The five-year integrated vascular surgery residency is organized to provide the fundamentals of general surgery and patient care integrated with vascular surgery experiences that build on the knowledge of anatomy, physiology and pathology gained in medical school. Clinical rotations include general surgery, including acute care and trauma surgery, colon and rectal surgery, plastic surgery, surgical critical care, cardiothoracic, transplant surgery and surgical oncology. These general surgery rotations will be supervised by general surgery faculty and senior residents.
Dedicated vascular surgery educational experiences are integrated throughout the first two years of the program culminating in a longitudinal vascular surgery experience during the last three years of the program. The integrated vascular surgery residency program includes the evaluation and clinical management of inpatient acute vascular surgery patients and vascular surgery outpatients including a dedicated vascular laboratory assignment. Additional clinical experiences on the integrated vascular surgical service will focus on developing basic open and endovascular skills, performing inpatient vascular surgical consults, and overseeing the inpatient vascular consult service. The integrated vascular surgery experiences during all years of the program will be scheduled separately and supervised by vascular surgery faculty.
During the vascular laboratory experiences, supervision will be provided by an IAC (Intersocietal Accreditation Commission) accredited vascular laboratory with technical instruction by RPVI (Registered Physician in Vascular Interpretation)-certified vascular surgeons with the support of RVT (Registered Vascular Technologist) vascular laboratory technologists.
Throughout training, vascular residents will participate in daily educational conferences, bimonthly morbidity and mortality conferences and regularly scheduled simulation sessions. Professionalism will be an integral part of all educational activities. Residents will interact with hospital staff, peers and attendings in a collegial and professional manner and maintain professional demeanor and behavior with patients. Residents will demonstrate compassion and respect for the patient and family while upholding their rights to confidentiality and privacy. Residents will also demonstrate sensitivity to patient gender, age, race, religion, culture and disabilities. Residents will develop dependable work ethic and demonstrate traits of personal integrity.
During the first year, the vascular fellow participates in clinical care and research activities while developing endovascular skills. First-year fellows participate in a large amount of endovascular surgery and a modest amount of traditional open vascular surgery procedures. These procedures are done under the supervision of staff vascular surgeons who train the fellows in these skills. The vascular surgeons at Geisinger are primary interventionalists for all procedures including carotid, peripheral and visceral stenting, thoracic stent grafts and AAA stent grafts. Overall endovascular volume includes approximately 500 interventional cases per graduating fellow. These cases are performed in dedicated endovascular suites used by the vascular staff.
A one-month block is spent in learning vascular lab skills including hands-on scanning in our own vascular laboratory with one of our registered vascular technicians. Our vascular laboratory performs approximately 14,000 examinations per year, allowing the fellow to develop competency in the interpretation and performance of vascular laboratory procedures. The fellows also read studies during their month rotation with instruction from the staff vascular surgeons, allowing the fellows to prepare for the RPVI exam.
The remaining time in the first year (approximately 15%) is spent in research efforts looking at either clinical projects or basic science research. The basic research program is supported with full-time research technicians. Presentations of findings at national and regional meetings and in publications in referred journals are strongly encouraged and supported.
During the second year, the vascular surgery fellow serves as the surgeon for more than 300 vascular disease patients whose conditions represent all the significant vascular reconstructive procedures. The attending staff physician supervises the fellows in clinic a half day per week, making regular patient rounds and providing consultation. Emergent and urgent procedures comprise approximately 10% of the caseload.
The clinical aspects of training are complemented with daily didactic, preoperative, staff rounds, a monthly journal club and morbidity and mortality conferences. The fellow is expected to participate in continued medical education activities for which a stipend is provided.
Mandatory sessions are offered daily and provide a comprehensive and in-depth look at a variety of topics in vascular surgery. Topics covered include:
VSCORE Vascular Didactics
This Week in SCORE – Vascular Surgery for Integrated Residents is a sequence of suggested topics over a two-year cycle where both the VSCORE and the SCORE core general surgery modules repeat every other year. This sequence is meant to be a less onerous time commitment for integrated residents, giving them exposure to all VSCORE modules two to three times during their residency. Each week features a new topic and a set of related modules, providing a systematic way for users to cover the Vascular Surgery-Fellowship Level content.
The senior resident on service at Geisinger Medical Center is responsible for identifying cases from the prior week for the purpose of reviewing interesting operative findings/imaging or approaches.
Morbidity and Mortality (M&M)
Fellow/resident most directly involved in surgical cases up for M&M review will lead the discussion for that case. The M&M conference is attended by all surgical faculty.
Vascular Video Lecture Series
This didactic session makes use of online educational resources and includes content from international and national lecture series and scientific courses.
Vascular Research Conference
This didactic session will review recent vascular and surgical research at Geisinger by faculty across the Surgical and Heart Institute.
Three to four papers are selected for discussion based on impact of publication, VSCORE modules, and current interesting cases. “Classic Journal Articles” are also referenced for discussion.
Surgery Simulation Workshop (PGY1, PGY2 and PGY3 only)
Simulation session will focus on general surgery simulation training as planned by the General Surgery Residency PD in collaboration with Vascular Surgery PD. PGY1, PGY2, and PGY3 Integrated Vascular Surgery residents will attend this simulation session. Vascular-surgery-focused simulation training will be attended by all residents of the integrated residency.
General Surgery Lecture (PGY1 and PGY2 only)
These lectures will focus on general surgery topics as planned by the General Surgery Residency PD. PGY1 and PGY2 Integrated Vascular Surgery residents will attend this lecture every Tuesday.
Vascular Lab Education Conference
These lectures will focus on vascular lab topics to include RPVI Review, review of challenging cases, and basics of non-invasive vascular imaging.
In keeping with Accreditation Council for Graduate Medical Education (ACGME) requirements, our fellows/residents are involved in quality improvement projects. These are designed to improve medical care, patient safety, workflow, and resident education. Many fellows/residents are also involved in research. We offer you:
- An involved faculty to serve as research and QI mentors
- A fundamentals of research curriculum
- Dedicated research support personnel and statisticians to guide you through study design, IRB approval and research funding
- The opportunity to serve on quality improvement committees in your field of interest
- Graduate medical education or departmental funding support to present your work at regional or national conferences
In the last two years, our fellows have presented at the following conferences:
- Delaware Valley Vascular Society Meeting
- Eastern Vascular Society Annual Meeting
James Elmore, MD: elmore jr - Search Results - PubMed (nih.gov)
Robert Garvin, MD: garvin r - Search Results - PubMed (nih.gov)
Gregory Salzler, MD: salzler g - Search Results - PubMed (nih.gov)
Jeremy Irvan, MD: irvan j - Search Results - PubMed (nih.gov)
David Mariner, MD: mariner d - Search Results - PubMed (nih.gov)
Melissa Obmann, DO: obmann m - Search Results - PubMed (nih.gov)
Shivprasad Nikam, MD: nikam s - Search Results - PubMed (nih.gov)