Vascular surgery residency
The integrated residency in vascular surgery is a five-year (0+5) training program leading to eligibility for certification by the Vascular Surgery Board of the American Board of Surgery. The program accepts two residents per year, one civilian and one military. Civilian applicants participate in the National Residency Match Program (NRMP), applying in their final year of medical school. Military applicants are accepted from either the Uniformed Services University of the Health Sciences (USUHS) or the Health Professions Scholarship Program (HPSP) via the Joint Services Graduate Medical Education Selection Board (JSGMESB).
Vascular surgery is a distinct specialty, with increased utilization of specialized technologies. The components of vascular surgery are diverse, including (1) diagnosis and management of vascular diseases, including medical management; (2) non-invasive vascular laboratory (ultrasound and other imaging technologies); (3) endovascular diagnostic and therapeutic interventions; (4) traditional open surgical procedures; and (5) surgical critical care. Many regions in the US remain relatively underserved by vascular specialists. There is an ongoing need for additional trained specialists to care for the growing and aging population, as well as to improve education of other care providers to help patients gain timely access to care.
Many of the best candidates for specialty training seek residencies that they can enter directly after medical school graduation. Several factors have made integrated residencies in vascular surgery a highly sought after option. These include the shortened training timeline compared to completion of a fellowship after general surgery residency. Also, advances in technology and changes in clinical care have increased the distinction between general and vascular surgery, reducing the relevance of many aspects of general surgery training. Importantly, integrated residency allows trainees to learn advanced imaging and interventional skills earlier facilitating the integration these skills into clinical practice.
The 0+5 option has strong support from the Society for Vascular Surgery (SVS) and the Association of Program Directors in Vascular Surgery (APDVS) and the number of accredited programs has grown steadily since this option was first offered in 2006. Ours is the only one that includes a Department of Defense medical treatment facility as an affiliated teaching site. With two resident positions a year, the UC Davis vascular surgery GME program is the largest in the western United States.
Cooperation between our civilian and military hospitals is well established. There has been long history of effective collaboration between David Grant Medical Center (DGMC) and the UC Davis Department of Surgery. This initially focused on trauma and critical care training. In 2005, the general surgery residency programs of the two institutions merged completely, creating what became the largest surgery residency program in the state of California.
UC Davis also has an accredited two-year vascular surgery fellowship (5+2), though opportunities for fellowship training starting in 2016 and later will only be available if there is a vacancy in the integrated residency (due to resident leaves of absence for family reasons, research, optional clinical training, or other reasons).
Faculty and Staff
The core surgical faculty integrates vascular surgeons and other specialists from the UC Davis Department of Surgery, the Sacramento VA (Mather) Medical Center, and active duty Air Force surgeons (board certified or board eligible in vascular surgery) assigned to the 60th Medical Group, 60th Surgical Operations Squadron (60 MSGS), David Grant USAF Medical Center (DGMC), Travis AFB, CA.
Program and Site Directors
David L. Dawson, M.D. is the program director. Misty Humphries, M.D. is the assistant program director and Major Timothy Williams is the DGMC site director. John G. Carson, M.D. is the site director at the VA.
Julie Skelton is the program coordinator. Her roles include maintaining training records and evaluations, and provision of other administrative support to the program faculty and residents.
Collette Delgado is the residency program coordinator at DGMC.
Institutional GME staff
Lori Teach is the manager of the UC Davis Office of Graduate Medical Education. She oversees administrative aspect of all residency and fellowship programs at UC Davis, including but not limited to ACGME duty hour and program requirements.
Barbara Erickson is the DGMC Director of Medical Education.
The five-year integrated curriculum includes both vascular surgery content and core surgical education.
Residents’ educational experiences includes 24 months of core surgical education (general surgery and other surgical specialties), including pre- and post-operative evaluation and care; critical care and trauma management; and basic technical experience in skin and soft tissue, abdomen and alimentary track, airway management, laparoscopic surgery, and thoracic surgery. Rotations in the first two years include orthopaedic surgery, neurological surgery, and anesthesiology. Senior residents will have operative experience in trauma care and major open procedures, laparoscopic and endoscopic procedures, as well as thoracic and cardiothoracic surgery.
Thirty-six months of rotations are concentrated in vascular surgery. The junior resident experience includes training in imaging, angiography and vascular intervention, and cardiovascular medicine.
The last year of the program includes only vascular surgery, with chief resident responsibility on a vascular surgery service at an integrated site.
Surgical Critical Care
Vascular surgery residents with an interest in surgical critical care may seek additional training in UC Davis’ ACGME accredited fellowship in surgical critical care. This program would, in most cases, follow the five year integrated vascular surgery residency experience. Completion of this training will qualify individuals to apply for American Board of Surgery certification of Added Qualifications in Surgical Critical Care. With this additional training, military graduates will be particularly well prepared for operational roles in deployed settings.
The program director for the surgical critical care program is Christine S. Cocanour, M.D.
Institutions and resources
UC Davis Medical Center is leading referral center in the region for the most seriously injured or ill patients, and the most medically complex cases, covering Sacramento and 32 other counties, more than 65,000 square miles and six million residents. UC Davis operates inland Northern California's only Level 1 trauma center, with comprehensive adult and pediatric emergency departments that see over 50,000 visits annually. The 577-bed medical center has been expanded with the addition of a 470,000-square-foot Surgery and Emergency Services Pavilion that includes a new emergency room, 24 new operating rooms, cardiac and interventional suites, a 12-bed burn unit and support services.
To improve the effectiveness of vascular disease care, UC Davis Vascular Center was established in 2006 as collaborative effort involving between specialists in surgery, cardiology, and radiology. The UC Davis Vascular Center is now the region’s largest clinical program specializing in vascular care. Residents interact with teaching faculty from other specialties and academic departments, broadening their experience.
The UC Davis Center for Virtual Care (CVC) has a virtual reality endovascular procedure suites, patient simulators, robotic surgery training, computer-assisted learning, and skills trainers that provide sophisticated adjuncts to traditional clinical training. The CVC grown with the addition of new facilities. Opened in 2013, the California Telemedicine Resource Center (TRC) at UC Davis is a hub for telehealth services among the five UC medical schools, providing expertise ranging from establishing best practices for clinical applications to providing advice on state and national health-related telecommunications policies. The TRC building provides additional space, production facilities, and teaching laboratories for the CVC.
The Department of Veterans Affairs Northern California Health Care System (VA NCHCS) is an integrated health care delivery system, offering a comprehensive array of medical, surgical, rehabilitative, primary, mental health and extended care to veterans in northern California. VA NCHCS serves an area consisting of more than 377,700 veterans dispersed over a wide geographic area spanning approximately 40,000 square miles. The health system is comprised of a medical center in Sacramento (located at the former Mather AFB); with a rehabilitation and extended care facility in Martinez; seven outpatient clinics, and other facilities through the region. The Sacramento VA Medical Center is a 50-bed, state-of-the-art, inpatient facility offering a full range of comprehensive health care services including medical, surgical, primary and mental health care. The medical center offers state-of-the-art operative, endovascular, and imaging services.
The 60th Medical Group (60MDG) operates the David Grant Medical Center, the premier DoD Tricare regional medical treatment facility which provides a full spectrum of health care and patient-centered treatment to a prime service area population of nearly 96,000 Tricare eligible beneficiaries in the immediate San Francisco-Sacramento vicinity and 377,000 Department VA NCHCS eligibles. It provides or arranges comprehensive community and referral health care, readiness, education, research, tele radiology services, aeromedical staging, and supports the DoD-VA Joint Venture.
Skills training and endovascular procedural simulation are part of the resident experience in the DGMC Clinical Investigations Facility (CIF) and Simulation Center.