Program description

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).

Background

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; (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 and this need will only become more apparent with the advancing age of the United States and world population.

Several factors make integrated residencies in vascular surgery a highly competitive field. These include advances in technology and changes in clinical care which have further defined the distinction between general and vascular surgery. Integrated programs provide a fast track that consolidates training time for motivated trainees who are particularly drawn to vascular surgery early in their development. Importantly, integrated vascular surgery residency allows trainees to learn advanced imaging and interventional skills earlier in their surgical training, facilitating the incorporation of these skills into their clinical practice.

To address the growing need for vascular surgeons as well as to harness the unique resources available at UC Davis to train high quality surgeon leaders in the field of vascular surgery, the UC Davis integrated vascular residency program was founded in 2012. It remains the only program which 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 also one of the largest in the western United States.

Vascular Surgery  UC Davis vascular surgery faculty, residents and fellows, from left to right: Cara Pozolo (resident), Joel Harding (resident), Mimmie Kwong (faculty), Connor Caples (resident), Nasim Hedayati (VA faculty), William Yoon (faculty), Matthew Mell (chief of vascular), Daniel Scott (Travis faculty), Misty Humphries (faculty), Jeremy Bolin (resident), Olivia Rapozo (NP), Meryl Simon (graduate), Andrew Wishy (resident), Austin Holmes (resident), Cole Nishikawa (resident) and Stefanie Generao (NP).

Faculty and Staff

The core surgical faculty integrates vascular surgeons and other specialists from the UC Davis Department of Surgery,Kaiser Permanente hospitals throughout Sacramento,  the Sacramento VA (Mather) Medical Center, and active duty Air Force surgeons assigned to the 60th Surgical Operations Squadron at David Grant USAF Medical Center (DGMC).

Program and Site Directors

Misty D. Humphries, M.D. is the program director. Nasim Hedayati, M.D. is the assistant program director and Lt. Col Shaun Gifford is the DGMC site director. Robert E. Noll, M.D. is the site director at the VA, and Christorpher Abbott is the site director at the Kaiser Permanente facility.

Program Coordinator

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.

Angela Lange is the residency program coordinator at DGMC.

Institutional GME staff

Dr. Susan Guralnick is the Associate Dean and DIO of the UC Davis Office of Graduate Medical Education. She oversees administrative aspect of all residency and fellowship programs at UC Davis.

Barbara Erickson is the DGMC Director of Medical Education.

Curriculum

The five-year integrated curriculum includes both vascular surgery content and core surgical education.

Residents’ educational experiences includes 18 months of core surgical education (general surgery and other surgical specialties), spread over the first 3 years of training, including pre- and post-operative evaluation and care; critical care and trauma management; technical experience in skin and soft tissue, and cardiac critical care, to provide a breadth of general surgery training and develop skills relevant to the practice of vascular surgery. Forty-two months of rotations are concentrated in vascular surgery. This includes training in advanced imaging, angiography and vascular interventions, and cardiovascular medicine.

The last year of the program is spent on dedicated vascular surgery rotations, providing the trainee with experience as a chief resident responsible for leading the vascular surgery service at each of the integrated sites.

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.

The program director for the surgical critical care program is Edgardo Salcedo, M.D.

Institutions and resources

UC Davis Medical Center

       UC Davis Medical Center is the leading referral center in the region for the most seriously injured or ill patients and the most complex cases. The institution provides care to the greater Sacramento area and 32 other counties, extending more than 65,000 square miles and including six million residents. UC Davis operates Northern California's only inland Level 1 trauma center, with comprehensive adult and pediatric emergency departments that see over 50,000 visits annually. The 577-bed medical center continues to expand with the addition of a 470,000-square-foot Surgery and Emergency Services Pavilion which opened in 2012. This facility houses the emergency room, operating rooms, cardiac and interventional suites as well as the cardiothoracic intensive care unit, the neurosurgical intensive care, and a 12-bed burn unit. The latest expansion will be a new pediatric surgical facility in Spring of 2019
To improve the comprehensive treatment for patient with vascular diseases, the UC Davis Vascular Center was established in 2006 as collaborative effort involving between specialists in vascular surgery, vascular medicine, interventional nephrology, cardiology, and radiology. The UC Davis Vascular Center is now the region’s largest clinical program specializing in vascular care. Working as members of the UC Davis Vascular Center provides our integrated vascular residents with the unique experience of interacting with teaching faculty from other specialties and academic departments, broadening their exposure to the different types of care required by the vascular patient.

The UC Davis Center for Healthcare Technology (CHT) has an endovascular simulator as well as a full ultrasound training facility for residents to learn in the protected simulation environment. The virtual reality endovascular trainer allows residents to practice cases prior to performing them in the live setting. The CHT is also 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 CHT building provides additional space, production facilities, and teaching laboratories for the simulation program.

Department of Veteran Affairs

      

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 Air Force Base); 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, 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. In 2018 the facility is breaking ground on two new cardiac catheterization labs with plans for a development of a hybrid operating suite once construction of the cardiac catheterization labs has been completed.

David Grant Medical Center

      

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 veterans in the VA NCHCS system. David Grant is located on Travis Air Force Base near Fairfield, CA. In addition to comprehensive health care, DGMC is a leader in military readiness, aeromedical staging, surgical and medical education and research, teleradiology services.

A unique feature of the DGMC clinical experience is the Clinical Investigations Facility (CIF). The CIF is dedicated to the education and training of surgical residents as well as the advancement of basic science and translational research. During their surgical training, trainees will have the opportunity to use large animal porcine models for the development of their open surgical, laparoscopic, endovascular, and other invasive procedural skills in an anatomical translational laboratory. These hands-on labs provide trainees the opportunity to learn, perform, and teach in a realistic but lower stress environment. Also, residents interested in becoming physician-scientists have the unique opportunity to collaborate with the CIF research team members on current projects or finding high quality mentors to help them with developing and leading projects of their own. This may be accomplished while on clinical duty or during a dedicated research fellowship.

Kaiser Permanente Medical Center

      

The Kaiser South Sacramento rotation provides exposure to one of the largest health care systems in California.  This rotation has provided our trainees with excellent experience in treating common to complex vascular procedures in a private single payer organization.