Curriculum/Schedule

Clinical instruction is provided by each cardiothoracic anesthesia faculty member as well as some members of the Thoracic anesthesia team. The fellow is responsible for providing both a comprehensive cardiac anesthetic as well as complete perioperative care.  The goal is to develop the fellow to the level of a cardiothoracic anesthesia attending prior to the end of the fellowship so as to allow the fellow to focus on any areas of weaknesses prior to graduating the program.  The fellow, in conjunction with the attending, is also responsible for the clinical teaching of the UCMC Anesthesiology residents during their time on both cardiothoracic anesthesia and echocardiography elective rotations. 

Intraoperative experiences are supplemented with a month spent in the Cardiovascular Intensive Care Unit (CVICU), which is staffed by Critical Care Anesthesiologists. The CVICU is a multidisciplinary unit that involves services such as Cardiac Surgery, Thoracic, Vascular, Heart Failure, and Transplant.  The fellow is expected operate collaboratively with these teams and take care of patients as a Critical Care Fellow would.  Congenital heart disease education occurs within the confines of Cincinnati Children’s Medical Center in both the clinic and intra-operative setting.  The fellow is also granted an elective to pursue an educational opportunity of his/her choosing.  Finally, the fellow will have dedicated time with Perfusion and learn cardiopulmonary bypass management.

Training in transesophageal echocardiography (TEE) covers both intraoperative and non-operating room locations. The majority of training takes place during cardiac procedures where the fellow is responsible for direct clinical performance obtaining appropriate images but also developing the interpretation and application of those intra-operative echocardiographic images within the surgical decision making process.  Fellows are expected to complete formal TEE reports after each exam performed.  Non-operative training includes TEE done during liver transplantation, rescue TEE in the OR, and TEE performed for critically ill patients in the ICU.  Finally, the use of transthoracic echocardiography is performed with Cardiology and Echo technicians as part of a collaborative effort to enhance the education of the ACTA fellow.

University of Cincinnati Medical Center Adult Cardiothoracic Anesthesiology, in conjunction with the Department of Anesthesiology, Perioperative Medicine, and Pain Medicine and the Department of Cardiothoracic Surgery, will provide the Fellow experience in the following areas:

• Coronary Revascularization (on/off CPB)
• Valve repair and replacement
• Thoracic Aorta operations
• Heart Transplantation
• Mechanical Ventricular Assist Devices (LVAD, RVAD, IABP, Impella)
• Extracorporeal membrane oxygenation (ECMO)
• Catheter-based aortic valve replacement (TAVR)             
• Catheter-based mitral valve repair (Mitral Clip)
• Endovascular aortic repair (TEVAR, EVAR)
• Minimally invasive coronary revascularization
• Adult congenital heart disease
• Pediatric congenital heart disease (CCHMC)
• Anesthesia for patient with pulmonary hypertension    
• Cardiovascular surgical critical care medicine

The educational curriculum includes the following available to the fellow:

• Intraoperative TEE instruction
• Quarterly Cardiothoracic Anesthesia Quality Assurance (QA) meetings
• Weekly Cardiology Grand Rounds
• Monthly Echo Rounds with Cardiothoracic Anesthesia faculty members
• Problem-Based Learning Discussions (PBLDs) with Cardiothoracic Anesthesia faculty
• Daily TEE Review Sessions
• Quality Improvement Project (QIP) development and implementation
• Fellow-directed learning by use of PTE-Masters

During the year, the fellow will be expected to give a Grand Rounds presentation to the Department of Anesthesiology on a topic of his/her choosing.  The fellow will also prepare two PBLDs to give to the residents during the year as well.  In addition, the fellow will receive an educational stipend that provides full coverage to attend the Society of Cardiovascular Anesthesiologists (SCA) Annual Comprehensive Review & Update of Perioperative Echo as well as full funding to attend both Thoracic Anesthesia Symposium (TAS) and annual SCA meeting. The expectation for TAS/SCA coverage is that the fellow is to participate in the case report poster session.  A quality improvement or quality assurance process project is expected to be started/completed during the program.  Also, the fellow will be provided with 2-3 non-clinical days per month to devote to the development of these educational material and projects.

At the end of the twelve months of fellowship, the graduating fellow should feel confidant and well-prepared to take on any cardiothoracic anesthetic and provide exemplary care that is the standard for University of Cincinnati Medical Center Adult Cardiothoracic Anesthesiology Department.

Rotations:

• Cardiothoracic Anesthesia – 7 months
• Cardiovascular ICU – 1 month
• Thoracic Anesthesia – 2 weeks
• Perfusion – 2 weeks
• Cardiology/TTE – 2 weeks
• Cincinnati Children’s Congenital Clinic/Cardiac ORs – 2 weeks
• Elective – 4 weeks
• Vacation – 4 weeks