Integrated Vascular Surgery Residency

The mission of the Yale Integrated Vascular Surgery Residency Program is to train the next generation of academic vascular surgery leaders. Residents will be exposed to the full spectrum of endovascular and open surgical procedures in a quaternary referral center environment. Each trainee will also spend time in the pursuit of a research experience where they learn how to design and publish investigative efforts in areas of their choosing. Potential opportunities exist in a wide variety of fields including basic science, translational, public health, and large database outcomes research. Our goal is to allow all vascular surgery trainees to develop into skilled, confident surgeons with the ability to pursue careers in academic surgery. Upon completion of this program, trainees will be eligible for certification in Vascular Surgery through the American Board of Surgery.

At Yale Vascular Surgery, we foster a culture of diversity, equity and inclusion among our faculty, residents and staff. We value and embrace differences in race, age, sex, gender identity, sexual orientation, religion, ethnicity, socioeconomic status, and nationality. This culture of diversity, equity, and inclusion, strengthens our team, fortifies our performance, and enhances the care of our patients. In our residency program, we strive to recruit and train highly successful, diverse and ambitious candidates, who will be an integral component of the future vascular surgery workforce, that represents the diversity of our country and the patients we serve.

During the first 3 years, the resident will establish a core foundation to include rotations in general surgery, trauma, critical care, cardiothoracic surgery, transplant, vascular ultrasound, and other surgical subspecialties. PGY 1-3 residents will also have significant exposure to vascular surgery, and will perform consultations, diagnose and manage vascular diseases, and interpret imaging studies. Residents will learn basic endovascular skills (angiograms, venograms, and fistulograms) and standard vascular procedures (arterial exposures, anastomoses, dialysis access, venous procedures).

Following the first 3 years of clinical rotations, residents will dedicate 2 years of their training to the design and implementation of research projects with the goal of presentation and publication. Previous residents have worked in basic science laboratories, obtained an MPH degree, qualified for patents, designed animal research, led quality improvement projects, and published large database research.

During the final 2 years of training, the vascular resident will master standard vascular and endovascular procedures, and will learn more complex procedures such as aortic aneurysm repair (open and endovascular), carotid surgery, leg bypass, peripheral vascular interventions, mesenteric artery intervention, and thoracic outlet decompression. In addition, the resident will function as “chief resident”, alternating between the main campus at Yale and the VA campus. They will be responsible for leading the team of junior residents, students, and APPs. By the completion of their training, the vascular resident will be adept at clinical decision-making, operative planning and performance, and the longitudinal care of patients with vascular disease.

The Yale-New Haven Hospital (YNHH) is one of the largest medical centers in the country and comprised of two campuses, York Street and St. Raphael’s. YNNH is also a level 1 trauma center and major regional referral center. The Veteran’s Affairs Connecticut Healthcare (VA) serves as a third training site for the residency.

All residents receive 18 months of core surgical rotations across all the 4 hospitals in the health system. Additionally, all residents have 4 weeks of vacations per year. For junior residents (PGY1-3), these are two 2-week vacation blocks and the senior residents have four 1-week vacation blocks.

Key: SRC: Saint Raphael’s Campus, YSC: York Street Campus, BPT: Bridgeport Hospital, VA: Veteran’s Affairs Hospital

Vascular residents will learn to perform and interpret vascular laboratory studies throughout their training. In addition, residents will spend a dedicated one-month rotation in vascular ultrasound under the direction of Dr. Leslie Scoutt, Chief of Ultrasound. Specifically, residents will become adept at interpreting carotid duplex, aortic aneurysm ultrasound, mesenteric and renal duplex, ABI/PVR studies, lower extremity arterial and venous studies. Residents will qualify for and complete the Registered Physician in Vascular Interpretation (RPVI) examination, which is required for board examinations.

Graduates of our residency program consistently achieve the 85th percentile in case volumes. Generally, our case mix for trainees is about 60% endovascular and 40% open. Our program emphasizes decision-making and progressive autonomy such that as a resident progresses through our program they will learn how to operate independently. Yale-New Haven Hospital is a quaternary care facility and receives transferred patients from around the state of Connecticut and adjacent states. We work collaboratively with oncology, transplant, urology, ENT, colorectal and cardiothoracic surgery for complex vascular problems and reconstructions.

Endovascular Procedures

Considerable clinical information is covered in a range of conferences held on Monday morning. The didactic lecture schedule is meant to encompass those clinical topics that are not routinely seen by the VS resident in the out-patient or in-patient setting. The senior resident, under supervision of an assigned full-time faculty member, is responsible for setting the schedule. The topics are related to anatomy, microbiology, infectious disease, vascular physiology and pathology especially as they relate to the diagnosis and management of vascular lesions. General information such as management of complications, occurs in Mortality and Morbidity sessions. Specific topics are addressed by the faculty in the vascular teaching conferences to draw on experiences and impart this material to the vascular resident in the clinical arena. The monthly multi-disciplinary peripheral vascular interventions conferences, the bimonthly multidisciplinary carotid management conference, and the Journal Club provide opportunities to address unique clinical topics not seen or discussed in routine patient care. The residents are also encouraged to visit the Association of Program Directors of Vascular Surgery website to review the cases that are installed on a monthly basis.

A number of talks on the physics, mechanics and physiologic interpretation of various non-invasive laboratory techniques are given by Dr. Leslie Scoutt, Chief of Ultrasound. The VS residents attends the out-patient clinics at both YNHH and VA. In the vascular rotations, Physiologic and duplex vascular testing are conducted on-site. The resident participates directly in the evaluation of the patient and assists in the interpretation of the test results. A specific one month rotation in the vascular diagnostic laboratory is provided in PGY1 rotation.

Training in endovascular surgery occurs during all years of VS resident training but the bulk of activity for the VS resident is during the 4th and 5th year. Since 2002, there has been a formal affiliation between the Interventional Radiology group and the Vascular Surgery Service. In addition, we have PV faculty members who perform procedure in the IR suite. Dr. Bart Muhs had formal training in endovascular procedures during his VS training as well as an additional year of post-fellowship experience. He was a Marco Polo Fellow and spent six months in Utrecht, Netherlands, training on fenestrated aortic grafts. He works two full days in the IR suites. Dr. Cassius Chaar joined the faculty in September 2011 and also completed formal vascular surgery training and is skilled in open and catheter directed vascular interventions. The VS resident is therefore trained in catheter and guidewire skills by both IR and VS faculty. In the first three years, the vascular resident will be exposed to endovascular surgery with rotations on the vascular surgery and medicine services amounting to 9 months, and one month at the VA vascular service. In the final two years, the resident will spend half of PGY4 in clinical vascular surgery rotations where endovascular surgery will be taught as appropriate to patient care, and the entire PGY5 year in clinical vascular surgery rotations. They learn to perform diagnostic angiography, angioplasty and stenting of appropriate lesions and repair of abdominal aortic aneurysms with stent-graft. These procedures are done both in the IR suites and OR by both interventional radiologists and vascular surgeons. Senior VS residents are intimately involved in the pre-operative planning of the procedures, including indications, imaging assessment, measurement of aortic characteristics and selection of appropriate device. At least one of the VS residents is scrubbed for aneurysm or carotid procedures and is involved in catheter selection, guidewire advancement, device deployment, and confirmatory angiography. VS residents are involved in the post-operative follow-up of the patients with regards to the interpretation of follow-up CT scans and the detection of endo-leaks in aneurysm patients.

Finally, at our twice monthly vascular teaching conference, and our monthly multi-disciplinary endovascular conference, endovascular surgery is discussed in all of its aspects.

All applications must be made through Electronic Residency Application Service (ERAS) and applicants must register with National Residency Matching Program (NRMP). We currently offer 1 training position per year, in a 7-year training program comprising 5 clinical years and 2 years of academic development time. Prospective residents can anticipate to begin training around the 2nd week of June.

All applications on ERAS through the common application form must include:

1. Dean's Letter (submitted by medical schools on November 1st)
2. Medical Student Transcript
3. At least 3 letters of recommendation
4. Personal Statement
5. USMLE Step 1 score

• Virtual Interview 1: December 7, 2020
• Virtual Interview 2: January 20, 2021