Subspecialty RotationsEach subspecialty rotation detailed here
comes with its own comprehensive curriculum to supplement the
main didactic series. Subspecialty faculty have fellowship
training and are subspecialty board-certified when such examinations
are available. They also publish articles in subspecialty journals
and are active in subspecialty societies.
Ambulatory AnesthesiaResidents get experience in ambulatory anesthesiology at both Strong Memorial Hospital (SMH) and the Lattimore Community Surgicenter. The Ambulatory Surgical Center (ASC) at Strong gets several thousand visits per year, covering all types of surgery. Residents are exposed to ambulatory cases that are integrated into daily operating room assignments. Senior residents gain valuable experience in ambulatory anesthesia with full-month rotations at Lattimore Community Surgicenter, where several thousand cases are performed each year. This is a unique training opportunity in a private-practice day-surgery facility with high volume and rapid turnover. Cardiac AnesthesiaResidents rotating on the Cardiac Anesthesiology Service are exposed to an integrated program that combines clinical experience and didactic teaching. The cardiac team provides coverage for approximately 1,000 open heart operations per year. These operations include coronary artery bypass surgeries (with and without the use of cardiopulmonary bypass), valve replacement and repair, operations involving diseases of the aorta, heart failure surgery (e.g., insertion and removal of ventricular assist devices), heart transplantation, and both pediatric and adult congenital heart defect repairs. Residents participate in the management of approximately 50 descending thoracoabdominal aortic repairs per year. Residents are exposed to many aspects of cardiovascular care of the surgical patient, including:
During the introductory rotation, residents
are exposed to the principles and practice of cardiac anesthesia
and develop skills in the use of invasive and non-invasive
monitoring of the cardiovascular system. The didactic program
includes morning conferences twice a week and comprehensive
but manageable recommended reading. Residents get a thorough
understanding of cardiovascular physiology, disease, and pharmacology.
This At the CA-3 level, the goal of elective rotations is to extend the application of the principles of cardiac anesthesia to patients with increasing degrees of cardiac pathology. The goals and program are flexible, and are developed with input from the resident who elects additional time on this service. Senior residents may spend time in specialized training for the use of transesophageal echocardiography. Critical Care/TraumaThe critical care experience is divided into two one-month rotations. The first month is spent in the SMH Surgical Intensive Care Unit (SICU), a high acuity 15-bed unit that provides care for transplant, thoracic, ENT, urology, and other critically ill patients. The extensive didactic program includes daily lectures by critical care faculty. Also participating are critical care fellows, medical students, and residents from general surgery, emergency medicine, ENT, and urology. The second month of the critical care rotation is in the burn/trauma ICU. There, the CA-2 resident gains advanced experience in the management of critically ill trauma patients as well as ill orthopedic and neurosurgery patients. Residents are taught by a rotation of ICU-boarded anesthesiologists and surgeons. Senior residents interested in research have an opportunity to participate in ongoing clinical trials or laboratory projects. Elective rotations in the SMH Pediatric ICU and Neonatal ICU are additional possibilities. NeuroanesthesiaDuring the neuroanesthesia rotation, residents provide anesthetic care for diverse neurosurgical cases, including craniotomies for removal of tumors, arteriovenous malformations, and aneurysms. Because SMH is the region’s trauma center, residents get experience in the anesthetic management of head trauma and in airway management of cervical spine injuries. SMH is a leader in performing “awake” craniotomies for the surgical treatment of intractable epileptic seizures. The hospital cares for the majority of pediatric neurosurgical patients in the region. During this comprehensive rotation, residents get a thorough understanding of the physiology and pharmacology of the brain; special considerations in neurosurgical patients (including monitoring and positioning); and safe anesthetic management for a variety of neurovascular diseases. Residents learn through operating room experience and formal structured didactics. In addition to traditional topics in neuroanesthesia, residents study advanced subjects such as brain protection and intraoperative monitoring of neural tissue integrity. Obstetric AnesthesiaThe obstetric (OB) anesthesiology service is responsible for the anesthetic care of pregnant women at SMH, the regional referral center for high-risk obstetrics. Residents get extensive experience with both healthy and critically ill parturients. The annual delivery rate is approximately 3,200 patients, with a cesarean section rate of 30%. The majority of parturients elect neuraxial analgesia during labor. The core curriculum in OB anesthesiology consists of weekday didactic sessions provided by faculty and based on daily reading assignments. The core curriculum is combined with a busy clinical service. Residents learn maternal/fetal physiology and pharmacology, management of high-risk parturients (including the proper utilization of invasive monitoring), and perioperative care of coexisting diseases that may occur during pregnancy. Senior residents electing additional experience in OB anesthesiology participate in an advanced curriculum. Residents also get many opportunities to help in ongoing research. Pain ManagementThe Division of Pain Management focuses on the relief of the pain and suffering in postsurgical patients, and those experiencing trauma, cancer, and chronic pain syndromes. The division’s faculty are all subspecialty board certified/eligible. There are three rotations offered for the anesthesiology residents, one for each year of the program. A two-week introductory rotation for CA-1 residents teaches the basics of acute postoperative and post trauma pain management in an inpatient setting. The residents, exposed to a wide variety of cases, provide consultations under the guidance of subspecialty trained faculty. A mandatory one-month rotation is offered to residents in their CA-2 year. They get involved in both the outpatient pain clinic and the inpatient pain service. Daily inpatient pain service rounds provide exposure to both acute and chronic pain patients. Residents are exposed to all modalities available for acute pain management in adults and children, and develop an understanding the physiology of acute pain and the perioperative stress response. More than 1,000 patients of all age groups (neonates included) are admitted to the Acute Pain Service LINK each year. Routine management methods include thoracic, lumbar, and caudal epidural analgesia, patient-controlled analgesia, intrapleural analgesia, and peripheral nerve and plexus catheters. The Outpatient Pain Clinic is scheduled several times a week. Every month, there are 100 new evaluations and 200 follow-up visits. So, residents evaluate outpatients with various pain syndromes, and implement and design treatment plans. Residents learn about the physiology of chronic and cancer pain, and the use of invasive and non-invasive modalities for its treatment. Block Clinic is scheduled three times a week, and offers hands-on experience performing many procedures designed to help alleviate pain. Included are neuraxial and peripheral blocks, sympathetic blocks, radiofrequency ablation, neurolytic blocks under fluoroscopic guidance, and surgical implantation of spinal cord stimulators and intrathecal pumps. During the CA-3 year, residents may elect an
advanced experience rotation in pain management.
In individualized programs, they learn the administrative,
compliance and financial aspects of an academic pain
practice. Residents who spend 12 to 24 weeks in pediatric
anesthesia assume the responsibilities of a junior fellow
and are actively involved in teaching medical students and
nursing staff. Residents interested in research may
join several ongoing projects in the pain management division. Weekly three-hour didactic sessions cover basic and advanced topics in pain management. These sessions involve presentations by subspecialty trained faculty, fellows, clinical psychologists, and a variety of guest speakers. Clinical activity during these sessions is minimal to optimize the learning experience. The Pain Division also holds a general morning lecture sessions for residents. Pediatric AnesthesiaThe Golisano Children’s Hospital at Strong is the region’s only tertiary-care referral center for pediatric patients, including neonatal, burn and trauma patients. The Department of Anesthesiology cares for approximately 6,000 pediatric patients a year. Many are outpatients and about half are under age 2. Residents receive a one-month introduction to pediatric anesthesiology during their CA-1 or CA-2 year. They learn pediatric physiology, common pediatric and neonatal surgical problems, regional anesthesia for children, pediatric airway management, and vascular access techniques. The Division of Pediatric Anesthesiology has its own active teaching program. The CA-3 resident may elect to spend up to six months dedicated solely to pediatric anesthesiology. Full-time pediatric anesthesiologists hold dual appointments in the Department of Pediatrics at the Golisano Children’s Hospital. Residents can take part in the pediatric nesthesia clinical research program. Post Anesthesia CareThis rotation provides clinical experience and directed independent study in managing postoperative patients recovering from general and regional anesthesia. Residents learn to recognize and manage common Post Anesthesia Care Unit (PACU) problems. They also learn how to communicate with surgical and nursing services and with the primary anesthesia team. When problems arise, the PACU resident makes an initial assessment, institutes therapy in urgent situations, and presents the problem, assessment, and proposed interventions to the intraoperative attending anesthesiologist. The ensuing discussion provides continuous learning and direct feedback. The resident consults pertinent reference sources during and after the management of specific PACU problems. During the month, each resident keeps a log of patients and discusses it with the rotation director. The resident presents patients whose cases serve to illustrate difficult and/or complex PACU management challenges. Each resident also prepares a formal didactic presentation for the PACU nursing staff. Preadmission EvaluationThe Department of Anesthesiology operates the 14-room Preadmission Evaluation Center for both routine and consultative evaluation of patients before surgery. The resident learns to evaluate patients preoperatively and to modify anesthetic risks in patients with significant co-morbid conditions. Residents learn to order and interpret laboratory and diagnostic tests to prepare each patient for anesthesia. For example, residents work with the Department of Cardiology if the need consultations or quick preoperative testing (echocardiography, stress testing). Residents also communicate with other physicians (primary care physicians, surgeons, specialists) to get each patient optimally prepared on the day of surgery. Regional AnesthesiaResidents learn proficiency in the delivery of effective and safe regional anesthesia. They get exposed to all regional anesthetic techniques, including intravenous (Bier blocks), epidural (thoracic and lumbar), peripheral upper extremity (interscalene, supra-infraclavicular, axillary), lower extremity (femoral, sciatic, ankle), and cervical plexus blocks. Residents learn to perform upper extremity blocks with and without ultrasound guidance. Experts in regional anesthesia provide daily supervision and guidance to residents during this four-week CA-2 rotation. There is a formal lecture series as well as informal one-on-one discussions with the faculty. Residents use the regional anesthesia atlas they receive at the beginning of their training. They also participate in an annual workshop on relational anatomy for central and peripheral regional anesthetics. The workshop includes cadaveric prosections and live human models. Thoracic and Vascular Anesthesia
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exposure helps the resident develop sound clinical judgment
in the managing cardiac surgery patients and those with severely
compromised cardiac function.
