Twelve-Month Curriculum

At the conclusion of this fellowship program, the fellow should be able to:

1. Describe the normal anatomy and physiology of the heart.
2. Discuss pharmacology pertinent to the cardiovascular system.
3. Describe coronary artery and valvular heart diseases.
4. Describe the anatomy and pathophysiology of major congenital heart diseases.
5. Describe the anesthetic management of patients with congenital heart diseases.
6. Discuss and explain the rationale of induction and maintenance of anesthesia techniques for cardiothoracic surgery.
7. Describe the anesthetic management for cardiac transplantation.
8. Describe the anesthetic management for ventricular assist device placement.
9. Describe the anesthetic management for pulmonary embolectomy.
10. Describe the management of pulmonary hypertension.
11. Describe the management of RV failure.
12. Describe the myocardial remodeling due to coronary artery disease.
13. Describe coronary anatomy and consequences of coronary occlusion.
14. Describe the hemodynamic changes due to valvular heart diseases.
15. Discuss the possible complications and their treatment during cardiopulmonary bypass.
16. Describe the indications and therapeutic role of intra-aortic balloon pump (IABP) treatment.
17. Describe the role of ECMO and ventricular assist devices in catastrophic adult cardiac cases.
18. Describe the pathophysiology and possible complications of aortic surgery.
19. Describe the anesthesia management of circulatory arrest.
20. Describe the indications and role of left ventricular partial bypass.
21. Describe the pharmacology of different inotropic and vasoactive agents and their role in complex heart cases.
22. Describe the role of iNO, and inhaled prostoglandin in anesthetic management of complex cardiac cases.
23. Describe common problems and their treatment during postoperative recovery of the complicated cardiac surgery patient.
24. Describe the changes of the coagulation system during cardiopulmonary bypass.
25. Describe the TEG and other coagulation laboratory parameters used for evaluate the coagulation system during cardiac surgery. Establish treatment plan based on the changes of coagulation parameters.
26. Describe the role of recombinant clotting factors in the treatment of catastrophic bleeding.
27. Describe the management of ventilation of the complicated cardiac/thoracic surgery patient.
28. Describe preoperative assessment for thoracic surgery.
29. Use preoperative respiratory parameters to expect complications during anesthetic management of thoracic cases.
30. Describe risks of prolonged intubation.
31. Describe the causes and treatment of failing one-lung ventilation.
32. Describe possible complications after major lung resection and pneumonectomy.
33. Describe the anesthetic management of lung transplantation.
34. Describe different techniques for analgesia during and after thoracic surgery.
35. Describe the expected postoperative recovery of the complicated thoracic surgery patient.
36. Use advanced TEE techniques to evaluate the patient and seek for pathology which might change the surgical and anesthetic management.
37. Describe the use of TEE in the management of endovascular cardiac surgical procedures (TAVR, Mitral Clipping, Balloon Valvuloplasty).
38. Describe common and complex congenital cardiac lesions that patients presenting as adults may need cardiac surgery for.
    

At the conclusion of the fellowship program, the fellow should be able to:

1. Insert, manage, and interpret the results of arterial catheterization, central venous catheterization and pulmonary artery catheterization.
2. Prepare the patient for cardiopulmonary bypass with considering possible complications.
3. Manage complex cases during cardiopulmonary bypass.
4. Prepare the patient for coming off cardiopulmonary bypass with considering possible difficulties.
5. Manage the process of coming off cardiopulmonary bypass.
6. Prepare the patient for transport to the CTICU after cardiac surgery in a safe and timely manner.
7. Transport the patient into the CTICU/CICU safely.
8. Give detailed report and handoff in the intensive care unit with continuous vigilance about the patient’s hemodynamic status.
9. Perform fiberoptic bronchoscopy under staff supervision.
10. Insert and manage double lumen endotracheal tubes with staff supervision.
11. Place and manage epidural catheters for patients having cardiothoracic surgery.
12. Identify high risk patients and establish effective plan to treat the problems.
13. Conduct one-lung ventilation and solve difficulties under staff supervision.
14. Transfer thoracic patients to the PACU and CTICU.
15. Recognize acute respiratory failure and establish appropriate treatment.
16. Safely reintubate patients after thoracotomy when indicated.
17. Recognize massive intrathoracic bleeding and initiate immediate treatment.
18. Initiate appropriate postoperative analgesia for thoracic surgery.

 

COMMUNICATION AND INTERPERSONAL SKILLS

At the conclusion of the fellowship program, the fellow should be able to:

1. Identify the relevant preoperative information needed to plan anesthesia for cardiac surgery.
2. Supervise residents and coordinate the cardiac anesthesia and surgery team to prepare the patient for cardiac surgery.
3. Expect possible complications during cardiac anesthesia management based on clinical and laboratory data and establish appropriate treatment plan.
4. Identify complications during the cardiac surgical procedure quickly by observation and interaction with the surgical team.
5. Supervise residents and coordinate the cardiac anesthesia and surgery team to manage the patient during cardiac surgery.
6. Identify the relevant preoperative information needed to plan anesthesia for thoracic surgery.
7. Expect possible complications during the thoracic surgical procedure based on clinical and laboratory data and establish appropriate treatment plan.
8. Identify complications during the thoracic surgical procedure quickly by observation and interaction with the surgical team.
9. Supervise residents and coordinate the cardiac anesthesia and surgery team to manage the patient during thoracic surgery.
   

At the conclusion of the fellowship program, the fellow will be able to:

1. Prepare the patient for the cardiothoracic procedures and invasive monitoring.
2. Prepare the patient for possible complications.
3. Properly perform consultative and preoperative assessments for complex cardiac and thoracic cases.
4. Effectively work as a team member to solve complications and difficulties during the anesthetic management.
5. Effectively communicate with the surgical team in critical situations.
6. Supervises and teach residents and other students during the cardiothoracic procedures.