Cardiovascular & Thoracic Anesthesia

Adult Cardiothoracic Anesthesiology (ACTA) Fellowship

The Stanford University Cardiothoracic Anesthesia Division offers an Adult Cardiothoracic Anesthesiology (ACTA) Fellowship, an intensive one-year clinical training program designed to prepare graduates for clinical and academic leadership positions in the subspecialty practice of cardiothoracic anesthesiology and cardiovascular critical care. The ACTA fellowship program is dedicated to providing state-of-the-art training and experience in a multidisciplinary academic environment to achieve competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice in the field of cardiothoracic anesthesiology and critical care. The fellowship program offers 4 Accreditation Council for Graduate Medical Education (ACGME) (www.acgme.org) positions each year to qualified applicants. Many of the fellows in the program elect to complete a combined 2-year fellowship in both Anesthesia Critical Care Medicine and Adult Cardiothoracic Anesthesiology with an emphasis in Cardiovascular Surgical Critical Care. Completion of the ACTA fellowship program curriculum fulfills the ACGME program requirements for Adult Cardiothoracic Anesthesiology as well as the National Board of Echocardiography (NBE) requirements for certification in Advanced Perioperative Transesophageal Echocardiography (http://www.echoboards.org).

Clinical instruction is provided in the cardiothoracic operating rooms under the supervision of cardiothoracic anesthesia faculty members. The fellow is assigned to provide comprehensive anesthetic and perioperative care that includes the performance and interpretation of the intraoperative echocardiographic examination. The fellow is also responsible for the supervision and education of Stanford Anesthesiology residents on the cardiothoracic anesthesiology and echocardiography rotations. Elective rotations at the Santa Clara Valley Medical Center and the Santa Clara Kaiser Permanente Medical Center provide opportunities to care for cardiac surgery patients in community hospital settings, and an elective rotation at the Lucile Packard Children’s Hospital provides the opportunity to care for children and adults with complex congenital heart disease.

The intraoperative experience in cardiothoracic anesthesiology will be supplemented with an immersive clinical experience in the postoperative management of cardiothoracic and major vascular surgical patients in the Cardiovascular Intensive Care Unit (CVICU) that is staffed by a team of Cardiothoracic Anesthesia Critical Care faculty, Pulmonary Critical Care Medicine Faculty, critical care medicine fellows, anesthesiology residents, and advanced practice providers. The CVICU is a multidisciplinary unit based on the model of the Perioperative Surgical Home where the fellow will have the opportunity to work collaboratively with cardiac, thoracic, and vascular surgeons; heart failure, heart transplant, and lung transplant teams; and other consultant services to provide comprehensive care to the cardiothoracic surgical patient.

Echocardiography training includes a period of formal instruction in perioperative transesophageal echocardiography (TEE) as well as hands-on training and direct clinical performance, interpretation, and application of intraoperative echocardiography in surgical decision-making. Fellows will also learn to formulate, generate, and archive a formal report of the comprehensive intraoperative TEE examination. During the year, ACTA fellows will also gain experience with 3-D echocardiography, transthoracic echocardiography, and the application of echocardiography in the management of critically ill patients.

The Stanford Cardiothoracic Anesthesiology Division, together with the Department of Anesthesiology, Perioperative, and Pain Medicine and the Department of Cardiothoracic Surgery, will provide the opportunity to gain extensive clinical experience in the following areas:

The educational curriculum of the fellowship also includes:

During the year, the fellow will prepare one Problem-Based Learning Discussion (PBLD) presentation for the Department of Anesthesiology Grand Rounds; two PBLD presentations for the Combined Cardiology, CT surgery, CT Anesthesiology and Radiology Case Conference; and participate in a multidisciplinary Quality Improvement project. In addition, ACTA fellows will receive an educational stipend that provides funding to attend the Society of Cardiovascular Anesthesiologists (SCA) Annual Comprehensive Review & Update of Perioperative Echo as well as funding to attend and present a case at the Fellows’ Component of the Annual Meeting of the SCA.

Clinical and basic science investigation is an important mission of the Stanford Medical School, and the ACTA fellowship program welcomes and strongly supports candidates planning careers in academic practice. An effort is made to engage fellows in ongoing clinical or laboratory research projects, and opportunities exist for fellows to initiate and carry out independent investigations with established researchers. Academic time and support is provided to fellows based on their individual career objectives and areas of investigation.

Clinical Case Volume

Number of Cardiac Procedures with CPB Per Year:

  • Stanford Hospital: 650
  • Valley Medical Center: 180
  • Kaiser Permanente - Santa Clara: 600
  • Lucile Packard Children's Hospital (pediatric and adult congenital): 380

Distribution of on-pump cases:

  • Stanford: CABG (25%), Open and Minimally Invasive Valve Surgery (35%), Open Aortic Surgery (30%), Ventricular Assist Device and Mechanical Circulatory Support (10%)
  • Valley Medical Center: Mixture of mostly CABG and Valve Surgery, small percentage of Open Aortic Surgery
  • Kaiser Permanente - Santa Clara: CABG (30%), Open and Minimally Invasive Valve Surgery (60%), Open Aortic Surgery (10%)
  • Lucile Packard Children's Hospital: Varied

Average Number of CPB Procedures Per Trainee Per Year: 150

Number of Cardiac Procedures off-CPB Per Year:

  • Stanford: 130
  • Valley Medical Center: 5
  • Kaiser Permanente – Santa Clara: 130

Distribution of off-pump cases:

  • Stanford: Transcatheter Aortic Valve procedures (90%), CABG (5%), Other (5%)
  • Valley Medical Center: CABG (100%)
  • Kaiser Permanente - Santa Clara: CABG (100%)

Average Number of off-CPB Procedures Per Trainee Per Year: 30

Number of Non-Cardiac Thoracic Cases Per Year: 400

Number of Heart, Lung and Heart/Lung Transplants Per Year: 70

Number of Major Vascular Cases Per Year: 400

 

Faculty: 

Albert T. Cheung, M.D. (Fellowship Program Director)
Ronald Pearl, M.D., PhD. (Department Chairman)
Christina Mora Mangano, M.D.
Linda Foppiano, M.D.
Ethan Jackson, M.D.
Pieter van der Starre, M.D.,
Max Kanevsky, M.D., Ph.D.
Charles Hill, M.D.
Daryl Oakes, M.D.
Sheela Pai-Cole, M.D.
P. David Soran, M.D.
Jimmy Wong, M.D.
Vidya Rao, M.D., M.B.A.
Jessica Brodt, M.D.

 

ACGME Fellowship Application Eligibility

 

ACGME Fellowship Application Process 

All applicants must register with the SF Match and submit a Common Application through the SF Match Common Application System (www.sfmatch.org). In addition, applicants are asked to submit the following items:

All clinical fellows must obtain a California medical license and DEA license prior to starting fellowship. You may contact the Medical Board of California, 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815, Phone 1-800-633-2322, for applications and information. Please allow a minimum of 6-9 months for processing. In rare cases it can even take 1 year.

ACGME fellows are appointed through the Graduate Medical Education (GME) office, which is part of Stanford Hospital and Clinics (SHC), and are not subject to the same registration requirements as the School of Medicine (SoM) fellows/postdocs. Please visit the GME website for further information.

Further questions about the program, application process, or the interview may be directed to:

Karlee Joice (ACTA Program Coordinator)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3689
Stanford, CA 94305-5640
Email: kjoice@stanford.edu
Tel: 650-736-6928
Fax: 650-724-7658

Bernadett Mahanay (Fellowship Coordinator)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3578
Stanford, CA 94305-5640
Email: bromo@stanford.edu
Tel: 650-723-6415

Albert T. Cheung, M.D. (ACTA Fellowship Program Director)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3578
Stanford, CA 94305-5640
Email: atcheung@stanford.edu
Tel: 610-742-0602

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