Acute Care Surgery Fellowship
ACUTE CARE SURGERY FELLOWSHIP
The University of Utah Acute Care Surgery (ACS) Fellowship program was established at the University of Utah in 2020 and has been continuously accredited by the American Association for the Surgery of Trauma since then. The program focuses on training surgeons to handle urgent and emergent surgical cases, primarily in the field of trauma and emergency surgery. Fellows gain experience in managing a broad spectrum of acute surgical conditions, including trauma, emergency general surgery, and surgical emergencies. They acquire skills in rapid assessment, resuscitation, and decision-making in critical situations. The fellowship also emphasizes the management of complex abdominal emergencies, such as acute appendicitis, bowel obstruction, and perforated viscera. Fellows become adept at performing a range of procedures, from damage control surgery to advanced laparoscopic techniques. The program prepares surgeons to provide immediate, life-saving interventions and expert acute surgical care.
The program is also committed to delivering excellent clinical exposure, as well as directed, expert instruction, promoting autonomous education, and fostering the refinement of fellows' scientific and academic pursuits. The fellowship consists of a combination of mentorship with a gradual increase in clinical, administrative, and educational responsibilities; didactic instruction; hands-on experience; and self-directed learning.
PROGRAM INFORMATION
Our acute care fellowship program is designed to give graduating fellows a firm foundation to elevate their surgical career. Our fellows our trained to be competent, caring physicians who are capable of caring for the most complex surgical cases. Learn more below!
- Develop Expert Acute Care Surgeons: Train highly skilled and versatile surgeons capable of providing comprehensive and specialized care to critically ill and injured patients requiring emergency surgical interventions.
- Enhance Surgical Expertise: Build upon general surgery residency knowledge and skills to develop specialized expertise in managing a wide spectrum of acute surgical conditions, trauma, and surgical emergencies.
- Advance Patient Outcomes: Focus on refining fellows' abilities to provide timely and effective acute care interventions that lead to improved patient outcomes, reduced complications, and enhanced quality of life.
- Promote Multidisciplinary Collaboration: Foster collaboration with various medical specialists, including intensivists, anesthesiologists, radiologists, and allied healthcare professionals, to ensure comprehensive patient care.
- Encourage Research and Evidence-Based Methods: Engage fellows in acute care surgery research and evidence-based methods, contributing to the evolution of protocols, treatment strategies, and innovations in acute care surgery.
- Cultivate Leadership Skills: Develop leadership skills that enable fellows to lead critical care teams, coordinate patient care, and manage complex clinical scenarios.
- Foster Professional Growth: Provide a supportive environment for fellows' professional growth, encouraging their pursuit of academic roles, teaching opportunities, and contributions to the field of acute care surgery.
- Empower Compassionate Care: Instill a patient-focused approach, emphasizing effective communication, empathy, and compassionate care to patients and their families during critical moments.
- Champion Ethical Practice: Engender ethical values and principles, ensuring fellows prioritize patient well-being, respect patient autonomy, and maintain the highest standards of integrity in their practice.
Our year-long ACS fellowship can only be completed as part of a 2-year track in which the first year is focused on surgical critical care and the second on ACS. One 2-year position is available every academic year.
In addition to their clinical training, fellows will participate in our trauma committee, SICU IDC meetings, and more as part of their systems education. Fellows will also be exposed to weekly lectures on SCC topics and AAST ACS modules, as well as a robust critical care ultrasonography (CCUS) curriculum. The CCUS curriculum includes lectures and hands-on training in conjunction with our Emergency Ultrasound Fellowship, and the education received on echocardiography involves computer modules and hands-on training with anesthesiology and cardiology while at the Veterans Affairs Medical Center.
Didactics
The following is a list of timely topics that are covered during lectures every Tuesday from 2 to 3 p.m. in the SICU Conference Room and broadcasted over Zoom. These lectures are geared towards our SCC and ACS fellows and it is mandatory that they attend; however, the burn surgery fellow, residents, and medical students are welcome to as well.
AAST ACS Module Topics
- Pleural infections; parapneumonic effusions/empyema
- Sacral pressure injury
- Palliative care in critical illness
- Severe and complicated c. diff
- Necrotizing soft tissue infections
- Difficult airway
- Ischemic bowel disease
- Cardiac tamponade
- Sternal fracture/rib fracture/SSRF
- Traumatic brain injury
- Fat embolism syndrome
- Abdominal compartment syndrome
- GI bleeding
- Nutrition/feeding access/short gut
- GE varices
- Blunt cardiac injury
- Vascular interventions for hypothermia
- Pelvic vascular injuries
- Acute ischemia of extremities
- Air embolism
- Iatrogenic vascular injuries
- Vascular intervention for VTE prophylaxis and treatment
- Tracheobronchial injuries
- Esophageal perforation
- Femoral artery injuries
- Vena cava injuries
- Ascending aorta injuries
- Blunt aortic injuries
- Extremity compartment syndrome
- REBOA
- Abdominal aortic injury
- Massive hemothorax
SCC Topics
- Advanced ventilator management
- Antibiotic management
- ICU delirium
- Nutrition – ASPEN guidelines
- Surgical feeding access
- Severe pancreatitis and complications
- ECMO
- Cardiac arrhythmias
- Cardiogenic shock, PACs, and bedside echo
- ARDS
- Coagulopathy, ROTEM/TEG and resuscitation
- Seizure
- Acute renal failure and RRT
- Urogenital tract injuries
- Prehospital transportation and care
- Pain management – multimodal, regional blocks and catheters
U of U Health Critical Care Ultrasonography Curriculum
- Intro: Introduction to Ultrasonography
- Unit 1: Basic Principles
- Unit 2: Hands-On Practice
- Unit 3: Thoracic (Lung & Pleural) Ultrasonography
- Unit 4: Basic Critical Care Echocardiography
- Unit 5: Cardiac Pathologies
- Unit 6: FAST & RUSH Exams
- Unit 7: Cardiac Arrest & Volume Assessment
- Unit 8: Advanced Critical Care Echocardiography
- Unit 9: Vascular Ultrasonography (Abdominal Aorta & DVT Evaluation)
- Unit 10: Vascular Ultrasonography (Vascular Access)
- Unit 11: Abdominal Ultrasonography (Gallbladder, Common Bile Duct, & Bowel/Appendix)
- Unit 12: Abdominal Ultrasonography (Kidneys & Bladder)
The Acute Care Surgery Fellowship Program offers fellows a variety of research opportunities depending on their interests. Below is a selection of previous fellow publications and research.
- Perioperative Evaluation and Decision-Making, When to Operate and by Which Approach: Tube Cholecystostomy - Bacon A, Corgan T, Pender T, Colonna A
- Modified Edwards Quilt Repair of a Chest Wall Reconstruction Failure - Bacon AW, White T, VanBoerum D
- Chest Trauma: Academic journal chapter - Bacon AW, Campion EM
The Acute Care Surgery Fellowship Program follows all institutional policies as outlined by the University of Utah GME Office, including those pertaining to salary, leave, program responsibilities, and more. To see current university policies, visit the GME policy website.
ROTATION INFORMATION
Clinical rotations take place at University of Utah Health, Huntsman Cancer Institute, and Intermountain Medical Center. During clinical rotations fellows evaluate new patients and manage patients under treatment, including the simulation and treatment planning, acting as junior attendings. Fellow progress is evaluated on an individual basis following the completion of each clinical rotation and by the program director on a quarterly basis.
- Develop advanced skills in managing a wide range of acute surgical conditions, including trauma, emergency general surgery (EGS), and urgent surgical interventions across multiple subspecialties.
- Build upon clinical decision-making abilities to effectively manage complex acute surgical cases in both critical care and non-critical care settings, addressing time-sensitive interventions.
- Acquire comprehensive knowledge and skills in peri-operative management, ensuring seamless transitions of care from the pre-operative evaluation through the operative period to post-operative recovery.
- Gain expertise in the assessment and management of severe traumatic injuries, including immediate interventions, damage control surgery, and coordination with trauma teams.
- Build leadership skills in guiding acute care surgical teams during urgent and emergent cases, ensuring effective resource allocation and critical decision-making.
- U of U Hospital Trauma and Emergency Surgery (4 months)
- U of U Hospital Transplantation and Hepatobiliary Surgery (2 months)
- U of U Hospital Vascular Surgery (2 months)
- U of U Hospital Cardiac Surgery (1 month)
- Intermountain Medical Center Trauma Surgery (2 months)
- Huntsman Cancer Institute Thoracic Surgery (1 month)
More information on individual rotation site objectives can be found below in the "STRUCTURE" section.
DUTY HOURS
Work hours are to be logged via MedHub daily. The Division of General Surgery is committed to ensuring full compliance with the resident duty hour policies set forth by the GME office. All fellows will have at least one full 24-hour period per week without clinical duties. Additionally, fellows’ work hours are to be limited to an average of less than or equal to 80 hours per week during each 4-week block beginning the first day of the month and for the entire month. Fellows’ schedules should ensure that all fellows have greater than 10 hours off between all shifts and clinical on-call duties must be compliant with the 24+4 hour requirement mandated by the GME office. Work hour violations can nearly always be anticipated, and it is the responsibility of the fellow to notify Program Leadership if there will be violations.
CALL
Fellows will be expected to take general surgery/trauma call during their ACS year
| Procedure | 2020 | 2021 |
|---|---|---|
| Head and Neck | 18 | 19 |
| Thoracic | 143 | 90 |
| Abdominal | 422 | 256 |
| Vascular | 48 | 36 |
| Ultrasound | 290 | 50 |
| Management of Complex Trauma | 107 | 53 |
| Complex EGS | 63 | 36 |
| Non-index/Other | 2 | 100 |
| Total | 1093 | 640 |
PROGRAM STRUCTURE
The below information outlines the learning objectives, clinical duties, and other expectations for each rotation site. The structure of each rotation is determine by program leadership. Fellows will be expected to meet all necessary learning requirements to progress. Individual fellow progress is evaluated following the completion of each clinical rotation and by the program director quarterly.
LEARNING OBJECTIVES: 4 MONTHS
- Develop expertise in the surgical and non-surgical management of acute, time-sensitive illnesses that fall within the realm of general surgery as defined by the American Board of Surgery.
- Manage emergent presentation of inguinal and abdominal wall hernias.
- Manage enteric fistulas, including techniques for complex fistula management.
- Demonstrate an understanding of available options for nutritional support in complex, critically ill surgical patients.
- Demonstrate an understanding of the management of acute, severe pancreatitis as well as complex biliary tract disease, including the role of medical management, percutaneous procedures and operative interventions in complex, critically ill surgical patients.
- Manage emergent processes leading to infectious complications, acute necrosis, perforation, or bleeding of the gastrointestinal tract, including esophagus, stomach, duodenum, small and large intestine, appendix, and rectum.
- Manage acute bowel obstruction, including the indications for surgery, non-operative management, the role of contrast studies, and the use of guidelines to optimize patient care.
- Understand and manage the presentations of acute ano-rectal disease.
- Recognize and treat necrotizing soft tissue infections, including radical resection, serial excision, and reconstruction.
LEARNING OBJECTIVES: 2 MONTHS
- Gain in-depth knowledge of transplant and hepatobiliary surgical procedures, including liver, kidney, and pancreas transplantation, as well as surgeries for hepatocellular carcinoma, biliary tract diseases, and complex liver resections.
- Develop proficiency in assessing potential transplant candidates, considering factors such as medical history, comorbidities, organ function, and suitability for transplantation or hepatobiliary surgery.
- Acquire advanced skills in performing transplant and hepatobiliary surgeries, including graft harvesting, vascular anastomosis, complex resections, and biliary reconstructions.
- Learn to manage the post-operative care of transplant recipients and patients undergoing complex hepatobiliary procedures, addressing complications such as graft dysfunction, bleeding, and infections.
- Understand the ethical dilemmas surrounding organ allocation, donor selection, and decision-making for high-risk patients; learn to navigate these challenges while maintaining patient-centered care.
LEARNING OBJECTIVES: 2 MONTHS
- Gain in-depth knowledge of vascular diseases and conditions commonly encountered in critical care settings, such as aortic emergencies, arterial injuries, venous thromboembolism, and complications of vascular access.
- Develop proficiency in interpreting vascular imaging studies with a focus on identifying acute vascular pathologies and understanding the implications for critical care management.
- Learn to assess patients' vascular conditions while factoring in their critical care status, identifying optimal treatment approaches, and planning interventions that align with critical care goals.
- Understand the intricacies of post-operative care for vascular patients in critical care, addressing wound care, hemodynamic monitoring, coagulation management, and potential complications.
LEARNING OBECJECTIVES: 1 MONTH
- Compare and execute various methods of gaining access to the chest.
- Identify and discuss the indications and contraindications for extracorporeal membrane oxygenation (ECMO) support, cannulation techniques, and potential complications.
- Identify and describe approaches to blunt and penetrating injuries to the heart and great vessels.
LEARNING OBJECTIVES: 2 MONTHS
- Develop patient-centered expertise in the management of the trauma patient from the initial resuscitation through patient discharge. This includes, but is not limited to, appropriate, timely decision-making; use of appropriate investigations; operative and non-operative management of neck, torso, and extremity injuries; nutrition; pre- and post-operative care; and in-hospital rehabilitation.
- Direct the entire team through trauma resuscitation.
- Learn to prioritize the diagnostic evaluation of patients with multiple injuries.
- Perform advanced surgical procedures to manage injuries in the neck, torso, and extremities, including the use of REBOA.
- Manage patients with multiple injuries appropriately using operative and non-operative techniques.
- Discuss the common injury patterns with various mechanisms of injury (front, side, and rear impact MVC with and without restraints, MCC, falls, and penetrating injuries).
- Clinically recognize, perform appropriate diagnostic maneuvers, and formulate a management plan for all systems in injured patients.
- Initiate transfusion of blood and blood products, massive transfusion protocols, use of thromboelastography, and understand potential complications.
- Demonstrate successful treatment of all types of shock.
LEARNING OBJECTIVES: 1 MONTH
- Observe and attend to thoracic exposures and incisions and demonstrate proper performance of thoracotomies, thoracoscopies, sternotomies, and pericardiotomies (including sub-xiphoid, transdiaphragmatic, and transthoracic approaches such as open cardiac massage following resuscitative thoracotomy).
- Acquire and apply essential organ management skills and demonstrate proper performance of procedures related to the lungs (including the pleural space and lung parenchyma), diaphragm, and heart; procedures related to the lungs should include bronchoscopies, diaphragm cases may include thoracoabdominal exposure for spine surgery, and cardiac cases may include elective or emergent cases requiring cardiac suture or repair.
- Understand and be able to explain how to perform a trachea/bronchus repair or resection, esophageal repair or resection, chest wall resection or reconstruction (including rib plating), thoracic great vessel repair or reconstruction (open and endovascular), and extracorporeal membrane oxygenation (ECMO)/extracorporeal bypass.
- Manage patients with traumatic injuries to lung and chest wall appropriately using operative and non-operative techniques.
APPLY TO THE PROGRAM
To be eligible for the two-year SCC/ACS Fellowship, an applicant must have completed an ACGME accredited general surgery residency program in the United States or Canada. Additionally, the fellow must meet all the requirements contained in the “Eligibility and Credentialing of House staff” Policy of the University of Utah Office of Graduate Medical Education, including:
- Being eligible for and obtaining a license to practice medicine in the state of Utah.
- Completion of all United States Medical Licensing Examination examinations.
- Graduation from a U.S. or Canadian medical school accredited by the Liaison Committee on Medical Education.
OR
- Graduation from a college of osteopathic medicine in the United States accredited by the American Osteopathic Association OR Graduation from a medical school outside of the United States AND meets one or more of the following qualifications:
- Has a currently valid Educational Commission for Foreign Medical Graduates certificate
- Has a full and unrestricted license to practice medicine in U.S. licensing jurisdictions
- Has completed a Fifth Pathway program provided by an LCME accredited medical school
- Passing a criminal background check
- Compliance with the Health Sciences Center Drug Testing
You can obtain more information regarding the GME policies and benefits, along with general information, at the GME website.
Eligible applicants apply through the Surgical Critical Care and Acute Care Surgery Fellowship Application Service. Applications are screened and then reviewed by the program director and assistant program director. Selected applicants are invited to interview. Candidates will then be evaluated on their standing within their residency program, educational qualifications, academic productivity (grants, publications, degrees, and experience), interviews, and letters of recommendation. Finally, selected fellows are matched via the National Resident Matching Program and are sent an offer letter.
ADDITIONAL REQUIRED INFORMATION:
- Personal statement
- Curriculum Vitae
- Three letters of recommendation
- USMLE and ABSITE Scores
Check back later for deadlines for the 2025 application season!
OUR FELLOWS
Residency: General Surgery, Tulane University School of Medicine
Medical Degree: Cairo University School of Medicine
Residency: General Surgery, University of North Carolina
Medical Degree: University of Florida
2022-2023
Rachel Koch, MD
Practice: UCSF Health, CA
2021-2022
Sophia Tam, MD
Practice: Northwell Health, NY
2020-2021
Anthony Bacon, MD
Practice: Intermountain Healthcare, UT
FACULTY
- Alexander Colonna, MD, MSCI, FACS
- Toby Enniss, MD, MBA FACS
- Joanna Grudziak, MD, MPH
- Sudha Jayaraman, MD, MSc, FACS
- Sarah Lombardo, MD, MSC
- Marta McCrum, MD, MPH
- Raminder Nirula, MD, MPH
- Jade Nunez, MD, FACS
- Jason Young, MD, PharmD, FACS
CONNECT WITH US
Alexander Colonna, MD, MSCI, FACS, Fellowship Director
Learn more about Dr. Colonna
Joanna Grudziak, MD, MPH, Associate Program Director
joanna.grudziak@utah.edu
Tonya Pickron, MEd, BA, Program Manager
tonya.pickron@hsc.utah.edu