Vascular-Thoracic-Transplant (VT) Anesthesia at Johns Hopkins

The “VT” anesthesia group at The Johns Hopkins Hospital is responsible for the anesthetic care of patients undergoing major vascular, liver transplantation, and thoracic surgeries. The goal of the fellowship in Vascular-Thoracic Anesthesia is to produce individuals with the varied practical and intellectual skills necessary to care for this challenging group of patients, while also developing the academic skills to become leaders in clinical and academic anesthesiology. Fellows gain extensive exposure to liver transplantation, thoracic surgery, and major vascular surgery with emphasis on those cases involving vascular crossclamps. Fellows are also responsible for the intraoperative management of patients undergoing other procedures who have severe underlying diseases such as coronary artery disease, congestive heart failure, stenotic and regurgitant valve lesions, major cardiac conduction disturbances, and pheochromocytoma.

Our fellowship emphasizes the development of those special skills which are a prerequisite for successful intraoperative care of severely debilitated patients. Fellows develop a broad background in cardiac and pulmonary physiology and pharmacology which promotes intelligent interpretation of measured and derived hemodynamic and pulmonary values. Using these data, fellows become experts at clinical decision making. The fellows learn to manage veno-veno bypass during liver transplantation and augmented (centrifugal) shunts during thoracic and thoracoabdominal aneurysm repair. Fellows learn the indications for the insertion of atrial and ventricular pacemakers and develop the ability to insert these devices under urgent and emergent conditions. Furthermore fellows acquire a fundamental appreciation of the physics of current monitoring equipment as well as hands-on-ability to calibrate, adjust and troubleshoot. An important component of fellowship training is learning supervisory skills, and fellows will primarily be involved in the supervision and training of junior residents.

Faculty members in the division have a wide range of research interests, both in basic science and in clinical research. Opportunities for academic activities, within the Division, the Department, and the Institution are boundless.

In response to changing needs and interests among residents regarding fellowship training, a two year flexible program for advanced clinical training and relevant academic experience is now being offered. Clinical work may be divided among cardiac, vascular-thoracic-transplant, and related elective experiences. The non-clinical portion may be devoted to traditional research activities ("research track") or to appropriate academic, educational, and teaching activities ("academic track"). In both tracks, the first year will be spent as an advanced clinical fellow and during the second year as a junior attending.

The number of positions available varies on a year-to-year basis depending on funding and the number of fellows currently enrolled. Interested applicants should sent a letter of intent, a C.V., and 3 letters of recommendation.

Clinical time divided among (approximately):

• Cardiac and VT 9 months
• TEE / Echocardiography 1/2 month
• Electives 1 1/2 months
  • CSICU
  • Cardiology / Cath lab
  • other

Will be considered part of VT group for posting as junior attendings.

• Echocardiography rotation- two months

Attending / fellow in cardiac as appropriate.

• Responsible for maintaining and distributing VT reading collection

• 50% clinical, 50% research.
• Research may be clinical or basic, with identification of appropriate advisor.

• 70% clinical commitment (3.5 d/wk), with at least 1 d/wk of that as a fellow supervising junior residents.

• Responsible for co-organizing (first year) weekly Cardiac Journal Club. Will present semi-monthly (both years).
• Will teach regularly at CA1/2 conferences on cardiac and VT topics.
• Will attend Dept. of Surgery Thoracic and Liver Transplant conferences periodically.
• Will present at Department Case Conference each year.
• July Clinical Associate 1 teaching during second fellowship year.

Participation in the department EBM course for fellows is required. EBM is an approach to caring for patients that involves the explicit and judicious use of the clinical research literature combined with an understanding of pathophysiology, clinical experience, and patient preferences to aid in clinical decision-making. The practice of EBM is a systematic process that will require physicians to learn new skills. The evidence-based approach offers explicit rules to critically appraise the evidence, defines an explicit hierarchy of evidence, provides specific tools to assist in quantitative clinical reasoning, and explicitly acknowledges the crucial role of patient values in clinical decision-making. This course will include 10 didactic sessions covering the basic tools of EBM, followed by a monthly journal club in which the fellows will analyze and present current articles from their areas of interest.