Denver Health's Trauma & Acute Care Fellowship was approved as an official training site by the American Association for the Surgery of Trauma (AAST) in May 2008. Our first fellow finished training in June 2008.
This fellowship encompasses trauma and non-trauma surgical emergencies, as well as surgical critical care. Individuals trained in TACS will be qualified to provide comprehensive emergent surgical and critical care to trauma and non-trauma conditions in virtually any body region or organ system. Through this integrated educational experience, we are providing residents with the training to become academic leaders in this emerging discipline.
The TACS curriculum is designed to build on the concepts and skills obtained during a 5-year General Surgery residency. The first year of the fellowship focuses on surgical critical care in an ACGME/RRC approved training program. Rotational experience includes trauma, cardiac, burn, and pediatric, as well as general surgical critical care. The broad experience gained through a diverse faculty and programmatic elements should prepare the fellow for their board examinations as well as their future career.
During the second year of the fellowship, the resident will acquire a comprehensive knowledge of critical care, trauma, and emergency general surgery as well as advanced operative skills and procedural techniques in thoracic and vascular surgery. Under the supervision of attending faculty members, the TACS fellow will be the physician responsible for patient evaluation, care, and intervention of all acutely ill surgical patients. Specific rotations on thoracic surgery, vascular surgery, transplant/hepatobiliary surgery, orthopedics, neurosurgery and interventional radiology will expand the general knowledge base and specific technical skills of the fellow. Acute Care Surgery rotations incorporate elective general, thoracic, and vascular surgery cases, surgical critical care, and emergent trauma and non-trauma cases. The TACS fellow takes call once a week, under the supervision of the TACS attending surgeon. Call at Denver Health embodies this paradigm of training, as the fellow will evaluate and operate on patients with trauma as well as thoracic, vascular, abdominal, neurologic, and orthopedic emergencies.
The TACS fellow is expected to participate in ongoing research at one of the parent institutions. Additionally, the fellow will be instructed in trauma system design and disaster management.
Clinical Rotations
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Rotation/ Location
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Description
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Trauma & Acute Care Surgery
Denver Health
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The TACS rotation at DHMC incorporates all aspects of the resident training experience. Under the supervision of attending faculty members, the TACS resident will be the physician responsible for evaluation, care, and intervention of the acutely ill surgical patient. The rotation also includes coverage of surgery clinic, which evaluates patients with general surgery, thoracic, vascular, endocrine, and oncologic diseases for elective surgery. Cases evaluated in clinic by the resident will be booked for that resident’s involvement, either as primary surgeon (if the general surgery chief is unavailable) or as the teaching assistant to the general surgery team. Being on call at DHMC incorporates the evaluation of patients with trauma, critical illness, thoracic, vascular, abdominal, neurologic, and orthopedic emergencies.
Also included in these 5 months of TACS rotations is exposure to Anesthesia, Plastic Surgery, and Interventional Radiology. Involvement with the Anesthesia department facilitates overall care of the patient and provides technical exposure to routine and complex intubations. Operative cases with the Plastic Surgery faculty provide exposure and learning in such arenas as complex facial reconstructions, facial fracture management, and free flap design. Due to the significant amount of overlap and interplay between Surgery and Interventional Radiology, a dedicated experience with IR techniques and therapeutic interventions is planned. The goal of the experience is broadened exposure to the clinical decision-making involved in determining if a patient warrants IR versus surgical intervention, the role of IR techniques, and the complications associated with such measures. Additionally, the TACS resident should have additional exposure to routine bedside procedures and body imaging.
Exposure and responsibility for administrative tasks and teaching is a mandatory requirement of these rotations but should also be pursued throughout the TACS Fellowship years. Administrative exposure is attained through such conferences and meetings as the Interdisciplinary Care Committee, Trauma Service Line, RETAC, and SEMTAC. Teaching of residents and students is inherent in bedside rounds, the operating room, and clinical conferences. In particular, the resident will be expected to lead M&M conference at least once a month. Additionally, the TACS resident is strongly encouraged to become an ATLS instructor during the first year of the fellowship and teach during subsequent months of the training program. Additional exposure to teaching and education of others is available through the DHMC Outreach Program; the TACS resident may volunteer to give lectures at outside facilities on a wide range of trauma, critical care, and emergent case topics.
The TACS resident is expected to engage in academic pursuits. A month-long research elective is available to encourage dedicated time to clinical research projects and authoring review articles. Over the 2-year training program, abstracts for at least 2 national meetings and associated participation in manuscript drafting under faculty mentorship is advocated.
At the completion of the fellowship training, the graduate will have demonstrated proficiency in the medical management and operative treatment of hemorrhage, infection, inflammation, perforation, laceration, obstruction and fractures. They should also master the technical skills necessary to manage the complex or multiply-injured patient, including operative intervention. They will also assume gradated responsibility in the role of “lead-surgeon” in all management arenas: ICU, trauma bay, resuscitation suite, clinic, IR, and OR.
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Burn/ Cardiothoracic/ Surgical Critical Care
University of Colorado Helath Sciences Center
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The University of Colorado Hospital is the Rocky Mountain’s regional academic medical center, and has been consistently ranked as one of America's best hospitals, according to U.S. News & World Report. University of Colorado Hospital is also the region’s leader in tertiary and referral-based care. The Department of Surgery at UCHSC incorporates general, hepatobiliary, oncologic, transplant, cardiothoracic, breast, and endocrine surgical disciplines. The UCHSC Burn Unit is the regional burn center verified by the American College of Surgeons and American Burn Association, serving the state of Colorado and the surrounding region. With more than 175 admissions per year, the Burn Unit provides emergent, acute, and rehabilitative services for this patient population including all follow-up and referral care.
The goal of the Burn Unit rotation at UCHSC to develop an understanding of the current concepts of burn pathophysiology and apply this information in the evaluation, resuscitation, clinical management, and rehabilitation of the burned patient. Emphasis will be placed on burn resuscitation and physiology, ventilator management in the setting of systemic inflammation accompanying burns and thermal airway injury, and nutritional support. The CCR will function as an integral component to the burn service in conjunction with the general surgery resident on the burn service and the burn attending. Responsibilities will include attending daily rounds in the burn unit, formulating and executing critical interventions, and monitoring patients. In addition, the CCR will be expected to attend multidisciplinary patient care and teaching conferences.
The goal of the rotation on the Cardiothoracic/Surgical Intensive Care rotation is to develop a clear understanding of pre-and post-operative management of the cardiac surgical patient. Emphasis will be placed on the pathophysiology and support of heart failure, diagnosis and treatment of arrhythmias, and use of vasoactive medications in the ICU setting. The CCR will function as an integral member of the cardiothoracic service in conjunction with the cardiothoracic surgery fellow, the general surgery residents, and attending cardiothoracic surgeons. Responsibilities will include attending daily rounds in the SICU and CCU, formulating and executing critical interventions, and monitoring patients. In addition, the CCR will be expected to attend multidisciplinary patient care and teaching conferences.
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Pediatric Intensive Care
The Children's Hospital Denver
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The CCR will rotate in the Pediatric Intensive Care Unit (PICU) at The Children’s Hospital as a member of the Pediatric Surgery/Pediatric ICU team. This rotation will focus on critical care issues related to neonates, infants and children in the setting of trauma and postoperative general surgery. Emphasis will be placed on ventilatory and hemodynamic support, fluid and electrolyte management, and nutritional support. The CCR will gain an understanding of the age specific requirements of pediatric critical care through participation in daily ICU rounds with the pediatric surgery fellow, general surgery residents, and the pediatric attending surgeons. During this rotation, the CCR will also work closely with the pediatric intensivists and pediatric residents rotating in the PICU.
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Thoracic Surgery
University of Colorado Health Sciences center
Veteran's Affairs Medical Center
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The goal of the Thoracic Surgery rotation is for the fellow to be comfortable and competent in the diagnosis of, operative techniques, and postoperative care and complications of patients with thoracic maladies. Emphasis will be placed on broadening the knowledge base acquired as a general surgery residents as well as refining associated techniques. The TACS resident will function as an integral member of the service in conjunction with attending surgeons. By the end of the rotation, the resident should be able to demonstrate the ability to effectively manage thoracic disease. Responsibilities will include attending daily rounds, formulating management plans, assisting/performing operations, and covering call for emergencies. In addition, the resident is expected to attend multidisciplinary patient care and teaching conferences.
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Vascular Surgery
Exempla Saint Joseph Hospital
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The goal of the Vascular Surgery rotation is to develop a clear understanding of pre and post-operative management, as well as intraoperative techniques and decision-making of the patient with vascular disease. Emphasis will be placed on the diagnosis and treatment of acute ischemia, evaluation of vascular trauma, and operative reconstruction techniques. The TACS resident will function as an integral member of the service in conjunction with attending surgeons. Responsibilities will include attending daily rounds, formulating and executing critical interventions, assisting/performing operations, and covering call for vascular emergencies. In addition, the resident is expected to attend multidisciplinary patient care and teaching conferences.
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Hepatobiliary/ Transplant
University of Colorado Health Sciences Center
Presbyterian Saint Lukes Denver
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The goal of the rotation on the Transplant service is to educate the TACS resident in all aspects of hepatobiliary problems, injuries, and operative techniques. The resident will have graduated responsibility and increasing exposure to the technical aspects of care. The clinical experience will be augmented by daily conference attendance, concentrating on review of the conditions encountered by the care team as well as various conditions. |
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Neurosurgery
Denver Health
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The goal of the Neurosurgery rotation is to gain experience in patients with traumatic brain and spine injuries, including appropriate monitoring techniques. The rotation will concentrate on the initial examination, diagnosis, and treatment of these conditions, and appropriate referral of such conditions to specialists when appropriate. The resident will have graduated responsibility and increasing exposure to the technical aspects of care. The clinical experience will be augmented by daily conference attendance, concentrating on review of the conditions encountered by the care team.
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Orthopaedic Surgery
Denver Health
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The goal of the Orthopaedics rotation is to educate the resident in all aspects of musculoskeletal conditions and skeletal trauma that are typically encountered in the emergent or urgent care setting. The rotation will concentrate on the initial examination, diagnosis, and treatment of these conditions, and appropriate referral of such conditions to specialists when appropriate. This rotation builds on the foundation of experience gained during the General Surgery PGY-I orthopaedic rotation. The TACS resident will have graduated responsibility and increasing exposure to the technical aspects of care. The clinical experience will be augmented by daily conference attendance, concentrating on review of the conditions encountered by the care team as well as various orthopaedic conditions.
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Faculty
Trauma & Acute Care Surgery Faculty:
(Left to Right)
Ed Kimm, MD
Jeffry L. Kashuk, MD
Jeffrey L. Johnson, MD
Clay Cothren Burlew, MD
Walter L. Biffl, MD
Carlton Barnett, MD
Ernest E. Moore, MD
Surgical Specialty Faculty:
Dave Fullerton, MD - Cardiothoracic Surgery
John Mitchell, MD – Thoracic Surgery
Michael Weyant, MD – Thoracic Surgery
Igal Kam, MD – Transplant/Hepatobiliary
Michael Wachs, MD – Transplant/Hepatobiliary
Thomas Bak, MD - Transplant/Hepatobiliary
Michael Zimmerman, MD – Transplant/Hepatobiliary
Thomas Rehring, MD – Vascular Surgery
Whitt Hollis, MD – Vascular Surgery
Bob Allen, MD – Interventional Radiology
Kathryn Beauchamp, MD – Neurosurgery
Wade Smith, MD – Orthopedic Surgery
Steve Morgan, MD – Orthopedic Surgery
Gordon Lindberg, MD - Burn Surgery
Surgical Critical Care Faculty:
Robert C. McIntyre, MD FACS
Joshua Goldberg, MD
Marty Zamora, MD
Fareed Azam, MD
Pierre Moine, MD
Paul Wischmeyer, MD
For the Trauma & Acute Care Surgery Fellowship (which includes a year of Surgical Critical Care training), applicants must have completed a RRC-approved General Surgery Residency and be Board Eligible in General Surgery.
Interviews will be granted on a rotating basis beginning March 1. Our program participates in the NRMP match. All documentation should be submitted to:
Clay Cothren Burlew, MD FACS
Program Director, Trauma & Acute Care Fellowship
Department of Surgery
Denver Health Medical Center
777 Bannock Street, MC 0206
Denver, CO 80204