Goals

• A one-year fellowship training program in anesthesiology focusing on the clinical aspects of organ transplantation.
• There is a well-developed structured didactic program that will systematically review all theoretical materials associated with transplant anesthesia. In addition, fellows are encouraged to participate in clinical research.
• Successful applicants will have at least 20% of their time protected to allow them to engage in academic activities. Research opportunities in transplant anesthesia abound in both the basic and clinical arenas. Investigation can take place either within the division or in collaboration with the transplant surgeons.

Assumptions

• Transplantation is a multidisciplinary field that encompasses a wide range of basic and clinical medical and biological sciences.
• The science of transplantation constitutes a biochemical, patho-physiologic, and clinical continuum from organ donor to organ recipient.
• A better understanding of the biochemical, patho-physiologic and clinical problems encountered in the management of the organ transplant recipient and organ donor can be achieved through a broad based multidisciplinary approach to the education and training of anesthesia trainees.
• Expertise in the anesthetic management of the organ recipient as well as the organ donor has a major impact on the quality of the graft organ, the viability of the transplanted graft, and as a result the long term survival of the transplant recipient.
• Specialized training in organ transplantation anesthesia will result in better initial management of these patients, innovative therapeutic interventions in the future, and improved outcome among transplanted patients.

Objectives

• Offer a unique scientific and clinical teaching environment for the purpose of educating and training physician specialists in transplantation.
• Provide a core curriculum in transplantation medicine ? To educate and train anesthesia fellows in the unique clinical problems encountered in the perioperative and intensive care management of organ recipients and organ donors.

Clinical Sites

• Jackson Memorial Hospital
• Broward General Hospitals

Program Content

The educational or didactic program will comprise three major areas:

1. Common core curriculum in transplantation medicine
2. Basic and followed by advanced clinical and scientific curriculum in anesthesiology for organ transplantation. The basic introductory seminar series of selected topics in general will be offered at the beginning of the fellowship and during the first 30 days. The purpose of this seminar series is to ensure that all new trainees have a solid and common foundation in the basic principles of anesthesiology. The format employed to impart knowledge will be that of the Problem Based Learning (PBL) approach. Each week trainees will be presented with a different topic or clinical problem and will be asked to research the topic drawing on a variety of medical knowledge sources. During the teaching sessions or seminars trainees will make short presentations on each assigned topic followed by a general discussion. A preceptor will be present to guide the discussion, elaborate on specific areas, fill gaps, and answer questions.
3. Participation in a university wide curriculum in basic sciences course.

The University of Miami School of Medicine has been awarded a K30 Clinical Research Curriculum Award (CRCA) through the National Institutes of Health (NIH). The objective of this award is to provide educational courses in fundamental skills needed for clinical research. Fellows will be expected to participate in those courses relevant to the fellowship program. The primary areas of study include: biostatistics, epidemiology, research project design, research ethics, and legal and regulatory issues in human subjects research.

Subject areas for the fellowship (not including the core curriculum in transplantation medicine) will include but will not be limited to:

Biochemistry

• Apoptosis
• Biochemical basis of ischemic-anoxic injury
• Reperfusion injury
• Antioxidant biochemistry
• Promising treatment modalities for reperfusion injury

Physiology and pathophysiology

• Acid-base equilibrium
• Hepatic physiology and mechanisms of hepatic drug metabolism
• Renal physiology, renal failure, and renal function tests
• The autonomic nervous system and receptor pharmacology
• Hypothermia and perioperative temperature control
• Coagulation
• Reperfusion syndrome in clinical liver transplantation
• End stage liver disease and clinical manifestations

Clinical sciences

• Organ procurement and donation
• Anesthesia for organ donation
• Anesthesia for organ transplantation
• Transfusion medicine
• Anesthesia for patients with hepatocellular disease
• Invasive hemodynamic monitoring
• Non-invasive hemodynamic monitoring
• Shock states
• Cardiopulmonary-cerebral resuscitation
• Cardiac emergencies and their management
• Intensive care management of the liver transplant patient
• History and organization of organ transplantation
• Pancreas transplantation
• Intestinal and multiple organ transplantation
• Infectious diseases and transplantation

Specialized training and skill areas (in each of the following areas the trainee must demonstrate clinical proficiency)

• Anesthetic management of the organ donor
• Anesthetic management for multiple visceral organ transplantation
• Advanced cardiac life support
• Central venous catheterization (femoral, internal jugular and subclavian veins)
• Right heart catheterization (pulmonary artery catheter placement)
• Arterial line placement (radial and femoral)
• Management of the difficult airway
• Transesophageal echocardiography
• Arterial blood gas analysis

Clinical rotations

Clinical rotations will take place in two sites: Jackson Memorial Hospital and Broward General Hospital. Clinical and scientific meetings will also take place at Cedars Hospital. Trainees will be exposed to Hepatic, Renal, Pancreatic, and Multi-visceral organ transplantation. There will be two months of external rotations:

• Intensive Care Unit, following and managing patients who have undergone solid organ transplantation
• Transesophageal Echocardiography (TEE), fellows will spend one month in a structured instructional program.

In addition fellows will be expected to scrub and have instruction in the critical potions of at five transplantation operations. They will be present for the key portions of the surgery.

Appointments and Applications

Application to the University of Miami/ Jackson Memorial Anesthesiology Fellowship Programs requires:

• A completed University of Miami/ Jackson Memorial application form
• A certificate of completion from an ACGME accredited anesthesia residency program (if US resident)
• An official record of board scores (NBME, FLEX, USMLE, LMCC, VQE, or FMGEMS)
• Three letters of recommendation
• Curriculum vitae
• A personal statement
• A valid ECFMG certificate (if a graduate from medical school outside of the United States or Canada)
• A letter from their anesthesiology residency program director stating that they have successfully completed a three-year

Inquiries

Applications and correspondence should be sent to:
Ernesto Pretto, M.D.
Program Director, Solid Organ Transplant Fellowship Program
Department of Anesthesiology
University of Miami/ Jackson Memorial Hospital
P.O. Box 016370
Miami, FL 33101