Accepting Applications for Two Positions for Academic Year 2008-09
Overview
Applicants are invited to apply for two fellowship positions in Acute Care Surgery. BWH is verified as a level I adult trauma center by the ACS Committee on Trauma and as a level I burn center by the American Burn Association. More than 2,000 adult trauma patients and 1,500 non-trauma emergency surgery patients are managed by the Hospital annually. Extensive clinical and basic science research opportunities are available.
BWH offers a two-year Acute Care Surgery and Surgical Critical Care Fellowship track: The first year is based on the AAST Acute Care Surgery Curriculum. It focuses on trauma and non-trauma emergency surgery and provides broad-based experience in general, vascular, and thoracic surgery, as well as training in damage control orthopedics and essential neurosurgical procedures. (This non-ACGME fellowship year is also available as a one-year fellowship.) The second year will be spent in the ACGME-accredited Surgical Critical Care Fellowship, leading to eligibility for the ABS Certificate in Surgical Critical Care.
Acute Care Surgery Fellowships are intended for general surgeons eligible for certification by the American Board of Surgery (ABS) with interest in an academic career in acute care surgery.
Leadership
The Acute Care Surgery Fellowship is directed by Dr. Edward Kelly, who has developed the program in concert with Dr. Selwyn O. Rogers, Jr. (Chief of the Division of Trauma, Burn, and Surgical Critical Care and Director of the Surgical Critical Care Fellowship) and the Division's trauma, burn, emergency surgery, and surgical critical care faculty members.
Vision
The Division of Trauma, Burn, and Surgical Critical Care seeks to train general surgeons demonstrating a strong aptitude for and commitment to an academic career in trauma and emergency surgery. Its aim is to produce clinical and investigative leaders in this emerging specialty, to actively participate in national efforts to develop an ACGME-approved fellowship, and to contribute more broadly to the dialogue regarding the appropriate scope of work for acute care surgeons.
Scope of Training
Clinical
Half of the fellowship year will be spent in six one-month rotations in General Surgery and Trauma Surgery. Fellows will evaluate and treat patients independently with consultation by the senior staff, keeping records of operations and outcomes that will be discussed at the close of each month. They will also participate in bedside procedures (tracheotomy, endoscopy, ultrasound guided CVL insertion) for patients under their care. As fellows gain technical proficiency, they will become the primary instructors of these skills for the residents on the Surgical Services.
The other half of the fellowship year will be spent in rotations in the Burn Unit, Orthopedics, Neurosurgery, and Vascular Surgery. Fellows will rotate on these services and participate in emergency cases involving these specialties, as described briefly below:
Burn care (two blocks)--focusing on the initial resuscitation, excision and grafting, reconstruction, and postoperative management (jointly with residents on the burn service) and the evaluation and treatment of burn patients in consultation with one of three primary burn surgeons.
Orthopedics (two blocks)--focusing on gaining experience with acute orthopedic conditions such as fracture/dislocation, joint relocation, emergency splint application, application of traction splints and traction pins, and femur and pelvic fractures.
Neurosurgery (one block)--focusing on traumatic brain injury and acute spinal cord injury, and specifically decompressive craniotomy, insertion of intracranial pressure monitors, and application of spinal traction.
Vascular surgery (one block)--focusing on acute surgical vascular conditions such as acute arterial occlusive disease, ruptured aneurysm, and vascular trauma and gaining familiarity with vascular duplex ultrasound, insertion of vena cava filter devices, operative exposure of the spine, and Duplex Ultrasound evaluation of arterial and venous disease.
Educational
In addition to the daily teaching in the OR, on the floors, and in the ambulatory areas, there are regular didactic sessions in general surgery as well as the subspecialties. On Wednesday mornings, there is a morbidity and mortality conference that faculty and trainees attend, followed by Surgical Grand Rounds featuring speakers of national prominence on a wide variety of topics and advances in the surgical field.
Fellows will also participate in weekly Trauma rounds, monthly Trauma Peer Review Committee Meetings, monthly Trauma and Burn Performance Improvement Committee Meetings, and monthly Burn Management Meetings. During surgical rotations, fellows will be responsible for preparing a lecture every six weeks.
Research
Fellows will be expected to conduct an independent research project in clinical outcomes, basic science, surgical innovation, surgical education, or clinical guideline development. Fellows may choose from ongoing clinical investigations.
The BWH Division of Trauma, Burn and Surgical Critical Care has a very productive program in clinical and basic science research. Under the principal direction of Dr. Francis D. Moore, Jr., Division Chief of General and Gastrointestinal Surgery, the Trauma Research Center consists of the Trauma Center Core and several basic science research projects directed by principal investigators from the Center. The Trauma Center Core provides transgenic animals, common animal models, and shared personnel support for study of problems related to the trauma patient. Its technical, organizational, and administrative support makes possible the high degree of integrated effort of all the involved investigators. The Core also organizes and tracks all group activities, as well as provides the Outreach to widen the Harvard Trauma Research Community. Current Trauma Center projects include: IgM-Binding Epitopes in Injured Tissue, Mast Cell/Mast Cell Mediators in Ischemia Reperfusion Injury, and The Role of Natural Antibody in Reperfusion Injury. For additional information, see the BWH Trauma Center Grant website.
In addition, the Division's trauma attendings have clinical research underway regarding retrievable IVC filters, catheter related sepsis, sedation and delirium, and the measuring of traumatic brain injury. Opportunities also exist for participation in drug trial research, clinical guideline development, surgical education research, anesthesia research, and translational research.
Please contact Dr. Kelly with questions about specific research interests, or visit the BWH Department of Surgery Research website.
Mentorship
Each fellow will meet on a monthly basis with Dr. Kelly to discuss clinical, academic, and professional progress. Dr. Kelly will share informal feedback at these regular meetings, and at least quarterly, will share formal feedback from the attendings evaluating the fellow. Fellows will sign this written feedback as acknowledgment of its receipt. Drs. Kelly and Rogers will provide formal career mentorship as well, and include as appropriate, mentors in general surgery and other related specialties. This mentorship could include advice on career development, nomination to national surgical societies, sponsorship for surgical meetings, guidance on research projects, and help with obtaining research funding. Each fellow will have a mentorship plan tailored to his/her specific academic career goals.
Supervision
Fellows will be closely supervised. This structured system of supervision will include daily rounds and the constant availability of an attending for review and consultation. Similarly, all operative cases will be discussed and planned in consultation with Dr. Kelly or another trauma attending. One senior faculty member will be available as a backup for the fellow in the operating room. Appropriate surgical faculty members will be involved for specialized cases (e.g., thoracic, vascular, advanced laparoscopy, endocrine, etc.). All complications will be presented and discussed in the regularly scheduled Morbidity and Mortality meetings, Trauma Peer Review meetings, and Trauma Performance Improvement Committee meetings. There will be a backup schedule to cover the fellow when he/she is taking call for trauma/emergency surgery.
Schedule and Compensation
Fellows' schedules will meet the following duty hour requirements:
* Work weeks no more than 80 hours
* At least one day off per week
* Consecutive work hours no greater than 24 hours
* Minimum of 10 hours between shifts
Fellows will take trauma/emergency surgery call no more than 7 times per month. While on call, a fellow will be responsible for taking care of all trauma and emergency surgery admissions, as well as responding to requests for surgical consults.
Fellows will be compensated according to the Partners Resident Salary Scale at PGY level 8, eligible for BWPO fringe benefits, and entitled to three weeks of vacation and two weeks of sponsored CME activities.
Fellows will comply with Brigham and Women's Physicians Organization (BWPO) billing procedures and must agree that only the BWPO can claim or receive any fees for services. Moonlighting will not be permitted.
Selection Process
The program invites applications from candidates who will have completed a general surgery residency and be board eligible by the start of the fellowship. Candidates most strongly demonstrating an aptitude for and commitment to an academic career in acute care surgery will be invited to interview in person. An ideal candidate will be interested in pursuing a second fellowship year in surgical critical care.
Brigham an Women's Hospital is an equal opportunity/affirmative action employer. Women and members of minority groups are encouraged to apply.
Applications must include:
Personal statement summarizing previous training and specific interests within the emerging field of acute care surgery
Curriculum vitae
Three letters of recommendation from physicians with whom you have worked closely during general surgery residency or in your laboratory research
USMLE Scores
The deadline for receipt of your fellowship application materials at the following address is April 10, 2008; late applications will be accepted until the positions are filled:
Edward Kelly, M.D.
Division of Trauma, Burn, and Surgical Critical Care
Brigham and Women's Hospital
75 Francis Street
Boston, MA 02115
Dr. Kelly, Dr. Rogers, and 1-3 trauma attendings will comprise the selection committee. Applications will be reviewed as they are received, and interviews will begin mid-April 2008. More detailed information about the interview process and selection timeline will be posted once the size of the applicant pool is known.
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