The integrated residency is aimed at successful graduates of an accredited medical or osteopathic school who wish to specialize in the field of vascular surgery. The program is 6 clinical years in length, and includes 2 years of core surgical training and 3 years of intensive vascular training. In keeping with our mission of training future leaders in vascular surgery, we have a mandatory academic development year between the third and fourth year. The curriculum stresses core education in the management of surgical patients with complex illnesses, and advanced education to develop competency in the diagnosis and treatment of patients with vascular disease.
The two teaching hospitals that form the basis for the vascular surgery residency are Yale-New Haven Hospital (YNHH) and the VA Connecticut Healthcare, West Haven (VA). The Yale General Surgery Residency program provides rotations in general surgery to all vascular surgery residents at the PGY-1 through PGY-5 levels. There is great opportunity at both hospitals for clinical training and research.
The core surgery education provide the PGY 1-3 vascular surgery resident with adequate exposure to the basic science of surgery, the basic principles of perioperative patient assessment and management, and the fundamentals of surgery techniques and procedures. The essential components of the core curriculum include preoperative assessment, perioperative physiology and hemodynamics, coagulation physiology, principles of infectious disease, wound healing, and nutrition. The minimum core technical skills acquired include airway management, invasive hemodynamic monitoring and AV access, soft tissue management, and basic thoracic, abdominal and surgical trauma techniques. The experience are of sufficient breadth to allow the vascular surgery resident to assess and manage common surgical conditions, perform common surgical procedures and to recognize and manage common surgical complications.
Vascular surgical residents receive clinical experiences in gastrointestinal surgery, trauma surgery, surgical critical care, plastic surgery, cardiothoracic surgery, and transplantation surgery. These clinical experiences provide the vascular surgery resident with the opportunity to evaluate and manage patients with multiple traumatic injuries, gastrointestinal tract pathology (malignancy, bleeding, obstruction, bowel ischemia/infarction, ileus, rectal diseases), the acute abdomen, pulmonary pathology (malignancy, hemothorax and pneumothorax), hernias (inguinal, ventral), end-stage organ failure (liver, kidney), and soft tissue defects.
Since patients with vascular disease commonly have associated co-morbidities, the vascular surgery resident also obtain experience in the management of diabetes, myocardial ischemia, renal insufficiency, hypertension and pulmonary disease as related to the preoperative preparation and postoperative management of the surgical patient. The vascular surgery resident have primary responsibility for and experience in all elements of preoperative and postoperative patient care including hemodynamic management (including arterial and central venous monitoring, interpretation of EKGs), respiratory care, ventilation management and pain management. These are acquired through the general surgery rotations as well as anesthesia and critical care. The assigned inpatient and outpatient cardiology rotations allow the vascular resident to become very familiar with the medical management of hypertension, elevated lipids and atherosclerotic vascular disease. A thorough understanding of platelet physiology and antiplatelet therapy is also required of these rotations.
The vascular surgery resident also learn the assessment of commonly performed diagnostic imaging studies as they pertain to the surgical patient. Special attention to vascular imaging techniques including CT angiography and MRA scans is expected to be achieved through an abdominal imaging rotation in Radiology during the PGY-1 year. Familiarity with scanning techniques and 2D and 3D image reconstructions as well as their advantages for specific vascular exams are expected.
The cardiac and thoracic surgery rotations provide understanding of the anatomy of the heart, aortic arch and branches as well as the thoracic aorta, understanding of bypass techniques, pump principles and the management of pleural collections, common lung and cardiac diseases and the presentations and principles of management of emergency thoracic aortic diseases.
The PGY-4 and PGY-5 years are designed to provide a more independent and “senior” experience on vascular services. They provide experience at the senior level in the more complex type of vascular problems, both elective and emergency. These years are spent entirely in the main sponsoring institution hospitals (YNHH and VA) where tertiary care is provided in addition to the common standard vascular procedures.
At the end of the intensive training the graduate is expected to have the skills necessary to diagnose and define abnormalities of the vascular system, formulate a treatment plan based on available medical and surgical therapeutic options and perform all various surgical and endovascular reconstructive procedures necessary. The graduating vascular surgeon will also have an in-depth understanding of the pathophysiology of vascular disease, especially in areas of hemodynamics, predisposing factors for atherosclerotic disease and knowledge of the pharmacokinetics of drugs used in the treatment of vascular pathology.