Anesthesiology Critical Care Medicine Fellowship at the University of California, San Diego …… A Unique Educational Experience in America’s Finest City……….

4 Educational Sites UCSD Thornton HospitalUCSD Medical Center, Hillcrest Sulpizio Cardiovascular Center Jacobs Medical Center (Opening 2016)

Clinical ICU Training Thornton Hospital: 12 Bed Medical/Surgical ICU Sulpizio Cardiovascular Center: 12 Bed CCU/Thoracic-Cardiovascular Post Op Unit UCSD Medical Center, Hillcrest: 20 Bed Surgical Trauma ICU, 8 Bed Burn ICU, and a dedicated Neurosciences Critical Care Unit Additional Opportunities for expansion include: Jacobs Medical Center (2016,) VA- ICU, Rady Children’s PICU

Critical Care Faculty Erik Kistler, MD, PhD – Director of Research Medical School: George Washington University, Anesthesiology Residency: UCSD, CCM Fellowship: MGH Interests: Sepsis and Shock (Mechanisms, Diagnosis, and Treatment) Brian Lemkuil, MD Medical School: Loma Linda, Anesthesiology Residency: UCSD, CCM Fellowship: UCSD/Cambridge Interests: Cerebral Blood Flow, Subarachnoid Hemorrhage, Cerebral Vasospasm Zeb McMillan, MD Medical School: University of Iowa, Anesthesiology Residency: Advocate Illinois Masonic Medical Center (Chicago) CCM Fellowship: UCSF Interests: Venous Blood Gas Analysis, Ventilator Synchrony, Pain and Sedation in ICU, RBC transfusion Angela Meier, MD, PhD Medical School: Ludwig Maximlans University (Munich), Anesthesiology Residency: MGH, CCM Fellowship: MGH Interests: Sepsis, Trauma, Immunologic Impact of Anesthesia

Critical Care Faculty Anushrivan Minokadeh, MD – Division Chief Medical School: LSU, Anesthesiology Residency: SUNY Downstate Hospital, CCM Fellowship: Johns Hopkins Interests: Neurocritical Care, Liver Transplantation, Resuscitation Science, Quality and Performance Improvement Beverly Newhouse, MD – Education Director Medical School: University of North Carolina, Anesthesiology Residency: UCSD, CCM Fellowship: MGH Interests: Medical Education, Mechanical Ventilation & Weaning, Resuscitation Physiology Albert Nguyen, MD Medical School: University of Colorado, Anesthesiology Residency: UT Southwestern, CCM Fellowship: UCSD Interests: Coagulopathy and Coagulation Monitoring E. Orestes O’Brien, MD – Clinical Chief Medical School: Harvard, Anesthesiology Residency: UCSF, CCM Fellowship: MGH Interests: Monitoring and hemodynamic optimization

Critical Care Faculty Kimberly Robbins, MD-Fellowship Director Medical School: University of Virginia, Anesthesiology Residency: UCSD, CCM Fellowship: UCSD Interests: Obstetric Critical Care, Echocardiography, Education Ulrich Schmidt, MD, PhD, MBA Medical School: University of Munich, Anesthesiology Residency: MGH, CCM Fellowship: MGH Interests: Care of the Critically Ill patient in OR and in the ICU, Optimization of high risk interventions in the ICU Christopher “Kit” Tainter, MD, RDMS Medical School: University of Washington, Emergency Medicine Residency: Mount Sinai NY, CCM Fellowship: MGH Interests: Point of Care Ultrasound, Resuscitation, Cardiac Arrest, Education

Educational Overview: Core and Elective Rotations The ACGME requires all fellows in Anesthesiology Critical Care Medicine to complete 9 months of adult critical care. Each fellow will spend approximately 7 months in the Thornton & Sulpizio CVC ICU. The patient population consists of complex Cardiovascular, Thoracic, Neurosurgical, General Surgical, Urologic, Gynecologic, & Orthopedic Patients. Fellows may complete their additional critical care requirement in the neuro, medical, burn, or surgical/ trauma ICUs.

Educational Overview: Core and Elective Rotations Fellows spend a total of 3 months of elective time either on corollary services with relevance to critical care (e.g. Infectious Disease, Cardiology, Palliative Care,) or completing original research Individualized electives may also be developed by the fellow Fellows are expected to complete both an academic project and a quality improvement project during the year

Educational Overview (cont.). Expectations & Goals The primary goal of the core fellowship training is to provide the fellow with clinical experience in the management of critically ill surgical and medical patients. Fellows will gain extensive experience managing heart and lung transplant patients, ventricular assist devices, total artificial heart, and extracorporeal circulation. Our fellows also develop expertise in coordinating a multidisciplinary team, and in all of the common procedures used in CCM. Training in Echocardiography & Bronchoscopy will be specifically emphasized & provided to all fellows.

Echocardiography Training Our flourishing cardiovascular program provides our fellows with opportunities to become proficient in both TTE and TEE. Bedside teaching as well as electives in both modalities are available. Fellows will attend the 3 day UCSD Perioperative TEE Review Course/Conference at no charge

Fiberoptic Bronchoscopy (FOB) Training FOB Training and experience is one of the Core CCM Procedures that will be mastered by ACCM Fellows. All Faculty are proficient in FOB use and teaching. In addition, Dr. Jonathan Benumof, “originator of the ASA Difficult Airway Algorithm”, will teach FOB techniques in his Difficult Airway Lab. An Airway Simulator is available. All Fellows will become expert bronchoscopists.

Research Opportunities All Fellows will participate in clinical research including planning of a project, production of IRB proposal, and eventual presentation of research findings. Research topics explored by previous fellows include: Effect of positive pressure ventilation on diastole as measured by echocardiography Effect of blood transfusion on SVO2 in post- cardiac surgery patients Long-term outcomes following SICU Admission CCM Faculty will closely assist the fellows in all aspects of research.

Current Research Projects Dr. Kistler – Analysis of the changes in hemodynamics and oxygen delivery in response to blood transfusions in the ICU. Shock and inflammation, with particular focus on the bowel. Dr Meier - Investigations on how sedatives and pain medications modify the immune response. Dr. Nguyen – Long Term Outcomes Following Surgical ICU Stay. Dr. O’Brien - Investigating the effects of neuraxial sympathectomy on cardiac function in term parturients. Dr. Schmidt – Investigating the value of high intensity interventions in the critical care setting.

Eligibility Criteria and Application Process The Eligibility Criteria For ACCM Fellowship are as follows: Board certification (or eligibility) in Anesthesiology by the ABA (or equivalent if non-American trained.) Possess (or be eligible for) a California medical license (must have current license in State of Residence at time of application.) Have certification in ACLS (or equivalent.) ATLS is also advised. Application Process U UCSD currently has 3 fellowship positions available beginning July 1. We participate in the SF Matching Program: Applications typically open in November, with the match occurring in May one year prior to start date. Applicants interested in a combined experience in CCM and Adult Cardiothoracic Anesthesia should apply to both programs individually and alert both program directors of your intent.

Julie Nguyen, ACCM Fellowship Coordinator Department of Anesthesiology and Critical Care University of California, San Diego 200 West Arbor Drive, #8770 San Diego, CA Phone (619) Fax: (619) ACCM Fellowship Contact Information