Department of Surgery
The intent of the integrated 5 year vascular residency program at the Medical University of South Carolina is to produce well-rounded trainees in all aspects of vascular surgery, leading to the development of thoughtful, ethical, and highly competent independent practitioners of the specialty. Our major goals are to provide incremental and progressive, multidisciplinary training in vascular surgery, general surgery, and relevant surgical/interventional radiology/medicine and sub-specialties during a 5-year training program to include both core surgery (CS) and vascular surgery (VS). The vascular surgery faculty have designed a program that will provide increasing responsibility under direct attending supervision, in the outpatient clinics, inpatient settings, the interventional suite, and the operating room.
- Service Rotations
- Hospitals, Institutions, and Faculty
- Training in management of vascular diseases
- Other Educational Activities
Core surgery rotations during the PGY-1 and PGY-2 years will focus on learning history and physical examination skills, diagnostic testing, patient assessment and patient management skills in both an outpatient and inpatient clinical setting. Core rotations will include general surgery, oncologic surgery, pediatric surgery, orthopedics, and trauma to develop basic surgical assessment, technical, and management skills. Midlevel experience/training during PGY-2 and PGY-3 years will focus on management of critically ill patients and development of fundamental operative skills especially in the abdomen, including laparoscopic skills. Rotations will include SICU and CTICU rotations, solid organ transplant surgery, trauma, and cardiothoracic and general surgery rotations at a more advanced level commensurate with their developing skill sets. Core surgical training will occur primarily on general surgery services that are focused on abdominal, trauma and critical care, and includes laparoscopic, pediatric, and oncologic-endocrine surgery in a distribution which is optimal for vascular surgeons who will not perform elective general surgery, but care for vascular surgery patients who can develop conditions that require a general surgical procedure and application of intensive critical care. Training in the management of the surgical ICU patients is provided in both in a medical-surgical ICU and a Cardiac/Vascular ICU with additional critical care experience obtained during all in-patient vascular surgery rotations. CT surgery will allow exposure to sternotomy, thoracotomy and aortic arch surgery, as well as coronary bypass. Senior resident experience in both general and vascular surgery will occur during the PGY-4 year, including rotations on the Interventional Radiology service.
During the PGY-1 thru PGY-2 years, the vascular surgery residents will have a total of 12 months vascular surgery training, and during PGY-3-4 year, a minimum of 6 months of vascular surgery training each year, including 4 months at Roper /St Francis. Chief resident experience will provide a 12-month chief resident experience in vascular surgery during the PGY-5 year.
A total of 36 months will be spent on vascular surgery rotations, and 24 months on core general surgery or surgical/medical subspecialty rotations. The schedule has been designed to appropriately interact with current general surgery, intensive care unit, cardiothoracic surgery, trauma, and transplant surgery rotations at the appropriate training levels to optimize resident education and experience. It specifically provides for a total of 6-months experience as the senior resident on general/trauma surgery, transplant, or cardiothoracic surgery rotations. The PGY-5 year is exclusively a “chief resident” experience in dedicated vascular/endovascular rotations.
Hospitals, Institutions, and Faculty
General and vascular surgery in-patient training will be obtained at tertiary-referral medical centers. These will include Medical University Hospital, its Heart and Vascular Center at Ashley River Tower (university hospital), the Robert H. Johnson Veterans Affairs Medical Center (Veterans Administration teaching hospital) and Roper St Francis Health care system (a community based hospital). Full-time faculty at the Medical University have extensive experience in training surgical residents and have received recognition and numerous awards for teaching. Inclusion of Roper /St Francis rotations under the supervision of 4 board-certified community based vascular surgeons who also have clinical appointments within the Department of Surgery at MUSC will allow a broad case mix to include endo-management of venous problems. These clinical faculty also have long experience with - and an interest in - surgical education. All vascular surgery training will occur on dedicated vascular surgery services at these institutions. The chief year will be dedicated to only vascular surgery and interventional experience involving all the faculty at each of these institutions.
This level of resident staffing is optimal for education and developing appropriate, independent responsibility for the vascular in-patient management, acquiring operative/endovascular skills, and compliance with the weekly resident work hour restrictions. For call purposes, residents will provide cross-coverage of the two services at MUH and the VA; the schedule will be implemented to ensure vascular surgery resident will work with all vascular surgery faculty and fall within the work hour guidelines mandated by ACGME . Of note, these same MUSC vascular surgery faculty also provide vascular services and supervision at the VAMC. The rotation at Roper /St Francis will integrate both in-patient care, outpatient clinic evaluations, and rotating on call with the board certified vascular surgeons in the community setting, also commensurate with the requirements of the current ACGME guidelines.
Training in management of vascular diseases
Vascular Surgery experience is organized in a step-wise and logical fashion. While PGY-1 rotations focus on the development of history-taking, physical examination and diagnostic skills, training in diagnostic catheter-based imaging and endovascular intervention begins the first year for each vascular resident during 2-month or 4 month rotations at the PGY- 1, 2 and 3 level - for a total of 12 months experience in either the MUH or ART Vascular Center interventional angiography suites (n=6) or operating room suite where both outpatient and in-patient endovascular procedures are staffed by vascular surgery and vascular interventional radiology faculty. There are block rotations with Interventional Radiology and the Vascular Laboratory to set firm foundations in imaging and non-invasive diagnosis that will be built upon as the residents progress through the program. PGY- 1’s and 2’s will focus on learning vascular anatomy and blood vessel exposures. Progressive resident responsibility will be provided beginning during the PGY-1 year with residents participating in diagnostic arteriography/venography studies, central venous access placement, and dialysis access procedures. PGY-2 residents will perform common peripheral arterial and venous interventions procedures. Basic percutaneous arterial and venous access, non-selective and “up and over” catheterization, diagnostic arteriography and venography, pseudoaneurysm injection, etc will be taught to a level of competence. PGY-3 and 4 residents perform more complex endovascular interventions, and will develop competence in IVC filter placement, thrombolysis, AV-access interventions, iliac angioplasty and stenting, and SFA interventions. The PGY-5 chief resident receives training in the most complex endovascular procedures, selective catheterization, embolization, and more complex techniques that will be sequentially introduced, leading to training in arch vessel catheterization, EVAR, TEVAR, visceral, renal, and tibial interventions including carotid/vertebral stent-angioplasty, and thoracic or branched endografting. Open procedural skills will be obtained in the same manner, building upon core surgical training, blood vessel exposures, AV-access procedures, amputations and wound debridements, progressing to femoropopliteal, upper extremity, and carotid procedures, followed by aortic, major intra-abdominal, vertebral and tibial and pedal reconstructions. The rotation schedule is designed so that residents of appropriate training level and experience will be situated on services that will provide them with sufficient exposure to case and patient volume appropriate to their level of training.
Training in noninvasive vascular laboratory testing and interpretation is part of the educational objective of this integrated program, since some peripheral interventions are conducted using duplex ultrasound guidance. At the conclusion of their training, each resident will have documented proficiency and >100 caseload experience in each testing area (peripheral arterial, peripheral venous, cerebrovascular duplex, and visceral vascular) to qualify for both ARDMS - Registered Vascular Technologist (RVT) and Registered Physician Vascular Interpretation (RPVI) certifying examinations.
Importantly, rotations have been scheduled each year at levels that provide the optimal concomitant experience on each of the non-VS services but will not interfere with the case volume exposure of general surgery trainees. At no time will a chief resident in vascular surgery and a chief resident in general surgery be on the same service. The case volume will remain adequate to train general surgery residents in core principles and techniques of vascular surgery while still providing an expansive and well-rounded exposure for the vascular resident.
Other Educational Activities
Residents are expected to participate in regularly scheduled conferences including morbidity and mortality cases, and basic science covering a core curriculum in fundamental problems relevant to surgical care. Presentations are given by members of the surgical staff, faculty from other clinical and basic science departments, and senior surgical house officers. In addition, case conferences include discussion about evaluation and decision making with current patients. Online and computer training as well as opportunities for simulation training will be included. Surgical grand rounds are held weekly and include presentations from all aspects of general surgery including vascular, trauma and critical care, endocrine, trauma and gastrointestinal surgery, as well as other surgical subspecialties. In each hospital, clinics are held weekly for follow-up of patients cared for on the vascular surgical services under the direct supervision of faculty. Attendance at clinics is expected of all surgical residents. Each resident takes the annual ABSITE in-service examination appropriate to training level.