Liver Transplant Anesthesiology Fellowship

Patient care and procedural skills

Fellows should be able to:

• Perform a comprehensive preoperative evaluation of the patient with end-stage liver disease including assessment of preoperative testing; perform preanesthetic assessments of high-risk transplant candidates
• Learn and participate in the formal selection of liver transplant candidates
• Demonstrate perioperative management of acute/emergent and chronic liver disease and concurrent comorbidities; Treat coexisting end-organ failure with evidence-based interventions in the perioperative period
• Demonstrate the ability to independently develop an appropriate intraoperative and post-operative plan for complex surgical procedures 
• Monitor and maintain normal physiology and delivery of anesthesia during the perioperative period for all types of liver procedures, including liver transplants, hepatic resections, emergency take backs for bleeding, and NORA site procedures for patients with hepatic disease
• Perform necessary arterial and venous cannulations safely and efficiently including utilization of ultrasound; demonstrate competency in interpreting invasive hemodynamic monitoring
• Provide goal directed management of both preoperative and intraoperative anemia, coagulopathies and massive transfusion utilizing and interpreting point-of-care testing modalities, utilizing best practice transfusion guidelines
• Demonstrate competency in obtaining basic images in transesophageal echocardiography, performing basic interpretation of imaging, and utilizing imaging to perform basic hemodynamic monitoring
• Understand the intensive care unit management of the pretransplant and posttransplant patient
• Manage intraoperative complications that occur during liver procedures
• Utilize available evidence to guide patient care including in the face of unclear or conflicting clinical information
• Demonstrate the ability to prioritize information and patient care in complex/critical situations, maintaining focus on larger goals while attending to important details of patient care
• Conduct oneself in a professional and ethical manner:
• the fellow will demonstrate respectful and compassionate behavior, and develop patient-centered interactive and communication skills with patients and their families 
• the fellow will learn appropriate, efficient interaction and communication with ancillary staff in various clinical settings in a way that benefits patient care

Medical knowledge
Fellows should acquire and demonstrate understanding of:

• The common etiologies and current treatment of liver failure
• Injury to other organ systems caused by end-stage liver disease and current treatment
• The effects of disease on recipient and donor graft outcome
• The diagnosis and treatment options available for acute liver failure including medical management and end-organ support devices
• The phases of liver transplant surgery and surgical options in transplantation
• Changes in the pharmacokinetics and pharmacodynamics of common perioperative medications in patients with end-stage liver disease
• Common perioperative complications and treatment
• Immunosuppressive protocols used in transplant recipients
• Enhanced surgical recovery methods
• How patients are prioritized for transplantation and organ allocation methods
• Types of organ donation and the influence on patient and donor organ survival
• Understanding of the perioperative management of the living donor and considerations in liver donor transplantation

Systems-based practice
Fellows should:

• Work effectively with all members of the multidisciplinary transplant team
• Develop knowledge of systems and regulatory requirements including HIPAA compliance and risk management
• Coordinate patient care within the health care system and ensure appropriate transitions of care
• Incorporate cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate
• Advocate for quality patient care and optimal patient care systems
• Maintain medical records and manage errors
• Work cooperatively as a member of the multidisciplinary professional team to enhance patient safety and improve patient care quality
• Evaluate and utilize performance data for professional development

Practice-based learning and improvement
Fellows should be able to:

• Participate in regular learning activities (journal clubs, morbidity and mortality conferences, etc.)
• Use information technology to optimize learning (simulation and web-based learning, etc.)
• Incorporate formative evaluation feedback into daily practice in a format that encourages regular self-assessment
• Systematically analyze practices using quality improvement methods and implement changes with the goal of practice improvement
• Locate, appraise, and assimilate scientific evidence related to their patients’ disease
• Participate in the education of patients, families, trainees, and other health professionals, and serve as a role model for teaching and mentoring

Professionalism
Fellows must demonstrate:

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Accountability to patients, society, and the medical profession
• Sensitivity and responsiveness to a diverse patient population, including, but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
• Complete tasks in timely and efficient manner
• Exhibit a professional appearance
• Maintain effective and clear medical records
• Demonstrate the ability to navigate difficult conversations with the patient and family, and navigate conflicts between the patient/family and the health care system

Interpersonal and communication skills

Fellows should:

• Communicate effectively with patients, families, and the public, as appropriate across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health-related agencies
• Work effectively as a member and leader of a health care team 

Weekly:

• Fellows will be involved in liver transplant and advanced hepatobiliary cases as they are scheduled, estimated to involve 40-50% of total effort.
• Fellows will function one day per week (20%) effort as an attending, assigned to general cases.
• The balance of time (30-40% of total effort) may be dedicated to research, other academic, and clinical elective activities as approved by the fellowship program director. Research activities must obtain approval from the Executive Vice Chair for Academic Affairs or Vice Chair for Research.

Overnight/weekend call:

• Flexible based on liver transplant cases booked
• Individual days available for call will be at the discretion of the fellow

Annual:

• Fellows will partake in the care of at least 50 liver transplant patients and maintain a log of all clinical cases

1. Individual topic reviews with liver faculty
   • Preoperative evaluation and patient selection for liver transplantation
   • Anatomy and surgical techniques for liver transplantation
   • Anesthetic considerations for each stage of liver transplantation
   • Extended criteria and DCD donation including machine perfusion and NRP
   • Monitoring for liver transplantation including TTE
   • Acid/base and electrolyte management for liver transplantation
   • Veno-venous bypass in liver transplantation
   • Care of the patient with fulminant liver failure
   • Living donor liver transplantation
   • Coagulation and transfusion management in liver transplantation
   • Considerations for intraoperative CVVH in liver transplantation
   • Postoperative care of the liver transplant recipient
   • Anesthesia for open/laparoscopic/robotic hepatectomy
   • POCUS in the perioperative period
2. Participation in multidisciplinary liver transplant selection committee (weekly)
3. TEE case conference (weekly)
4. Journal club with liver transplant faculty and CA-3 residents (quarterly)
5. Resident lecture series (twice/year)
6. Access to online repositories of lectures and educational materials through membership in professional societies:
   • SATA (Society for the Advancement of Transplant Anesthesia)
   • ILTS (International Liver Transplantation Society)
   • ASE (American Society of Echocardiography)
   • SABM (Society for the Advancement of Patient Blood Management)

• Presentation at annual Abdominal Transplant Division Grand Rounds
• Participation in some formal scholarly activity (e.g., submission/presentation of an abstract, chapter, or manuscript)
• Attendance and participation at regional and national society meetings as opportunities allow

Eligibility:
To be eligible to apply, fellowship applicants must have received a degree from medical school, followed by successful completion of four or more years of training in an ACGME-accredited residency program in anesthesiology. 

Required documents are:

• CV
• Personal statement
• Medical school transcript and Dean's letter
• 3 letters of recommendation
• Passport-size photo

Additional documentation accepted: ITE Exam Score, SAE and any other similar progress examinations (can be emailed to maa2010@med.cornell.edu).

Only J-1 visas are accepted for appointment at NewYork-Presbyterian Hospital/Weill Cornell Medicine Liver Transplant Fellowship Program.

Please email all liver transplant fellowship queries to Marlene Augustine, maa2010@med.cornell.edu.

Living in New York City
The Cornell campus of NewYork-Presbyterian Hospital is located on the Upper East Side of Manhattan.

• Learn more about living in New York City. 
• View the subsidized housing offered to our fellows.