Rotations

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 entire medical/clinical presentation and non-invasive study data to make accurate diagnoses and appropriate clinical decisions with respect to the further invasive evaluation of the patient 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. 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 be involved in evaluating and managing 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. 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 Dr. 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, and 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 perspectives on the endovascular and surgical management of vascular diseases and experience regarding choices between using 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, all of whom 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 involved 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 the assessment, debridement, and dressing of the patients.

e. Other electives

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