Experience

Individuals who complete the fellowship year(s) will be competent in the management of patients with critical illness and prepare them to independently provide care to the most injured and ill emergency general surgery and trauma patients.

Surgical Critical Care Fellowship Experience (PGY-6)

SCC Training will also include techniques for both lifesaving and diagnostic procedures not only their performance but the correct interpretation within the scope of the critical illness. Trainees will be competent in the interpretation of radiographic studies to include head, chest and abdominal and pelvic CT scan, abdominal ultrasound, and vascular angiographic studies. Fellows will be knowledgeable in the application of monitoring techniques applicable to surgical critical care and be aware of the indications and contra-indications to these approaches. It is anticipated that upon completion of the fellowship in surgical critical care, that fellows will be prepared to play an active role in the socioeconomic, political climate, and unit administration that has impact on the care that they are able to provide to patients. They will also develop the presentation skills that will allow them to deliver an effective medical presentations and effective communication of complex disease processes amongst other healthcare providers.

Surgical Critical Care (PGY-6) Rotations by Hospital

down arrowUofL Health – University of Louisville Hospital

Trauma Rotation ~Surgical Critical Care Unit and Burn Unit
Objectives: To thoroughly understand the diagnosis along with the medical and surgical treatment of disorders that affect critical ill patients in the intensive care setting, and to develop technical mastery of procedures needed by critically ill patients. The fellow we also begin to gain autonomy in surgical decision-making and operative techniques.

Structure: Under the supervision of the full-time faculty, the fellow will evaluate and treat patient with the full spectrum of critical illness. The evaluation of the patients takes place primarily in the surgical intensive care units and the burn unit of University of Louisville Hospital. Frequently, surgical patients are also housed in the MICU, CCU & Neuro ICU, allowing for additional patient exposure and experience in these areas as well. The varied patient demographic differences that are reflected in these venues provide the fellow with a rich and vast experience. In addition, they will get operative experience on call nights not covered by chief residents (Tuesdays and Fridays). This will form the bulk of trauma cases needed for the fellows on the AAST track. They will have some outpatient duties, mainly focused on burn care. Occasionally, the fellows will also help in trauma clinic when there is overflow if ICU rounds are already complete.


Elective Rotation - Burn
Objectives: To thoroughly understand the diagnosis and treatment of burns, necrotizing soft tissue infections, toxic dermal necrolysis, and chronic wounds of varying etiologies. The fellows will gain knowledge on all aspects of wound care, from topical therapy to advanced surgical techniques for wound coverage. They will gain further procedural competence in normal critical care procedures including central line placement, bronchoscopy, and those specific to burns such as escharotomies. They will learn fluid replacement strategies specific to the burn population, as well as nutritional replacement, which is often so critical in any wound care scenario.

Structure: Under the supervision of the full-time faculty, the fellow will evaluate and treat patients with the full spectrum of wounds. The evaluation of the patients takes place primarily in the emergency room and in the burn unit at the University of Louisville Hospital. They will be responsible for all aspects of burn care, from daily wound management and critical care needs, to the operative management of wound coverage. They will be responsible for covering our outpatient wound clinic on Wednesdays, in conjunction with our burn nurse practitioners. They will participate in our monthly Burn Quality Improvement Conference, and in the weekly meetings involving our burn center verification process.


Elective Rotation - Neuroanesthesia Rotation
Objectives: To thoroughly understand the diagnosis and medical treatment of disorders affecting critically ill patients in the Neuroanesthesia Unit. This includes stroke patients, isolated head injuries, and post-operative patients in ENT, OB-GYN, and Neurosurgery.

Structure: Under the supervision of the full-time faculty, the fellow will evaluate and treat patients with a full spectrum of critical illnesses with an emphasis on the above patient population. They will become further skilled in all types of criticl care procedures, with emphasis on this rotation for airway management, as this critical care team is responsible for most inpatient airway emergencies. Furthermore, they will get more dedicated exposure to stroke management and Neurosurgical monitoring devices.


down arrowUofL Health – Jewish Hospital

Surgical ICU Rotation~Surgical Intensive Care Unit
Objectives: To thoroughly understand the diagnosis along with the medical and surgical treatment of disorders that affect critical ill patients in the intensive care setting, and to develop technical mastery of procedures needed by critically ill patients.

Structure: Under the supervision of the full-time faculty, the fellow will evaluate and treat patient with the full spectrum of critical illness. The patient population in this ICU setting will include emergency general surgery patients, vascular surgery patients, transplant surgery patients, urology patients, surgical oncology patients, and thoracic surgery patients. This will introduce an even more medically diverse patient population than what we typically care for in trauma, thereby expanding fellow education. They will perform all necessary critical care procedures to the patients. Necessary surgical interventions will be deferred to the patient’s primary surgical team.


Cardiovascular ICU Rotation~Cardiovascular Intensive Care Unit
Objectives: To thoroughly understand the diagnosis and medical treatment of disorders affecting critically ill patients in the CVICU.

Structure: Under the supervision of the full-time faculty, the fellow will evaluate and treat patients with a full spectrum of critical illnesses with an emphasis on post-procedure cardiac patients (CABG, VAD, and heart valves), ECMO patients, and heart and lung transplant patients. Fellows will help put patients on ECMO and run the circuits daily. They will place Swan-Ganz catheters and get dedicated echocardiography training. They will get experience with ventricular assist devices and their associated physiology. Furthermore, they will get exposure to intra-aortic balloon pump devices and associated heart failure issues which could prove life-saving in our patients with cardiogenic shock in the acute care and trauma setting.


Pulmonary Critical Care Rotation~Medical Intensive Care Unit
Objectives: To provide critical care experience in the management of non-surgical patients in a medical ICU.


Acute Care Surgery Fellowship Experience (PGY-7)

The AAST Accredited ACS training will provide education to fellows in the care of patients, in teaching, and in research. Surgeons admitted to each fellowship are required to have completed the core training requirements of a Resident Review Committee (RRC)-approved residency in General Surgery and/or be American Board of Surgery eligible. Thus, the fellows should have already developed a satisfactory level of clinical maturity, technical skills, and surgical judgment that will enable them to begin a fellowship in the field of Acute Care Surgery. The period of training is two sequential years, and the program must comply with these requirements for fellowship training. The key components of this training include trauma surgery, surgical critical care, and complex emergency general surgery. The surgical critical care component of the fellowship must meet the requirements of an ACGME accredited Surgical Critical Care Fellowship.

Acute Care Surgery (PGY-7) Rotations by Hospital

down arrowUofL Health – University of Louisville Hospital

Trauma Rotation~Surgical Critical Care Unit and Burn Unit
Objectives: To further their understanding of trauma and acute care surgery by offering a more autonomous setting to practice.

Structure: In the second year, the fellows will transition to leading a trauma team. The emphasis in the second year will be more geared to operative management, complex trauma cases, and management of level one activations. They will work closely with the chief residents in devising appropriate treatment strategies for complex trauma patients. They will be responsible for daily floor rounds and all trauma activations for their respective team. They will participate in all of their team’s trauma and acute care surgery cases. They will take in house trauma calls on Tuesdays and Fridays with direct attending supervision. They will also be responsible for trauma and burn clinic coverage. This year will emphasize more of a leadership role for the entire trauma team, and hopefully provide an experience of what life will be like as an attending.


down arrowUofL Health – Jewish Hospital

Cardiothoracic Surgery Rotation
Objectives: To understand the diagnosis, preoperative decision-making, and surgical techniques of cardiac and thoracic pathologies.

Structure: Fellows will be a part of the cardiothoracic team, rounding and performing operations with them daily. Their main focus will be on attaining appropriate cardiac and thoracic case numbers not covered by their trauma experience to become more comfortable with exposures and operative control of hemorrhage in the mediastinum. They will be encouraged to attend clinic when not operating, to continue advancing their knowledge in cardiac physiology and echocardiography. They will also have the opportunity to travel with the cardiac and lung donor teams for organ procurement.


down arrowUofL Health – Mary and Elizabeth Hospital

Vascular Surgery Rotation
Objectives: To understand the diagnosis, preoperative decision-making, and surgical techniques associated with vascular diseases.

Structure: Fellows will spend a month on our vascular service at M and E Hospital, which does not have resident or vascular fellowship involvement. They will attend clinic, daily rounds, and operate with the team there. The emphasis will not only be on operative exposures required for AAST cases, but also endovascular techniques, which will improve the fellow’s ability to perform on table angiography and gain vascular access safely.


down arrowNorton Hospital and UofL Health – University of Louisville Hospital

Vascular Surgery Rotation
Objectives: To diagnose and treat a wide range of surgical pathologies in the acute care setting. Indirect supervision will be provided to allow appropriate autonomy.

Structure: Fellows will spend the latter months of their final year gaining necessary autonomous practice with indirect supervision. They will help staff our ACS service, taking call and performing weekly rounding duties. They will also have their own surgery clinic, to help maintain patient continuity for postop care. They will not graduate to this until approved by the program director as explained in our supervision policy. Back-up call will always be available. In addition, fellows will have the opportunity to be involved in donor call, where they will travel with the transplant team for organ procurement.