Advanced Perioperative Ultrasound & Clinical Anesthesia Fellowship

Overview and Goals

The current education and training model for Point of Care (POC) ultrasound skills is often not sufficient to allow trainees to reach a level of proficiency to practice these skills confidently and independently. In order to develop the complete set of clinical skills (e.g., regional anesthesia, invasive monitoring, POC ultrasound, echocardiography, management of ECMO and ventricular assist devices) to rise to the challenge as perioperative physicians, additional training beyond residency is highly beneficial.

In addition to leading the integration of advanced technologies into the care of complex patients, future leaders must be able to teach and disseminate their knowledge and approaches to patient care. Multimodal approaches to education including online, live lecture, and simulation require training in order to learn to adapt these approaches to adult learning. Development and incorporation of assessment tools are likewise critical to ensure the successful uptake of new approaches to care. This fellowship will develop an Advanced Perioperative Clinical Anesthesiologist who will be able to provide the highest level of clinical care and also train the next generation.

Our fellowship goals include:

  • The graduating fellow will be highly skilled in the use of point of care ultrasound and echocardiography for high-risk patients undergoing non-cardiac procedures.
  • The graduating fellow will have expertise in preoperative, intraoperative and postoperative management of high-risk patients undergoing non-cardiac procedures.
  • The graduating fellow will become an innovative academic leader who can apply multimodal, competency-based educational programs, and interactive teaching tools to the training of residents and faculty.
  • The graduating fellow will gain expertise in advanced monitoring and management devices, e.g. ventricular assist devices, spinal drains, pacemakers, hybrid OR with stand-by pump through participation in high risk surgeries.
  • The graduating fellow will master the fund of knowledge to participate as a consultant in a multi-disciplinary team caring for high-risk patients undergoing non-cardiac procedures.

Eligibility/How to Apply/Contact Information

  • Completion of residency training in Anesthesiology in an Accreditation Council for Graduate Medical Education (ACGME), ACGME-International (ACGME-I) or Royal College of Physicians and Surgeons of Canada (RCPSC) accredited training program; or
  • Equivalent non-ACGME residency to include:
    • Completed a residency program in the core specialty outside the continental United States that was not accredited by the ACGME, AOA, ACGME-I, RCPSC or CFPC.
    • Demonstrated clinical excellence in comparison to peers throughout training. Additional evidence of exceptional qualifications is required, which may include one of the following:
      • Participation in additional clinical or research training in the specialty or subspecialty;
      • Demonstrated scholarship in the specialty or subspecialty;
      • Demonstrated leadership during or after residency. Applicants being considered for these positions must be informed of the fact that their training may not lead to certification by ABMS member boards or AOA certifying boards.
    • In recognition of the diversity of medical education and training around the world, this early evaluation of clinical competence required for these applicants ensures they can provide quality and safe patient care. Any gaps in competence should be addressed as per policies for fellows already established by the program in partnership with the Sponsoring Institution.
    • If needed, have a valid ECFMG certification either with no expiration date or if the certificate has an expiration date an extension letter from the ECFMG will need to be submitted also.
  • Be eligible for a Massachusetts Limited Medical License and J1 visa (if needed).

Program Director

Robina Matyal, MD

Fellowship Coordinator

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Rotations and Schedules

  • Point of Care (POC) ultrasound for two months. Training in echocardiography, regional anesthesia and focused ultrasound use in perioperative arena.
  • Intensive Care Unit: Cardiovascular Intensive Care Unit/Surgical Intensive Care Unit (CVICU/SICU) for one month. Training in the management of patients with high-acuity illness.
  • Advanced Clinical for three months. Providing exposure to complex thoracic, vascular and transplant patients.
  • Cardiology anesthesia for two months. Providing exposure to patients undergoing cardiac catheterization and electrophysiology procedures.
  • Academic rotation for four months. Providing training and experiential training in educational practice and training.

The fellow will be expected to take OR call 1 weekend per month (Saturday and Sunday, 7am-5pm) and one late OR call per week, including non-OR rotations. The division of Clinical: Non-clinical days will be 3:2 during the initial phase of training and will change to Clinical: Non-clinical days of 2:3 during the education focused part of the training.

Curriculum and Didactics

The training during this fellowship will be based on a comprehensive and multi-faceted model spread over 1 year. The training model is envisioned to be a combination of didactic, simulation and advanced clinical learning. Initial training will focus on acquiring a variety of skills in perioperative clinical anesthesia to manage high-risk patients undergoing non-cardiac surgery. Subsequently, additional training will include:

  • Approaching current knowledge deficits through research.
  • Devising innovative educational curricula and educational tools.
  • Applying these curricula and tools to reduce knowledge deficits.

Research and Other Opportunities

Fellows will be expected to complete a mentored scholarly/Quality Assurance/process improvement project during their fellowship, focusing on utilization of perioperative ultrasound in training. The research time will provide dedicated time whereby the fellows can develop and initiate an ultrasound/Echo research project from start to finish. The fellows will be responsible for trainee/patient recruitment, enrollment and data collection. Finally, the fellows will then analyze the data for presentation to the research group with the ultimate goal of publication.

Examples of projects may include:

  • Develop a process improvement project for enhanced recovery from the postoperative anesthesia care units by introducing point of care ultrasound, and pain management strategies.
  • Identification of training deficits in current educational curricula and proposed strategies to improve the current and standard training models.
  • Develop “Standard of Practice” pathways for vascular surgery and advance non-cardiac surgical cases.
  • Develop and update preoperative evaluation program especially for vascular and high-risk non-cardiac surgeries.