Description

Thomas Jefferson University and Jefferson Health is pleased to announce an opening for the unaccredited Cardiac Surgery Fellowship.  The selected fellow will actively participate in management of patients on the Cardiovascular Surgery Service under the direct supervision of the attending cardiac surgeons. Responsibilities will include weekday nights and weekend days and nights for the service. The qualified candidate will hold a current, unrestricted or institutional Pennsylvania medical license and have experience in cardiology, cardiac surgery, and/or critical care medicine. The fellow will not maintain an independent surgical practice or perform independent elective cardiovascular surgical procedures without direct supervision by the Chief of Cardiovascular Surgery or his designee.

Duration: 12 months

Citizenship/Visa:  US Citizens or US permanent resident status only

 Educational Goals and Objectives:

• Fellow are expected to become proficient in the preoperative workup, indications, and postoperative care of common adult cardiac conditions.   
• Fellow will review the case preoperatively with the attending and during the operative procedure will function as primary surgeon or first assistant depending on the complexity of the case and their ability to perform the case.
• Fellow will see patients preoperatively and postoperatively in the hospital as well as in the outpatient clinics.  
• Fellow will interact with  the cardiac surgery team consisting of cardiac surgery attendings, physician assistants, nurse practitioners, surgical assistants, medical students, and perfusionists.   
• Fellow will be required to attend all mandatory core curriculum conferences.  In addition, they are also encouraged to attend the aortic conference, cardiac cath lab conference, & cardiology M & M.
• Fellow will be responsible for occasional presentation of cases at the weekly educational conference, Cardiac Surgery M & M and Department of Surgery M & M 

 On-Call Responsibilities:

• Fellow will have weekday nights and weekend days and nights.
• Fellow will make rounds on patients on the cardiovascular surgery step-down and intensive care units.
• Fellow will be available for consultation.
• Fellow will be immediately available to respond to all calls for assistance from other healthcare providers at the Hospital.
• Fellow will promptly involve the attending surgeon in any evaluation or management issue requiring attention.
   

Outpatient Activity:

• Fellow will be expected to experience a broad outpatient exposure.
• Fellow will be expected to attend the Cardiac Surgery Clinic with the Cardiac Surgery team.
   

Facilities:

• All clinic and inpatient care will take place within the Jefferson Health system.

Core Competencies:

Patient Care
The fellow must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. The fellow is expected to:

• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
• Gather essential and accurate information about their patients.
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
• Develop and carry out patient management plans.
• Counsel and educate patients and their families.
• Use information technology to support patient care decisions and patient education.
• Perform competently all medical and invasive procedures considered essential for the area of practice.
• Provide health care services aimed at preventing health problems or maintaining health.
• Work with health care professionals, including those from other disciplines, to provide patient-focused care.
• Assess patients referred for adult cardiac surgery in the inpatient and outpatient settings and perform a history and physical exam concentrating on the areas relevant to adult cardiovascular disease.
• Arrive at an appropriate differential diagnosis.
• Order appropriate diagnostic tests/procedures demonstrating knowledge in the interpretation of these investigations. 
• Use the history, physical exam, and diagnostic tests to arrive at an acceptable patient assessment and management plan, demonstrating knowledge in the operative and nonoperative management of the disease process.
• Care for  the adult cardiac surgery patient throughout the hospital stay, including management in an intensive care setting, demonstrating knowledge and ability to anticipate, recognize, and manage potential complications of the disease processes and operative procedures.
• Provide a plan for patient follow up and care for the adult cardiac surgical patient in the outpatient clinic after hospital discharge.
• Demonstrate adequate technical skills including the proper handling of tissues and surgical instruments in an appropriate manner and strict adherence to sterile technique.
• Demonstrate an operating room awareness showing appropriate management of and interaction with first assistants, perfusionists, anesthetist, scrub technicians, and circulating nurses.
• Demonstrate the ability to act as first assistant in below procedures and anticipate surgical maneuvers, give and take direction well, make reasonable suggestions, and contribute to a positive operating room atmosphere.
• Demonstrate the ability to perform the variety of procedures performed by the cardiac surgeon, including but not limit to:
  • Cardiopulmonary bypass cannulation (via variety of arterial and venous access)
  • Coronary revascularization conduit harvest (IMA, saphenous vein, radial artery)
  • Coronary artery bypass grafting (on- and off-pump)
  • Aortic surgery (aortic root, ascending aorta, aortic arch, descending aorta, aortic dissection)
  • Aortic valve surgery (AVR, repair)
  • Transcatheter aortic valve replacement
  • Tricuspid valve surgery (TVR, repair)
  • Mitral valve surgery (MVR, repair)
  • Ventricular septal defect repair
  • Atrial septal defect repair
  • Pericardial surgery (pericardial window, pericardiectomy)
  • Arrhythmia surgery (MAZE procedure)
  • Pacemaker and ICD surgery and programming

Medical Knowledge
The fellow must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. The fellow is expected to:

• Demonstrate an investigatory and analytic thinking approach to clinical situations.
• Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.
• Describe the anatomy, physiology, and pathophysiology of the pericardium, heart, and great vessels.
• Describe the natural history of treated and untreated cardiovascular surgical conditions, including ischemic heart disease, valvular heart disease, thoracic aortic disease, heart failure (transplant and non-transplant options), conduction system disturbances, cardiac tumors, pericardial disease, and trauma.
• Acquire the ability to interpret noninvasive diagnostic methods including EKG, CXR, CT, MRI, ECHO, and viability studies.
• Describe the procedure of and potential complications involved with invasive diagnostic methods including coronary angiography and cardiac catheterization.
• Describe the pharmacology, indications, and complications of the various drugs commonly used by the adult cardiac surgeon including anti-arrhythmics, inotropes, diuretics, anti-lipid, anticoagulants, thrombolytics, and pain medications.
• Describe the anesthetic management of the adult cardiac surgical patient, including preanesthetic evaluation and preparation, conduct of cardiopulmonary bypass, and conduct of anesthesia.
• Describe the physiology, technology, indications, and complications of cardiac pacemakers and defibrillators.
• Describe the physiology, technology, indications, and complication of mechanical assistance (ECMO, ventricular assist devices, artificial heart).
• Describe the principles and techniques for myocardial and cerebral protection

Practice-Based Learning and Improvement

The fellow must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. The fellow is expected to:

• Analyze practice experience and perform practice-based improvement activities using a systematic methodology.
• Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems.
• Obtain and use information about their own population of patients and the larger population from which their patients are drawn.
• Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
• Use information technology to manage information, access on-line medical information; and support their own education.
• Facilitate the learning of students and other health care professionals.
• Develop the ability to evaluate one’s patient care and strive for continuous improvement based on critical self-evaluation.
• Recognize gaps in knowledge and develop strategies to correct this by self-directed reading and consultation with other professionals.
• Read and critically review sources of medical information.
• Find and apply scientific evidence to the care of the patients.
• Demonstrate the ability to accept and incorporate scientifically valid practices.
• Participate in the education of patients, Fellows, and other health professionals.
• Prepare for and participate in organized conferences aimed at practice-based learning including M&M and Grand Rounds.

Interpersonal and Communication Skills

The fellow must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patient’s families, and professional associates. The fellow is expected to:

• Create and sustain a therapeutic and ethically sound relationship with patients.
• Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
• Work effectively with others as a member or leader of a health care team or other professional group.
• Communicate effectively with patients and families and demonstrate the ability to inform them of their condition at an understandable level.
• Communicate effectively, both written and verbally, with physicians and other healthcare professionals.
• Demonstrate the ability to act as a consultant for other physicians and healthcare professionals.
• Effectively lead a team of surgical Fellows, medical students, physician assistants, and nurse practitioners.
• Write concise, clear operative reports which incorporate all significant findings.
• Write clear consultation notes, discharge summaries, and clinic notes.
• Document all operative reports, consultation notes, discharge summaries, and clinic notes in a timely fashion.

Professionalism

The fellow must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.  The fellow is expected to:

• Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.
• Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practice.
• Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities
• Demonstrate respect for patients and families.
• Demonstrate acceptance of responsibility for patient care.
• Demonstrate respect for patient privacy and autonomy.
• Demonstrate ethically sound behavior.
• Demonstrate sensitivity to cultural, age, gender, sexual orientation, and disability issues.
• Demonstrate openness to constructive criticism from others.
• Demonstrate the ability to keep appointments and be on-time.
• Maintain a professional appearance.

Systems-Based Practice

The fellow must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. The fellow is expected to:

• Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
• Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
• Practice cost-effective health care and resource allocation that does not compromise quality of care.
• Advocate for quality patient care and assist patients in dealing with system complexities.
• Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance
• Demonstrate the ability to work effectively within  Jefferson Health
• Demonstrate the ability run an efficient outpatient clinic.
• Demonstrate the ability to critically assess the risk/benefit and cost effectiveness of diagnostic and therapeutic interventions.
• Demonstrate the ability to delegate tasks and empower teams to maximize effectiveness.
• Demonstrate the ability to use institutional resources, such as, social services, home healthcare, outpatient services, etc. for effective discharge planning and demonstrate the ability to begin this process well in advance for efficient and patient-orientated discharge.