Anesthesiology & Pain Medicine >> Education >> Fellowship in Cardiothoracic Anesthesiology

Fellowship Training Program:
Fellowship in Cardiothoracic Anesthesiology

Description

The University of Washington (UW) Adult Cardiothoracic Anesthesiology Fellowship is a one-year clinical fellowship based at University of Washington Medical Center (UWMC). The fellowship has been ACGME-accredited since 2008, and provides extensive experience with anesthesia and perioperative/periprocedural management of patients undergoing cardiac, non-cardiac thoracic, and intrathoracic vascular surgery, as well as non-operative diagnostic and interventional cardiovascular and electrophysiological procedures.

It is the program’s goal to produce graduates who are highly competent in anesthesia and perioperative care for the cardiothoracic/cardiovascular patient, proficient in advanced perioperative echocardiography, qualified to provide consultant advice, and dedicated to leading and advancing excellent Cardiothoracic Anesthesiology practice.

Please note that UW Adult Cardiothoracic Anesthesiology Fellowship training position appointments typically start on August 1.

Clinical Experience

Cardiac OR

The Division of Cardiothoracic Anesthesiology provides anesthesia/perioperative care for cardiac surgical procedures both at UWMC and at Northwest Hospital & Medical Center (NWH), a community hospital that is part of UW Medicine. Over 630 cardiac surgical cases, predominantly of high complexity, were performed in academic year 2015-2016. Surgical case distribution, excluding transcatheter therapies (see below), was as follows

  • CABG (isolated) 15%
  • Congenital 8%
  • Heart transplantation 7%
  • Thoracic aortic - open 14%
  • Thoracic aortic - endovascular - 2%
  • Valvular (including combined CABG + valve surgery) 30%
  • Ventricular assist device / total artificial heart 14%
  • Other 8%

In addition, the Division of Cardiothoracic Anesthesiology provides anesthesia/periprocedural care in patients undergoing transcatheter therapies for structural heart disease, electrophysiological procedures, and percutaneous coronary interventions. A significant proportion of transcatheter aortic valve implantation procedures and the majority of other transcatheter valve therapies at UWMC are performed under general anesthesia and involve periprocedural TEE evaluation by Division of Cardiothoracic Anesthesiology faculty. In academic year 2015-2016, case volumes were

  • TAVI / TAVR: 276
  • Other transcatheter therapies for structural heart disease: >77

Fellow responsibilities in the cardiac operating rooms balance personal delivery of anesthesia/perioperative care with supervision and instruction of junior Anesthesiology residents, all under appropriate, frequently one-to-one, supervision by Cardiothoracic Anesthesiology faculty.

Training in advanced perioperative transesophageal echocardiography is integrated into the Cardiac OR rotation experience. Perioperative/periprocedural TEE is utilized in virtually all cardiac surgical cases, in a proportion of transcatheter aortic valve implantations, most other transcatheter therapies for valvular and structural heart disease, and in many other cardiovascular interventions performed under general anesthesia. Fellows personally perform the majority of perioperative/periprocedural TEE studies, with direct supervision and guidance by Cardiothoracic Anesthesiology faculty who are either National Board of Echocardiography (NBE)-certified in Advanced Perioperative Transesophageal Echocardiography (12 of 15 faculty), NBE-certified in Adult Transesophageal Echocardiography (1 of 15), or testamurs of the Advanced Re-PTE pursuing NBE re-certification (1 of 15).

Cardiothoracic Intensive Care Unit

The required critical care rotation experience on the UWMC Cardiothoracic Intensive Care Unit (CICU) offers exposure to a population of critically ill patients recovering from cardiac, thoracic, and vascular surgery. The UWMC CICU is a high-acuity and high-complexity unit with an emphasis on the care of patients after thoracic organ transplantation, patients with adult congenital heart disease, and patients after implantation of cardiac assist devices. Through a combination of clinical experience, bedside teaching, didactic lectures and conferences, and directed fellow reading, the CICU rotation enables learning of a systematic approach to the management of critically ill adult cardiothoracic surgical patients.

Echocardiography Lab

All fellows currently complete a one-month elective rotation in the UWMC Echocardiography Lab. Fellows gain experience in lab-based and bedside 2D and 3D transthoracic as well as transesophageal echocardiography. The rotation experience will progress from the observation to the performance, under supervision, of echocardiographic examinations, and the offline interpretation and reporting, under supervision by UW Cardiology faculty, of echocardiographic studies performed by registered medical or cardiac diagnostic sonographers.

Thoracic OR

769 non-cardiac thoracic surgical cases were performed at UWMC in academic year 2015-2016. The program at UWMC provides experience with the full range of contemporary thoracic surgical practice including lung transplantation; open, video-assisted, and robotic lung resection including pneumonectomy; lung volume reduction surgery (both video-assisted and open); tracheal resection/reconstruction; pulmonary thrombendarterectomy; esophageal resection; and numerous endoscopic airway interventions. The lung transplant program at UWMC is one of the larger programs in the US. The rotation provides ample opportunities to become proficient in thoracic epidural catheter placement, lung isolation, management of one-lung ventilation, and anesthesia management for airway interventions.

Electives

Established elective rotation options include:

  • Adult Congenital Heart Disease Clinic
  • Cardiopulmonary Perfusion
  • Cardiothoracic Intensive Care Unit
    (—that is in addition to the “required” one-month cardiothoracic surgical critical care rotation)
  • Cardiac Implanted Electronic Device (aka pacemaker and ICD) Management
  • Echocardiography Lab
  • Pediatric Cardiac Anesthesiology
  • Research

Elective rotations are based at University of Washington Medical Center, with the exception of the Pediatric Cardiac Anesthesiology rotation which is based at Seattle Children’s Hospital.

Didactic Education

Weekly Cardiothoracic Anesthesiology fellow seminars cover knowledge areas required by ACGME, and provide didactic education in perioperative echocardiography. This perspective is supplemented and enhanced by fellow attendance of relevant didactic lectures and seminars of the Cardiology, Cardiothoracic Surgery, and Critical Care Medicine fellowship training programs at University of Washington.

Conferences

The conference program includes the weekly interdisciplinary Cardiology Case Conference, a forum for review of interesting and challenging cases, often involving presentation of echocardiographic findings; weekly Cardiothoracic Anesthesiology TEE Review; weekly Anesthesiology & Pain Medicine Grand Rounds; and bimonthly Cardiothoracic Anesthesiology Journal Club.

Faculty

  • Arora, Vivek, MB MB Acting Assistant Professor, VAPSHCS
    Regular Faculty
    photo of faculty member

    Vivek Arora, MB BS

    Acting Assistant Professor,
    Anesthesiology & Pain Medicine

    varora2@uw.edu

    Primary Location: VA Puget Sound HC

  • Bowdle, T. Andrew, MD, PhD Professor & Director (CT Anesth Simulation), UWMC
    Regular Faculty
    photo of faculty member

    T. Andrew Bowdle, MD, PhD

    Professor & Director of Cardiothoracic Anesthesiology Simulation,
    Anesthesiology & Pain Medicine;
    Adjunct Professor, Pharmaceutics

    bowdle@uw.edu

    Primary Location: UW Medical Center

    Clinical Interests: Cardiothoracic anesthesiology, echocardiography, physiologic monitoring.

    Research Interests: Clinical pharmacology, patient safety and outcomes.

    Personal Interests: Skiing, photography and cycling.

  • Dziersk, Jorg, MD, FRCA Clinical Associate Professor, UWMC
    Regular Faculty
    photo of faculty member

    Jorg Dziersk, MD, FRCA

    Clinical Associate Professor,
    Anesthesiology & Pain Medicine

    jorgd@uw.edu

    Primary Location: UW Medical Center

    Clinical Interests: Anesthesia for Cardiothoracic Surgery, Intraoperative TEE.

    Personal Interests: Contemporary fiction, biking, hiking, jazz.

  • Ferreira, Renata, MD Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Renata G. Ferreira, MD

    Assistant Professor, Anesthesiology & Pain Medicine
    Staff Anesthesiologist, UWMC

    Primary Location: UW Medical Center

  • Hall, Michael, MD Acting Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Michael Hall, MD

    Acting Assistant Professor,
    Anesthesiology & Pain Medicine

    Primary Location: UW Medical Center

  • Jelacic, Srdjan, MD Acting Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Srdjan Jelacic, MD

    Acting Assistant Professor,
    Anesthesiology & Pain Medicine

    sjelacic@uw.edu

    Primary Location: UW Medical Center

  • Joffe, Denise C., MD Associate Professor, SCH
    Regular Faculty
    photo of faculty member

    Denise C. Joffe, MD

    Associate Professor,
    Anesthesiology & Pain Medicine

    denise.joffe@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Clinical Interests: Adult and pediatric congenital heart disease.

    Research Interests: Use of dexmetetomidine in patients with single ventricle physiology and patients post-heart transplant.

  • Lombaard, Stefan A., MB ChB, FANZCA Clinical Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Stefan A. Lombaard, MB ChB, FANZCA

    Clinical Assistant Professor,
    Anesthesiology & Pain Medicine

    lombaard@uw.edu

    Primary Location: UW Medical Center

  • Mackensen, G. Burkhard, MD, PhD, FASE Professor & Chief (CT Anesthesia), UWMC
    Regular Faculty
    photo of faculty member

    G. Burkhard Mackensen, MD, PhD, FASE

    Professor & Chief (Cardiothoracic Anesthesiology),
    Anesthesiology & Pain Medicine;
    UW Medicine Research & Education Endowed Professor
    in Anesthesiology, Adjunct Professor of Medicine

    gbmac@uw.edu

    Primary Location: UW Medical Center

  • Natrajan, Krishna M., MB BS, FRCA Clinical Professor, UWMC
    Regular Faculty
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    Krishna M. Natrajan, MB BS, FRCA

    Clinical Professor, Cardiothoracic Anesthesiology
    Anesthesiology & Pain Medicine

    natrajan@uw.edu

    Primary Location: UW Medical Center

    Clinical Interest: Computers in medical education, trans-esophageal echo, automated anesthesia records.

    Research Interest: Adult congenital heart disease and trans-esophageal echo in those patients. Special expertise in lung transplant anesthesia, particularly avoiding bypass. Interest in management of pulmonary hypertension patients undergoing anesthesia.

    Personal Interest: Computing, sailing, photography, playing saxophone, cycling.

  • Oxorn, Donald C., MD, CM, FRCPC, FACC Professor, UWMC
    Regular Faculty
    photo of faculty member

    Oxorn, Donald C., MD, CM, FRCPC, FACC

    Professor, Anesthesiology & Pain Medicine

    oxorn@uw.edu

    Primary Location: UW Medical Center

    Professional Interest: Cardiothoracic anesthesiology, and more specifically in transesophageal echocardiography (TEE).

    Personal Interests: Jogging, golf, and family outings.

  • Peterson, Carly, MD Acting Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Carly, Peterson, MD

    Acting Assistant Professor,
    Anesthesiology & Pain Medicine

    cp66@uw.edu

    Primary Location: UW Medical Center

  • Sheu, Richard, D., MD Acting Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Richard Sheu, MD

    Acting Assistant Professor,
    Anesthesiology & Pain Medicine

    sheurich@uw.edu

    Primary Location: UW Medical Center

  • Togashi, Kei, MD Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Kei Togashi, MD

    Assistant Professor, Anesthesiology & Pain Medicine

    ktogashi@uw.edu

    Primary Location: UW Medical Center

  • Von Homeyer, Peter, MD, FASE Assistant Professor, UWMC
    Regular Faculty
    photo of faculty member

    Peter Von Homeyer, MD, FASE

    Assistant Professor
    Anesthesiology & Pain Medicine

    peter2@u.washington.edu

    Primary Location: UW Medical Center

    Professional Interests: Cardiovascular physiology, coagulation, echocardiography, and adult congenital heart disease.

    Personal Interests: He loves to spend time outdoors with his family, cycling, mountaineering, and reading.

Application

Eligibility

According to ACGME, effective July 1, 2016, “All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, or in an RCPSC-accredited or CFPC-accredited residency program located in Canada. Prior to appointment in the program, fellows must have successfully completed an ACGME- or RCPSC-accredited residency in anesthesiology.” While current ACGME program requirements for Adult Cardiothoracic Anesthesiology allow acceptance of "exceptionally qualified applicants" who did not complete an ACGME- or RCPSC-accredited residency in anesthesiology, acceptance criteria are extremely restrictive. This means that, in general, only current trainees in ACGME- or RCPSC-accredited Anesthesiology residency programs with a realistic expectation of successful training completion before August 2018, and recent graduates of ACGME- or RCPSC-accredited Anesthesiology residency programs, are eligible for appointment to our 2018-2019 fellowship positions.

Match Process

The UW Cardiothoracic Anesthesiology Fellowship program participates in the nation-wide Adult Cardiothoracic Anesthesiology Fellowship Match organized by SF Match.

SF Match now provides a Centralized Application Service (CAS) for Adult Cardiothoracic Anesthesiology fellowships.  Applicants must complete the online CAS application form and submit three (3) letters of recommendation to SF Match - instructions can be found on the SF Match website.  Other required documentation is listed below and should be submitted directly to the program.

The UW Cardiothoracic Anesthesiology Fellowship program currently does not have a program-specific application deadline but is bound by SF Match timelines. Applicants are encouraged to carefully review the information under Timetable on the SF Match website.

Application Documents

As explained above, an online application and three (3) letters of recommendation must be submitted to the SF Match Centralized Application Service.

Applicants should submit the following supporting documentation directly to the program:

  • Curriculum vitae
  • USMLE, COMLEX, or MCCQE transcript
  • Official medical or osteopathic school transcript
  • ABA BASIC Examination status
  • ECFMG certificate (if applicable)
  • Information about visa status (if applicable)

Please note: Official medical or osteopathic school transcripts must be sent directly to the program by the office generating the transcript.

Please send supporting documentation to:

Ashley E. Walker
Administrative Coordinator -
Cardiothoracic Anesthesiology
Department of Anesthesiology & Pain Medicine
University of Washington
Box 356540
1959 NE Pacific Street
Seattle, WA 98195-6540

Phone: 206-598-1994
F ax: 206-598-8269
Email: actanes@uw.edu

Fellowship Director

For further information please contact:

photo of fellowship director

Jörg Dziersk MD FRCA
Clinical Associate Professor,
Anesthesiology & Pain Medicine

Health Sciences Building, AA-117E, Box 356540
1959 NE Pacific Street, Seattle, WA 98195
Phone: 206-616-4252
Email: jorgd@uw.edu

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