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The Vascular Surgery and Endovascular Therapy Fellowship Experience

The Johns Hopkins Fellowship in Vascular Surgery and Endovascular Therapy is a two-year clinical tract that provides a comprehensive experience in the diagnosis and management of the broad spectrum of circulatory disorders, including arterial, venous and lymphatic disease. Known for our breadth of both open and endovascular experience, the first year was traditionally inpatient heavy with the second year being dedicated more to research, presentation at meetings and independent surgical experience.

With our ever increasing volume and service lines, as well as the Registered Physician in Vascular Interpretation (RPVI) requirement, the fellowship transitioned in 2014 to a balanced program over both years. The service is divided into two teams with a single fellow responsible for each. Fellows rotate between services every 3 months with the goal of having a complete inpatient and outpatient experience at the completion of the two years. The call is approximately every 3rd night and is split with the PGY-3 on the service. All call is “home call”, as there is a night-float intern on service throughout the year.

The inpatient service is run by the fellows. This includes morning rounds along with the PGY-3, PGY-1 and physician’s assistants. Our service is staffed by 5 full time advanced practitioners and 1 wound nurse who are integral members of our team, assisting the attendings, fellows, and residents with a wide spectrum of inpatient and outpatient clinical and administrative duties.

The second year fellow frequently operates independently, serving as a teaching assistant to the residents in both open and endovascular cases. The second year is also expected to run Thursday morning conference.  Ample time is set aside for presentations at national meetings, board examinations, and job interviews.

Both the first and second year fellows are assigned to an outpatient clinic a week where they participate in the preoperative evaluation and postoperative follow-up of patients with the attending surgeons. Over the two years, fellows rotate through each outpatient clinic in an effort to gain a comprehensive understanding of the outpatient management of vascular disease.

There is a dedicated and protected educational morning on Thursdays. Each morning there is a vascular morbidity and mortality, followed by interesting case conference, and a lecture series. Lecture topics vary weekly and range from aortic measurement to journal club and vascular lab interpretation. There is a lecture on a specific vascular surgical or vascular medicine subject given by a Johns Hopkins expert attending approximately once a month. 

In 2014, the ACGME revised the requirement for the RPVI, such that board eligibility in vascular surgery now necessitates that candidates obtain the RPVI Credential of the American Registry for Diagnostic Medical Sonography. In line with this new requirement, fellows spend time in our Vascular Laboratory learning non-invasive techniques, as well as interpretation of the diagnostic studies. There are also lectures throughout the year targeted at all aspects of non-invasive vascular lab diagnosis.  The Vascular Laboratory is fully accredited with the Intersocietal Accreditation Commission in extracranial cerebrovascular, peripheral arterial and venous and visceral vascular testing.

Clinical research is an integral part of the fellowship experience.  Fellows are expected to participate in multiple projects throughout their training.  The Johns Hopkins Surgery Center for Outcomes Research (JSCOR) within the Department of Surgery provides the division with expert statistical assistance, and is an invaluable resource.  Our goal is that fellows will be able to start their independent careers with a sound understanding of IRB protocols and reviews, statistical methodologies, and seeing a project through its inception, presentation, and publication. 

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