A First in Acute Care Surgery Training

synapse: University of Nevada, Reno School of Medicine

John Fildes

Fildes is currently national chair of the American College of Surgeons Committee on Trauma. Photo by Dave Smith.

After decades of providing excellent surgical care, the University of Nevada School of Medicine and University Medical Center in Las Vegas have developed a national reputation as a practical model of acute care surgery.

By Anne McMillin, APR

The two institutions took their expertise to the next level when in early spring 2008 they successfully established the country’s first acute care surgery fellowship.

“The creation of the first acute care surgery fellowship program in the U.S. helps provide a solution to the problem of patient access to emergency surgical care,” said John Fildes, M.D., professor and vice chair of the surgery department and current national chair of the American College of Surgeons Committee on Trauma.

“The immense and growing need for emergency and critical care surgical coverage has been long been recognized. The goal of this fellowship was to redefine the training and practice of trauma surgery to include broad training in elective and emergency general surgery, trauma surgery, and surgical critical care as well as expanded training in surgical specialties like orthopaedics and neurosurgery.”

Fildes said the fellowship was born from the need for the specialty and the desire to serve. “As surgery becomes more and more elective, acute care and emergency surgery has become strained. The professional surgical societies have recognized this and sought to develop guidelines and curriculum in order to establish fellowships,” he continued, saying it was a natural progression for University Medical Center and the Department of Surgery to parlay their long-time expertise into a formal program sanctioned by the American Association for the Surgery of Trauma.

In making the announcement last spring, the association said, “The University of Nevada School of Medicine’s training proposal is well thought out, comprehensive and will prove to be a valuable resource to the Las Vegas community.”

While the School of Medicine was the first to apply for the fellowship program in September 2007, and the first site approved in February 2008, the University of Colorado, Denver and the University of Pittsburg have since also successfully established their fellowships.

Comprising the faculty core for the new program are Fildes; Jay Coates, M.D., assistant director of the school’s surgical critical care fellowship; Timothy Browder, M.D., assistant director of the acute care surgery fellowship; Deborah Kuhls, M.D., director of trauma ICU, and Michael Casey, M.D., general, trauma and critical care surgeon.

William A. Zamboni, M.D., chair of the Department of Surgery, credits his faculty for the success in establishing the fellowship. “I’m proud of the success of the division of trauma and critical care under John’s leadership to achieve this major accomplishment. They are already internationally recognized for excellence in patient service and research. The fact that we were first in the country speaks to the quality of the division and its staff,” he said.

The new fellowship focuses on surgery critical care in the first year and acute care surgery in the second. Two fellows, Dan Wu, M.D. and Scott Cinelli, D.O., are currently in their final year of the fellowship. Cinelli, who completed his trauma rotation with the Department of Surgery as a fourth-year resident, said the fellowship program offers him the opportunity to stay well-versed in a variety of surgical techniques.

“For someone like me who enjoys it all and likes to do it all, this is a perfect fit,” he said. “I particularly like the vascular aspect because it is so critical to trauma.” He said the training will allow him to step into critical situations and complete the procedure if the subspecialty surgeon is not immediately available or there is a physician shortage in the subspecialty.

Working at University Medical Center is a wonderful experience, Cinelli said, because it is one of the busiest trauma centers in the country. “It has a great free-standing trauma center and faculty surgeons involved in teaching,” Cinelli said. “With this experience, I feel I am more than capable of dealing with any problem I come across.”

The center’s administration believes the fellowship offers another feather in their cap and validates the hospital’s mission as a teaching hospital as well as its desire to be innovative, according to Rick Plummer, director of marketing and community outreach.

“This fellowship gives University Medical Center a two-for-one in critical care management and surgery with the school’s surgeons giving their level of expertise to the hospital,” he said.

Looking ahead to the future, Fildes said the emphasis will now be on improving and raising the bar for emergency surgical care. Over the next 12 to 18 months, faculty will take the lead in further developing the course curriculum and the training experience in anticipation of the fellowship’s renewal for its first three-year cycle in 2010.