Program Director-Fred A. Weaver, M.D.
Program Coordinator-Kathy Pollock
Phone: (323) 442-5907
Fax: (323) 442-5735
E-mail: kpollock@surgery.usc.edu

OVERVIEW

The University of Southern California (USC) Program in Vascular Surgery is a two year experience conducted at the University of Southern California Health Sciences Campus (USC University Hospital – USCUH and Los Angeles County+USC Medical Center – LAC+USCMC) in Los Angeles, and Huntington Memorial Hospital (HMH) in Pasadena, California. The first year is focused on providing a thorough and in depth endovascular and noninvasive vascular laboratory experience. During this first year the resident with faculty oversight will also be engaged in clinical research. The second year is structured around open vascular surgery, ambulatory care, and inpatient care at USCUH and HMH.

The Vascular Surgery faculty at all hospitals who are responsible for Vascular Surgery resident education are full time faculty of the University of Southern California. The Vascular Surgery resident rotations are three months in duration and designed to provide the resident with a balanced education in index Vascular Surgery procedures; complex, redo and unusual procedures; endovascular procedures; and invasive and noninvasive diagnostics for vascular disease.

At HMH, the Vascular Surgery resident is exposed to a large volume of open reconstructive vascular procedures. The resident team consists of a PGY I, and PGY II or III general surgery resident along with the Vascular Surgery resident. The hospital has an active emergency room and is a Level II Trauma Center. As the major provider of acute care services in the west San Gabriel Valley, a diverse experience in vascular problems of an urgent and emergent nature is available to the Vascular Surgery resident. The hospital has a busy noninvasive vascular laboratory, which is directed by the USC Vascular Surgery faculty and an endovascular experience

At USC Health Sciences Campus, the Vascular Surgery resident will be the senior resident on Vascular Surgery at USCUH which also includes either a PGY I or II general surgery resident. USCUH is a major referral center, providing the resident with experience in complex and re-do Vascular Surgery procedures. Vascular Surgery faculty also perform a wide range of endovascular procedures at both USCUH and LAC+USCMC, including aortic stent grafts, percutaneous angioplasty/stents and diagnostic angiography. The USCUH also has an active ICAVL accredited noninvasive vascular laboratory directed by USC Vascular Surgery faculty.

1. BACKGROUND AND ADMINISTRATIVE ORGANIZATION

   The USC Program in Vascular Surgery was accredited by the Residency Review Committee in Surgery on July 1, 2000. The Vascular Surgery Program at USC is conducted through the Department of Surgery at the Keck School of Medicine of USC. Dr. Fred Weaver the Chief of Vascular Surgery makes policy, appoints personnel, and directs the program. The training program utilizes the facilities of USC Health Sciences. Campus (USCUH and LAC+USCMC) and Huntington Memorial Hospital. The attending staff at all hospitals are fulltime faculty in the USC Division of Vascular Surgery

2. INPATIENT VASCULAR SURGERY SERVICES

   The Vascular Surgery service at the USCUH is a separate unit with an average census of ten patients. The service is composed of the Vascular Surgery resident and a PGY I surgical resident. At HMH, the Vascular Surgery service is also a separate entity with an average census of 15 patients. The service is comprised of the Vascular Surgery resident and a PGYII or III general surgery resident as well as a PGY I surgical resident. The Vascular Surgery resident has senior resident level operating and patient care responsibility. The attending is scrubbed at the operating table to teach, direct, and assume ultimate surgical responsibility. The goal is for the Vascular Surgery resident to receive a broad case experience which includes exposure to the difficult, the unusual, and redo vascular procedures and the associated patient care.

3. AMBULATORY EXPERIENCE

   While at USCUH, the Vascular Surgery resident is expected to attend the Tuesday Vascular Surgery clinic located on the 5th floor of the Healthcare Consultation Center from 9:00 a.m. to 5:00 p.m. During rotations at HMH, the Vascular Surgery resident ambulatory experience is on Wednesday from 9:00 a.m. to 5:00 p.m. at the Pasadena Office of Dr. Steven Katz or Dr. Roy Kohl. This ambulatory experience gives the resident an opportunity to see patients both pre and postoperatively with attending surgeons.

4. VASCULAR LABORATORY

   The Vascular Diagnostic Laboratories are physically located in the hospital at USCUH, HMH and LAC+USC. The Vascular Surgery resident will interpret all vascular studies at USCUH with attending vascular surgeon supervision. The Vascular Surgery resident will provide a preliminary interpretation based on videotape review that will be confirmed and signed by the attending. During the first year of the residency, at least one day a week is spent performing duplex and physiologic studies which is supervised by the USCUH Technical Director. The vascular surgery resident (PGY VI) also organizes the Quarterly Vascular Lab Q/A with the assistance of the USCUH Technical Director..

   At the completion of the residency, the Vascular Surgery resident will have obtained knowledge concerning the physiologic basis of laboratory testing, the performance of vascular studies, the application of laboratory testing for the evaluation and management of patients undergoing vascular repair, and the interpretation of laboratory tests results. This educational objective will be accomplished predominantly during the USCUH rotation and augmented by experience at HMH and LAC+USC. At the completion of the residency the Vascular Surgery resident will be a candidate for Registered Vascular Technologist certification.

5. ANGIOGRAPHY/ENDOVASCULAR PROCEDURES

   The Vascular Surgery resident will become proficient and comfortable with arterial and venous angiograms as well as the indications for angiography through hands on experience. Performing and interpretting angiograms is woven into the program at both USCUH and HMH such that the Vascular Surgery resident performs >100 diagnostic angiograms and 50 endovascular procedures during the residency. The Vascular Surgery resident will be involved with a wide variety of endovascular procedures including carotid angiography endografts, angioplasties and stent placement.

6. ROUNDS AND CONFERENCES
   1. USCUH AND HMH VASCULAR SURGERY ATTENDING ROUNDS

      Attending rounds are made daily with the on-call faculty member. In addition, formal attending rounds with all Vascular Surgery faculty, housestaff and medical students occur once a week. Residents as well as medical students should be prepared to review pertinent diagnostic studies and give bedside patient presentations.

   2. VASCULAR SURGERY PREOP CONFERENCE

      While at USCUH the Vascular Surgery resident will present patients scheduled for a vascular procedure in the coming week. These selected cases are presented to an audience of faculty, housestaff, medical students and other clinical staff each Thursday from 8:00 a.m. to 9:30 a.m. at LAC+USC Room 9241. The Socratic method of teaching will be used and the resident is expected to understand and justify the preop surgical plan.

   3. VASCULAR SURGERY MORBIDITY AND MORTALITY CONFERENCE

      The morbidity and mortality (M & M) from the Vascular Surgery services at USCUH, HMH, and LAC+USC are discussed. The Vascular Surgery resident is responsible for presenting all cases of M & M on his/her service along with pertinent diagnostic studies. (1st Thursday of each month from 6:00 p.m. to 8:00 p.m. at HMH, Surgical Conference Room, 2nd floor, East Tower.)

   4. LAC+USC VASCULAR SURGERY WALK ROUNDS

      LAC+USC bedside walk rounds begin at 7:00 a.m. on ward 10-800. Vascular Surgery preop conference follows immediately thereafter at approximately 8:00 a.m. in room 9241

   5. VASCULAR SURGERY JOURNAL CLUB

      Articles from the recent Vascular Surgery literature are reviewed by Vascular Surgery housestaff. Selection and assignment of specific articles to be digested, summarized and discussed by the residents on the Vascular Surgery service is done by a member of the full time faculty. The Vascular Surgery resident is encouraged to research and discuss recent articles which may be related to his/her assigned article. (3rd Thursday of the month, 6:00 p.m. to 8:00 p.m., Health Care Consultation Center, 4th floor conference room, suite 409.)

   6. VASCULAR LABORATORY QUALITY ASSURANCE

      The results of vascular lab studies performed for the past quarter are reviewed and compared to the angiographic findings. Discrepancies between the noninvasive study and angiogram are discussed with a focus on technique and criteria used for interpretation. (Once a quarter, 5th Thursday of the month, Health Care Consultation Center, 4th floor conference room, suite 409)

   7. BASIC SCIENCE CURRICULUM

      Many aspects of the basic science of Vascular Surgery are covered in the previously described conferences. In addition, a specific Vascular Surgery curriculum is part of the resident experience. A series of nine basic lectures comprise the curriculum. Presenters include Division faculty, School of Medicine faculty and the Vascular Surgery resident. The Basic Science conference occurs the 4th Thursday of the month, 6:00 p.m. to 8:00 p.m., Health Care Consultation Center, 4th floor conference room, suite 409.

   8. DIVISION RESEARCH INITIATIVES

      Progress on ongoing studies and research presentations comprise the Conference activities. (4th Thursday of the month, 5:00 p.m. to 6:00 p.m., Health Care Consultation Center, 4th floor conference room, suite 409)

   9. ANNUAL REVIEW COURSE IN VASCULAR SURGERY

      The annual Vascular Surgery review course at UCLA occurs in the fall of each year. Attendance at this course is part of the Vascular Surgery curriculum. The Vascular Surgery resident is free of clinical responsibilities during that week.

   10. USC SURGERY GRAND ROUNDS

       This conference is held every Saturday morning from 9:00 a.m. to 10:30 a.m.. Topics of interest in the discipline of surgery, including Vascular Surgery, are presented. (Saturday, September-May, 9:00 a.m. to 10:30 a.m., Doheny Vision Research Center)

   11. USC DEPARTMENT OF SURGERY MORBIDITY AND MORTALITY

       A review of M&M occurs weekly for the surgical services in the USC Program in Surgery. Vascular Surgery M&M is discussed at this conference approximately once a month before an audience of surgical faculty, housestaff and medical students. (Friday morning, 8:00 a.m. to 9:30 a.m., LAC+USC MC, Room 1645)

   12. HMH SURGERY MORBIDITY AND MORTALITY

       A review of M&M occurs weekly for the surgical services in the HMH Program in surgery. Vascular Surgery M&M is discussed at this conference approximately once a month before an audience of surgical faculty, housestaff and medical students. (Thursday mornings, 7:00 a.m., Doctor’s Dining Room at HMH)

   13. HMH MEDICINE AND SURGERY GRAND ROUNDS

       This conference is held once a month on Thursday morning from 9:00 a.m. to 10:00 a.m. Topics of interest in the discipline of surgery, including Vascular Surgery are presented. (3rd Thursday of the month, 8:00 a.m., Braun Auditorium)

7. SUPERVISIORY LINES OF RESPONSIBILITY FOR THE VASCULAR SURGERY RESIDENT

   The PGY VI resident will spend six months in the USC UH vascular laboratory, which is a ICAVL laboratory, interpreting the studies and providing a preliminary report prior to faculty sign off. All ultrasound based studies will be interpreted using videotape review of each individual case. The resident will also spend Thursday scanning in the vascular laboratory under the supervision of the Technical director of the USCUH vascular laboratory. In this capacity, the resident is expected to, by the end of the first year, have an appreciation and functional expertise in performance and interpretation of noninvasive vascular studies. The first year resident is expected to participate in all endovascular cases performed on the USC Health Sciences campus, including those cases at USC University Hospital and LAC+USC Medical Center. In that capacity, the resident will have the primary responsibility for preoperative evaluation of the patient, developing a therapeutic plan of endovascular intervention in consultation and input of the faculty, performance of the endovascular intervention, and follow up of the patient. In addition to the above activities, the resident will provide clinical support when needed and asked for at LAC+USC MC and USCUH for care of the vascular surgery patient. The resident will attend the Rancho Los Amigos Vascular Clinic on a weekly basis, seeing patients who may need a referral either to USCUH or LAC+USC MC. The resident is responsible for participating in journal club as assigned, presenting cases at Morbidity and Mortality and Vascular Surgery Preop conferences, providing basic science lectures as assigned and organizing, with the assistance of the vascular lab technical director, the vascular lab Q/A conference.

   The PGY VII resident functions as the chief resident on the USCUH and HMH Vascular Surgery Services. In that role, the Vascular Surgery resident as supervised by the attending staff has a primary responsibility for the preoperative assessment/care, the operative procedure and the postoperative care of each patient on the service. The Vascular Surgery resident can expect to have a significant role in all cases in which he or she scrubs. It is expected that the Vascular Surgery resident will have read about the procedure prior to coming to the OR and developed a surgical plan. The Vascular Surgery resident is expected to make rounds twice daily on all service patients and direct resident subordinates in the duties of patient care. The postoperative care of the patient is a primary responsibility of the Vascular Surgery resident with patient care concerns promptly communicated to the appropriate attending. The Vascular Surgery resident is responsible for participating in journal club as assigned, presenting cases at Morbidity and Mortality and Vascular Surgery Preop conferences, and providing basic science lectures as assigned.

8. ROTATION SCHEDULE

   The first year of the residency (PGY VI) is spent at the USC Health Sciences Campus and is comprised of endovascular activity at USCUH and LAC+USCMC, a USCUH vascular laboratory experience and Clinical Research. As a PGY VII the Vascular Surgery resident alternates between USCUH and HMH in three-month blocks. Rotations at USCUH include vascular laboratory experience while the rotations at HMH include experience with endovascular procedures.

9. DUTY HOURS AND ON-CALL RESPONSIBILITIES

   The Vascular Surgery resident call is by beeper or at home. In house call is not required, with the exception of those clinical situations where patient care concerns or instability dictate that the resident stay in house. Even though the on call responsibilities are not burdensome, the program is committed to providing the Vascular Surgery resident with time free of patient care responsibilities on a periodic basis. While on call the resident is responsible for discussing any patient care concerns or consults with the on call faculty. During the week (Monday-Thursday) faculty call begins at 5:00 p.m. Week-end call commences 4:00 p.m. Friday and ends 7:00 a.m. Monday morning. The week-end on call surgeon will coordinate cases and rounds with the Vascular Surgery resident. Rounds on every patient will be made by the on-call team everyday. Any week end calls or consults received by the Vascular Surgery resident for surgeons not on call should be referred to the on call surgeon.

10. DRESS CODE FOR VASCULAR SURGERY RESIDENT

    The following dress code has been established for the Vascular Surgery resident. The Vascular Surgery resident is expected to adhere to the code, which is intended to project to patients and visitors the professionalism they expect.

    1. All attire should be both clean and clean appearing.
    2. Men’s Attire: Shirt and tie, slacks, white uniform jacket or coat.
    3. Women’s Attire: Dresses, skirts or slacks and blouses, white uniform jackets or coats.
    4. Unacceptable Clothes: Stained, soiled appearing clothes, open necked shirts, polo shirts, blue jeans, shorts, stained or dirty running shoes, sandals.
    5. Operating Room Attire: Hospital policy forbids anyone from wearing these clothes (scrubs) off the hospital grounds.

    There are certain obvious exceptions to the above which include the following:

    1. When seeing patients in the Emergency/Admitting areas or while on night call duty.
    2. In the operating rooms and adjacent areas.

    In all circumstances, white coats are recommended whenever direct contact with patients is anticipated.