Vascular Service Vascular Service Curriculum 2010-2011Curriculum 2010-2011

St Luke’s-Roosevelt Hospital St Luke’s-Roosevelt Hospital

Division of Vascular Surgery at Division of Vascular Surgery at St Luke’s – RooseveltSt Luke’s – Roosevelt

Plans to lead the way to maximizing Plans to lead the way to maximizing the resident staffs’ learning the resident staffs’ learning experience experience

Our goal as a faculty is “to train the Our goal as a faculty is “to train the resident staff to be the best clinicians resident staff to be the best clinicians they can be.” they can be.”

PGY level and campus specific core PGY level and campus specific core knowledge and process goals; these knowledge and process goals; these are to serve as focus points to are to serve as focus points to maximize your Adult Learning maximize your Adult Learning process.process.

Expectation of residentsExpectation of residents

Operating roomOperating room Cath labCath lab Clinic/OfficeClinic/Office In patient managementIn patient management Academic performanceAcademic performance

Operating Room:Operating Room: All interns/residents will know what case(s) they are All interns/residents will know what case(s) they are

scrubbing the following dayscrubbing the following day They will be expected to have read the appropriate section They will be expected to have read the appropriate section

in “Cameron” for the case, (at a minimum)in “Cameron” for the case, (at a minimum) They will be prepared to answer questions prior to and They will be prepared to answer questions prior to and

during the case as to the pre-operative evaluation, the during the case as to the pre-operative evaluation, the intra-operative decision making and the post operative intra-operative decision making and the post operative management of the patientsmanagement of the patients

They may be asked to leave the operating room if they are They may be asked to leave the operating room if they are not prepared. not prepared.

Therefore, you must know what case you are doing the Therefore, you must know what case you are doing the next day prior to leaving the hospital.next day prior to leaving the hospital.

Cath LabCath Lab This is an unique opportunityThis is an unique opportunity This represents how up to 70% of long leg This represents how up to 70% of long leg

revascularizations are donerevascularizations are done You need to gain experience before you You need to gain experience before you

can gain independencecan gain independence If your taken care of them; you should If your taken care of them; you should

have operated on them….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 Fridays – Dr Benvenisty/Dr Lee – 3 rd Floor cath

lablab

Clinic:Clinic:

For members of the Vascular For members of the Vascular Service, NO OTHER clinic Service, NO OTHER clinic supercedes vascular clinic.supercedes vascular clinic.

The goal of clinic is to learn the The goal of clinic is to learn the outpatient management of the outpatient management of the patient with vascular and general patient with vascular and general surgical disease. surgical disease.

In addition it is to provide continuity In addition it is to provide continuity of care. of care.

Roosevelt ClinicRoosevelt Clinic

Clinic occurs on the second and Clinic occurs on the second and fourth Friday of the Month. From 1 fourth Friday of the Month. From 1 pm – 4 pm. This clinic is staffed by pm – 4 pm. This clinic is staffed by Dr. Lee. Dr. Lee.

There is also vascular office on There is also vascular office on Monday and Wednesday in 5G77 Monday and Wednesday in 5G77 staffed by Dr. Todd. (Attendance in staffed by Dr. Todd. (Attendance in Clinic on Monday and Wednesday is Clinic on Monday and Wednesday is by arrangement with Dr Todd)by arrangement with Dr Todd)

St Luke’s ClinicSt Luke’s Clinic Monday – 12th Floor 1090 Amsterdam 9 - 5 – Dr Monday – 12th Floor 1090 Amsterdam 9 - 5 – Dr

BenvenistyBenvenisty Monday – 7Monday – 7thth Floor 1090 Amsterdam 11-3 – Dr Floor 1090 Amsterdam 11-3 – Dr

MendesMendes Tuesday -7Tuesday -7thth Floor 1090 Amsterdam 9-5 Dr Lantis Floor 1090 Amsterdam 9-5 Dr Lantis Wednesday – 7th Floor 1090 Amsterdam 10 - 5 Dr Wednesday – 7th Floor 1090 Amsterdam 10 - 5 Dr

LeeLee *Thursday – 12*Thursday – 12thth Floor 1090 Amsterdam 9-5 (2 days Floor 1090 Amsterdam 9-5 (2 days

per month) Dr Benvenistyper month) Dr Benvenisty *Thursday – 7*Thursday – 7thth Floor 1090 Amsterdam 11-3 – Dr Floor 1090 Amsterdam 11-3 – Dr

MendesMendes Friday – 7th Floor 1090 Amsterdam – 9 - 5 – Dr LantisFriday – 7th Floor 1090 Amsterdam – 9 - 5 – Dr Lantis

Clinic Coverage ScheduleClinic Coverage Schedule Monday:Monday: Mendes - PGY1Mendes - PGY1 Benvenisty PGY2 or PGY4Benvenisty PGY2 or PGY4    TuesdayTuesday Lantis - Anybody if free from other dutiesLantis - Anybody if free from other duties    WednesdayWednesday Lee - PGY2Lee - PGY2    ThursdayThursday Benvenisty: PGY2 or 4Benvenisty: PGY2 or 4    FridayFriday Lantis - PGY 1 and PGY4Lantis - 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 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 clinichave had TOO MUCH clinic

  

Floor Management:Floor Management: The vascular surgery patient represents the most The vascular surgery patient represents the most

complex and ill patient type that the surgical complex and ill patient type that the surgical resident will encounter.resident will encounter.

They require a comprehensive approach, just They require a comprehensive approach, just getting a medical consult is not the way to think getting a medical consult is not the way to think about these problems. about these problems.

On a daily basis each patient’s problem list needs On a daily basis each patient’s problem list needs to be reviewed, and to be reviewed, and more importantly acted more importantly acted upon.upon. • Abnormal lab values need to be corrected, or addressed Abnormal lab values need to be corrected, or addressed

as to why they are not being corrected. Fluid status and as to why they are not being corrected. Fluid status and wounds need to be assessed daily. Antibiotics need to wounds need to be assessed daily. Antibiotics need to be chosen based on objective data.be chosen based on objective data.

Floor ManagementFloor Management

It is the responsibility of the senior It is the responsibility of the senior resident to make sure that the junior resident to make sure that the junior resident understands the medical resident understands the medical management of each patient, and the management of each patient, and the junior resident instructs the interns. junior resident instructs the interns. However, ultimately it is the Attending However, ultimately it is the Attending surgeons’ responsibility.surgeons’ responsibility.

Wound management – wounds may need Wound management – wounds may need intervention not just dressings; why wet to intervention not just dressings; why wet to dry may be good?dry may be good?

Notes:Notes: Notes: The daily progress note on the Notes: The daily progress note on the

Vascular patient should state at the top:Vascular patient should state at the top:• Hospital day/Post operative dayHospital day/Post operative day• Anti-biotic day (and what anti-biotic) and Anti-biotic day (and what anti-biotic) and

FOR WHAT ORGANISM(S)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 These are not chores these are opportunities to learn. In addition it is the opportunities to learn. In addition it is the residents job to ask; 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…

Walk Rounds/Teaching Rounds:Walk Rounds/Teaching Rounds: At present there is a once a month formal At present there is a once a month formal

walk round schedule. walk round schedule. However: daily- However: daily- Attendings and residents are encouraged Attendings and residents are encouraged

to find each other and make co-joined to find each other and make co-joined rounds on patients as their schedules rounds on patients as their schedules permit. permit.

As vascular attending and coverage staff As vascular attending and coverage staff grows we will try to formalize at least a grows we will try to formalize at least a weekly – campus walk round schedule.weekly – campus walk round schedule.• Currently planning once a week – walk roundsCurrently planning once a week – walk rounds

Vascular Conference:Vascular Conference:

This educational conference remains This educational conference remains weekly on Tuesday Morning from 7-7:45 weekly on Tuesday Morning from 7-7:45 AM. AM.

This conference is designed to be This conference is designed to be RESIDENT DRIVEN, RESIDENT DRIVEN, meaning that cases meaning that cases and topics that the residents have recently and topics that the residents have recently encountered are to be a used as the encountered are to be a used as the fulcrum for discussion.fulcrum for discussion.

Core CurriculumCore Curriculum

‘‘Cameron’ readingCameron’ reading Assigned by levels Assigned by levels Minimum requirementMinimum requirement All reading prior to you level “fair All reading prior to you level “fair

game”game” St Luke’s CampusSt Luke’s Campus

PGY 4/PGY 3/ PGY 1/PGY 1PGY 4/PGY 3/ PGY 1/PGY 1 Roosevelt Campus Roosevelt Campus

PGY 5/PGY 4/ PGY 2/PGY 1/PGY 1PGY 5/PGY 4/ PGY 2/PGY 1/PGY 1

RooseveltRoosevelt Chief Resident – A RotationChief Resident – A Rotation Abdominal Aortic Aneurysm: Open Repair 703Abdominal Aortic Aneurysm: Open Repair 703 Abdominal Aortic Aneurysm: Endovascular repair Abdominal Aortic Aneurysm: Endovascular repair

709709 Abdominal Aortic Aneurysm and Unexpected Abdominal Aortic Aneurysm and Unexpected

Abdominal Pathology 718Abdominal Pathology 718 Brachiocepahlic reconstruction 758Brachiocepahlic reconstruction 758 Profunda Femoral Reconstruction 789Profunda Femoral Reconstruction 789

RooseveltRoosevelt Chief Resident – B RotationChief Resident – B Rotation

Acute Aortic Dissection and its Acute Aortic Dissection and its Complications 729Complications 729

Upper Extremity Occlusive Disease 801Upper Extremity Occlusive Disease 801 Acute mesenteric Ischemia 846Acute mesenteric Ischemia 846 Chronic Mesenteric Ischemia 849Chronic Mesenteric Ischemia 849 Atherosclerotic Renovascular Disease 831Atherosclerotic Renovascular Disease 831

RooseveltRoosevelt Senior ResidentSenior Resident Ruptured Abdominal Aortic Aneurysm 713Ruptured Abdominal Aortic Aneurysm 713 Transperitoneal vs. Retroperitoneal Approach to Transperitoneal vs. Retroperitoneal Approach to

the Aorta 721the Aorta 721 Popliteal and femoral artery aneurysms 732Popliteal and femoral artery aneurysms 732 Carotid endarterectomy 747Carotid endarterectomy 747 Recurrent Carotid Stenosis 751Recurrent Carotid Stenosis 751 Balloon Angioplasty and Stents in Carotid Balloon Angioplasty and Stents in Carotid

Occlusive Disease 755Occlusive Disease 755 Aneurysms of the Extracranial Carotid and Aneurysms of the Extracranial Carotid and

vertebral Arteries 762vertebral Arteries 762 Thoracic Outlet Syndrome 840Thoracic Outlet Syndrome 840

RooseveltRoosevelt Consult ResidentConsult Resident Nonoperative treatment of claudication 768Nonoperative treatment of claudication 768 Aortoiliac Occlusive Disease 772Aortoiliac Occlusive Disease 772 Femoropopliteal Occlusive Disease 777 Femoropopliteal Occlusive Disease 777 Cardiovascular pharmacology 1141Cardiovascular pharmacology 1141 Acute renal failure 1147Acute renal failure 1147 Coagulopathy in the critically ill patient 1184Coagulopathy in the critically ill patient 1184 Peripheral Arterial and Bypass Graft Occlusion: Peripheral Arterial and Bypass Graft Occlusion:

Thrombolytic Therapy 824Thrombolytic Therapy 824 Pulmonary Thromboembolism 876Pulmonary Thromboembolism 876 Vena Cava Filter Placement 879Vena Cava Filter Placement 879 Reynaud’s Syndrome 838Reynaud’s Syndrome 838

RooseveltRoosevelt InternIntern Fluid and electrolyte therapy 1087Fluid and electrolyte therapy 1087 Pre-operative assessment of the elderly Pre-operative assessment of the elderly

patient 1101patient 1101 Perioperative care and monitoring of the Perioperative care and monitoring of the

surgical patient 1105surgical patient 1105 Prevention of Venous Thromboembolism in Prevention of Venous Thromboembolism in

the Surgical Patient 884the Surgical Patient 884 Surgical site infections 1118Surgical site infections 1118 The diagnosis of Venous Insufficiency 860The diagnosis of Venous Insufficiency 860 Deep Venous Thrombosis 869Deep Venous Thrombosis 869

St Luke’sSt Luke’s

Senior /Chief Resident Senior /Chief Resident Thoracoabdominal Aneurysms 723Thoracoabdominal Aneurysms 723 Tibioperoneal Arterial Occlusive disease Tibioperoneal Arterial Occlusive disease

781781 Axillofemoral bypass 792Axillofemoral bypass 792 Peripheral Arterial Occlusive Disease: Peripheral Arterial Occlusive Disease:

Angioplasty, Stenting, and Endovascular Angioplasty, Stenting, and Endovascular Graft Treatment 797Graft Treatment 797

Infected Vascular Graft 808Infected Vascular Graft 808 Peripheral artery embolus 817Peripheral artery embolus 817

St Luke’sSt Luke’s Consult ResidentConsult Resident Vascular Access 828Vascular Access 828 False aneurysm and Arteriovenous fistula 741False aneurysm and Arteriovenous fistula 741 Buerger’s Disease 821Buerger’s Disease 821 Vascular Trauma- 984Vascular Trauma- 984 Penetrating Neck Trauma 1018Penetrating Neck Trauma 1018 Necrotizing Infections of the Skin and Soft Necrotizing Infections of the Skin and Soft

Tissue1082Tissue1082 Gas gangrene of the extremity 1079Gas gangrene of the extremity 1079 Extremity Compartment syndrome 989Extremity Compartment syndrome 989

St Luke’sSt Luke’s

InternIntern Skin lesions: Evaluation, Diagnosis Skin lesions: Evaluation, Diagnosis

and Management 1043and Management 1043 Nerve injury 1066Nerve injury 1066 Varicose Veins 864Varicose Veins 864 Venous reconstruction 871Venous reconstruction 871 Gangrene of the Foot 813Gangrene of the Foot 813 Management of LymphedemaManagement of Lymphedema

AWARDSAWARDS

Three awards will be given out by the Division of Three awards will be given out by the Division of Vascular Surgery to reward outstanding Vascular Surgery to reward outstanding achievement while on the Vascular Surgery achievement while on the Vascular Surgery Rotation. Rotation.

The recipients will be agreed upon by the The recipients will be agreed upon by the Vascular Surgery Attending Staff. Vascular Surgery Attending Staff. • Appropriate patient management, informed input to Appropriate patient management, informed input to

clinical and operative care, correct diagnosis and clinical and operative care, correct diagnosis and algortihmalgortihm

• Participation in conference and teaching rounds, and Participation in conference and teaching rounds, and active participation in clinic are considered the minimum active participation in clinic are considered the minimum requirements. requirements.

• The recipient of any of the award(s) may be planning to The recipient of any of the award(s) may be planning to pursue a career in any subspecialty, NOT only vascular pursue a career in any subspecialty, NOT only vascular surgery surgery

AWARDSAWARDS

Each recipient will be announced at the year-end Each recipient will be announced at the year-end dinner and the will be able to add the dinner and the will be able to add the commendation under Awards Section of their commendation under Awards Section of their Curriculum Vitea.Curriculum Vitea.

(PGY 4) Outstanding Vascular Senior (PGY 4) Outstanding Vascular Senior ResidentResident: 1-year subscription to : 1-year subscription to Journal of Journal of Vascular Surgery (JR Nitzkorski, MD;)Vascular Surgery (JR Nitzkorski, MD;)

(PGY 2 or 3) Outstanding Vascular Consult (PGY 2 or 3) Outstanding Vascular Consult ResidentResident: 1-year subscription to : 1-year subscription to Annals of Annals of Vascular Surgery (Manu Sanchet(t)i MD, Ryan Vascular Surgery (Manu Sanchet(t)i MD, Ryan Swan, MD)Swan, MD)

Outstanding Vascular InternOutstanding Vascular Intern: 1-year : 1-year subscription to subscription to Wound Repair and Regeneration Wound Repair and Regeneration (Liz Myers MD; Ron Ross, MD)(Liz Myers MD; Ron Ross, MD)