The Adult Cardiac Anesthesia Fellowship Program at Tufts Medical Center is a well established, and now a fully accredited (ACGME), training program attracting national and international applicants. Each year two candidates are accepted into the Cardiac Anesthesiology Fellowship Program at Tufts-Medical Center.
The period spent in the Fellowship is a minimum of twelve months, with no more than one interrupted period due to reasonable circumstances.
Fellows start their training in January or July.
- Our Cardiac Anesthesia Fellowship is now fully accredited by the ACGME.
- This training is not recognized towards residency training in Massachusetts. However, the Fellowship may lead to Perioperative Transesophageal Echocardiography Certification.
- Although not subject to Board Certification, Cardiac Anesthesia subspecialty is recognized by the American Society of Anesthesiologists and the Canadian Society of Cardiovascular Anesthesiologists.
- Certificates are given to the fellows who successfully complete the program.
The program is described as a Clinical Adult Cardiac Fellowship program. This involves 100% clinical rotation with five days per week of clinical service. In addition, the fellows are expected to take ten calls per month. The call is from home, and if a team works at night, they get the next day off. Call does not include any ICU involvement. Fellows will also be exposed to pacemaker and defibrillator insertions, heart catheterization procedures and percutaneous closure of atrial septal defects.
Staff anesthesiologists will supervise fellows with reducing supervision as their clinical year progresses. The fellows at all times will be responsible for their own cases.
Depending on the caseload on any particular day, fellows may be doing their own cases or supervise residents. Fellows rotate for up to two months in the echocardiography lab supervised by the cardiology/echocardiography attendings. They are expected to participate in all the activities of the echocardiography lab, including the afternoon ECHO reading sessions.
During the year, fellows gain further proficiency in and exposure to the perioperative evaluation and intraoperative management of elective and emergency cardiac patients undergoing primary and repeat revascularizations, valvular replacements and repairs, insertion of mechanical assist devices, heart transplantation, minimally invasive heart surgery, off-pump heart surgery and combination procedures.
During the first week of clinical work it may be required the fellow to work with a senior resident/CRNA. This will allow time for the fellow to become familiar with local practice and customs. During the first three months of the fellowship year, set as probationary period, the fellow will be closely supervised in a one to one capacity by staff anesthesiologists during cardiac operations and be assessed for suitability of clinical skills. Following successful completion of the probationary period, fellows are expected to be able to function with minimum supervision, although staff coverage will always be readily available.
TEE is used routinely for all cardiac operations. Therefore with everyday use and the ECHO rotation, fellows can get enough exposure and knowledge to be able to sit for the examination after the end of their fellowship.
The goals of the ECHO training include:
- Basic understanding of the indications, contraindications and risks of peri-operative TEE.
- Understanding of the principles of 2D and Doppler echocardiography and also gain an understanding of the physical principles of the Echo machine.
- Understanding and recognition of normal cardiac structures and common pathological echocardiographic findings. i.e. LV function, regional wall motion abnormalities, degree of mitral regurgitation, aortic stenosis etc. This includes the measurements of regurgitant flow, gradients and valve area calculations.
- The fellow should be able to perform a routine monitoring TEE, including insertion of the TEE probe and gaining standard echo views i.e. Mid-esophageal 3-chamber, mid-esophageal 4-chamber, trans gastric short axis, etc.
- Gain basic knowledge to provide a basis for further training in TEE and perioperative cardiac anesthesia management.
- Basic care for and maintenance of the TEE probe and machine (cleaning and storage).
Although there will be guidance and teaching, the fellows are ultimately responsible for their background learning of TEE. Reading materials and video's are available either through handouts or in the Department’s library. The formal echo rotation, in the ECHO lab, will be up to two months in duration and will provide most of the hands on education for the fellow.
The attending cardiology echo staff will supervise this activity. During the rotation, the fellow is expected to attend all operating room cases where TEE is involved and cardiology is consulted, except when other clinical duties interfere. In addition, all ECHO findings will be discussed in every case with the attending Anesthesiologist and the form describing the findings should be filled out and attached to the patient chart.
There will also be regular seminars and echo case discussions throughout the year that will be mandatory to attend.
Fellows are expected to familiarize themselves with the location of equipment and familiarize themselves with the proper maintenance and cleaning of the equipment.
At the end of the fellowship year the individual is expected to have accomplished the following goals:
- Staff level preoperative assessment of the patient with cardiopulmonary disease.
- Evaluation of anesthetic risks and knowledge of the necessary interventions to minimize risk.
- Determination of cardiovascular and pulmonary monitoring requirements and expertise in the use and interpretation of values of invasive monitoring techniques including TEE.
- Formulation of anesthetic plan and administration of anesthetic medications for providing optimal surgical conditions, with consideration of patient disease processes.
- Effective perioperative management of the cardiac surgical patient with complex cardiovascular pathophysiology based upon knowledge and consideration of cardiac, respiratory, neurologic, renal, hepatic, neuromuscular, hematologic and coagulation systems.
- Preoperative, intraoperative, and postoperative management of patients with coronary artery disease, valvular disease, congenital heart disease, cardiomyopathies, transplants, dysrhythmias, thoracic and aortic disease.
- Management of the patients difficult to wean from cardiopulmonary bypass.
- Anticoagulation and coagulation management during and after cardiopulmonary bypass.
- Management of the patient in the Cardiac Catheterization Lab, from the routine invasive procedure to the emergent complication.
- Understanding of the principles of extracorporeal circulation, cardiopulmonary bypass and circulatory assist devices.
- Understanding of the principles of myocardial preservation.
- Acute management of routine and ill patients in the postoperative cardiac intensive care setting.
- Critical review of the cardiovascular literature.
Evaluation of fellows
- Evaluations are done through New Innovations Web-based system quarterly. These evaluations try to cover all of the six ACGME’s core competencies. The fellowship director also formally meets with each fellow after the first 6 months of training to discuss their evaluations and formulate a plan to take care of areas of concern.
- Direct feedback daily throughout the subspecialty training from faculty
- Assessment of presentations of a cardiac topic as above
- Assessment of Research Project
- 360 degree evaluations
It is expected that each fellow will be responsible for two major seminars during the year. This will involve the preparation of two presentations to be given in one of the Department’s didactic sessions on topics related to broader cardiac anesthesia spectrum as indicated in the following list:
- Cardiovascular Physiology and Pharmacology
- Fast Track Cardiac Anesthesia
- Weaning From Cardiopulmonary Bypass
- Cardiopulmonary Bypass Equipment
- Pathophysiology of Cardiopulmonary Bypass
- Caogulation / anticoagulation / antifibrinolytics
- Intraaortic Balloon Pump
- Management of Perioperative Dysrrhythmias
- Myocardial Protection
- Adult Congenital Heart Disease
- Thoracic Aneurysms
- Cardiac Assist Devices
- Alternative Cardiac Surgery Techniques (e.g., MIDCABS)
- Blood Conservation
- Heart Transplantation
- Cerebral Protection and Outcomes
- "Common Problems" In Cardiovascular ICU
Fellows complete their training at Tufts Medical Center, a world-class academic medical center located in Boston and the principal teaching hospital for Tufts University School of Medicine. It also sponsors nineteen specialty ACGME-accredited clinical training programs.
Tufts Medical Center is a 415-bed robust organization, providing everything from routine medical care to treating the most complex diseases affecting adults and children. Tufts Medical Center is also home to the Floating Hospital for Children, a full-service children's hospital dedicated exclusively to all levels of pediatric care.
Tufts Medical Center provides heart, kidney and bone marrow transplants, is a level I trauma center, provides comprehensive neurological and neurosurgical care, and offers cutting-edge cancer treatments.
Tufts Medical Center is also home to The Boston Gamma Knife Center, the first and only Gamma Knife Center in Massachusetts and northern New England.
All candidates for the fellowship must have satisfactorily completed an accredited residency program in anesthesiology and be eligible for and obtain a Massachusetts medical license.
Application for a fellowship position should contain a letter of intent/personal statement, Curriculum vitae and three letters of recommendation from the current residency program.
Documents should be addressed to:
Bhawana Dave, MD
Director, Cardiac Anesthesia Fellowship Program
800 Washington Street, Box 298
Boston, MA 02111
After applications are reviewed, certain applicants will be selected and invited for a formal interview. The finalists will be selected after a unanimous decision of the cardiac anesthesia group in consultation with the department chair.
To learn more about benefits at Tufts Medical Center, download our benefits package.
Graduate Medical Education (GME) stipend levels
- PGY1 $51,148.46
- PGY2 $53,205.53
- PGY3 $55,785.81
- PGY4 $59,204.46
- PGY5 $63,029.70
- PGY6 $66,738.31
- PGY7 $68,796.44
To learn more, contact:
Bhawana Dave, M.D.
Program Director, Cardiac Anesthesia Fellowship Program
Department of Anesthesiology
800 Washington Street, Box 298
Boston, MA 02111
Tufts Medical Center
800 Washington Street, Box 298
Boston, MA 02111