Vascular Rotation

The Vascular Medicine Rotation at University Hospitals Cleveland Medicine Center, in collaboration with Case Western Reserve University, enables fellows to achieve the knowledge and skills in the care of patients with a broad range of vascular conditions. Fellows are expected to gain proficiency in the diagnosis and management of vascular conditions typical of a well-qualified internist. Learning occurs through the following methods:

• Bedside teaching
• Departmental conferences
• Hands-on, supervised clinical experiences, both inpatient and outpatient
• Vascular laboratory attendance

Comprehensive Acquired Skills

Attending physicians are expected to reinforce the understanding of the etiology pathogenesis, clinical presentation and natural history of vascular diseases treated by internists and cardiologists. Additionally, fellows are expected to develop their skills in the following:

• Clinical problem-solving
• Communication
• Diagnosis
• Diagnostic testing
• Interpersonal skills
• Therapy

The rotation should enhance fellows understanding of the pathogenesis and management of a variety of vascular conditions.

Principal Teaching Methods

The principal teaching methods are varied and include the following:

Direct Supervision of Patient Care

In the Vascular Medicine Rotation, the fellow will utilize available staff and services and be exposed to a widely variable patient population to gain experience in systematic performance of a cardiovascular physical examination. Clinical focus will be primarily on developing a differential diagnosis and utilizing appropriate diagnostic testing to aid in improving patient care. Bedside teaching in the outpatient and inpatient setting will be incorporated.

Case-Based Learning

Fellows will be the initial contact for all inpatient consults and responsible for follow-up of the hospital patients.

Wide Range of Conferences for Enhanced Learning

Fellows will attend the following conferences:

• Weekly Clinical Conference: weekly topic discussion by the fellows
• Vascular Teaching Conference: third Tuesday of each month
• Vascular Surgery Conference: Didactic, clinical case presentations, vascular laboratory didactics and M&M are discussed
• Cardiology Grand Rounds (GR) occurs each Thursday at noon: Grand Rounds content spans clinical and basic science topics

Patient Characteristics for Vascular Diseases

The mix of patients is typical for a vascular medicine service at a tertiary hospital and includes patients with all types of arterial, venous and lymphatic diseases. Patients are seen in the inpatient setting as a consultant and in the outpatient setting as a primary caregiver.

Vascular Laboratory Testing and Interpretation

Fellows will have the opportunity to participate in vascular laboratory testing as well as interpretation.

Principle Educational Materials

Fellows have 24-hour access to the core library located in the hospital with computer access for literature search, online journals, Up-to-Date and other reference materials.

Evaluation of Resident and Program Performance

A competency-based evaluation matrix for written evaluations is to be completed at the end of the rotation using the myevaluations system. Attending evaluations are completed electronically and are available for review by the residents online and at the time of their semi-annual evaluation/counseling meetings. In addition to a written evaluation, the attending physician will give verbal feedback.

Residents complete written evaluations of the attending, which are anonymous, and a written rotation evaluation with specific attention to the learning objectives. Duty hour compliance should not be an issue but will be monitored daily by the program director, chief resident, the rotation evaluation, and a one-week detailed duty hour audit carried out during each rotation block.

Objectives by Year

The objectives for the first and second Vascular Medicine Rotation are as follows:

First Contact Rotation for History and Vascular Physical Examination Skills

During the first Vascular Medicine Rotation fellows are expected to master history and vascular physical examination skills for all types of vascular disease. Fellows should understand when ordering physiologic testing and imaging are most appropriate. They should also develop a basic understanding of the use and performance of vascular laboratory tests. The fellow should begin to develop a basic understanding of the therapeutic options for managing all types of vascular disease.

Second Contact Rotation for Diagnosis of Vascular Diseases

Fellows who elect to do a second Vascular Medicine Rotation are expected to begin to develop a differential diagnosis of vascular diseases. They should demonstrate knowledge in ordering cost-effective laboratory and vascular testing to support the differential diagnosis. In addition, they should demonstrate an advanced understanding of therapeutic options for managing all types of vascular disease, including the ability to discuss with patients their therapeutic options and expected outcomes.

For More Information

For more information on the Vascular Medicine Rotation, please contact the following:

Faculty Contact: Teresa Carman, MD
teresa.carman@UHHospitals.org