Rotations
Cardiac - 28 weeks
Maine Medical Center (MMC) has significant cardiac surgical volume that includes on and off-pump CABG, valve repair and replacement, major aortic reconstruction, insertion/implantation of circulatory assist devices (ECMO and VAD), and adult and pediatric congenital repair. MMC has three cardiac operating rooms and one hybrid operating room for TAVR, Mitral Clips, Convergent Maze procedures, and complex endovascular surgery.
Over the course of the year, the fellow is expected to gain mastery in all aspects of care of the cardiovascular patient, including: preoperative evaluation and optimization, interpretation and application of preoperative testing, perioperative pharmacologic and physiologic evaluation and management, interpretation of invasive monitoring, performance and interpretation of perioperative TEE, management of intra-aortic balloon counter pulsation, extracorporeal and implanted circulatory assist devices (ECMO and VADs), cardiopulmonary bypass and post-operative management in the ICU. The fellow will interact with the entire care team, and be an integral part of the perioperative management for patients throughout their hospitalizations.
Vascular/Thoracic - 6 weeks
The fellow will be responsible for the care of patients having lung and esophageal surgery through both open and video-assisted approaches. The fellow will be responsible for the perioperative management of the patient, including; preoperative evaluation and optimization, interpretation of preoperative pulmonary function testing, intraoperative management of lung isolation strategies, and post-operative pain management.
We do a wide range of vascular surgery at MMC including thoracic and abdominal repair through both endovascular and open approaches. The fellow will build on his/her residency experience and gain expertise in the care of vascular patients.
The fellow will be an integral part of the care team, and be active in patients’ care throughout the perioperative period. In both vascular and thoracic, the fellow will have the opportunity to both personally perform and supervise the care of these patients.
CVCC - 8 weeks
The MMC Cardiovascular Critical Care (CVCC) Service provides care to all critically ill patients within the Cardiovascular Institute and is separated into two units. The Cardiac Intensive Care Unit (CICU) is a 12 bed medical ICU which is staffed with intensivists, cardiologists and housestaff from Internal Medicine, Pediatrics, Emergency Medicine, and Anesthesiology. This patient population can range from standard post-PCI patients to patients with multi-organ failure requiring mechanical support including IABP, Impellas, and VADs.
The Cardiothoracic Intensive Care Unit (CTICU) is a 10-15 bed unit staffed with Advanced Practice Providers (APPs) and housestaff, which includes postoperative cardiac patients as well as patients requiring mechanical circulatory support (including VV and VA ECMO). Each fellow will have the opportunity to participate in the care of medical and surgical cardiovascular patients while working alongside physicians in a complicated, highly functional, multidisciplinary environment.
Electrophysiology - 2 weeks
MMC has a robust electrophysiology (EP) department. The fellow will be exposed to a wide range of EP cases, including; ablations (atrial fibrillation and flutter, SVT, VT), implantation of cardiac implantable electronic devices (CIEDs) including permanent pacemaker (PPM) placement, cardiac resynchronization therapy with (CRT-D) and without (CRT-P) defibrillators, implantable cardiac defibrillators (ICDs), leadless pacemakers, diagnostic congenital catheterizations, and interventional congenital catheterizations including transcatheter pulmonary valve replacement. The fellow will gain expertise in the management of this complex group of patients and will function as an integral part of the care team. The fellow will have the opportunity to both personally perform and supervise the care of our EP patient population.
Electives - 8 weeks
- ECHO/TEE – The fellow can elect to spend 2 weeks getting additional TEE experience in the OR and with the cardiology service interpreting TTEs and TEEs with the reading cardiologist.
- Perfusion – The fellow can elect to spend 1:1 time the perfusion team during cardiopulmonary bypass (CPB) cases learning the management of the CPB machine, the ECMO machine, VADs including the HeartMate II and III, and the Heartware HVAD, and Impellas.
- Transfusion Medicine – The fellow can elect to spend 2 weeks in the blood bank learning all aspects of blood banking, from type and screen/cross, blood storage and preparation, coagulation testing and management, and complications of transfusion.
- Catheterization Lab– The fellow can elect to rotate in the catheterization lab with the interventional cardiologists assisting with diagnostic and interventional catheterizations where the fellow will evaluate and interpret coronary angiography, and right heart catheterizations.
Didactic
Cardiac Ultrasound Lectures
Lectures put together by faculty in the Anesthesiology, Cardiology, Pediatric Cardiology, and Critical Care Departments are held on Wednesday mornings with a frequency of two per month.
Cardiac Conference
Case conferences are held by the cardiac anesthesiologists, residents and fellows on Wednesday mornings with a frequency of two per month.
Fellow Lectures
Lectures are hosted by the fellows (with a topic of their choosing) on Wednesday mornings before the start of clinical duties.
Simulations and Workshops
This includes the TEE and TTE simulator, CPB workshops, ECMO, Impella, VAD, and IABP workshops, diagnostic imaging with Cardiology, ROTEM and TEG with Transfusion Medicine, and bronchoscopy simulation.
Basic Cardiothoracic and Vascular Lectures
This conference series is hosted by the Department of Anesthesiology and is protected academic time for the residents every Thursday. Fellows are encouraged to attend as their clinical duties allow.
Morbidity and Mortality Conference
Morbidity and Mortality Conferences (M&M) are held periodically throughout the year. The fellow will attend these conference along with the rest of the department and will also be expected to present at M&M a case of his/her own.
Journal Club
Two of these will be held during the course of the year. They are hosted by one of the faculty members with journal articles selected by the fellows.
Grand Rounds
This is protected educational time every Thursday morning. It will be the expectation that the fellows attend these conferences. This will be an opportunity for them to present to the Department in the form of M&M, Grand Rounds, and/or QI project.
QI Project
The fellow will be required to complete the Patient Safety Quality Improvement (PQSI) institutional curriculum mandatory for all residents and fellows. The fellows will be responsible for the development of an inter-professional QI project during their fellowship year. The product of this project will be published to our Anesthesiology Practice Management website and serve as a reference for our department.
