Adult Cardiothoracic Anesthesiology(ACTA) Fellowship 

The Stanford University Cardiothoracic Anesthesia Division offers an Adult Cardiothoracic Anesthesiology (ACTA) Fellowship, an intensive, one-year clinical training program designed to prepare graduates for clinical and academic leadership positions in the subspecialty practice of cardiothoracic anesthesiology and cardiovascular critical care. The ACTA fellowship program is dedicated to providing state-of-the-art training and experience in a multidisciplinary academic environment so that Fellows can achieve competence in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice in the field of cardiothoracic anesthesiology and critical care.

The fellowship program offers 4 ACGME positions each year to qualified applicants. Many of the fellows in the program elect to complete a combined 2-year fellowship in both Anesthesia Critical Care Medicine and Adult Cardiothoracic Anesthesiology, with an emphasis in Cardiovascular Surgical Critical Care. Completion of the ACTA fellowship program curriculum fulfills the ACGME program requirements for Adult Cardiothoracic Anesthesiology as well as the National Board of Echocardiography (NBE) requirements for certification in Advanced Perioperative Transesophageal Echocardiography.

Clinical instruction is provided in the cardiothoracic operating rooms under the supervision of cardiothoracic anesthesia faculty members. The Fellow is assigned to provide comprehensive anesthetic and perioperative care. Fellows are also responsible for the supervision and education of Stanford Anesthesiology residents on the cardiothoracic anesthesiology and echocardiography rotations. Elective rotations at the Santa Clara Valley Medical Center and the Santa Clara Kaiser Permanente Medical Center provide opportunities to care for cardiac surgery patients in community hospital settings, and an elective rotation at the Lucile Packard Children’s Hospital provides the opportunity to care for children with complex congenital heart disease.

The intraoperative experience in cardiothoracic anesthesiology is supplemented with an immersive clinical experience in the postoperative management of cardiothoracic and major vascular surgical patients in the Cardiovascular Intensive Care Unit (CVICU). The CVICU is a multidisciplinary unit based on the model of the Perioperative Surgical Home, where the Fellow will have the opportunity to work collaboratively with cardiac, thoracic, and vascular surgeons; heart failure, heart transplant, and lung transplant teams; and other consultant services to provide comprehensive care to the cardiothoracic surgical patient.

Echocardiography training includes a period of formal instruction in perioperative transesophageal echocardiography (TEE), as well as hands-on training and direct clinical performance, interpretation, and application of intraoperative echocardiography in surgical decision-making. Fellows will also learn to formulate, generate, and archive a formal report of the comprehensive intraoperative TEE examination. During the year, ACTA fellows will also gain experience with 3-D echocardiography, transthoracic echocardiography, and the application of echocardiography in the management of critically ill patients.

The Stanford Cardiothoracic Anesthesiology Division, together with the Department of Anesthesiology, Perioperative, and Pain Medicine and the Department of Cardiothoracic Surgery, will provide Fellows the opportunity to gain extensive clinical experience in the following areas:

• Transesophageal echocardiography (2-D and 3-D)
• Coronary revascularization
• Cardiac valve repair and replacement 
• Thoracic aortic operations
• Heart, lung, and multi-organ transplantation
• Mechanical ventricular assist devices (IABP, LVAD, RVAD, BIVAD, TAH)
• Extracorporeal membrane oxygenation (ECMO)
• Catheter-based aortic valve replacement (TAVR)
• Catheter-based mitral valve repair (Mitral Clip)
• Catheter-based pulmonic valve replacement (Melody Valve)
• Endovascular aortic repair (TEVAR, EVAR, and fenestrated grafts)
• Port-access and minimally invasive cardiac operations
• Robotic lung resection
• Surgical and catheter ablation for arrhythmias
• Electrophysiology and cardiac catheterization laboratory procedures
• Adult congenital heart disease
• Pediatric congenital heart disease
• Anesthesia for patients with pulmonary hypertension and other high-risk patients undergoing non-cardiac operations
• Cardiovascular surgical critical care medicine

The educational curriculum of the fellowship also includes:

• Introduction to Intraoperative TEE Course
• Weekly Adult Cardiothoracic Anesthesiology Core Didactic Series
• Weekly Combined Cardiology, Cardiothoracic Surgery, Cardiac Anesthesia, and Radiology Case Conference
• Monthly multidisciplinary Cardiothoracic Surgery, Anesthesiology, Nursing, and Perfusion Quality and Education Conference
• Monthly Cardiac Surgical Morbidity and Mortality Conference
• A Bi-Weekly Adult Cardiothoracic Anesthesiology Journal Club
• Monthly Critical Care Medicine Journal Club
• Monthly ICU Echo Rounds
• Weekly Cardiovascular ICU and Critical Care Medicine Didactic Series
• Weekly Department of Anesthesiology, Perioperative, and Pain Medicine Grand Rounds
• Daily TEE Review Sessions

Fellows are also encouraged to take advantage of the rich collaborative and entrepreneurial environment that the Stanford community has to offer. Opportunities include open lectures at the business, law, and engineering schools as well as seminars and workshops in grant writing and professional development.

During the year, the fellow will prepare one Problem-Based Learning Discussion (PBLD) presentation for the Department of Anesthesiology Grand Rounds; two PBLD presentations for the Combined Cardiology, CT surgery, CT Anesthesiology and Radiology Case Conference; and participate in a multidisciplinary Quality Improvement project. In addition, ACTA fellows will receive an educational stipend that provides funding to attend the Society of Cardiovascular Anesthesiologists (SCA) Annual Comprehensive Review & Update of Perioperative Echo as well as funding to attend and present a case at the Fellows’ Component of the Annual Meeting of the SCA.

Clinical and basic science investigation is an important mission of the Stanford Medical School, and the ACTA fellowship program welcomes and strongly supports candidates planning careers in academic practice. An effort is made to engage fellows in ongoing clinical or laboratory research projects, and opportunities exist for fellows to initiate and carry out independent investigations with established researchers. Academic time and support is provided to fellows based on their individual career objectives and areas of investigation.

Number of Cardiac Procedures with CPB Per Year:

• Stanford Hospital: 800
• Valley Medical Center: 180
• Kaiser Permanente - Santa Clara: 600
• Lucile Packard Children's Hospital (pediatric and adult congenital): 380

Distribution of on-pump cases:

• Stanford: CABG (25%), Open and Minimally Invasive Valve Surgery (35%), Open Aortic Surgery (30%), Ventricular Assist Device and Mechanical Circulatory Support (10%)
• Valley Medical Center: Mixture of mostly CABG and Valve Surgery, small percentage of Open Aortic Surgery
• Kaiser Permanente - Santa Clara: CABG (30%), Open and Minimally Invasive Valve Surgery (60%), Open Aortic Surgery (10%)
• Lucile Packard Children's Hospital: Varied

Average Number of CPB Procedures Per Trainee Per Year: 150

Number of Cardiac Procedures off-CPB Per Year:

• Stanford: 130
• Valley Medical Center: 5
• Kaiser Permanente – Santa Clara: 130

Distribution of off-pump cases:

• Stanford: Transcatheter Aortic Valve procedures (90%), CABG (5%), Other (5%)
• Valley Medical Center: CABG (100%)
• Kaiser Permanente - Santa Clara: CABG (100%)

Average Number of off-CPB Procedures Per Trainee Per Year: 30

Number of Non-Cardiac Thoracic Cases Per Year: 400

Number of Heart, Lung and Heart/Lung Transplants Per Year: 70

Number of Major Vascular Cases Per Year: 400

• Albert T. Cheung, M.D. 
• Ronald Pearl, M.D., PhD. (Department Chairman)
• Christina Mora Mangano, M.D.
• Linda Foppiano, M.D.
• Ethan Jackson, M.D.
• Max Kanevsky, M.D., Ph.D.
• Charles Hill, M.D.
• Daryl Oakes, M.D. (Fellowship Program Director)
• Sheela Pai-Cole, M.D.
• Vidya Rao, M.D., M.B.A.
• Jessica Brodt, M.D.
• Sara Nikravan, M.D
• Worasak Keeyapaj, M.D.
• Lindsay Raleigh, M.D.

Applicants must be

• A graduate of an ACGME-accredited Anesthesiology Residency Program
• Eligible for California Medical License (Medical Board of California)

All applicants must register with the SF Match and submit a Common Application through the SF Match Common Application System. In addition, applicants are asked to submit the following items:

• Current CV
• Passport-sized photo (upon invitation for interview)

All clinical fellows must obtain a California medical license and DEA license prior to starting fellowship. You may contact the Medical Board of California, 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815, Phone 1-800-633-2322, for applications and information. Please allow a minimum of 6-9 months for processing. In rare cases it can even take 1 year.

ACGME fellows are appointed through the Graduate Medical Education (GME) office, which is part of Stanford Hospital and Clinics (SHC), and are not subject to the same registration requirements as the School of Medicine (SoM) fellows/postdocs. Please visit the GME website for further information.

Dual 2-year ACCM and Adult Cardiothoracic Anesthesiology (ACTA) Fellowships:  This fellowship track involves two years of training after completing the CA3 year at an approved anesthesia program. Both ACCM and ACTA fellowships are completed over a two-year consecutive time frame.  Both the ACTA and ACCM fellowships require use of the SF Match Central Application Service (CAS) system, which require separate application distribution fees.  To assure applicants applying to our dual 2-year fellowship have a seamless experience, we have outlined the below application process:

The 2-year consecutive ACCM and ACTA fellowship are considered two separate programs within the SF matching system and therefore is NOT currently an option in the SF matching program.  We ask that all applicants interested in completing both fellowships at Stanford to register and apply through the SF Match under the ACCM program (please see detailed application information below, similar to the one-year fellowship program for ACCM).   Once you have applied please send an email to us to let us know that you have submitted your application through the SF Match ACCM program and wish to be considered for both fellowship programs. 

Please see section below regarding interview process and ranking/matching process for more information regarding how this process is conducted for applicants applying to both programs.

ACCM Application Review Process and Interview Schedule for the Dual-Fellowship Candidates

Dual 2-year applicants invited to interview will do so under the ACCM fellowship program (please see dates and descriptions above).  We will coordinate the interview day to include faculty from both respective fellowships.  

Steps for applicants interested in both fellowships:

• Apply through SF Match CAS to the ACCM fellowship program (as stated above)
• Alert us to your interest in both fellowships (as above, please send an email to us) once your application has been started using SF Match CAS
• Applications will be reviewed by both the ACCM and ACTA review committees on a rolling basis
• Interviews will be offered through the ACCM coordinator.  Candidates invited to interview will have the following options (provided for flexibility)
• Choose interview dates in which they can participate fully in the ACCM interview day (on Thursday) and the ½ day interview day for ACTA (on Friday)
• Interview on one of the scheduled ACCM interview days (coordinators will schedule CCM interviews in the morning and ACTA interviews in the afternoon).  See above regarding interview dates for ACCM
• If the above options do not work out with your schedule you can opt to interview with the ACTA fellowship program and we will coordinate CCM interviews on that day.  This day will not include the CCM overview/orientation, rounding, or didactic component of the standard ACCM interview day.
• Candidates applying for both fellowships meet the SOCCA and SCA match exception criteria.  Once a match exception offer has been accepted by both the candidate and the program, we will work with the candidate to determine which fellowship will be completed first and how to proceed with the SF Match process.
• Candidates that are not given a match exception process by the agreed upon SOCCA date (TBD) will receive an email from our program stating their options to proceed with applying/ranking single fellowship positions.  The ACCM match occurs first and we encourage applicants to pursue this route.

Karlee Joice (ACTA Program Coordinator)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3689
Stanford, CA 94305-5640
Email: kjoice@stanford.edu
Tel: 650-736-6928
Fax: 650-724-7658

Bernadett Mahanay (Fellowship Coordinator)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3578
Stanford, CA 94305-5640
Email: bromo@stanford.edu
Tel: 650-723-6415

Daryl Oakes, M.D. (ACTA Fellowship Program Director)
Stanford University Medical Center
Department of Anesthesiology, Perioperative and Pain Medicine
300 Pasteur Drive, H3578
Stanford, CA 94305-5640
Email: doakes@stanford.edu