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Surgical Critical Care/Acute Care Surgery Fellowship

Surgical Critical Care/Acute Care Surgery Fellowship

The Surgical Critical Care (SCC) Fellowship is designed to allow fellows to develop advanced proficiency in the care of critically ill patients and to develop the qualifications to supervise surgical critical care units. This critical care education has now been supplemented with an additional year of comprehensive surgical training to create the Acute Care Surgery (ACS) Fellowship Program.

Overview

Under the direction of Program Director Marc de Moya, MD, the Massachusetts General Hospital postgraduate Surgical Critical Care Fellowship is designed to allow fellows to develop advanced proficiency in the management of all aspects of the care of critically ill surgical patients and to develop the qualifications necessary to supervise surgical critical care units. Fellows spend several months in the Surgical Intensive Care Unit, working alongside surgical and anesthesia intensivists. This one-year fellowship is approved by the ACGME. We also offer a two-year AAST approved comprehensive Acute Care Surgery Fellowship Program. We offer one postion per year in each program. One position for the Surgical Critical Care Fellowship and a second position in the Acute Care Surgery Program. Both positions are offered by the National Resident Matching Program (NRMP). Applications for both tracks are accepted from March 1 to June 15 via the SAFAS application site

Two-year Acute Care Surgery (ACS) Fellowship

The first year is focused on surgical critical care, but also includes some operative rotations. The second year is focused on trauma and complex emergency general surgery with the option of a four-week rotation at the one of the busiest long-standing trauma centers in the world at the Chris Hani-Baragwanath Hospital in Johannesburg, South Africa. Additional training in damage-control Orthopedics, Neurosurgical procedures, Vascular, Thoracic, Interventional Radiology and Hepatobiliary is provided to fulfill the Acute Care Surgery requirements. American Board Certification/Eligibility, in General Surgery is required to be considered as a candidate. The two-year fellowship also focuses on trauma system development, quality improvement and research. By a combination of cadaver operative skills assessments and graduated levels of supervision, we ensure that the fellow graduates with a high level of operative competency.

One-year Surgical Critical Care (SCC) Fellowship

This is an ACGME-approved fellowship focused purely on surgical critical care. The majority of the time spent in the ICU will be in our leading-edge surgical ICU’s and cardiac surgical ICU. There is a didactic focus on evidence based medicine, ECMO, bedside ultrasonography for critical care, critical analysis of research and advanced respiratory care. The fellow will have the opportunity to rotate in the neurosurgical ICU, burn ICU, medical ICU, or pediatric ICU as electives. Other electives may be tailored to the needs/interests of an individual fellow.  Applicants must have completed an ACGME-accredited General Surgical, OB/GYN, Emergency Medicine, Anesthesia, Orthopedic, Otolaryngology, Thoracic Surgery, Vascular Surgery or Urology residency. In the case of Emergency Medicine trainees, the fellow must complete a preliminary year in surgery at Mass General prior to matriculation in the critical care year. This preliminary year is focused on rotations that have critically ill patients.

ACS Curriculum AY1

Year One Curriculum: 

Orthopedic Surgery Rotation: Mass General

Goals

The goals of the fellowship are to provide:

  • A broad exposure to the evaluation and management of patients with urgent/emergent orthopedic injuries
  • Broad exposure to operative techniques and an opportunity to develop technical skills related to early management of orthopedic injuries
  • Practical orthopedic experience appropriate for a career in Acute Care Surgery

Competency-based Learning Objectives

Upon completion of this rotation the fellow will be able to:

Medical Knowledge:

  • Describe what is meant by damage control orthopedics
  • Compare and contrast the risks/benefits of early vs delayed fixation of orthopedic fractures
  • Demonstrate familiarity with traction, splints/casts, irrigation and debridement of fractures and external fixation
  • Describe management of nerve and tendon injuries
  • Demonstrate competent placement of pelvic binder
  • Compare and contrast treatment of severe pelvic fracture management options
  • Describe the diagnosis and treatment options for spine fractures and spinal cord injuries
  • Demonstrate how to perform 4 compartment fasciotomy of the leg
  • Demonstrate ability to interpret radiologic imaging studies of orthopedic injuries

Patient Care:

Demonstrate compassionate, appropriate, and effective care for the treatment of health problems and the promotion of health in the setting of the provision of surgical care in the following areas as they pertain to orthopedic trauma:

  • Musculoskeletal System: Interpretation of musculoskeletal imaging in orthopedic trauma.  The Fellows will participate as Surgeon or First Assistant in orthopedic trauma procedures to gain experience in fracture reduction and repair
  • Infectious Disease: Evaluate and treat infectious complications of orthopedic trauma
  • Neurological System: Diagnose and manage neurological complications associated with spine trauma

Neurosurgery Rotation: Mass General

Goals 

To provide:

  • A broad exposure to the evaluation and management of patients with urgent/emergent brain and spine injuries
  • Broad exposure to operative techniques and an opportunity to develop technical skills related to early management of brain injuries.
  • Practical orthopedic experience appropriate for a career in Acute Care Surgery

Competency-based Learning Objectives

Upon completion of this rotation the fellow will be able to:

  • Medical Knowledge:
  • Describe the indications and technique for placing an intra-cranial pressure monitor
  • Describe and demonstrate familiarity with indications and technique for burr holes and craniectomy
  • Compare and contrast the methods to treat traumatic brain injury, including decompressive craniectomy and decompressive spine surgery
  • Describe the non-surgical options for treatment of brain and spinal cord injuries
  • Demonstrate competency in interpretation of brain and spine radiographic imaging

Patient Care:

Demonstrate compassionate, appropriate, and effective care for the treatment of health problems and the promotion of health in the setting of the provision of surgical care in the following areas as they pertain to neurologic trauma:

  • Neurologic System: diagnosis and treatment of traumatic brain and spine trauma
  • Musculoskeletal System: Interpretation of spine imaging in trauma. The Fellows will participate as Surgeon or First Assistant in spine/TBI procedures to gain experience in spine fixation and operative decompression of brain and spine.
  • Infectious Disease: Evaluate and treat infectious complications of neurotrauma

Thoracic and Vascular Rotations: South Shore Hospital

Competency-based Learning Goals and Objectives

Patient Care:

Fellows must provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health in the setting of the provision of surgical care. Specifically, Fellows are expected to demonstrate proficiency in the following ACGME-based core competencies:

  • Circulatory System: Use and interpretation of invasive and non-invasive assessment tools such as peripheral Doppler evaluation and Duplex scanning of arterial and venous systems, arteriography (including CT Angiography).  Interpretation of Chest Imaging for Vascular disease. The Fellows will participate as Surgeon or First Assistant in Vascular procedures to gain experience in exposure of the vessels of the chest, abdomen, pelvis and extremities.
  • Endocrine System: Evaluate and manage endocrine conditions requiring Thoracic or Vascular exposure techniques (eg mediastinal goiter, adrenal tumor)
  • Gastrointestinal System: Evaluate and manage vascular conditions affecting the mesenteric circulation (eg occlusive mesenteric insufficiency, visceral artery aneurysm). Carry out operative approaches to esophageal resection, including open and VATS techniques.
  • Hematologic System: Understand and apply principles for anticoagulation as practiced in treatment of Vascular Surgery patients Diagnose and manage hematologic complications of Vascular surgery (eg heparin-induced thrombocytopenia). Diagnose and manage post operative bleeding.
  • Infectious Disease: Evaluate and treat infectious complications of Thoracic and Vascular surgery (eg graft infection, aortoenteric fistula, aspiration pneumonia, empyema).
  • Monitoring/Bioengineering: Use and calibration of invasive and non-invasive monitors used in Vascular and Thoracic Surgery (eg Continuous Intra-operative EEG monitoring, Carotid artery stump pressure, Intra-operative Doppler ultrasound, Esophageal manometry)  
  • Neurological System: Diagnose and manage neurological complications associated with Vascular and Thoracic surgery, including stroke, delirium, and spinal cord ischemia.
  • Nutritional System:  Assess nutritional goals in Vascular and Thoracic surgery patients. Manage nutritional support using enteral and parenteral routes. Assess response to nutritional support and adjust nutritional goals accordingly.
  • Renal System: Manage fluid and electrolyte balance in Vascular and Thoracic surgery patients. Understand and apply the principles of diuretic therapy in lung disease. 
  • Respiratory: Evaluate and manage lung cancer. Apply diagnostic tools to determine resectability of thoracic tumors (eg Exercise capacity, Maximal VO2, Ventilation/Perfusion Scan). Diagnose and manage respiratory insufficiency. Diagnose and manage pneumothorax with chest tubes. Carry out open and VATS approaches to pulmonary resection.

ACS Curriculum AY2

Trauma

  • Complex emergency general surgery
  • Bedside surgical procedures program
  • Hepatobiliary/pancreatic surgery

Transplant/Hepatobiliary Pancreatic Experience

Goals 

To provide:

  • A broad exposure to the surgical exposure and operative techniques for hepatobiliary and pancreatic surgery.
  • Provide practical surgical experience in this area in preparation for a career in Acute Care Surgery

Competency-based Learning Objectives

Upon completion of this rotation the fellow will be able to:

Medical Knowledge:

  • Demonstrate how to mobilize the liver and pancreas
  • Compare and contrast the methods for achieving hemostasis of a bleeding liver
  • Compare and contrast the methods for treating a pancreatic lesion
  • Describe the methods for damage control techniques for hepaticopancreatic injury and emergencies

Patient Care:

Demonstrate compassionate, appropriate, and effective care for the treatment of health problems and the promotion of health in the setting of the provision of surgical care in the following areas as they pertain to hepatobiliary and pancreatic disesase:

  • Circulatory System: Interpretation of abdominal imaging for hepatobiliary and pancreatic disease. The Fellows will participate as Surgeon or First Assistant in hepatobiliary/pancreatic procurements/transplant procedures to gain experience in exposure of the vessels of the liver and pancreas.
  • Gastrointestinal System: Evaluate and manage conditions affecting the liver and pancreas function during both pre-operative and post-operative phases
  • Hematologic System: Understand and apply principles for anticoagulation as practiced in treatment of coagulopathies related to liver dysfunction
  • Infectious Disease: Evaluate and treat infectious complications of liver and pancreatic surgery
  • Neurological System: Diagnose and manage neurological complications associated with liver or pancreatic dysfunction

Electives (0-3 Months)

  • Options include:

  • South Africa

  • Vascular/Thoracic

  • Pre-hospital/Med-Flight

  • Extended ortho/neurosurgical rotations

SCC Curriculum

The selected individual would have full privileges as a staff surgeon, and be eligible for a faculty appointment at the Harvard Medical School.

Required Clinical Rotations

Surgical Critical Care 

  • Trauma/Critical Care (9 months)
    Resuscitative and post-op management of complex surgical diseases related to general surgery and trauma
  • Electives in Trauma/Critical Care (3 months)
    Management of complex critical illness such as pediatric surgical care, neurocritical care, burns, etc.

Emergency and Elective Surgery (12 months)

Total: 24 months

Clinical Rotations During Emergency and Elective Surgical Experience

Training in the Division of Trauma, Emergency Surgery and Surgical Critical Care (12-15 months)

  • Trauma
  • Emergency non-trauma surgery
  • Thoracic
  • Vascular
  • Hepatobiliary/pancreatic
  • Endoscopy
  • Bedside surgical procedures program
  • Orthopaedic surgery (concurrent)
  • Neurological surgery (concurrent)
  • Thoracic (concurrent)
  • Vascular (concurrent)
  • Hepatobiliary/pancreatic surgery (concurrent)

Electives (0-3 months)

  • Burn surgery and pediatric surgery are recommended. Others would include endoscopy, imaging, plastic surgery, intervention radiology, etc.
  • Or, maximize time in above rotations

Total: 15 months

How to Apply

Starting March 1, we are accepting electronic applications through the Surgical Critical Care and Acute Care Surgery Fellowship Application Service (SAFAS). Please create an account and follow the applicant instructions provided on the SAFAS website

Required Supporting Documents

  • Personal Statement
  • Three letters of recommendation
  • Curriculum vitae
  • Copy of your medical school transcript
  • Copy of ECFMG (if applicable)

Applications will be accepted through June 15 of each year.

Contact Information

For further information, please contact:

Marc de Moya, MD, Program Director
c/o Susanne Benotti, Program Coordinator
Email: ymironovas@partners.org
Tel: 617-724-4121
Fax: 617-726-9121

Massachusetts General Hospital is an equal opportunity/affirmative action employer. Women and members of minority groups are encouraged to apply.

Alumni

Acute Care Surgery Fellows

  • Jeffrey Ustin, MD
    Cleveland Clinic, OH
  • Heena Santry, MD    
    UMass Memorial Medical Center, MA
  • Chad Wilson, MD    
    NYU, Bellevue Hospital, NY
  • Georgios Kasotakis, MD    
    Boston Medical Center, MA
  • Haytham Kaafarani, MD    
    Massachusetts General Hospital, MA
  • Eric Klein, MD    
    UCONN / Hartford Hospital, CT
  • David Fink, MD    
    South Shore Hospital, MA

    Surgical Critical Care Fellows

  • Kathryn Butler, MD    
    Massachusetts General Hospital, MA
  • Peter Fagenholz, MD    
    Massachusetts General Hospital, MA
  • Karim Sadik, MD    
    Guthrie Robert Packer Hospital, PA
  • David Turay, MD    
    Loma Linda University Medical Center, CA
  • Matthew Tichauer, MD    
    Hartford Hospital, CT

Contact

For further information, please contact:

Marc de Moya, MD, Program Director
c/o Susanne Benotti, Program Coordinator
Email: sbenotti@partners.org
Tel: 617-724-4121
Fax: 617-726-9121

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