Cardiothoracic Transplantation Surgery Fellowship

The one-year fellowship is available for a board-eligible or certified cardiothoracic surgeon seeking additional training in lung transplantation surgery. In the lung transplantation program, our surgeons perform approximately 60-110 lung transplant procedures/year. The lung transplant fellowship at the Hospital of the University of Pennsylvania is established to provide advanced training in pulmonary transplantation surgery. The goal is for the fellow to develop the skills required to become an attending transplant surgeon and to provide a comprehensive training to include inpatient and outpatient management in advanced thoracic end stage pulmonary disease surgery. During the training we expect to enhance the candidate's surgical skills to perform lung transplant procedures, train them in the pre and postoperative surgical management and to allow them to engage in a scholarly pursuit related to lung transplantation.

The candidate’s clinical duties will include all aspects of lung transplant surgery and will occur under the supervision of the attending surgeons. The Fellow will participate in research activities and teaching of junior trainees as appropriate. The program includes exposure to all aspects of donor lung procurement and organ perfusion techniques (ex-vivo perfusion and normothermoic regional perfusion), mechanical support as a bridge to lung transplant surgery including extracorporeal membrane oxygenation (ECMO), lung transplant procedure and peri-operative management of transplant recipients. The candidate duties will also include participation in the outpatient clinics and pulmonary team weekly meetings including selection committees and patient management meetings.

Overall Educational Goals and Objectives

1. Develop skills in the preoperative assessment and selection of patients with advanced pulmonary diseases considered for lung transplantation.
2. Develop skills in the management of complex lung transplant surgery and associated procedures including emergencies.
3. Be responsible for post-operative management of patients with lung transplant surgery and mechanical support including ECMO used a bridge or for primary graft dysfunction.
4. Become proficient in lung procurement procedures and current donor lung preservation techniques with Dr. Susuki and assist in ex-vivo perfusion procedures as requested.
5. Experience an in-depth patient exposure attending regularly the transplant Clinic with Dr. Bermudez, Dr. Cantu and the Lung Transplant surgery team.
6. Participate in the teaching activity of the Department of Surgery and the Division of Cardiothoracic Surgery. This includes presentation of cases at the patient multidisciplinary review meeting and lung transplant selection committees if they were involved in the case.

Curriculum

The Fellow will be assigned to the Lung Transplant Service at HUP for the duration of their fellowship. When specific transplant or procurement cases of interest occur, the fellow will participate on an ad hoc basis and may, depending on learning goals, spend additional time with the interventional pulmonary team or pulmonary medicine team as requested.

Didactic Sessions

The Fellow will be responsible for attending all educational conferences including Tuesday Lung Transplant M&M and service patient discussion, Thursday lung transplant candidate selection committee and cardiac surgery M&M and Wednesday ECMO meeting and Transplant research meeting. The transplant Fellow occasionally will be responsible for presentation of cases or candidates during these meetings as planned in advance. 

Clinical Responsibilities

1. The Lung Transplant Fellow (LTF) will scrub with the attending surgeons in cases of lung transplant surgery.
2. The LTF will rounds daily on all patients on the transplant service and communicate directly with the attending surgeon on peri-operative clinical issues including pre-operative patients, pre-lung transplant transfers and consultations, and post-operative patients.

On-Call Responsibilities

1. The LTF will have weekday nights and weekend days and nights on call responsibilities as defined by the division chief.
2. The LTF will make rounds on all patients on the lung transplant service in the ICU and step-down unit.
3. The LTF will be available for consultation.
4. The LTF will be immediately available to respond to all calls for assistance from other healthcare providers at the Hospital caring for patients being evaluated for transplant, on the waitlist or with the history of lung transplant.
5. The LTF will promptly involve the attending surgeon in any evaluation or management issue requiring attention.
6. The LTF will assume a position within the regular in-house on-call schedule for cardiac surgery/thoracic surgery residents when one of the surgical residents is not available.                                                                                                                              

Out-Patient Activity

1. The LTF will be expected to experience a broad out-patient exposure.
2. They will be expected to attend with the transplant surgeons and the transplant team the lung transplant clinic on Wednesday and Friday morning depending on the service and surgical activity.

Core Competencies

Patient Care: The Fellow must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. The fellow is expected to:

• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
• Gather essential and accurate information about their patients.
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
• Develop and carry out patient management plans.
• Counsel and educate patients and their families.
• Use information technology to support patient care decisions and patient education.
• Perform competently all medical and invasive procedures considered essential for the area of practice.
• Provide health care services aimed at preventing health problems or maintaining health.
• Work with healthcare professionals, including those from other disciplines, to provide patient-focused care.