Vascular Medicine

Vascular Medicine Fellowship Program

The Vascular Medicine fellowship is a non-ACGME-accredited one-year training program. It is designed for physicians who have already completed internal medicine residency training and are seeking additional expertise in the care of vascular patients. Additional training in cardiovascular medicine is not a requirement. Training is clinically based, with experience in both the outpatient and inpatient settings, as well as in vascular imaging.

Program Goals

Trainees in the Vascular Medicine Fellowship Program are given intensive exposure to all facets of vascular disorders. Specific learning goals for their 12-month fellowship include gaining competence in the following areas:

• Identifying and managing acute and long-term patients with atherosclerotic peripheral arterial disease (including lower extremity peripheral arterial disease and carotid, renal, or subclavian artery stenosis) and venous diseases (including venous insufficiency and May-Thurner syndrome). Fellows will also become proficient in determining appropriate procedures for individual patients.
• Identification and acute and long-term management of patients with lymphatic diseases, vascular wounds, and thrombosis. Fellows will also gain advanced knowledge of hematological testing of thromboembolic conditions.
• Identification, acute and long-term management of patients with non-atherosclerotic peripheral arterial disease, including fibromuscular dysplasia, spontaneous arterial dissections, vasospastic disorders, thromboanginitis obliterans, and connective tissue disorders.
• Interpret non-invasive vascular studies, including vascular duplex physiological studies, transcutaneous oximetry, and carotid IMT studies. Fellows will gain an understanding of the basics of other non-invasive vascular studies, such as CT or MR angiogram, and of invasive vascular imaging, such as peripheral angiograms or venograms.
• Familiarity with and expertise in working in a team environment composed of house officers at all levels of training, attending physicians, nurse practitioners, and other ancillary support staff from different departments.
• Knowledge of factors that cause predispose patients to or exacerbate vascular syndromes and treatment options for reducing risk.
• Preoperative evaluation of patients undergoing vascular surgery; peri- and post-operative care of such patients.

Trainees are also expected to conduct mentored clinical research. Additional professional goals include:

– Successful completion of the certifying exam of the American Board of Vascular Medicine (ABVM), which covers:

1. Prevention
2. Evaluation
3. Management
4. Procedures
5. Disease management
6. Basic mechanisms

– Completing the “Registered Physician in Vascular Interpretation” (RPVI) certification in non-invasive vascular laboratory imaging.

Inpatient Clinical Consultation

The fellow will participate in the inpatient consultation service. Responding to vascular medicine consultations, the fellow will see and evaluate inpatients with various vascular diseases. The fellow will obtain a history of the patient’s presentation, perform a physical examination, and actively participate in the interpretation of the non-invasive test data. The case will be discussed, and an attending staff physician and the fellow will review pertinent physical examination, laboratory, and non-invasive study data. The fellow will be trained to integrate the patient’s medical/clinical presentation and non-invasive study data to make accurate diagnoses and appropriate clinical decisions concerning further invasive patient evaluation and therapeutic interventions. The strengths of medical vs. percutaneous vs. surgical therapy will be discussed for each case by the attending and the fellow. Written consultation will be provided addressing the pertinent issues relevant to the patient. The fellow will work with Drs. Aditya Sharma, Randy Ramcharitar, and Kanwar Singh.

Outpatient Clinic

The fellow will see patients with vascular medicine attending in the outpatient setting. As described in the inpatient consultation section above, the fellow will evaluate and manage patients. These patients will become the fellow’s primary responsibility throughout the academic year. This will be on an average of 2 days per week. Outpatient longitudinal follow-up will be performed for all the patient groups outlined above, and the fellow will be expected to communicate with their patients between office visits and see the fellow’s patient in the hospital when relevant. The fellow will work with Drs. Aditya Sharma, Randy Ramcharitar, and Kanwar Singh.

Non-Invasive Vascular Laboratory

The fellow will be scheduled to spend at least 8-12 weeks in the non-invasive vascular laboratory. They will shadow and work with technologists to learn how to perform non-invasive vascular examinations. During that time, the fellow should work with that technologist and learn the basics of ultrasound physics, knobology, optimization of color, and general maintenance of the ultrasound equipment. After a brief introductory period in which the fellows learn how to operate the ultrasound and PVR machines, the fellow will learn to perform studies. Then, they will be checked by the technologist with whom they work. The fellow will receive a series of cases to review in the vascular laboratory. The fellow is encouraged to review these cases blindly and compare them to the formal interpretation. Any questions will be reviewed with a staff member. The fellow will also read studies with attending interpreting vascular studies. Also, fellows are encouraged to schedule ad-hoc sessions with staff members reading non-invasive studies to review ongoing clinical studies with them. Fellows must document their formal interpretation before reviewing cases with the attending physician. Finally, fellows are expected to review all studies about in- and outpatients they see with the staffing physicians. Fellows should maintain a record of the studies that they have reviewed. The fellow will work with technologists and Drs. Aditya Sharma and Randy Ramcharitar.

Additional Rotations

Several rotations have been arranged to enhance the fellow’s clinical experience during the Vascular Medicine fellowship. The fellow will attend all Vascular Medicine conferences during these rotations. The fellow may have on-call related Vascular Medicine duties during any elective months. The required rotations include Wound care clinic, Vascular Surgery, Vascular Intervention, Neurovascular, and Pulmonary Hypertension. The fellow will have dedicated time for research and is expected to initiate and, ideally, complete a research project during the fellowship. In some circumstances, one elective rotation may be arranged in the latter half of the academic year, but such rotations require discussion and approval by the Program Director.

a. Vascular Surgery

Vascular Surgery will allow you to gain different perspectives on the endovascular and surgical management of vascular diseases and experience choosing between endovascular versus open procedures for treating various conditions.

During the 4-week rotation in Vascular Surgery, the fellow will be expected to scrub in on operative cases and follow patients with their assigned Vascular Surgery fellows. They should participate in as many cases as possible. Specifically, involvement in carotid endarterectomy, aneurysm repair, open and endovascular, and peripheral bypass surgery is expected. Additional experience in endovascular techniques will complement the exposure you achieve during your vascular intervention rotations. Fellows are usually assigned to a “team,” including vascular surgery residents, fellows, and mid-level providers, who round daily as a “team” with a designated Staff. Fellows must write progress notes, order tests, and prescribe therapies as discussed during rounds. The fellow will rotate with Drs. Darren Clouse, William Robinson, Carlin Williams, Margaret Tracci, and John Kern.

b. Vascular Intervention

During this 4-week rotation, you should gain familiarity with relevant aspects of arterial puncture/access, catheter positioning, different diagnostic and interventional techniques, including angioplasty and stent placement, arterial and venous thrombolysis, IVC filter placement and retrieval, diagnostic venography and venous intervention, as well as arterial closure. During this rotation, the fellow will work with Drs. John Angle, Ziv Haskal, Auh Park, Luke Wilkins, Minhaj Khaja, and Daniel Shereen.

c. Neurovascular Clinic

This rotation will allow you to familiarize yourself with the clinical approach to and management of patients with neurovascular diseases. Understanding the principles of laboratory diagnosis of neurovascular diseases and the decision-making process in selecting appropriate therapy and monitoring should widen the Vascular Medicine fellows’ knowledge beyond what is typically expected from a Vascular Medicine specialist. The fellow will complete a total of 10-16 clinic sessions, which will be equivalent to a 2-week rotation. During this rotation, the fellow will work with Drs. Andrew Southerland and Bradford Worrall.

d. Wound Care and Hyperbaric Oxygen Therapy

During this rotation, you will work closely with the Wound care team, including Dr. Thomas Gampper and Caroline McDaniel, RN. You will gain experience in the basic principles of wound care. The fellow will actively participate in patient assessment, debridement, and dressing.

e. Other electives

Electives can be arranged in the pulmonary hypertension clinic, hematology, Vascular MR and CTA, or other areas of interest. Please discuss elective rotations with the Program Director before the month they are assigned. The fellow also participates in the pulmonary embolism response team and learns in-depth management of acute massive and submassive pulmonary embolisms.

Conference Schedule

These didactic lectures are designed to enhance your learning experience. Participation is key to obtaining maximum benefit from these lectures.

Thursday or Friday Vascular bi-monthly Noon Conference

Weekly Noon – 1:00 PM
Vascular and cardiology fellows will attend this conference.

The format of the conference varies from formal lectures of vascular medicine and laboratory topics by staff, clinical management, case-based discussions with Staff, review of Guidelines (one fellow assigned to present a portion of a selected Guideline), review of relevant book chapters (one fellow assigned to review and present a given book chapter).

Vascular Medicine Journal Club

Occur at variable dates throughout the year. Two articles are reviewed by two different fellows (one article each) and presented for discussion.

Cardiovascular Medicine Grand Rounds

Every Wednesday: 7:30 AM – 8:30 AM
During this, speakers (including external invited speakers) present state-of-the-art lectures on various cardiovascular medicine topics.

At the end of the year, the fellow is scheduled to give a formal Grand Round presentation. This can be on any topic of the fellow’s choice, preferably on their research project.

Interdisciplinary (Vascular Medicine/ Vascular Surgery/ Interventional Radiology/ Interventional Cardiology) Weekly Morning Conference

Weekly Thursday 6:45 AM – 7:30 AM (Vascular Core lecture series, morbidity/mortality, and Imaging/ Interventional conference)

Monthly Multidisciplinary Pulmonary Embolism Conference:

Every third Thursday, 7:00 AM – 8:00 AM
This is an interdisciplinary conference between all thrombosis experts/proceduralists and surgeons where complex PE cases are reviewed, new literature is reviewed, and quality improvement programs are discussed and implemented.

Vascular Neurology Weekly Morning Conference

Weekly 9:00 AM – 10:00 AM
This conference is attended by vascular, neurology, and interventional neurology fellows.
The conference format is case-based discussions with Staff of recently encountered clinical cases.

Internal Medicine Grand Rounds

Every Friday Noon – 1:00 PM
Fellows are encouraged to attend Medical Grand Rounds weekly and are expected to attend any vascular-oriented conferences.

Additionally, the fellow will attend the Society for Vascular Medicine sponsored Fellows course and Vascular Medicine Board review. The fellow also has access to an online vascular ultrasound board review course and a vascular medicine board review course.

Research

Each fellow is expected to participate in a research project, which should be presented and submitted for publication. To accomplish this, they are provided a ½ day each week. The research project must be approved in advance by the Program Director. The research elective is for fellows with an active and ongoing project that can be taken to completion. The plans for time must be outlined in detail.

We want the project to be submitted to a national meeting for presentation (e.g., the Society for Vascular Meeting Annual Meeting, American College of Cardiology Annual Meeting, or American Heart Association Annual Meeting) and prepared for publication. The topic is expected to be decided upon and initiated as early as possible, ideally by September. There will be an introductory meeting to discuss the research opportunities within the department and how to get started. Each fellow will select a staff physician who will supervise this research project/s.

Advanced Vascular Medicine Fellowship Program:
How to Apply

*We are currently filled for the 2024-2025 academic year.
We will start reviewing applications for the 2025-2026 academic year around Nov-Dec 2024 and anticipate offering a position by the end of January 2025.

Applications are accepted on a rolling basis. To be eligible for this fellowship, you must have completed at least two years of residency training in internal medicine in the United States. Physicians who have completed training in internal medicine and/or are currently in internal medicine-based fellowship programs, such as cardiology, hematology, etc., are welcome to apply.

Application requirements:

• Online application form (click the “submit” box at the bottom to send)
• Curriculum vitae (see below)
• Personal statement (see below)
• Three letters of recommendation (see below for details)

CV and personal statement:

We prefer you email these documents to us (rather than include them as part of the online application form). Make sure they are clearly labeled with your name and contact information, and email them to:

Aditya Sharma, MBBS, Program Director (as8ah@virginia.edu) and Program Coordinator, Kara Watts (kt7r@uvahealth.org).

Letters of recommendation:
We require three letters of recommendation, as follows:

• One from the director of your internal medicine residency program
• Two from other faculty members, physicians, or scientists with whom you have trained or under whom you have worked, at your discretion

Please have your letter writers (or their office) directly email them to our Program Director, Dr. Aditya Sharma, and Program Coordinator, Kara Watts (kt7r@uvahealth.org). We do not accept letters of recommendation sent directly from applicants.

More information:

Email program director Aditya Sharma, MBBS, at: asharma@virginia.edu.