Introduction to Anesthesiology
- Occurs during the first month of the CA-1 year, beginning with classroom didactics and WISER simulation center instruction followed by three weeks of residents being paired one-on-one with an attending anesthesiologist or senior resident in the operating room. These pairings occur for a week at a time to ensure consistency.
- Daily hour-long lectures supplement clinical responsibilities and provide a broad-base of knowledge for further learning.
- The goal of this program is for the new CA-1 resident to care for patients undergoing relatively simple procedures without constant attending presence in the operating room upon completion.
- Acute Pain (1 month): An in-depth exposure to techniques for perioperative pain control, including a variety of peripheral nerve blocks and placement of peripheral nerve catheters. Our residents routinely achieve the required number of blocks early in their training and most complete hundreds of blocks by the end of the residency.
- Ambulatory and Regional Anesthesia (1 month): Exposure to the unique requirements of ambulatory anesthesia with an emphasis on ultrasound and nerve stimulator-guided placement of peripheral nerve blocks and their management in the perioperative period.
- Cardiac Anesthesiology (2 months): Residents work with cardiac anesthesiologists to learn the complete perioperative management of patients undergoing cardiac procedures ranging from routine to complex, such as valve replacements, aortic repairs, heart transplants, and lung transplants. Transesophageal echocardiography (TEE) is used routinely in all cardiac cases.
- Chronic Pain (1 month): Residents will learn how to evaluate patients presenting with a variety of pain syndromes as well as the multimodal treatment of these syndromes, including epidural steroid injections, advanced neuraxial blocks, sympathetic blocks, long-term opiate management, implantable nerve stimulators, and opioid pumps.
- Critical Care Medicine (2 months): During this rotation, residents will rotate through two of UPMC’s world-renowned ICUs and learn the evaluation and management of the severely-injured and critically-ill patient including all diagnostic and therapeutic procedures.
- General Anesthesiology (8-10 months): Offers residents a broad introduction to anesthesiology. Sites available for rotations include a variety of hospitals ranging from a quaternary care transplant center to community hospitals. This uncommon breadth of experience ensures that graduates from our program are facile in any clinical setting.
- Neuroanesthesia (2 months): This rotation teaches the unique anesthetic care of patients undergoing intracranial, cerebrovascular, and complex spine procedures.
- Obstetric Anesthesiology (2 months): In-depth exposure to the unique anesthetic care of the parturient, including epidural labor analgesia, anesthesia for cesarean section, and management of coexisting maternal and fetal pathology. Our OB referral center, Magee-Womens Hospital of UPMC, cares for almost 10,000 deliveries per year ranging from routine to high risk patients.
- PACU (4 weeks): Provides a setting for the management of postoperative problems including pain management, airway compromise, post-op nausea and vomiting, and mental status changes.
- Pediatric Anesthesiology (3 months): Offers residents a thorough experience managing the unique anesthetic concerns of children from neonates to adolescents including their unique physiology, anatomy, and pharmacologic needs. This rotation takes place in our quaternary care pediatric referral center, Children’s Hospital of Pittsburgh of UPMC.
- Perioperative Evaluation Center (1 month): Residents will be taught the appropriate evaluation, testing, and optimization of patients prior to elective surgery as well as how to formulate a comprehensive anesthetic plan to improve patient safety in the OR.
- Thoracic Anesthesiology (1 month): Residents will learn and apply a thorough knowledge of respiratory physiology to provide anesthetic care for a variety of complex thoracic procedures.
The overall philosophy of our residency program is to be finished with the core ACGME case requirements so that the CA-3 year is free for electives involving advanced teaching. A major goal of these months is to allow our CA-3 residents to “sub-staff” and supervise junior residents and other providers under the watchful eye of our faculty. This allows the CA-3 resident to master the unique challenges of the patient care team model before they graduate. CA-3 residents will choose from the following rotations:
- Advanced Acute Pain Anesthesiology: This elective rotation gives residents the chance to gain further experience with regional anesthesia techniques and with managing pain in post-op patients. Many opportunities to “sub-staff” are provided as well by working with the CA-1 and CA-2 residents.
- Advanced Cardiac Anesthesiology: The CA -3 on this rotation can dedicate additional months to advanced cardiac cases such as ventricular assist device placement, thoracoabdominal procedures, and heart-lung transplants at Presbyterian Hospital. In addition, familiarity can be gained in the more routine bypass grafting done at our community hospitals, providing more of a private practice experience. An additional rotation is available in TEE which provides an entire month to focus on this imaging/diagnostic modality.
- Advanced Chronic Pain: This rotation focuses on beginning to developing the senior resident into an expert in pain medicine capable of providing a consultant’s opinion.
- Advanced Critical Care Medicine: The advanced CCM rotation allows the CA-3 resident to participate in the care of complicated patients in the Surgical, Trauma, Cardiothoracic, and Transplant ICU’s within Presbyterian and Montefiore Hospitals. Supervision of medical students, interns, and residents is expected of the CA-3 resident.
- Advanced General Anesthesia: During this rotation, residents care for more complicated procedures and a higher acuity of patient than during their earlier training. More autonomy is given to the resident as they prepare for their transition into a board-certified anesthesiologist. The ability to substaff other providers and act in a charge position to assist with running of the operating room schedule and assignment of OR personnel is also focused upon during this rotation.
- Advanced Neuroanesthesia: Provides additional experience caring for neurosurgical patients. Residents choosing this rotation receive progressive responsibility and autonomy in the clinical arena.
- Advanced OB Anesthesia: By combining substaffing, charge anesthesiologist duties, advanced cases, and the opportunity to be involved in clinical research, this rotation provides the interested CA-3 resident an advanced obstetrical anesthesiology rotation at Magee Woman’s Hospital.
- Advanced Thoracic Anesthesia: Provides additional experience caring for thoracic patients. Residents choosing this rotation receive progressive responsibility and autonomy in the clinical arena.
- Advanced Pediatric Anesthesia: Based from Children’s Hospital of Pittsburgh of UPMC, this rotation provides the CA-3 resident with the opportunity to participate in one to two additional months caring for critically ill neonates, children and adolescents, as well as participation on the pediatric acute pain service.
- Ambulatory Anesthesia (1 month): The focus is on taking care of both adults and children in the outpatient setting. Surgical procedures include ophthalmic, otolaryngology, gynecological, orthopedic, maxillofacial, dental, and some general surgery.
- Business of Anesthesia (1 month): Residents will be actively involved in planning the day-to-day staffing of the OR and off-site anesthesia as well as long term staffing models. These models will include rooms running analysis, the balance of surgical demands and OR resources, including projected needs, and the needs of nuances of staffing flexibility. The resident will also be involved with “running the board.”
- Liver Transplant Anesthesia: One of the few non-elective rotations of the CA-3 year, care of the patient undergoing liver transplantation requires all of the skills the anesthesiology resident has learned over the previous two years. Management of massive blood transfusion, TEE, and thromboelastogram interpretation are key elements to this rotation.
- Mission Anesthesia: This rotation refreshes the pediatric skills of the resident as preparation for one of the many international mission trips that our department helps to coordinate. As detailed on other pages of our website, these mission trips are funded by our department and are ACGME-approved for residency credit. Residents not only provide care during this rotation, but also learn what it takes to prepare for and organize this type of activity. For more information, please visit the Surgicorps website.
- Transeophageal Echocardiography (TEE) (2 months): An opportunity for CA-3 residents to develop skills in basic TEE through both clinical training and a dedicated lecture series. Residents will learn from current cardiothoracic fellows as well as experienced cardiothoracic attendings. This rotation will prepare residents for basic TEE certification.
- UPMC Palermo: Our UPMC hospital in Palermo, Sicily, Italy provides a unique opportunity for our residents. CA-3 residents can choose to spend two months at this facility experiencing transplant and cardiac anesthesia in an English-speaking hospital that follows a European practice model. This rotation is also ACGME-approved for residency credit.