Residency Training

Clinical Base Year Training - PGY1

The Clinical Base year should consist of a strong balanced program in all areas of medicine for residents who have chosen the specialty of anesthesiology and varies with the individual's educational needs. Loyola University offers a Clinical Base Year for incoming residents of Anesthesiology. All Clinical Base Year rotations (thirteen 4-week blocks) occur in the PGY-1 year and are completed prior to the beginning of the CA-1 year at Loyola. All CBY interns meet monthly with the Program Director over lunch to discuss current rotations and receive educational sessions.

The rotations will include:

• 2 blocks of Hines VA General Medicine
• 1 block of Loyola General Medicine
• 1 block of Cardiology
• 1 block of Emergency Medicine
• 1 block of ENT
• 1 block of Acute Pain Medicine
• 1 block of Surgery (General Surgery, Urology)
• 1 block of Cardiovascular Intensive Care Unit (Staffed by the Department of Anesthesiology & Perioperative Medicine)
• 1 block of Medical Intensive Care Unit
• 2 blocks of Anesthesiology
• 1 block of Quality/Research/Safety/Teaching Curriculum (QRST)

The "QRST" month (in May) and the second Anesthesiology month (in June) are done together as an entire class. This not only helps strengthen the relationships with your classmates, but helps prepare everyone for the beginning of CA-1 year in the ORs.

Anesthesiology residents will perform the same level of hands-on patient care and work as any other PGY-1 resident on the rotation.

Clinical Anesthesia Training - CA1 and CA2 Years

The clinical anesthesia experience is primarily devoted to the education of residents in the management of patients requiring surgical, obstetric, and diagnostic procedures requiring anesthesia. Residents receive training in the management of chronic pain medicine, intensive care unit, cardiothoracic & pediatricanesthesia. This is achieved through didactic instruction, diverse case assignments and a thorough grounding in the use of modern anesthetic drugs and techniques. The majority of this experience is offered at Loyola University Medical Center. Other rotation sites include Edward J. Hines Jr. VA Hospital, Ann & Robert H. Lurie Children's Hospital of Chicago, and Northwestern's Prentice Women's Hospital.

The first year of training concentrates on experience in an academic operating room, involving the anesthetic management of patients requiring surgery. It starts with a one-to-one preceptorship with attending staff. Training goals include the ability to perform a complete preoperative evaluation, plan anesthetic management, administer anesthesia, and follow-up patients in the Post-Anesthesia Recovery area and beyond. CA-1s also do a month of neuroanesthesia, pre-op clinic, outpatient anesthesia, a second month in the cardiovascular intensive care unit and spend one month at the neighboring affiliated Hines VA Hospital. In addition, residents spend a month in the chronic pain clinic with exposure to a variety of chronic pain conditions.

Residents discuss the patient's conditions and the choice of anesthesia with the attending anesthesiologist and perform the required tasks during the administration of anesthesia under the direct supervision of an attending anesthesiologist.

Many of our faculty have had additional subspecialty training in areas such as pediatric anesthesia, cardiothoracic anesthesia, chronic pain management, neuroanesthesia, and critical care medicine. While attending anesthesiologists provide 1:1 supervision of residents during the first few months of training, this relationship evolves to offer progressive independence and judgment as experience and skill of the resident increases. Faculty are continuously available as residents take on more responsibility for each patient. Coverage by in-house attending faculty is available to all residents 24 hours a day.

As trainees enter the second year of clinical anesthesia training, residents begin rotating in subspecialty areas of practice, such as cardiothoracic, pediatric, and obstetric anesthesia. During the CA-2 year, residents spend one month in high-risk obstetric anesthesia where residents are engaged in the evaluation and management of patients requiring pain relief during labor and vaginal or cesarean delivery. During this rotation, residents work with dedicated obstetric anesthesiologists on a 1:1 basis at Loyola University Medical Center.

During their training, residents also learn about chronic pain problems and manage inpatients and outpatients. The outpatient visits in the Pain Clinic include procedures such as epidural steroid injections, nerve blocks, and nerve stimulation.

During their clinical anesthesia training, residents will spend two months in the cardiac surgery intensive care unit where our house staff provides complete care for these patients under the direction of our anesthesiology trained critical care faculty.

Residents will spend an average of three months at Loyola Outpatient Center's surgery center across their clinical training years, in addition to several weeks of pediatric anesthesiology at this outstanding facility. There are over 4,000 surgical cases per year, and 25% of these cases are children below the age of 12 years. There is a major emphasis on regional anesthesia and physicians employ a multi-modal, proactive approach to pain management in the ambulatory surgical patient, including clinical research in acute pain management for the ambulatory patient and peripheral nerve catheters.

CA3 Year

Options

All residents are encouraged to master a special area of anesthesiology and pursue an independent project. Towards the end of the third year, the resident, in consultation with the Program Director, decides on the type of training that would be most appropriate. Two possible clinical tracks are available for pursuit: advanced clinical track and clinical scientist track.

With the advanced clinical track, a resident may decide to focus on one or more of the following areas:

Cardiovascular Anesthesia Experience

Loyola University Medical Center is a large tertiary cardiac surgery center where over 800 heart procedures are performed annually. These procedures represent the full range and include coronary, valvular, electrophysiological and complex vascular operations (including minimally invasive techniques). The center is also active in heart and lung transplantation. The critically ill nature of these patients provides excellent experience in the management of respiratory and cardiac disease.

Residents may spend several months assigned to the cardiac operating rooms. The goal of this period is for the resident to acquire the skills necessary to become a subspecialist in cardiac anesthesia. These skills include facility in invasive and non-invasive monitoring, the use of inotropic and vasoactive medications, and the safe administration of an anesthetic to the cardiac patient. The CA3 residents will also have the opportunity to perform a clinical or laboratory research project. An option to spend time on the Cardiology Service is available. Cardiology rotations include time in cardiographics, cardiac catheterization lab, postoperative cardiology service or perhaps some training in echocardiography.

Neuroscience Experience

Residents may elect to spend extra time in the neuroanesthesia rotation. A very active neurosurgical department performs various procedures including craniofacial reconstruction, major spine reconstruction and instrumentation, posterior fossa and skull base tumor surgery, vascular aneurysm clipping, and supratentorial craniotomies. The residents are trained in the use of various neurosurgical monitoring devices including sixteen lead EEG, processed EEG including Compressed Spectral Analysis, Density Spectral Analysis, Spectral Edge, etc.

Pain Management

Residents may elect to rotate for several additional months in the multi-disciplinary pain management center. All residents rotate on the Pain Service prior to their CA-3 year. During the CA-3 year, residents may further master the techniques of pain control including interventional and medication management approaches for both inpatients and outpatients. The residents develop primary patient contact and participate in research activities in this area.

Acute Pain Service

Senior residents participate in a one month rotation on the newly redesigned Acute Pain Service (APS). At Loyola the APS is a separate entity from chronic pain management. The service focuses on treatment of perioperative pain through a multimodal approach. One key feature of multimodal treatment of postoperative pain is regional anesthesia. The APS resident performs most of the blocks and epidurals done in the main operating room. On average the resident should expect to do 60-70 blocks during the month long rotation. Residents learn a wide variety of procedures including peripheral nerve catheters, paravertebral catheters, epidurals, and TAP blocks. Almost all peripheral nerve blocks are performed under ultrasound guidance. Besides learning the procedural aspects of fundamental and advanced regional techniques, residents have a well designed curriculum which includes a daily reading topic with board type study questions, and a daily discussion with a member of the acute pain faculty.

Pediatrics

During the CA-3 year, a limited number of qualified residents interested in furthering their training in pediatrics will have the opportunity to spend extra months in pediatric rotations. This will be divided between ambulatory and inpatient locations. Our ambulatory centers perform a high volume of pediatric cases, particularly in ENT and GU. Our inpatient Loyola Medicine Children's Hospital facility offers opportunities to become more familiar with anesthesia for orthopedic (including spine), general, neonatal (in conjunction with our 50-bed NICU), and pediatric open-heart surgical procedures. Residents may also participate in research studies and presentations at regional conferences.

Obstetrical Anesthesia

The facilities at Loyola University Medical Center afford a superior experience in high risk obstetrical anesthesia. The Labor and Delivery Unit at Loyola University Medical Center performs over 1,500 deliveries per year, of which over 85% may be classified as high risk. Typical problems which are routinely encountered include severe juvenile onset diabetes with retinopathy/cardiomyopathy, valvular cardiac disease, severe toxemia of pregnancy, multiple births, morbid obesity and parturients with corrected pediatric congenital cardiac anomalies. Procedures performed in this unit include Cesarean section, cervical cerclage, dilation and curettage and vaginal delivery. In addition, the management of premature labor is also performed here.

In obstetrical anesthesia, the rotation for CA-3 residents is a night float experience at Loyola University Medical Center. Because our hospital is a regional center for high-risk obstetrical patients, residents become proficient with complex obstetric techniques, specifically the management of high risk patients in labor. The goal of this period is twofold: (1) to acquire the skills necessary to become a true consultant in obstetrical anesthesia and (2) to intellectually explore the boundaries of this subspecialty. The acquired skills include invasive and non-invasive monitoring, administration of spinal and epidural analgesia/anesthesia, the use of obstetric-related drugs, and the safe administration of both regional and general anesthesia to the parturient under a variety of medical conditions. In addition, the CA-3 resident is expected to participate in teaching residents and participating in research.

Regional Anesthesia

During the CA-3 year, residents often choose to spend a month at the Loyola Ambulatory Surgery Center at Oakbrook Terrace. Orthopedic operations predominate and techniques in ultrasound-guided interscalene, infraclavicular, supraclavicular, femoral and sciatic nerve blocks are perfected.

Hepatobiliary Anesthesia

The CA-3 year resident with an interest in obtaining more exposure to liver transplantation and hepatobiliary anesthesia can elect to spend time on the hepatobiliary rotation. During their time, the resident will be participate in complex liver cases including hepatic resections, biliary reconstructions, and liver transplantation. In addition, they will be exposed to caval surgeries such as IVC thrombectomies associated with renal tumors or other solid organ transplantations (e.g., renal and pancreatic transplantation). There is significant exposure to the management of complicated coagulation states added by the use of rotational thromboelastrometry (ROTEM), as well as to the theories of massive transfusion therapy.

Research

Residents with interest in research and documented clinical accomplishments may spend up to six months in our Research Lab. CA-3 residents who spend six months in research may also be offered a CA-4 year in laboratory or clinical research. A 2000 square foot research facility for anesthesiology department members is located at the medical center. The laboratories are equipped with sophisticated analytical and monitoring equipment for basic research involving large or small animal models as well as bench experiments. The research activities range from applied animal experimentation to clinical studies requiring supportive laboratory investigation. Several residents have presented their research results at the MARC meeting, ASA, IARS, and other national meetings of anesthesiology.

The quality of resident research is exemplified by the fact that residents frequently have won special awards for their presentations. The primary objective of this rotation is to acquire knowledge in:

• Basic Physiological Research
• Clinical Pharmacological Research
• Laboratory Research

The Didactic Educational Program - CA1-CA3 Years

The didactic program is varied and intensive. One of the goals of the didactic training program is preparation for the written and oral examination leading to successful completion of the American Board of Anesthesiology requirements for Board Certification. But there are many other goals, including preparation for a lifetime of growth and excellence as a consultant in anesthesiology, learning new skills regarding teaching and learning, and developing educational leaders who will be an asset to the medical community. We strictly adhere to the philosophies of the educational outcomes project as described by the ACGME and focus on the six core competencies (e.g., patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal communications) throughout the education process.

An initial, intensive lecture series delineates the field of study for the new residents. For the next three years, residents participate in a didactic program that includes general and subspecialty lectures, monthly Continuous Quality Improvement (CQI) conferences and a separate weekly conference designed for each individual resident class. In addition, there are subspecialty journal clubs open to all residents. Senior residents receive mock oral examination from current ABA oral examiners. Residents at all levels receive regular simulation experiences including routine and rare complications and seniors receive mock Objective Structured Clinical Examination (OSCE) scenarios. The education curriculum is planned to be completed over three years and is tailored for each class to ensure participation and growth. To prevent conflicts between the clinical and educational responsibilities of residents, the department maintains a staff of certified nurse anesthetists who provide support for the house staff educational program.

Annually, the residents take the ASA/ABA In-Training Examination. The senior residents are expected to give at least one lecture to underclassmen on anesthesia-related topics with supervision and feedback from an attending. Each CA-3 resident is also responsible for a Grand Rounds with a faculty mentor. All residents are encouraged to participate in both regional and national conferences such as the annual Midwest Anesthesia Residents' Conference in which presentations are given on interesting cases or ongoing research within the department.

Each resident is paired with a faculty mentor based on their input and career interests. The mentorship program allows for strong development of mentor/mentee relationships, fosters additional teaching/learning outside of the didactic setting, and gives the resident an opportunity to have a big brother or sister in the field of anesthesia.