 OnService Rotation UW Acute Care/Endovascular (3 months/yr) 2 two month blocks as chief each of the PGY-4 & -5 years General vascular open and endovascular cases Mentored experience with “OnService Faculty” each week Work with inpatient NPs, rotating PGY-2 & -3 residents Endovascular experience in UWHC Zeego Angio Operating Room, UW cath lab, Meriter Cath Lab and VA Zeego Room. Time for research, vascular lab work and additional vein care opportunities

Vascular Call PGY2 & 3 –On core rotations Every third night call from home Except 2 months SICU in-house every third night –On vascular rotations Share back-up call from home for in-house night-float intern with PGY3 general surgery resident, PGY4 & 5 and the fellow PGY4 & 5 –Call is from home –Backup night-float intern every 3-4 nights during week –Backup junior residents every fourth weekend in rotation with fellows –The vascular PGY4, PGY5 and fellows are on call and have rounding duties every fourth weekend –Weekend Midlevel NP support

Vascular Resident Cases UW ResidentNational Ave. Breast1214 Transplant33 Thoracic1725 Hernia4225 Biliary2419 Abd Gen910 Lg Intest2219 Sm Intest47 Skin1622 Total Core Operations Total Vascular Operations Total Major Vascular Total All Operations

2015 Vascular Resident Graduate “Defined Categories”

Vascular Resident UW Fellow National Average Fellows UW Resident National Average Residents Abdominal Obstructive Open AAA All Aneurysm Cerebrovascular Peripheral Mesenteric TEVAR Open TAA EVAR Total Major Operations /826*465/737* * Primary and secondary cases

Fellow vs Resident Endovascular Experience Limb Salvage Angioplasty Program Carotid Stent Program (1 post-marketing trials allowing treatment of asymptomatic and symptomatic patients) Thoracic Endograft Program Fenestrated EVAR program (>25year) Site for Gore Tag Clinical Trials TEVAR for Trauma, Dissection, TAA BEST CLI Trial Cordis Low-Profile EVAR Trial; SCAFFOLD CAS Trial; Branched TEVAR Trial UW FellowPercentileUW Resident Diagnostic59990%629 Therapeutic35485%384 Endografts10190%99

Resident Evaluation Resident performance evaluation –Faculty at end of each Rotation –Semi-annual Review –360 evaluation by nursing (floor and OR), cath lab personnel, NP’s and support staff –March In-service Exam (VSITE) –Quality Improvement Project Anonymous evaluation of program and faculty via MedHub

Clinical Research and Critical Thinking Faculty research mentor assigned PGY1 year (PD acts as Resident advocate) PGY1: –Present once in Vascular conference –Case report PGY2 –Initiate clinical study involving imaging or other topic –Attend AAS Fundamentals of Surgical Research Course –Quality Project PGY3 –Retrospective Review –1 month research rotation –Quality Improvement paper –Introduction to Clinical Trials Course –Initiate Prospective study PGY4 –Retrospective paper –Prospective study continues –Should be presenting at regional or national meeting PGY5 –Complete projects initiated in prior years –Should be presenting at national meeting –After PGY-5 year: T32 Grant: opportunity to spend 1-2 years in postgraduate clinical or basic research

New Initiatives Global Health: Ethiopia –Beginning in July 1, 2016 –The first vascular residency in Africa (outside South Africa) –Faculty from the Univ. of Wisconsin and other invited institutions will rotate monthly to Addis Ababa –PGY-4 Vascular resident will rotate for 1 month when UW faculty present. Simulation Curriculum: #1 goal for Division this year –Simulation Center UWHC –Mentice Endovascular simulator –Open skills training: low cost and high-end –Active faculty mentoring

80-Hour Work Week

Questions?