beth israel deaconess medical center a harvard medical school teaching hospital

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Fellowship Outline

The fellowship is structured to meet or exceed the requirements set forth by the ACGME. Typically, the cardiothoracic anesthesia fellow will spend the equivalent of six months in the cardiac operating rooms as the primary anesthesia caregiver. During this time they will be involved in a large variety of cases which will include coronary artery bypass graft surgery, valvular repair and replacement surgery, minimally invasive cardiac procedures, adult congenital cardiac surgery, and a variety of complex thoracic aortic surgeries. The fellow will be given opportunities to perform a variety of specialized procedures such as the placement of all coronary sinus catheters for minimally invasive procedures. The fellow will also participate in combined cardiac and vascular as well as combined operative and percutaneous "hybrid" cases in our new multi-million dollar endovascular room. surgery

In addition to the six months noted above, the fellow will have one month formally assigned to non-cardiac thoracic cases. These cases will be comprised of a variety of pulmonary procedures including lung resections through standard and minimally invasive incisions, tracheal surgeries, rigid bronchoscopies, and esophageal related surgeries. The fellow will also be assigned to these cases intermittently throughout the rest of their year.The fellow will, whenever feasible, perform preoperative assessment on all in-house cardiothoracic patients that he/she is assigned to care for intraoperatively. The fellow will be expected to develop a comprehensive anesthetic plan based on this assessment. After completion, this assessment and plan will be discussed with and reviewed by a supervising member of the Division of Cardiac Anesthesia. This serves as an important opportunity for teaching.

During the intraoperative period, the fellow is expected to put the anesthetic plan into effect and to modify the plan in real time as indicated or necessary. The fellow will always be supervised patientby an attending but given appropriate independence to make management decisions. During cardiac cases, the attending covers one case at any given time. During the intraoperative period, the fellow will receive teaching from faculty on an informal, one-on-one basis that will cover a broad range of topics related to cardiothoracic anesthesia, cardiothoracic surgery, cardiopulmonary bypass and perfusion management. The fellow will learn proper communication techniques and the concepts and practice as they relate to the team based approach to patient care.

The fellow will have two months dedicated to TEE experience. During this time the fellow's sole clinical responsibility, other than cardiac call responsibility, will be to perform and interpret TEE studies with an attending anesthesiologist assigned daily to the TEE service. This experience will be supplemented by the TEE studies performed and interpreted by the fellow on his/her own cases during the other clinical months. There also exists the opportunity for the fellow to read transthoracic studies with our cardiology colleagues every afternoon.

The fellow will spend one month of mandatory service in the Cardiovascular Intensive Care Unit (CVICU). During this rotation, the fellow will actively participate in every phase of patient care within the unit. Specifically, the fellow will admit patients to the unit, participate in daily rounds, develop and carry out patient care plans, assist with the placement and interpretation of invasive monitoring, and write appropriate orders and notes in the medical record. All of this activity will be under the direct supervision of a critical care attending whose sole responsibility is for the care of CVICU patients. These attendings are members of either the Department of Anesthesia or Department of Medicine.  During their rotation in the CVICU, fellows will be actively involved in the postoperative management of cardiac patients. The fellow will have numerous educational opportunities during this process including informal teaching on rounds as well as formal didactic sessions.

The elective rotations will consist of two one-month blocks. The choices for electives include but may not be limited to research (clinical or basic science), critical care, perioperative transesophageal echocardiography, non-invasive cardiology, and invasive pulmonary medicine. An elective rotation in pediatric cardiothoracic anesthesia is available for interested fellows at nearby Children's' Hospital of Boston. During this rotation, the fellow will actively participate in the preoperative assessment, intraoperative management, and postoperative follow-up of pediatric patients, including newborns undergoing a wide variety of cardiac surgeries. In addition, the fellow will participate in the anesthesia care of pediatric patients undergoing both invasive and non-invasive cardiology procedures.  There is opportunity to participate in weekly meetings between cardiologists, cardiac surgeons and cardiac anesthesiologists. This is a valuable piece in understanding the pathophysiology of these children with complex congenital cardiac disease.