Thoracic Anesthesiology Fellowship

Welcome from our Program Director

Thank you for your interest in the Brigham and Women’s Thoracic Anesthesiology Fellowship. Our program provides a rich environment for fellows to acquire expertise in the anesthetic management of thoracic surgical procedures. The Thoracic Surgical Division at BWH, is one of the leading thoracic surgical divisions in North America, producing a volume of over 3,700 thoracic surgical cases, annually. We offer an unmatched experience, under the guidance of our dedicated Thoracic Anesthesia faculty, to nurture and develop the future leaders and innovators in the field of Thoracic Anesthesia. We look forward to hearing from you.

Contact Us

If you are interested in the Thoracic Anesthesia Fellowship, please contact:

Stephanie Yacoubian, MD
Thoracic Anesthesia Fellowship Program Director
syacoubian1@bwh.harvard.edu

Arthur R. Formanek, III, MD
Thoracic Anesthesia Fellowship Associate Program Director
aformanek@bwh.harvard.edu

Aymee Beaudoin
Fellowship Program Manager
abeaudoin1@bwh.harvard.edu

Overview

Our non-ACGME accredited fellowship program provides a diversity of clinical cases with exceptional acuity, volume, and challenge. Knowledge of tracheobronchial anatomy, pulmonary physiology and pharmacology, respiratory pathophysiology and the effects of anesthesia, regional anesthesia, lung ultrasound, extracorporeal life support and cardiopulmonary bypass, are just the basis for the development of expertise in the perioperative management of patients with end-stage respiratory disease.

Clinical Experience

The Thoracic Anesthesia division is comprised of a group of thoracic trained anesthesiologists, with diverse clinical and academic backgrounds. The fellows will find great value in the mentorship and guidance of our staff, leaders in the field of thoracic anesthesia. The goal is for the fellow to develop detailed knowledge in thoracic anesthesia. The fellow is expected to function at the expert consultant level in the perioperative care of patients undergoing thoracic surgical procedures, and to develop expertise with thoracic anesthesia-related procedures.

Curriculum

The duration of the Thoracic fellowship is 6-12 months, individualized based on the experience and goals of applicants. One nonclinical day a week confers fellows guaranteed academic time to pursue educational, basic science or clinical research projects. Weekly core lectures, and the opportunity to attain experience outside the Thoracic surgical operating rooms (echocardiography laboratory, thoracic radiology, Thoracic intensive care unit, etc.), may be organized.

We’ve established two distinct pathways within the Thoracic Anesthesia Fellowship Program to better accommodate our applicants' needs and aspirations. The first pathway is a six-month intensive clinical training program designed for fellows to swiftly meet their clinical competency requirements. The second pathway extends over 12 months, incorporating the same six months of rigorous clinical training alongside an additional six months dedicated to elective and research opportunities.

Admission into either pathway is contingent upon the applicant's prior experience, offering the flexibility to choose a path aligned with their professional objectives. This adjustment will be implemented starting July 2024. Additionally, we have compiled a standardized list of core clinical competencies and case requirements that fellows must complete before graduation. This list applies to both pathways, ensuring that all fellows achieve the necessary clinical proficiency to successfully complete the program.

Thoracic Surgical Procedures

• Bronchoscopy
• Cervical Mediastinoscopy
• Anterior Mediastinoscopy
• Endobronchial Ultrasound-Guided Transbronchial Biopsy (EBUS)
• Pleuroscopy / Pleural Biopsy
• Drainage of Pleural Effusion / Pleurex Catheter Placement
• Pleurodesis
• Electromagnetic Navigational Bronchoscopy / Veran Spin System / Peripheral Transbronchial Biopsy/ Robotic bronchoscopy
• Radiofrequency Ablation of Tumors of the Chest
• VATS versus Open Pulmonary Resection (Lobectomy or lesser resection) - Wedge Resection, Segmentectomy, Lobectomy
• Bilobectomy
• Sleeve Resection / Bronchoplasty
• Pneumonectomy - Standard, Intrapericardial, Completion
• Extrapleural Pneumonectomy (+/- Intracavitary Heated Chemo)
• Radical Pleurectomy (+/- Intracavitary Heated Chemo)
• Chest Wall Resection
• Tracheostomy (+/- PEG)
• Rigid Bronchoscopy (jet ventilation versus side-port ventilation)
• Surgery for Major Airway Stenosis
• Tracheal / Bronchial Dilation
• Airway Stent Deployment or Manipulation
• Photodynamic Therapy
• Mechanical Core-out of Major Airways
• Laser Ablation of Airway Obstruction (Tumor, Granulation Tissue, Scar, etc.)
• Removal of Foreign Body of the Airway
• Tracheal Resection / Reconstruction
• Esophagoscopy
• Esophageal Dilation
• Esophageal Reflux Surgeries (Nissen Fundoplication, etc.)
• Esophagectomy (3-Hole, Transhiatal, Ivor-Lewis)
• Redo Esophagectomy with Colonic Interposition
• Heller Myotomy
• Esophageal Diversion for Perforation
• Evaluation & Treatment of Tracheoesophageal Fistula
• Evaluation and Treatment of Bronchopleural Fistula (including Clagett Window)
• Lung Volume Reduction Surgery
• Lung Transplantation
• Repair of Pectus Excavatum
• Surgical Sympathectomy
• First Rib Resection for thoracic outlet syndrome
• Broncho-alveolar Lavage for Alveolar Proteinosis
• iVATS (Image-Guided VATs)
• Thymectomy
• Robotic-Assisted thoracic surgery

Thoracic Anesthesia Procedures

• Fiberoptic Intubation
• Use of Tube-Exchange Catheters
• Lung Isolation - Left & right double-lumen tubes, Bronchial blockers (Arndt, Cohen, Fogarty, EZ Blocker), Endobronchial Intubation
• Fiberoptic Bronchoscopy
• Techniques to optimize operative lung collapse
• Use of CPAP during one-lung ventilation (OLV)
• Optimization of PEEP during OLV
• Optimal setting of ventilator during OLV
• Use of air insufflation during OLV
• Cross-Field Ventilation
• Jet Ventilation (Sanders)
• Thoracic epidurals (including paramedian approach)
• Other types of postoperative pain blocks (paravertebral, proximal intercostal, etc. evolving list)
• Ultrasound guided arterial catheters (radial and femoral)
• Ultrasound-guided central venous catheters
• Pulmonary artery catheters
• Safe positioning of patients for various thoracic surgical procedures
• Management of the airway threatened by a mass effect within the chest
• Management of the airway threatened by an intraluminal mass (tumor, thrombus, foreign body, etc)
• Management of the airway threatened by bronchomalacia, bronchospasm, or other causes of closure
• Management of cardiopulmonary bypass as applied to patients receiving lung transplantation
• Management of patients supported by VA or VV ECMO
• Management of patients at risk for airway loss or damage from surgical procedures (core-outs, laser fire risk, stents, massive hemoptysis, etc.)
• Lung Ultrasound

FAQs

Q. What are the annual salary and benefits like?
A. The starting salary for a PGY-5 in 2024 is $95,150. Employment benefits include health, dental, disability, and other insurance. For more information please refer to FREIDA and the Mass General Brigham Office of Resources for Trainees.

Q. Can you give me some information about trainee contracts?
A. Please refer to the Trainee Contract section of our website.

Q: Do you sponsor Visas? 
A. At this time, our institution sponsors both H1b and J1 Visas.

Q. Is moonlighting available?
A. Moonlighting is available within the Mass General Brigham System to residents at the CA-2 level of training or higher. Fellows need permission from the Program Director and must have obtained a full medical license, Massachusetts Controlled Substances Registration (MCSR), and Federal DEA numbers.  Moonlighting Fellows cannot be on a J1 Visa.

How to Apply

Application Documents

Thoracic Anesthesia Fellowship Application (pdf)

Please submit the following documents electronically to Aymee Beaudoin (abeaudoin1@bwh.harvard.edu)

• Current curriculum vitae
• A copy of your medical school transcript
• Valid ECFMG Certificate (if applicable)