A Fellowship Program Director’s Perspective…
Brandi Anne Bottiger, MD, BS
Program Director, Cardiothoracic Anesthesiology Fellowship Department of Anesthesiology
Duke University Medical Center
Why did you pursue a Cardiothoracic Anesthesiology fellowship?
I fell in love with anesthesia for cardiac and thoracic surgery at multiple points in my life. I had early exposure to the patient population after hearing stories from my mom, a long time CTICU nurse, received exposure to CT imaging as part of a shadowing experience in college, and then had the opportunity to be incredibly hands on while rotating with CT surgery as a medical student. I had excellent medical school and anesthesia training at Penn State, and great experiences on the CT anesthesia rotation there as a resident. From there, I knew I wanted additional training to truly be a consultant in cardiac anesthesia. I wanted to contribute clinical and TEE skills, and to be intimately involved in decision making for patient care plans. I interviewed at several great programs, but Duke really stood out to me because of the quality and diversity of the training, and really that every single faculty member I met was interesting, engaged, incredibly talented, and down to earth— they asked how they could help develop my personal career, and genuinely meant it. Doing the ACTA fellowship at Duke changed my career, made me a better anesthesiologist, and opened my mind to see potential opportunities I didn't even know existed.
What is the goal or intent of the CT fellowship program?
As a resident in anesthesiology, you are truly making a huge time and financial investment to do a fellowship in cardiac anesthesia. Remember, this is an extra, extremely intense and challenging year of commitment to subspecialty training that is completely voluntary. Therefore, our program philosophy is that we provide you the tools to achieve not only excellent skill set during the year, but build leadership skills and great relationships. The relationships you have the opportunity to build with colleagues and mentorship through the 12 months, though intangible, are what can really alter the course of your career. While we maintain a high standard for fellow performance to ensure all ACGME requirements are met, we anticipate that each learner's career goals will be a bit different, and we get excited about providing applicants an opportunity to think about how their career goals are unique and what resources we can provide to get you there.
Our program is organized to provide excellent clinical exposure to a diverse cardiac and thoracic surgical patient population, at a high volume center which often provides quaternary care. Case exposure includes not only myocardial revascularization and valve procedures, but aortic surgery and deep hypothermic circulatory arrest, heart failure/VAD, heart and lung transplant, ECMO, minimally invasive valve procedures, TAVR, adult congenital and pediatric cardiac surgery, pulmonary thrombendarterectomy, and airway management for advanced thoracic procedures, ranging from lung resection to management of tracheal procedures, and electrophysiology/ cath lab procedures.
- Excellent TEE training in 2D and 3D TEE, with all of the fellows achieving certification in advanced perioperative TEE training. This year we have added formal chest wall ultrasound imaging to our program.
- Experiences in perfusion to include cardiopulmonary bypass, venovenous ECMO, venoarterial ECMO, balloon pump, and various types of ventricular assist devices.
- Experiences in post operative management of our 32-bed cardiothoracic intensive care unit.
- Research/clinical project-we ask that each fellow identify a project to work on through the course of their year. These have ranged from bench research, to clinical outcomes, to clinical outcomes, TEE research, and quality improvement projects. We ensure success by pairing you with a faculty mentor that shares areas of stated interest, with the goals of abstract submission to the Society for Cardiovascular Anesthesiology, with significant numbers of fellows going on to publish their work.
- Quality improvement projects- we ask that fellows participate in group projects, which can effect process change and positively impact patient care. The goal of this project is to achieve abstract submission to our local meeting, with some groups moving forward with achieving publication and awards at the level of the APSF.
Multiple structured didactic series and workshops, led by experts in the field with opportunities for multidisciplinary discussion.
What career paths were taken by prior fellows - Private vs academic?
Both. Every year is a little different, we have had graduates demonstrate a variety of exceptional career paths with both tracks. Our fellows are extremely driven and motivated, with a diverse range of interests and career goals. A wise previous fellowship director (my mentor), always said "cream always rises to the top". Its true. We have the pleasure of recruiting, teaching and collaborating with the best and brightest trainees in the country, and it doesn't take long for those people to grow and flourish. The bottom line in thinking about academic vs private practice is that it's a really personal career decision, and depends on which track individuals feel meet their career goals. The great part is we have a large alumni network for fellows to meet and talk to as they are figuring these things out. The unique thread that our fellows share is that they want to make a difference for the subspecialty, therefore many graduates go on to lead in various ways and do great things. My only advice is to keep talking to people who have pursued both, and decide what resonates with you.
Where do you see the future of the fellowship heading over the next 5- 10 years?
I have observed great moves nationally for anesthesiologists to become involved in perioperative medicine, pain management, and critical care, which employs skills in optimizing patients before, during and after surgery. Cardiothoracic anesthesia training offers this same opportunity, as we train to be experts in the perioperative management of the cardiothoracic surgical patient. Continued innovation and research in cardiothoracic anesthesia is needed. We should continue to demonstrate our value in streamlining care and improving the quality of care we bring to our patients, and continue to help great ideas come to fruition. We have great collaborations with our surgical and medical colleagues, and there is a ton of subspecialty programs within cardiothoracic surgery that would benefit from our involvement. We can truly help lead the way here.
For our program, with the help of my esteemed colleagues, I anticipate:
1. Growth of our case volume and fellowship here at Duke.
2. Growth in echocardiography training, and a need for robust infrastructure in both TEE and chest wall imaging.
3. Growth in educational resources in cardiac anesthesiology and echo, particularly in the area of online learning.
4. Structured collaborations with other fellowship and institutional programs to offer increased diversity of training
What type of resident do you expect to be successful in a CT fellowship?
We look for residents who are accomplished in their current residency, who have demonstrated the drive and motivation to be successful in a very challenging year, who will
make the most of the resources that are available. We seek future colleagues that are engaged, and will continue to demonstrate their leadership and excellence after they finish their fellowship, to serve as mentors and role models for others, who will continue to grow the subspecialty. Its a challenging clinical year, and we have high expectations-- our fellows are the primary anesthesia providers for these complex patients. The schedule is challenging-- we deal with many emergencies and transplants, so we do seek individuals that can communicate well, be flexible and thrive in this intense environment.
Date of Publication: Winter 2018