The Stanford Vascular Surgery Fellowship is an RRC-accredited two-year fellowship leading to board eligibility for a certificate of Special Qualifications in Vascular Surgery granted by the American Board of Surgery. The first year is devoted to an intense clinical experience involving, as the primary surgeon, a large number and variety of open and endovascular cases and supervising the management of an active inpatient university vascular surgery service. The second year is a flexible year that includes hands-on experience in advanced endovascular procedures, noninvasive diagnosis, and clinical or basic research. There is ample opportunity to present at national meetings and produce peer-reviewed publications.
The first year of the fellowship involves an intense clinical experience in the total preoperative, intraoperative, and postoperative management of complex vascular patients characteristic of a major tertiary referral center. The entire 12-month rotation is spent at the Stanford University Medical Center.
Wei Zhou, MD and First Year Fellow, Tae Song, MD
The first year experience includes:
Operative experience: The operative experience
consistently involves over 400 open and endovascular cases during a 12-month period,
over 350 of which are RRC Category I major vascular reconstructions.
This is well above the 90% percentile of all the vascular fellowships
in the country. The case mix is relatively evenly distributed among
aortic, cerebrovascular, and distal arterial revascularizations.
Within each of the major categories, approximately 25% are "redo" reconstructions. The first year fellow also is invovled with a large proportion of endovascular cases, including aortic stent-grafting, diagnostic arteriograms, and peripheral angioplasty/stenting.
Vascular Surgery Service: The university vascular surgery service is comprised of the Fellows, a clinical PGY-3 general surgery resident, one surgery intern, and one nurse practitioner. On-call evening and weekend coverage is shared between the PGY-3 resident and the two Fellows. The Fellow does not participate in any other general surgery call. A dedicated Clinical Nurse Coordinator provides preoperative teaching, scheduling of routine studies, and aids in the discharge planning, as well as supports other daily clinical activities of the service. The vascular surgery service shares a 28-bed Cardiovascular Intensive Care Unit with the Cardiothoracic service. It has an open-service structure and all the vascular patients are managed by the vascular service in conjunction with a Surgical Intensive Care Unit service.
Dr. Christopher Zarins with former fellow and current faculty, Jason T. Lee, MD
Conferences: The first year Clinical Fellow is responsible for organizing the weekly vascular conference, which is held every Monday morning. The conference alternates every other week between Interesting Case presentations and vascular M&M. There is a weekly didactic Rutherford basic science review conference organized by the fellows. Journal club is held on a quarterly basis reviewing current controversial topics.
Outpatient Experience:
The Fellow is assigned to the outpatient clinic one day a week, and participates in the preoperative evaluation and postoperative follow-up of patients with the attending surgeons.
Benefits:
Time is allowed for presentations at national meetings, board examinations, and up to three weeks of paid vacation. The cost of California licensure and a $1000 educational stipend is provided through the Residency Office. In addition, a $1500 stipend is also given to cover moving expenses to Northern California.
The second year is devoted to endovascular surgery, clinical/basic research, and active participation in the noninvasive vascular laboratory.
The second year experience includes:
Endovascular Surgery:
The second year (Endovascular) Fellow devotes approximately 50% of his/her time in the endovascular program. This involves the preoperative evaluation and the postoperative follow-up of aortic stent graft patients. The Endovascular Fellow gains considerable experience in diagnostic angiography, carotid, visceral and peripheral interventional procedures, balloon angioplasty, and stenting techniques. At the completion of the year, the Endovascular Fellow will have performed enough cases to meet the SVS/ISCVS standards for hospital credentialing interventional peripheral vascular privileges.
Research:
The Division has an active clinical trials program as well as well-funded research laboratories in biomechanical engineering and vascular biology. Stanford's location near the heart of Silicon Valley provides a unique opportunity for collaboration with biotechnology industries for medical device research and development. In addition, the vast case volume offers a tremendous amount of material for conducting prospective and retrospective clinical studies, either within the Division or with our vascular imaging divisions (Interventional, MR, and CT). The Fellow is expected to participate in research projects leading to presentations at national meetings and write peer-reviewed publications.
Conferences: In addition to the weekly vascular conference, the Endovascular Fellow is expected to actively participate in the weekly Joint Cardiovascular Interventional Radiology-Vascular Surgery conference. Other educational activities include the weekly Basic Science Conference, quarterly Vascular Surgery Journal Club, and weekly teaching sessions with residents and medical students.
Other Responsibilities:
The Endovascular Fellow shares call responsibilities with the first year Clinical Fellow.
Vascular Surgery Training in General Surgery
General Surgery residents receive their vascular training as junior residents on the University Vascular Surgery service during their PGY-I and PGY-III years, when they are actively involved in the daily management of the vascular patients. The Chief Resident in General Surgery obtains the majority of their vascular experience at the Palo Alto VA hospital and affiliated institutions. At the completion of their training, the Chief Residents typically will have performed 70 to 120 major vascular cases, which is well above the RRC guidelines.
