The goal of the Liver Transplant Anesthesiology Fellowship Program is to train academic leaders in liver transplantation and the management of complex patients requiring surgery through the acquisition of advanced perioperative care management skills and active participation in QI projects. The clinical emphasis of the program is on liver transplant cases; however, other cases of particular educational benefit are given a priority. Fellows have priority in case selection in a busy tertiary academic medical center and have a key role in supervising residents on these cases.
ACGME Accredited : No
ABA Certified: No
Duration of Program: 1 year advanced clinical training (hybrid faculty-fellow position)
Positions Available: 2
Application enrollment date(s) or deadline: April 1st (or until all slots filled)
Applicant Qualifications (which are required prior to starting program):
Completion of an ACGME-accredited residency anesthesia program
Eligible to hold:
Unrestricted Maryland State Medical License
Maryland State Controlled Dangerous Substances (CDS) registration
United States DEA Registration Certificate
Eligible to be credentialed and appointed as full faculty
J-1 Visa candidates CANNOT be considered at this time, due to CMS and JHU billing practices
Fellow candidates must be eligible to be credentialed and appointed as a full faculty position. Faculty positions are contingent on satisfactory performance during a probationary period in which fellows must demonstrate the ability to perform general anesthesia cases
- CV with photo
- 500 Word Personal Statement
- Medical School Transcripts
- Medical School Performance Evaluation (in English)
- USMLE (1 & 2) or COMLEX Scores
- Minimum of 3 Letters of Recommendation (include one letter from current training program)
- Copy of Visa (if applicable)
- Copy of ECFMG Certificate (only applicants who attended medical school outside of the US)
Fellows in the Liver Transplant Advanced Specialty Training Program are appointed in the Johns Hopkins School of Medicine as Assistant Professors or Instructors as independently licensed physicians. As part of a full faculty member at Johns Hopkins University, fellows will have call obligation and assist with supervising during the approximately 100 annual liver transplant cases. They will also be specially trained in transesophageal echocardiography (TEE) to achieve certification in the basic TEE. Interested fellows have the opportunity to complete elective rotations of their choice. Fellows will be allotted a minimum of 6 months of training over the course of the 12 month program.
Fellows will advance their medical knowledge through a number of didactics. Fellows will be required to participate in Resident lecture series (given by faculty and fellows every two weeks), in monthly quality assurance/quality improvement meetings dedicated to transplant patients, attend at least monthly the Liver Transplant Selection Committee held weekly, and complete the transesophageal echocardiogram curriculum and quality improvement along with the Cardiac Anesthesia Fellows.
Fellows will spend time assisting in management of complex anesthesia cases including but not limited to liver transplantation, vascular and thoracic cases. Fellows will also take liver transplant anesthesia call in which they will sometimes provide direct supervision to rotating residents. The educational objectives during this time include:
- Improvement in procedural skills (arterial catheter, central line insertion, pulmonary artery catheter, flexible fiberoptic intubation, and transesophageal echocardiography)
- Establish proficiency in the evaluation and management of end-stage-liver disease including
- Preoperative assessment
- Anesthetic management
- Post-operative recovery
- Establish proficiency in administration of anesthesia for liver transplantation including:
- Operating room set-up for cadaveric liver transplants, living liver donor and living donor liver transplantation
- The stages of the case and their implications on patient management
- Reperfusion management
- Hepatopulmonary syndrome
- The association of pulmonary hypertension with ESLD and its management implications
- Hepatorenal syndrome
- Rapid infuser use
- Management of patients with complications of cirrhosis, including portal hypertension, hemodynamic alterations, cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, and hepatorenal syndrome
- Management of patients with acute liver failure
- Establish proficiency in administration of anesthesia for:
- Open thoracic and thoracoscopic (VATs) cases including esophagectomy cases
- Vascular cases including thoracoabdominal aortic aneurysm cases
- Simultaneous liver and kidney transplantation
- Pancreas transplantation
- Kidney transplantation
- Achieve certification in basic TEE
- Establish proficiency in management of coagulopathy, in the selection and use of the various available blood products and their associated potential complications.
Fellows are recommended to also engage in a suggested total of up to 6 weeks of electives. Potential electives available to Fellows include rotations consistent with the future of the goals of the Fellow (e.g. Blood Bank, nephrology, cardiology, hepatology, etc.).
The remaining time during this Fellowship will be spent attending in complex anesthesia cases.
In addition to the above patient care competencies, the Liver Transplant Anesthesiology Fellowship will be organized according to ACGME core competencies with specific applications for their advanced training:
- Act responsibly and with integrity with their patients, nurses, fellows, residents and health care providers.
- Fulfill clinical duties in a timely and appropriate manner.
- Adhere to ethical principles including respect for privacy.
- Demonstrate and active interest in learning and participating in the care of patients.
- Interpersonal and Communication Skills
- Understand the importance of effective communication between all those involved with the management of complex transplant patients (transplant surgeons, OR, ICU, and transplant unit).
- Learn and demonstrate effective communication techniques during periods of stress to support patients and families.
- Effectively communicate concerns to surgical colleagues.
- Learn and demonstrate strategies and techniques to educate medical students and residents the principles of anesthesiology in managing patients with end-stage liver and other complex patients.
- Medical Knowledge
- Improve understanding of physiology of normal and pathologic cardiovascular system.
- Understand the pharmacology of anesthetic agents and their associated effects on the cardiovascular system, of drugs used in the treatment of end-stage liver disease, and of the interactions between these drugs.
- Establish proficiency in transfusion medicine.
- Interpret invasive hemodynamic monitoring data.
- Practice-Based Learning and Improvement
- Utilize information technology, on-line resources, consultation, and primary texts to expand medical knowledge base.
- Learn to critically evaluate literature.
- Apply scientific evidence to support clinical decision making.
- Utilize evidence-based practice data and experience based decision making to develop personal practice strategy.
- Assess the impact of actions on outcomes.
- Systems-based practice
- Develop and conduct Quality Improvement (QI) projects in caring for complex patients.
Fellows’ performance will be evaluated on the monthly basis by the program director via 1:1 meetings. The program director will solicit information from the core program faculty prior to each meeting. The core faculty currently includes 7 anesthesiologists, with the plans to add 2 additional faculty members in the near future. In addition, fellows will receive verbal feedback during his/her clinical performance. Fellows will maintain a case/procedure log that will be evaluated quarterly by the fellowship director to ensure fellows are obtaining adequate experience.
Fellows have multiple opportunities to work with Faculty in the areas of vascular biology, transfusion medicine, patient safety and quality, electronic health records and database analysis.
Activities requiring faculty supervision:
During the fellowship and during elective rotations fellows will function under the supervision of ACCM faculty
For program inquiries and applications, please contact LiverTxAnesth@jhmi.edu.
Leadership and Contact Information
Nicole Rizkalla, MD
William Merritt, MD, MBA
Office: (443) 287-3981
Fax: (410) 955-9062