The Unit

Description

The Critical Care fellow will rotate to two hospitals that are part of the University of California, San Francisco, School of Medicine integrated hospital system.  The parent general surgery training program is based at the UCSF/Moffitt-Long Hospital and rotates general surgery residents to both hospitals (# 4400521052).  San Francisco General Hospital is a fully integrated teaching hospital in the UCSF, School of Medicine Hospital System.

The postgraduate residency program in surgical critical care provides 6 months in the Intensive Care Unit of the San Francisco General Hospital, 2 months in at the UCSF/Moffitt-Long Hospital.  The resident spends one additional month at SFGH rotating on the anesthesia service in the operating room.  The resident has on average three weeks of vacation during the year.  The resident rotates in the ICU for eight months of the twelve-month period.  The resident spends two months on the trauma service at San Francisco General Hospital.  The resident receives experience in the Intensive Care of blunt and penetrating trauma victims, the head injured patient, the injured child, burns and inhalation injuries, necrotizing soft tissue infection, post operative thoracic and vascular surgery, and complex abdominal surgery at San Francisco General Hospital.  The resident also receives experience in the intensive care of solid organ transplantation, patients following major oncological surgery, including liver resection, Whipple procedures, and major surgical complications referred for care by outside institutions at the UCSF/ Moffitt-Long Hospital.

The primary (operative) surgical team (or service) consists of the admitting attending surgeon, the chief surgical resident, junior surgical residents, surgical interns and medical students who are assigned to the patients when they are admitted.  This team will care for the patient throughout their entire hospitalization.  The critical care service consists of consulting ICU attendings, the surgical critical care fellows, surgery and anesthesia residents and medical students in the ICU. 

Currently, the critical care service consists of nine faculty members that rotate through he ICU on a weekly basis throughout the year at SFGH.  At UCSF/Moffitt-Long there are eleven faculty members that rotate on a weekly basis.

Each critical care fellow is typically on call one to two times a week.  The surgical critical care resident takes call in turn with the other residents.  Currently, each month there are two anesthesia residents, one general surgical resident, and one critical care resident.  We also have residents from the obstetrical and gynecology service rotating and the medical service in the ICU.  The medical students are on call with the residents and are supervised by the surgical critical care resident.  Each week the surgical critical care resident gets one day off from their ICU responsibilities.

During the second (trauma surgery) fellowship year, the fellow will take regular in-house call as previously described and be available when not out of town, for major trauma surgical cases.  The fellowship is designed to not interfere with the ACGME accredited program in general surgery.  The fellow will rotate through various subspecialty services including neurosurgery (6 weeks), thoracic/vascular surgery (4-6 weeks), interventional radiology (2-3 weeks), and pediatric surgery.

Research Activities

The UCSF Surgical Research Laboratory at San Francisco General Hospital provides ample opportunity to perform translational research.

The faculty at the UCSF Hospitals in the ICU is actively involved in research related to critical care.  In addition, opportunity exists for the resident to pursue basic science research interests in the UCSF Department of Surgery Research Laboratory at SFGH.  This state of the art laboratory is focused on the study of the response to Stress and Sepsis after injury.

The second year is flexible with opportunities to study trauma system development, the trauma registry or pursue clinical or basic science investigation.  A second year concentrating on trauma has been added.

The intensive care unit at SFGH is a modern facility that has a totally computerized database that can be used for clinical study.  The following studies in Intensive care are in progress or have recently been submitted for presentation and/or publication:

-Patients in the ICU at UCSF/Moffitt-Long and SFGH have been enrolled in the NIH sponsored Acute Respiratory Distress Syndrome Network Trial (ARDS NET) of low pressure and low tidal volume ventilation, rescue steroids, ketoconazole, and Lisofylline therapy. There are 10 centers involved in this multi-center trial of therapies for patients with ARDS.
-The Traumatic Lung Injury Group at SFGH has been involved with the study of the epidemiology and mechanisms of acute lung injury and ARDS after major trauma. 
-A study of the effect of fluid resuscitation and oxygen administration on tissue oxygen after major trauma was recently completed.
-A study was recently completed examining the effect of pressure control and volume control modes of ventilation on patients with Acute Lung Injury and ARDS.
-The role of heat shock proteins in acute lung injury.
-Activated protein C in the treatment of sepsis.
-Dexmeditomidine for the treatment of stress related failure to attain unassisted breathing.
-Effects of artificial breathing patterns on the work of breathing.
-Ventilation abnormalities in patients with ARDS.
-Magnetic residence imaging of traumatic brain injury
-National acute brain injury study: Hypothermia II (NABIS:H II)
-NIH ARDS Network Trial of fluid management and catheter use in patients with ALI
-NIH ARDS Network trial of high dose corticosteroids vs placebo in patients with late phase ARDS.
-Assessment of leukotrienes in pulmonary edema fluid.
-Review of patients with ARDS receiving aerosolized vasodilator therapy for refractory hypotension.
-Effect of tidal volume demand upon work of breathing during simulated lung protected ventilation.

The San Francisco Injury Center is based at San Francisco General Hospital and provides opportunities for clinical and laboratory investigation.  The Injury Center is funded by the Centers for Disease Control and The Principal Investigator is M. Margaret Knudson, M.D., surgeon with the ABS Certificate of Added Qualification in Surgical Critical Care who is on faculty at SFGH.

As part of the developing academic leadership a fellowship involving violence prevention has been offered for five years at SFGH affiliated with The Pacific Center for Violence Prevention. The Principal Investigator for the training grant is Robert C. Mackersie, M.D.  This grant is geared to expose fellows to the health policy, community, and legal aspects of violence prevention in conjunction with the Trauma Foundation at SFGH.

Fellowship Program

Salary

$51,676.00 and $500 monthly housing allowance

Applicant Requirements

Applicants should be board certified or eligible (preferred), or enrolled in an accredited residency program in surgery.

Contact

Wenia Lee

1001 Potrero Avenue
San Francisco, CA 94110
USA

Phone: (415) 206-4627
Fax: (415) 206-5484

Email:

Mar 20, 2007