Cardiothoracic Anesthesia Fellowship

Program Overview

Since it's inception in the 1970s, it has been the intent of our Cardiothoracic Anesthesiology Fellowship to prepare the fellow to practice cardiothoracic anesthesiology independently and competently through a program organized to ensure optimal patient care while providing an opportunity to develop skills in clinical care, judgment, teaching, and research. Pivotal to our continued success is a highly motivated team of academic cardiothoracic anesthesiologists, a comprehensive didactic teaching program, and a very busy cardiothoracic surgical service.

On an annual basis, our division provides anesthetic care to approximately 3000 cardiac and thoracic surgical patients. We routinely perform 1200-1300 cardiac surgical procedures utilizing cardiopulmonary bypass each year. Of these, approximately one quarter are coronary revascularizations and approximately one-half are complex valve procedures (particularly mitral valve repairs). The remaining bypass cases annually include major aortic reconstructions, major pediatric congenital procedures, implantation of a large number of mechanical circulatory support devices (VADs), adult and pediatric heart transplantation, and congenital procedures on adults. Non-bypass procedures include off-pump coronary revascularization and approximately 400 video-assisted and open procedures on the lungs and esophagus. Additionally, we routinely provide care to approximately 175 - 200 pediatric patients undergoing diagnostic and therapeutic interventional cardiology procedures as well as both pediatric and adult patients undergoing percutaneous electrophysiologic studies and cutting-edge interventions.

Approximately 1400 Transesophageal Echocardiographic (TEE) examinations are performed by our division each year, and it is a major focus of our training program to prepare the fellow to perform perioperative TEE competently. We proudly boast that 100% of our cardiac anesthesia attending staff is either board certified by the National Board of Echocardiography to perform perioperative TEE or in the certification process, and the vast majority of our previous fellows who took the perioperative TEE exam passed on the first attempt.

Current Status of the Fellowship

Our CT anesthesia fellowship has been ACGME-accredited to train 5 fellows since July, 2006, and our most recent site visit (April 2010) resulted in full, multiyear accreditation with no citations. Fellow duty hours and conditions of work are in compliance with ACGME guidelines as well as with those of the Bell Commission of New York State. All weekend and night "on-call" duties are from home by beeper and there is no elective operating schedule at the Mount Sinai Hospital on weekends, national or major religious holidays.

Didactics

Complimenting the varied and busy clinical experience of our fellowship is a comprehensive series of 41 didactic lectures covering topics pertinent to the practice of cardiac and thoracic anesthesiology as well as transesophageal echocardiography. These talks encompass the required teaching curriculum of both the ACGME-accredited fellowship in cardiothoracic anesthesiology as well as the core teaching curriculum of the American Society of Echocardiography. In addition to these scheduled presentations, dedicated time is spent each week reviewing intraoperative TEE exams, and an abundance of teaching takes place daily during the course of patient care.

Rotations

Fellows will spend 8 of the 12 months assigned to clinical duty in the adult and pediatric cardiothoracic operating rooms and other cardiac anesthetizing locations at The Mount Sinai Hospital. In accordance with ACGME guidelines, one month will be spent rotating through the 24-bed Cardiothoracic Surgical Intensive Care Unit at Mount Sinai, and two months will be spent on elective rotations of the fellows' choosing. Available rotations currently include pediatric cardiac anesthesia, thoracic anesthesia, interventional and diagnostic cardiac anesthesia, perfusion, and research. Each fellow is entitled to 4 weeks of paid vacation that can be taken anytime throughout the year.

Scholarly Activity

The Division of Cardiothoracic Anesthesiology at the Mount Sinai Hospital is very academically involved in both national and international professional societies and symposia, and our attendings have authored numerous definitive textbooks and textbook chapters in the field of cardiac and thoracic anesthesiology. Areas of active research currently include: neurological outcomes in cardiac surgery, coagulation and hemostasis, pediatric cardiac anesthesia, geriatric cardiac anesthesia, new pharmacologic agents and new monitoring technologies. Fellows are encouraged to participate in research projects that are of interest to them, to present abstracts and interesting case series at major meetings, and to assist with the writing of articles for publication, and book chapters. During their training, each fellow is expected to complete at least one writing assignment (e.g., abstract, case report, ECHO rounds, review article, etc), to run at least one journal club (on a timely topic of their choosing) and to give at least one formal presentation to the division during our protected didactic teaching time. Faculty mentors are assigned to assist fellows with their scholarly activity. Each year, one of our fellows is chosen to present a complex case at the Annual Meeting of the Society of Cardiovascular Anesthesiologists (SCA), and one presents a complex case at the New York TEE Symposium.

Eligibility

The Consortium for Graduate Medical Education of the Icahn School of Medicine is dedicated to attracting the highest quality House Staff as well as to maintaining cultural diversity among the resident body. The Department of Anesthesiology and the Division of Cardiothoracic Anesthesiology at the Icahn School of Medicine share this vision and therefore welcome applications for fellowship from all eligible physicians. In compliance with federal, state, and municipal laws, and in observance of Mount Sinai's well-established tradition of fairness, equal opportunity is given to all applicants without regard to race, creed, color, religion, national origin, age, gender, disability, marital status, sexual orientation, veteran status, or citizenship status. Applicants with the following qualifications are eligible for appointment to the Icahn School of Medicine Fellowship in Adult Cardiothoracic Anesthesiology:

1. Graduates of a residency program in Anesthesiology in the United States or Canada accredited by the Liason Committee on Medical Education (LCME).
2. Graduates of a residency program in Anesthesiology (or equivalent training) outside the United States or Canada who meet one of the following qualifications:
   1. have received a currently valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG); or
   2. have a full and unrestricted license to practice medicine in a U.S. licensing jurisdiction.

Fellow selection is based on the applicant's demonstrable ability to benefit from the educational program and qualifications for the job, as well as the favorable outcome of a personal interview. Aptitude, academic credentials, personal characteristics, ability to communicate in the English language, and information contained within letters of recommendation from practicing clinicians familiar with the applicant's work are considered in the selection process.

Once selected, appointment as a member of housestaff is contingent upon the satisfaction of all Institutional requirements for employment.

Application

Applications are sent out on request, and will be accepted from December through April of the year preceding that of the desired matriculation into our program. Eligible applicants will be contacted to schedule an interview once we have received a complete application, which includes at least two letters of recommendation from practicing clinicians familiar with the applicant's clinical work. It is also desirable to include a letter from the applicant's program director addressing performance evaluations to date in the areas of the 6 ACGME core competences. All letters of recommendation must be sent directly from the author to our program. We cannot accept "open", previously written, general letters of reference directly from applicants on their own behalf. A current e-mail address and preferred telephone contact information should be included on the application or applicant's personal statement.

Our interview season runs from January through May. We will be participating in the SF Match for Cardiothoracic Anesthesiology Fellowships, and must input our rank list by the first Monday in June. All ACGME applicants to our program must be registered for the SF match (details and instructions for applicants are available on the SCA website). Match results will be released on the third Monday in June.

Thanks for your interest the Cardiothoracic Anesthesiology Fellowship training program at Mount Sinai. Please do not hesitate to contact me or our program coordinator Michelle Meehan at 212-241-4441 if you have any questions.