1. Vascular Surgery Fellowship  Established 1999 as an ACGME-approved one-year clinical fellowship  Primary certificate approved in 2006, mandating minimum two years of training  RRC approval to move to two-year program (2006-2008)  First Year  acquiring endovascular skills  learning the science and the clinical application of the non-invasive vascular laboratory  mentored experience in clinical research  Second Year  inpatient and outpatient care utilizing traditional open vascular surgery and endovascular techniques

2. Vascular Surgery Faculty  Craig Kent, Chairman, Department of Surgery  William Turnipseed, Section Chief  John Hoch, Residency Program Director  Charles Acher, complex aortic surgery  Girma Tefera, endovascular leader  Gretchen Schwarze, surgical ethicist  Matthew Mell, public health researcher

3. Craig Kent, MD  A.R. Curreri Professor, Chairman, Department of Surgery  Residency UCSF, 1981-1986  Vascular Fellowship Brigham & Women's Hospital, 1986-1988  Chief, Combined Columbia and Cornell Division of Vascular Surgery, New York Presbyterian Hospital, 1997-2008  President Society For Vascular Surgery, 2006- 2007  Member, Vascular Surgery Board of American Board of Surgery, 2008-2012  PI on more than 45 Industry Sponsored Clinical trials  PI or co-investigator on 4 active NIH grants  Author of 233 manuscripts and 44 book chapters

4. William Turnipseed, MD  Professor of Surgery  Chief Section of Vascular Surgery  MD, Emory University, Atlanta, Ga., 1969  Residency, NIH Academic Trainee, Ohio State University Hospitals, 1969-1974  Fellowship, Peripheral Vascular Surgery, Ohio State University Hospitals, 1974-75  Clinical and Research interests  Thoracic outlet syndrome management  Management of chronic compartment syndrome  Stepping down as section chief, 2009

5. Charles Acher, MD  Professor of Surgery  Director, Thoracoabdominal Aneurysm Program  Residency, University of Wisconsin, Madison, Wis., 1973-1978  Fellow, GI and Peripheral Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, England, 1978-1980  Peripheral Vascular Fellow, Baylor College of Medicine, 1982-1983  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

6. John R. Hoch, MD  Professor of Surgery  Program Director Vascular Residency, 1999 - present  Chief Vascular Surgery, VA Hospital, 1994 – present  Residency, Thomas Jefferson University, Philadelphia, Penn., 1983-1989  Fellow, Vascular Surgery, University of Missouri-Columbia, Columbia, Mo., 1989-1991  Research:  PI VA Co-op trial #410 and #498  Industry sponsored clinical trials  Translational research  Clinical Interests:  Complex aortic and visceral artery occlusive disease  Endovascular management of arterial occlusive and aneurysmal disease  Less invasive management of varicose vein disease

7. Girma Tefera, MD  Associate Professor of Surgery  Director, UW Limb Salvage Angioplasty and Carotid Stenting Program  Residency in General Surgery, Howard University Hospital, Washington, D.C., 1994-1999  Fellowship in Vascular Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis., 1999- 2000  Research and Clinical Interests  Carotid stenting  Limb salvage angioplasty  Endovascular aortic stent grafts and angioplasty of peripheral arteries  Thoacoabdominal aneurysm repair by open and endovascular means  Developer and Manager of Vascular Surgery Database

8. Gretchen Schwarze, MD  Assistant Professor of Surgery  MD, Harvard Medical School, 1995  John F. Kennedy School of Government, 1995  Mass General, General Surgery Residency, 2002  University of Chicago Vascular Residency, 2004  Research and Clinical Interests  Surgical ethics research  Developer of the UW School of Medicine and Public Health Ethics Curriculum  Endovascular specialist  Surgical education

9. Matthew Mell, MD  Assistant Professor of Surgery  General Surgery, Stanford, 1987-1992  Transplant, Stanford, 1992-1993  Senior Surgeon, The Permanente Medical Group, Hayward, Calif. 1993- 2005  Vascular Residency, University of Wisconsin, 2005-2006  Director, third- and fourth-year medical student rotations in vascular surgery  Clinical and Research Interests  Complex aortic disease and its management by open and endovascular techniques  Public Health and Vascular Disease research  Surgical education

10. Vascular Surgery Fellowship Goals Develop Excellence in:  Routine and complex open vascular surgery  Diagnostic arteriography  Endovascular intervention of aneurysmal and occlusive disease  Interpretation of non-invasive vascular laboratory studies and their limitations  Clinical research project with faculty mentor

11. Vascular Surgery Fellowship Goals  Competency in the basic science and clinical curriculum *  Competency as a teacher  Compliance with the 80-hour work week  Management of the weekly teaching and indication conferences and monthly Journal Club * http://apdvs.vascularweb.org/APDVS_Contribution_Pages/New_Curriculum/Clinical/Clinical_Curriculum_INDEX.html

12. Curriculum  APDVS curriculum online with references  Written Curriculum Goals and Educational Objectives  September UCLA Vascular Review Course, first year  Selected topics presented weekly by residents, faculty, and invited speakers at Vascular Conference  Files with selected references in hard copy filed in resident’s office  VSEP exam in Fall to direct your reading; Vascular Surgery Inservice Exam in February.

13. Structure of First Year  Daily rounds  Non-invasive vascular lab  Diagnostic arteriography and endovascular interventions  Venous disease rotation  Arterio-venous access rotation  Clinical research and critical thinking

14. Non-invasive Vascular Lab  Daily reading at the VA and on a rotational basis at the University Hospital  One-half day per week hands-on in the lab first six months  Didactic lectures on CD  Gain a complete understanding of the indications, interpretation and limitations of each test  Prepared to pass ARDMS examination during second year of residency

15. Endovascular Interventions  Preoperative evaluation of the patient  Developing a therapeutic plan of endovascular intervention, in consultation and input of the faculty  Performance of the endovascular intervention, and follow up of the patient  Responsible for endovascular procedures in the UW Cath lab, and VA OR.  Participate in weekly VA clinic and indications conferences and monthly endovascular Q&A conferences; quarterly city-wide endovascular forum dinner meeting

16. Venous Disease Rotation  One month rotation at Meriter Hospital  Rotate into venous clinic  Office-based and hospital operating room-based interventions  Minimally invasive techniques, and the postoperative care of patients with venous disorders

17. Arterio-Venous Access Clinic  Pre-operative and post operative care of patients requiring complex venous access surgery  AV access endovascular procedures with Dr. Alex Yevzlin, interventional nephrologists  Yolanda Becker’s clinic PRN

18. Clinical Research and Critical Thinking  The first-year resident will be enrolled in two classes:  1. Biostatistics and Medical Informatics  2. Introduction To Clinical Trials  Prepare the resident for the design, implementation, and conduct of clinical trials  Assigned research mentor  Database manager  Section will cover meeting costs for presentation  Weekly didactic lecture, monthly Journal Club

19. Clinical Coverage in First Year  Call is from home, backing up an intern who is on in- house first call  Approximately every third night during the week and every other weekend call and rounding responsibilities  First-year vascular fellow rounds with the UW Hospital Service daily  Cover of clinical services when second-year vascular resident or the VA PGY-4 out on vacation (6 weeks)  Optional participation in basic science vascular lab/meetings  The first-year vascular fellow will act as a consultant for the PGY-4, and will be responsible for many percutaneous and open VA endovascular cases if scheduling permits.

20. Second Year of Training  Second-year vascular fellow runs UW vascular service; general surgery PGY-4 runs the VA vascular service.  UW Service  PGY-3, PGY-1 and two nurse practitioners  Clinic on Wednesdays at VA; Dr. Kent has clinic Monday afternoons in the UW Hospital  OR #5, 7:30 a.m. starts (two on Tuesday)  Endovascular experience in operating room and periodically in cath lab (Wednesday mornings)

21. Second Year of Training  VA Service  General Surgery PGY-4, PGY-1, PGY-3 and VA NP  Clinic on Wednesdays at VA  OR #4, 7:30 a.m. starts  Endovascular experience in OR, OEC 9800. New construction of an Operating Room VA angio suite to begin Fall 2009.  The first-year vascular fellow will act as a consultant for the PGY-4, and will be responsible for most percutaneous and open VA endovascular cases.

22. Second Year of Training  Call:  Approximately every third night from home during the week, backing up the intern who is in house. The general surgery night float admits vascular patients from the ER.  The vascular faculty member on call backs up the PGY-3 when they are on first call  The vascular fellows are on call and have rounding duties every other weekend  When the PGY-3 is on weekend first call, the faculty will not call in the fellow except for “index” cases, allowing greater vascular exposure for the PGY-3

23. Conferences / Teaching  Weekly Wednesday Teaching Conference  30-minute didactic lecture by vascular and guest faculty members  PGY-4 and PGY-3 give one didactic lecture during 10-week rotation  Vascular fellows each give a didactic lecture every eight weeks  Morbidity/Mortality Weekly  1-2 interesting cases if time allows  Weekly Thursday Vascular Indications Conference  Pre-operative presentation of patients requiring endovascular and open procedures  Two vascular fellows and VA PGY-4 present with faculty.  Monthly Journal Club  Monthly Endovascular Q&A  Quarterly City-wide Endovascular Forum

24. Conferences / Teaching  Grand Rounds  Each vascular fellow is assigned one grand rounds presentation per year  All third-year medical students rotate in VA Clinic  Additional third-year medical students complete a two- week rotations and fourth-years do month long electives  Attend SVS meeting second year; attend any meeting at which you are presenting  First-year resident attends UCLA Vascular Basic Science Review Conference  Summer Core Competency Lectures

25. Resident Evaluation  Fellow performance evaluation  Every four months  Faculty  360-degree evaluation by nursing (floor and OR), cath lab personnel, NPs and support staff  February Inservice Exam (VSITE)  Quality Improvement Project  Anonymous evaluation of program and faculty by computer input

26. Routine and complex open vascular surgery cases 2007-2008 UW Fellow Nat’l Average Percentile UW Fellow Nat’l Average Percentile  Abdominal167 65 98%  Open AAA 44 16 98%  Cerebrovascular 37 54 22%  Peripheral100 101 58%  Complex200 85 97%  Mesenterics 5 4 64%  TAA 35 5 96%  Endografts 106 71 81%  Total Open 504 305 93%

27. Endovascular Experience UW Fellow Nat’l Average Percentage UW Fellow Nat’l Average Percentage  Diagnostic 82 (615) 95 (382) 50%  Therapeutic 239 (487) 151 (255) 80%  Endografts 76 (106) 55 (71) 80%  First number is primary recorded procedure, the number ( ) is secondary recorded procedures (Both are recorded for the RRC for Surgery)  Limb Salvage Angioplasty Program  Carotid Stenting Program  Thoracic Endograft Program

28. 80-Hour Work Week

29. Questions?