Advanced Practice Provider Fellowship Program

The focus of the Advanced Practice Provider Fellowship – Surgery Track is to provide surgical didactic and clinical experience across the continuum of care for surgical patients.

The program is designed for both Physician Assistants and Adult Acute Care Nurse Practitioners who are interested in a career in general surgery or a surgical subspecialty. The fellowship is ideal for new graduates who wish to pursue a career in surgery or practicing APPs who wish to change their career focus.

Clinical Curriculum

During the 12-months, APP Fellows will work alongside surgical APPs, surgical residents (including first year interns and chief residents) and attending surgeons. Duties of the APP Fellow will include obtaining an accurate history and performing physical examinations, presenting a concise HPI, writing orders, reviewing patient records, developing a differential diagnosis for a host of common surgical conditions, assisting in the operative room, ordering and interpreting diagnostic studies, and performing a variety of procedures with the supervising provider. Day, night, and weekend shifts are to be expected over the course of the year and APP fellows can anticipate working an average of 60 hours per week, not to exceed 80 hours per week.

During the program, fellows will gain experience in all areas of perioperative surgical care, including pre-operative, intra-operative, and post-operative care (including at least one rotation in the surgical ICU). Additional skills fellows can expect to acquire include wound care, removal of surgical drains, phlebotomy and urinary catheter placement. Under approved supervision, fellows may also acquire skills in central line placement, arterial line placement, chest tube placement, exposure to endoscopic vein harvesting, and assisting in robotic surgery.

Clinical rotations for the surgical track will occur at two locations across the UCHealth System, including Aurora, Colorado, at the Anschutz Medical Campus and Loveland, Colorado at Medical Center of the Rockies.

Clinical rotations are one month in length and occur in a variety of surgical subspecialties, including but not limited to:

• Trauma and acute care
• Surgical oncology
• MIS/bariatric
• Breast
• Endocrine
• Urology
• Transplant
• Cardiac
• Thoracic
• Vascular
• Plastic and Reconstructive
• Surgical Trauma ICU

Didactic Curriculum

Didactic education is embedded in the program throughout the year and will largely occur in conjunction with the surgical track and medical ICU track APP fellows. Elements of didactic curriculum include:

• Comprehensive 3-week orientation
• Skills labs (knot tying, suturing techniques, cautery basics, chest tube insertion, central line insertion, and training in laparoscopic and robotic techniques)
• Fellow case presentations
• Biweekly education lectures
• Simulation
• Point-of-care ultrasound
• Conferences including grand rounds and morbidity and mortality presentations
• Quality Improvement Initiatives
• Advanced Trauma Life Support

Graduation Requirements

APP Fellows will receive clinical feedback after each of their rotations. Each APP Fellow must receive a passing evaluation from each of their clinical rotations to complete the fellowship. Additional laboratory, skills and classroom testing will occur throughout the year, which fellows will be expected to pass. Each fellow will also develop and complete an end of year project, poster or presentation as a requirement for graduation. Remediation of each of these requirements will be considered on an as needed basis.

For additional questions regarding the surgical track program, please e-mail erin.mcintyre@cuanschutz.edu.

The focus of the Advanced Practice Provider Fellowship – Surgical Critical Care Track is to provide critical care didactic and clinical experience across the continuum of care for critically ill patients, with a specific focus on surgical critical care subspecialties. It is important to note that there is no operative experience included in this track as the primary focus is to train new-graduate or transition-in-practice APPs to function as autonomous, thoughtful critical care practitioners.

The program is designed for both Physician Assistants and Adult Acute Care Nurse Practitioners who are interested in a career in surgical critical care. The fellowship is ideal for new graduates or practicing APPs who wish to change their career focus.

Clinical Curriculum

During the course of the 12-month program, APP Fellows will work alongside faculty APPs across a variety of medical, critical care, and surgical subspecialties, surgical and anesthesia residents, critical care MD fellows, and attending physicians. Duties of the APP Fellow will include obtaining an accurate history and physical examination, daily rounds on patients, reviewing patient records, presenting on multi-disciplinary ICU rounds, writing orders, developing a differential diagnosis for a host of common medical and critical care conditions, ordering and interpreting diagnostic studies, following up on plans and patient progress throughout the day, responding to patient emergencies, participating in family meetings, interdisciplinary communication with consultants, and performing a variety of critical care procedures with a supervising provider. Day, night, and weekend shifts are to be expected over the course of the year and APP fellows can anticipate working an average of 60 hours per week, not to exceed 80 hours per week.

During the program, fellows will gain experience in all areas of adult critical care, including a variety of consulting services relevant to the management of critically ill patients. A majority of clinical rotations occur at the Anschutz Medical Campus, however each fellow should expect to spend one six-week rotation at one of two sister hospitals – Medical Center of the Rockies in Loveland, CO or Memorial Hospital in Colorado Springs, CO.

Rotations

Clinical rotations vary in length and occur in a variety of subspecialties relevant to critical care and surgery. A majority of ICU time is spent in our surgical ICUs, with a focus on Cardiothoracic and Surgical Trauma critical care, although surgical critical care track fellows also gain exposure to general medicine, including time with the Medical ICU and Hospitalist service. For those candidates with a primary interest in medical critical care, our Medical ICU track offers exposure to each of our ICUs, but with a larger proportion of the year spent in the Medical ICU (please see below for more information on the Medical ICU track).

Rotations for the surgical critical care track include:

• Cardiothoracic ICU
• Surgical Trauma ICU
• Neuro ICU
• Burn ICU
• Medical ICU
• Cardiac ICU / Advanced Heart Failure Service
• Trauma Acute Care Surgery Consults
• Hospital Medicine
• Renal
• Infectious Diseases
• Palliative Medicine
• Elective

Procedures

APP Fellows will gain experience with the following common critical care procedures:

• Central Line Insertion
• Hemodialysis Line Insertion
• Arterial Line Inertion
• Endotracheal Intubation
• Chest Tube Insertion and Management
• Endotracheal Intubation
• Point-of-Care Ultrasound

Didactic Curriculum

Didactic education is embedded in the program throughout the year and will largely occur in conjunction with the surgical track and medical ICU track APP fellows. Elements of didactic curriculum include:

• Comprehensive 3-week orientation
• Skills labs (airway and ventilator management, chest tube insertion, and central line insertion)
• Fellow case presentations
• Biweekly education lectures
• Simulation
• Point-of-care ultrasound
• Conferences including grand rounds and morbidity and mortality presentations
• Quality Improvement Initiatives
• Advanced Trauma Life Support
• Fundamentals of Critical Care Support

Graduation Requirements

APP Fellows will receive formal written clinical feedback after each of their rotations in addition to informal feedback throughout their rotations. Each APP Fellow must receive a passing evaluation from each of their clinical rotations to complete the fellowship. Additional skills and classroom testing will occur throughout the year. Each fellow will also be required to present at critical care journal club in addition to several times throughout the year at APP fellowship didactic conference. Remediation of each of these requirements will be considered on an as needed basis.

For additional questions regarding the surgical critical care track program, please e-mail alexis.keyworth@cuanschutz.edu.

For information on this track, visit the following page on the website of the Division of Pulmonary Sciences and Critical Care Medicine:

APP Medical Critical Care Fellowship