1. Vascular Service Curriculum 2010-2011 St Luke’s-Roosevelt Hospital

2. Division of Vascular Surgery at St Luke’s – Roosevelt Plans to lead the way to maximizing the resident staffs’ learning experience Plans to lead the way to maximizing the resident staffs’ learning experience Our goal as a faculty is “to train the resident staff to be the best clinicians they can be.” Our goal as a faculty is “to train the resident staff to be the best clinicians they can be.” PGY level and campus specific core knowledge and process goals; these are to serve as focus points to maximize your Adult Learning process. PGY level and campus specific core knowledge and process goals; these are to serve as focus points to maximize your Adult Learning process.

3. Expectation of residents Operating room Operating room Cath lab Cath lab Clinic/Office Clinic/Office In patient management In patient management Academic performance Academic performance

4. Operating Room: All interns/residents will know what case(s) they are scrubbing the following day All interns/residents will know what case(s) they are scrubbing the following day They will be expected to have read the appropriate section in “Cameron” for the case, (at a minimum) They will be expected to have read the appropriate section in “Cameron” for the case, (at a minimum) They will be prepared to answer questions prior to and during the case as to the pre-operative evaluation, the intra-operative decision making and the post operative management of the patients They will be prepared to answer questions prior to and during the case as to the pre-operative evaluation, the intra-operative decision making and the post operative management of the patients They may be asked to leave the operating room if they are not prepared. They may be asked to leave the operating room if they are not prepared. Therefore, you must know what case you are doing the next day prior to leaving the hospital. Therefore, you must know what case you are doing the next day prior to leaving the hospital.

5. Cath Lab This is an unique opportunity This is an unique opportunity This represents how up to 70% of long leg revascularizations are done This represents how up to 70% of long leg revascularizations are done You need to gain experience before you can gain independence You need to gain experience before you can gain independence If your taken care of them; you should have operated on them…. If your taken care of them; you should have operated on them…. Tuesdays – Dr Mendes – ST Lukes ORTuesdays – Dr Mendes – ST Lukes OR Wednesdays – Dr Lantis – 3 rd Floor cath labWednesdays – Dr Lantis – 3 rd Floor cath lab Thursdays – Dr Lee – 3 rd Floor cath labThursdays – Dr Lee – 3 rd Floor cath lab Fridays – Dr Benvenisty/Dr Lee – 3 rd Floor cath labFridays – Dr Benvenisty/Dr Lee – 3 rd Floor cath lab

6. Clinic: For members of the Vascular Service, NO OTHER clinic supercedes vascular clinic. For members of the Vascular Service, NO OTHER clinic supercedes vascular clinic. The goal of clinic is to learn the outpatient management of the patient with vascular and general surgical disease. The goal of clinic is to learn the outpatient management of the patient with vascular and general surgical disease. In addition it is to provide continuity of care. In addition it is to provide continuity of care.

7. Roosevelt Clinic Clinic occurs on the second and fourth Friday of the Month. From 1 pm – 4 pm. This clinic is staffed by Dr. Lee. Clinic occurs on the second and fourth Friday of the Month. From 1 pm – 4 pm. This clinic is staffed by Dr. Lee. There is also vascular office on Monday and Wednesday in 5G77 staffed by Dr. Todd. (Attendance in Clinic on Monday and Wednesday is by arrangement with Dr Todd) There is also vascular office on Monday and Wednesday in 5G77 staffed by Dr. Todd. (Attendance in Clinic on Monday and Wednesday is by arrangement with Dr Todd)

8. St Luke’s Clinic Monday – 12th Floor 1090 Amsterdam 9 - 5 – Dr Benvenisty Monday – 12th Floor 1090 Amsterdam 9 - 5 – Dr Benvenisty Monday – 7 th Floor 1090 Amsterdam 11-3 – Dr Mendes Monday – 7 th Floor 1090 Amsterdam 11-3 – Dr Mendes Tuesday -7 th Floor 1090 Amsterdam 9-5 Dr Lantis Tuesday -7 th Floor 1090 Amsterdam 9-5 Dr Lantis Wednesday – 7th Floor 1090 Amsterdam 10 - 5 Dr Lee Wednesday – 7th Floor 1090 Amsterdam 10 - 5 Dr Lee *Thursday – 12 th Floor 1090 Amsterdam 9-5 (2 days per month) Dr Benvenisty *Thursday – 12 th Floor 1090 Amsterdam 9-5 (2 days per month) Dr Benvenisty *Thursday – 7 th Floor 1090 Amsterdam 11-3 – Dr Mendes *Thursday – 7 th Floor 1090 Amsterdam 11-3 – Dr Mendes Friday – 7th Floor 1090 Amsterdam – 9 - 5 – Dr Lantis Friday – 7th Floor 1090 Amsterdam – 9 - 5 – Dr Lantis

9. Clinic Coverage Schedule Monday: Monday: Mendes - PGY1 Mendes - PGY1 Benvenisty PGY2 or PGY4 Benvenisty PGY2 or PGY4 Tuesday Tuesday Lantis - Anybody if free from other duties Lantis - Anybody if free from other duties Wednesday Wednesday Lee - PGY2 Lee - PGY2 Thursday Thursday Benvenisty: PGY2 or 4 Benvenisty: PGY2 or 4 Friday Friday Lantis - PGY 1 and PGY4 Lantis - PGY 1 and PGY4 Note: If you aren’t doing anything you should be in clinic, when you get out you will NEVER say you have had TOO MUCH clinic Note: If you aren’t doing anything you should be in clinic, when you get out you will NEVER say you have had TOO MUCH clinic

10. Floor Management: The vascular surgery patient represents the most complex and ill patient type that the surgical resident will encounter. The vascular surgery patient represents the most complex and ill patient type that the surgical resident will encounter. They require a comprehensive approach, just getting a medical consult is not the way to think about these problems. They require a comprehensive approach, just getting a medical consult is not the way to think about these problems. On a daily basis each patient’s problem list needs to be reviewed, and more importantly acted upon. On a daily basis each patient’s problem list needs to be reviewed, and more importantly acted upon. Abnormal lab values need to be corrected, or addressed as to why they are not being corrected. Fluid status and wounds need to be assessed daily. Antibiotics need to be chosen based on objective data.Abnormal lab values need to be corrected, or addressed as to why they are not being corrected. Fluid status and wounds need to be assessed daily. Antibiotics need to be chosen based on objective data.

11. Floor Management It is the responsibility of the senior resident to make sure that the junior resident understands the medical management of each patient, and the junior resident instructs the interns. However, ultimately it is the Attending surgeons’ responsibility. It is the responsibility of the senior resident to make sure that the junior resident understands the medical management of each patient, and the junior resident instructs the interns. However, ultimately it is the Attending surgeons’ responsibility. Wound management – wounds may need intervention not just dressings; why wet to dry may be good? Wound management – wounds may need intervention not just dressings; why wet to dry may be good?

12. Notes: Notes: The daily progress note on the Vascular patient should state at the top: Notes: The daily progress note on the Vascular patient should state at the top: Hospital day/Post operative dayHospital day/Post operative day Anti-biotic day (and what anti-biotic) and FOR WHAT ORGANISM(S)Anti-biotic day (and what anti-biotic) and FOR WHAT ORGANISM(S) The labs are to included in the daily noteThe labs are to included in the daily note These are not chores these are opportunities to learn. In addition it is the residents job to ask; These are not chores these are opportunities to learn. In addition it is the residents job to ask; why is this patient in the hospital?why is this patient in the hospital? what am I doing to get them better today?what am I doing to get them better today? …..the answer to this should be evident daily……..the answer to this should be evident daily…

13. Walk Rounds/Teaching Rounds: At present there is a once a month formal walk round schedule. At present there is a once a month formal walk round schedule. However: daily- However: daily- Attendings and residents are encouraged to find each other and make co-joined rounds on patients as their schedules permit. Attendings and residents are encouraged to find each other and make co-joined rounds on patients as their schedules permit. As vascular attending and coverage staff grows we will try to formalize at least a weekly – campus walk round schedule. As vascular attending and coverage staff grows we will try to formalize at least a weekly – campus walk round schedule. Currently planning once a week – walk roundsCurrently planning once a week – walk rounds

14. Vascular Conference: This educational conference remains weekly on Tuesday Morning from 7-7:45 AM. This educational conference remains weekly on Tuesday Morning from 7-7:45 AM. This conference is designed to be RESIDENT DRIVEN, meaning that cases and topics that the residents have recently encountered are to be a used as the fulcrum for discussion. This conference is designed to be RESIDENT DRIVEN, meaning that cases and topics that the residents have recently encountered are to be a used as the fulcrum for discussion.

15. Core Curriculum ‘Cameron’ reading ‘Cameron’ reading Assigned by levels Assigned by levels Minimum requirement Minimum requirement All reading prior to you level “fair game” All reading prior to you level “fair game” St Luke’s Campus St Luke’s Campus PGY 4/PGY 3/ PGY 1/PGY 1 PGY 4/PGY 3/ PGY 1/PGY 1 Roosevelt Campus Roosevelt Campus PGY 5/PGY 4/ PGY 2/PGY 1/PGY 1 PGY 5/PGY 4/ PGY 2/PGY 1/PGY 1

16. Roosevelt Chief Resident – A Rotation Chief Resident – A Rotation Abdominal Aortic Aneurysm: Open Repair 703 Abdominal Aortic Aneurysm: Open Repair 703 Abdominal Aortic Aneurysm: Endovascular repair 709 Abdominal Aortic Aneurysm: Endovascular repair 709 Abdominal Aortic Aneurysm and Unexpected Abdominal Pathology 718 Abdominal Aortic Aneurysm and Unexpected Abdominal Pathology 718 Brachiocepahlic reconstruction 758 Brachiocepahlic reconstruction 758 Profunda Femoral Reconstruction 789 Profunda Femoral Reconstruction 789

17. Roosevelt Chief Resident – B Rotation Chief Resident – B Rotation Acute Aortic Dissection and its Complications 729 Acute Aortic Dissection and its Complications 729 Upper Extremity Occlusive Disease 801 Upper Extremity Occlusive Disease 801 Acute mesenteric Ischemia 846 Acute mesenteric Ischemia 846 Chronic Mesenteric Ischemia 849 Chronic Mesenteric Ischemia 849 Atherosclerotic Renovascular Disease 831 Atherosclerotic Renovascular Disease 831

18. Roosevelt Senior Resident Senior Resident Ruptured Abdominal Aortic Aneurysm 713 Ruptured Abdominal Aortic Aneurysm 713 Transperitoneal vs. Retroperitoneal Approach to the Aorta 721 Transperitoneal vs. Retroperitoneal Approach to the Aorta 721 Popliteal and femoral artery aneurysms 732 Popliteal and femoral artery aneurysms 732 Carotid endarterectomy 747 Carotid endarterectomy 747 Recurrent Carotid Stenosis 751 Recurrent Carotid Stenosis 751 Balloon Angioplasty and Stents in Carotid Occlusive Disease 755 Balloon Angioplasty and Stents in Carotid Occlusive Disease 755 Aneurysms of the Extracranial Carotid and vertebral Arteries 762 Aneurysms of the Extracranial Carotid and vertebral Arteries 762 Thoracic Outlet Syndrome 840 Thoracic Outlet Syndrome 840

19. Roosevelt Consult Resident Consult Resident Nonoperative treatment of claudication 768 Nonoperative treatment of claudication 768 Aortoiliac Occlusive Disease 772 Aortoiliac Occlusive Disease 772 Femoropopliteal Occlusive Disease 777 Femoropopliteal Occlusive Disease 777 Cardiovascular pharmacology 1141 Cardiovascular pharmacology 1141 Acute renal failure 1147 Acute renal failure 1147 Coagulopathy in the critically ill patient 1184 Coagulopathy in the critically ill patient 1184 Peripheral Arterial and Bypass Graft Occlusion: Thrombolytic Therapy 824 Peripheral Arterial and Bypass Graft Occlusion: Thrombolytic Therapy 824 Pulmonary Thromboembolism 876 Pulmonary Thromboembolism 876 Vena Cava Filter Placement 879 Vena Cava Filter Placement 879 Reynaud’s Syndrome 838 Reynaud’s Syndrome 838

20. Roosevelt Intern Intern Fluid and electrolyte therapy 1087 Fluid and electrolyte therapy 1087 Pre-operative assessment of the elderly patient 1101 Pre-operative assessment of the elderly patient 1101 Perioperative care and monitoring of the surgical patient 1105 Perioperative care and monitoring of the surgical patient 1105 Prevention of Venous Thromboembolism in the Surgical Patient 884 Prevention of Venous Thromboembolism in the Surgical Patient 884 Surgical site infections 1118 Surgical site infections 1118 The diagnosis of Venous Insufficiency 860 The diagnosis of Venous Insufficiency 860 Deep Venous Thrombosis 869 Deep Venous Thrombosis 869

21. St Luke’s Senior /Chief Resident Senior /Chief Resident Thoracoabdominal Aneurysms 723 Thoracoabdominal Aneurysms 723 Tibioperoneal Arterial Occlusive disease 781 Tibioperoneal Arterial Occlusive disease 781 Axillofemoral bypass 792 Axillofemoral bypass 792 Peripheral Arterial Occlusive Disease: Angioplasty, Stenting, and Endovascular Graft Treatment 797 Peripheral Arterial Occlusive Disease: Angioplasty, Stenting, and Endovascular Graft Treatment 797 Infected Vascular Graft 808 Infected Vascular Graft 808 Peripheral artery embolus 817 Peripheral artery embolus 817

22. St Luke’s Consult Resident Consult Resident Vascular Access 828 Vascular Access 828 False aneurysm and Arteriovenous fistula 741 False aneurysm and Arteriovenous fistula 741 Buerger’s Disease 821 Buerger’s Disease 821 Vascular Trauma- 984 Vascular Trauma- 984 Penetrating Neck Trauma 1018 Penetrating Neck Trauma 1018 Necrotizing Infections of the Skin and Soft Tissue1082 Necrotizing Infections of the Skin and Soft Tissue1082 Gas gangrene of the extremity 1079 Gas gangrene of the extremity 1079 Extremity Compartment syndrome 989 Extremity Compartment syndrome 989

23. St Luke’s Intern Intern Skin lesions: Evaluation, Diagnosis and Management 1043 Skin lesions: Evaluation, Diagnosis and Management 1043 Nerve injury 1066 Nerve injury 1066 Varicose Veins 864 Varicose Veins 864 Venous reconstruction 871 Venous reconstruction 871 Gangrene of the Foot 813 Gangrene of the Foot 813 Management of Lymphedema Management of Lymphedema

24. AWARDS Three awards will be given out by the Division of Vascular Surgery to reward outstanding achievement while on the Vascular Surgery Rotation. Three awards will be given out by the Division of Vascular Surgery to reward outstanding achievement while on the Vascular Surgery Rotation. The recipients will be agreed upon by the Vascular Surgery Attending Staff. The recipients will be agreed upon by the Vascular Surgery Attending Staff. Appropriate patient management, informed input to clinical and operative care, correct diagnosis and algortihmAppropriate patient management, informed input to clinical and operative care, correct diagnosis and algortihm Participation in conference and teaching rounds, and active participation in clinic are considered the minimum requirements.Participation in conference and teaching rounds, and active participation in clinic are considered the minimum requirements. The recipient of any of the award(s) may be planning to pursue a career in any subspecialty, NOT only vascular surgeryThe recipient of any of the award(s) may be planning to pursue a career in any subspecialty, NOT only vascular surgery

25. AWARDS Each recipient will be announced at the year-end dinner and the will be able to add the commendation under Awards Section of their Curriculum Vitea. Each recipient will be announced at the year-end dinner and the will be able to add the commendation under Awards Section of their Curriculum Vitea. (PGY 4) Outstanding Vascular Senior Resident: 1-year subscription to Journal of Vascular Surgery (JR Nitzkorski, MD;) (PGY 4) Outstanding Vascular Senior Resident: 1-year subscription to Journal of Vascular Surgery (JR Nitzkorski, MD;) (PGY 2 or 3) Outstanding Vascular Consult Resident: 1-year subscription to Annals of Vascular Surgery (Manu Sanchet(t)i MD, Ryan Swan, MD) (PGY 2 or 3) Outstanding Vascular Consult Resident: 1-year subscription to Annals of Vascular Surgery (Manu Sanchet(t)i MD, Ryan Swan, MD) Outstanding Vascular Intern: 1-year subscription to Wound Repair and Regeneration (Liz Myers MD; Ron Ross, MD) Outstanding Vascular Intern: 1-year subscription to Wound Repair and Regeneration (Liz Myers MD; Ron Ross, MD)