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

Fellowship Training Program:
Fellowship in Cardiothoracic Anesthesiology

Mission Statement

"Training outstanding leaders and educators in Adult Cardiothoracic Anesthesiology while improving the health of the public"

Description

The University of Washington (UW) Adult Cardiothoracic Anesthesiology Fellowship is a one-year clinical fellowship based at University of Washington Medical Center (UWMC) - Montlake campus. The fellowship has been ACGME-accredited since 2008, and provides extensive experience with anesthesia care 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.

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

Clinical Experience and Education

Cardiac OR

Approximately 600 cardiac surgical cases, predominantly of high complexity, were performed at UWMC in academic year 2018-2019. Case volume was reduced by approximately 20% in academic year 2019-2020 due to COVID-19. Surgical case distribution in 2018-2019, excluding any transcatheter interventions (see below), was as follows:

  • CABG (isolated) 13%
  • Heart transplantation 15%
  • Thoracic aortic surgery (open - excluding TEVAR) 16%
  • Valve surgery (including combined CABG + valve surgery) 40%
  • Ventricular assist device / total artificial heart 6%
  • Other (including congenital) 10%

The UW Division of Cardiothoracic Anesthesiology provides anesthesia and periprocedural care for all patients undergoing transcatheter therapies for structural heart disease, electrophysiological procedures, and percutaneous coronary interventions. A proportion of complex transcatheter aortic valve implantation/replacement procedures and the vast majority of other transcatheter valve therapies (e.g. MitraClip, transcatheter mitral valve replacement, left atrial appendage occluder device implantation) are performed under general anesthesia and involve procedural TEE evaluation and guidance that is exclusively provided by Division of Cardiothoracic Anesthesiology faculty. In academic year 2018-2019, case volumes were

  • Transcatheter aortic valve: 347
  • Other transcatheter therapies for structural heart disease: 115

Fellow responsibilities in the cardiothoracic operating rooms balance personal delivery of anesthesia/perioperative care with supervision and instruction of 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 complex transcatheter aortic valve implantation procedures, in a large proportion of 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 National Board of Echocardiography (NBE)-certified in Advanced Perioperative Transesophageal Echocardiography or Adult Transesophageal Echocardiography (12 of 18 faculty), or are testamurs of the NBE’s Advanced PTEeXAM pursuing NBE certification.

Cardiothoracic Intensive Care Unit

The required critical care rotation on the UWMC Cardiothoracic Intensive Care Unit (CICU) provides experience with the management of critically ill patients after cardiac, complex thoracic, and major vascular surgery. Care of patients following thoracic organ transplantation, with adult congenital heart disease, after implantation of durable cardiac assist devices, and/or on advanced mechanical circulatory support accounts for a significant proportion of the rotation experience. A combination of clinical experience, bedside teaching, didactic lectures and conferences, and directed fellow reading, promotes learning of a systematic approach to the management of critically ill adult cardiothoracic surgical patients.

Echocardiography Lab

All fellows complete an elective rotation (currently of three weeks duration) in the UWMC Echocardiography Lab, gaining experience in lab-based and bedside 2D and 3D transthoracic and transesophageal echocardiography. The rotation experience progresses 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

Approximately 800 non-cardiac thoracic surgical cases are performed at UWMC annually. The Thoracic Surgery 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. 60 lung transplants were performed at UWMC in 2019. (This places UWMC in the top 20% of US transplant programs by volume.) 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
  • Cardiac Care Unit (Cardiology critical care)
  • Cardiothoracic Intensive Care Unit
    (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
  • Transfusion Medicine
  • Research (depending upon availability of funding)

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 provide didactic education in anesthesia and perioperative/periprocedural management of the cardiothoracic/cardiovascular patient and in advanced 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 Cardiothoracic Anesthesiology TEE Review conference; the weekly Wednesday Interdisciplinary Case Conference, a forum for review of interesting and challenging cases, frequently involving presentation of echocardiographic findings; the weekly Anesthesiology & Pain Medicine Grand Rounds; and bimonthly Cardiothoracic Anesthesiology Journal Club.

Faculty

Application, Interview, and Match Process

Eligibility

According to ACGME, effective July 1, 2020, “All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, an AOA-approved residency program, a program with ACGME International (ACGME-I) Advanced Specialty Accreditation, or a Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency program located in Canada.” While current ACGME program requirements for Adult Cardiothoracic Anesthesiology allow acceptance of "exceptionally qualified applicants" who did not complete an ACGME-, AOA-, 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 2021, and recent graduates of ACGME-, AOA-, or RCPSC-accredited Anesthesiology residency programs, are eligible for appointment to the program’s 2021-2022 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 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:

  • 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
Fax: 206-598-8269
Email: actanes@uw.edu

Interview Arrangements

The University of Washington Medicine GME administration has determined, in accordance with recommendations by the Coalition for Physician Accountability (CoPA) and others, that all interviews for University of Washington GME training positions will continue to be conducted remotely until further notice.

Interviews for 2021-2022 UW Cardiothoracic Anesthesiology fellowship positions will be conducted through Zoom or another appropriate videoconferencing platform. Interview dates to be announced soon.

Fellowship Director

photo of fellowship director

Jörg Dziersk MD FRCA
Clinical Associate Professor, Program Director,
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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