Pediatric Surgery

Name of Host Institution: Cincinnati Children’s Hospital Medical Center

Program Specialty / Subspecialty: Vascular Anomalies Fellowship Training Program

Program Mailing Address:
Cincinnati Children’s Hospital Medical Center
MLC 2023
3333 Burnet Ave.
Cincinnati, OH 45229-3039

Program Phone Number: 513-636-7365

Program Fax Number: 513-636-7657

Program Email: denise.adams@cchmc.org

Program Codirectors: Richard Azizkhan, MD, and Denise Adams, MD

Alternate Program Contact: Julie Ludwig, residency coordinator, julie.ludwig@cchmc.org

History

This program was approved by the Graduate Medical Education Committee in August 2006. The first trainee began in July 2007.

Duration

One year.

Prerequisite Training / Selection Criteria

The trainee should preferably be a fully trained surgeon. He or she must have completed a residency in pediatric surgery, general surgery, otolaryngology or plastic surgery.

Goals and Objectives

Individuals will participate in the broad clinical and academic experience now available in the Hemangioma Vascular Malformation Center (HVMC) under the supervision of Richard G. Azizkhan and Denise Adams, codirectors of this interdisciplinary center.

Currently, the HVMC has more than 3,000 active patients and new patient accrual is exceeding 550 per year. Our center is one of five comprehensive vascular anomalies programs in North America. We have a superb interdisciplinary faculty with internationally acclaimed expertise in this field. The faculty members are engaged in clinical and translational research. In addition, we are building a basic science vascular biology research program that is anticipated to have at least four faculty members.

Vascular anomalies are common disorders that affect approximately 15 percent of children although only 1 percent require evaluation and treatment. Throughout the United States, vascular anomalies are frequently misdiagnosed and often inappropriately treated. There is a significant need to train subspecialists with expertise in managing these types of patients. Our program is one of two formal training programs for vascular anomalies in North America.

Program Certifications

None at this time.

Teaching Staff

• Pediatric Surgery – Richard Azizkhan and Roshni Dasgupta
• Hematology / Oncology – Denise Adams
• Dermatology – Anne Lucky
• Pediatric Otolaryngology – Ravi Elluru
• Plastic Surgery – David Billmire and Kevin Yakuboff
• Interventional Radiology –John Racadio and Manish Patel
• Pathology – Anita Gupta
• Pain Management – Kenneth Goldschneider

The training program directors, Azizkhan and Adams, will coordinate all aspects of the fellowship training program for the vascular anomalies fellow. Other faculty members will be involved in specific training experiences. The surgical faculty (pediatric general, plastic and otolaryngology surgeons) will supervise the vascular anomalies fellow on all operative cases as well as on inpatient and outpatient care. From dermatology, Lucky will also contribute outpatient supervision in the interdisciplinary clinics. Kevin Bove in pathology will instruct the trainee on gross and microscopic pathology for this complex spectrum of vascular tumors and malformations. Racadio and Patel will be involved in the educational process in both diagnostic and interventional radiology. These individuals are participating in our teaching conferences.

Facilities

All training is conducted at Cincinnati Children’s Hospital Medical Center, a private medical center providing 523 registered beds. The hospital is one of the largest children’s care facilities in the United States in several categories: number of beds, number of emergency room visits, and number of operative procedures.

During the training period, this individual will be expected to participate in the vascular anomalies educational programs, outpatient and inpatient care, routine and complex surgical procedures, interventional radiology procedures and pain management. The trainee will also be involved in clinical research projects. The trainee may also participate in shared general pediatric surgery clinical and educational experiences with our current pediatric surgery trainees when deemed to be beneficial.

The goal of this fellowship position is to enable the trainee to gain expertise in the diagnosis, medical and operative management of a wide spectrum of complex vascular anomalies. This experience will expand the pool of specialists who will be able to care for these patients. In addition, this experience will permit the practitioner to enhance expertise in the treatment of vascular anomalies in anticipation of a subspecialization in this area.

The ultimate responsibility for care of the patients is the attending surgeon. No patient is admitted to the hospital, undergoes a procedure or procures a consultation without the attending surgeon being made fully aware and assuming the responsibility for this. The fellows interact with the attendings on a daily basis to go over the patient’s progress or to raise any concerns. If necessary, the attending surgeon is called directly by the fellow. The fellows round with the attendings, frequently on patients that are complicated. There is frequent communication both at the bedside and in the department regarding patient management decisions.

The operative procedures and skills require at least four years of general surgery training or its equivalent. The trainees will be performing major surgical procedures including major soft tissue resections in all regions of the body (except in the intracranial position).

In addition, soft tissue transfers and flaps will be an essential part of this training experience. The trainees will be supervised in performing image-guided sclerotherapy by the interventional radiologists.

Daily

Bedside rounds

Weekly

Tumor Board
UC Surgical Grand Rounds
Pediatric Surgery Grand Rounds
Pediatric Surgery / Radiology Conference
Pediatric Surgery Morbidity and Mortality Conference
Textbook Chapter Review
Hemangioma and Vascular Malformation Conference (two to three times / month)
Hemangioma Vascular Malformation Radiology Conference (two times / month)

Monthly

Pediatric Surgery Pathology Conference
Trauma Case Review
Trauma Morbidity and Mortality Conference

Fellows are evaluated every three months by the program director, and a summary evaluation is conducted at the conclusion of the fellowship. In addition, the subspecialty residents are expected to provide formal evaluations of the individual faculty members, the program of learning and the program resources on an annual basis. This information is collated and presented to the faculty in an anonymous fashion.