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| The PGY-2 and PGY-3 Years |
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The PGY-2 (CA-1) year starts with a two month block of Basic Anesthesia Training (BAT). Thereafter, rotations in both the CA-1 year and the CA-2 year parallel each other, making it easier to think of the CA-1 and CA-2 years together. They form a block of two months BAT followed by a block of 22 months of rotations.
What's involved with each of these rotations is covered in-depth by clicking the links below.
Total = approximately 24 months, however, these numbers will vary a small amount between individual residents.
PGY-4 (CA-3) Year
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| Basic Anesthesia Training |
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The first several weeks of anesthesia training in the operating rooms are spent working very closely with fellow orientees and anesthesia faculty. The case selection is aimed to provide basic experience in patient evaluation, anesthetic selection, and anesthetic management. You will develop competence in airway management including bag-mask ventilation, direct laryngoscopy with placement of oral and nasal endotracheal tubes, and LMA placement. Typical cases include laparoscopic cholecystectomy, plastic surgery procedures, hysterectomy, thyroidectomy, bowel resection, ureteroscopy/cystoscopy, and bone fracture repair. Case selection is expanded over the first several months to include a broader variety of patient disease states and more complicated surgical procedures, prone to acid-base abnormalities and significant blood loss. Skills learned include epidural and subarachnoid blocks, placement of intraarterial catheters and central venous catheters and combined epidural-general anethetics. New patient positions (lateral, prone and beach chair) are included. By the end of basic anesthesia training, you will be prepared to take on the subspecialties. Return to top |
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Each year, approximately 3,500 neonates, infants, and children are provided anesthesia care by the Division of Pediatric Anesthesia. This care occurs not only in the operating room arena, but also with numerous diagnostic and therapeutic procedures throughout the hospital, including diagnostic and interventional radiology, dermatology, pediatric cardiac catheterization lab, and radiation therapy. The spectrum of medical and surgical diseases encountered in our patient population provides residents clinical opportunities that vary from simple outpatient procedures on healthy children to premature neonates who undergo complex surgical procedures. The care of these patients extends from the preoperative evaluation and education process to intraoperative planning and management and lastly,to postoperative concerns. Senior residents have the opportunity to obtain elective critical care experience, working with colleagues in the neonatology or pediatric critical care divisions. Residents are involved in the care of pediatric patients throughout their training, with increasing case complexity that is commensurate with their experience. Didactic presentations review those anesthesia concerns frequently encountered in this population group as well as those specific to the pediatric patient. The clinical and didactic experiences during the residency training should provide a confidence to encounter almost any pediatric anesthesia dilemma. A year of additional training is also available to those interested in focusing their practice in the care of the neonate, infant, and child. Return to top |
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The Department of Anesthesia is committed to quality resident training in obstetric anesthesia. We are able to provide an excellent clinical and educational experience for residents encompassing all aspects of anesthesia for labor and delivery. Each resident spends approximately one month each year providing anesthesia in labor and delivery. Clinical Experience
At The University of Iowa we take care of most of Eastern Iowa¹s (pop. 2 million) high risk obstetrical patients, including patients with congenital heart disease, diabetes, preeclampsia, multiple gestations, and premature labor. Participation in the care of these patients ensures that each resident will be familiar with the special needs of these challenging patients. Obstetric care is given in a new $23 million Maternity Center, NICU, and PICU within University Hospitals. There are spacious labor-delivery rooms, modern operating rooms, and an adjoining NICU all close to the main OR and central anesthesia supplies. A high percentage of laboring patients request epidural anesthesia, and most non-emergent (and some emergent) cesarean deliveries are performed under spinal or epidural anesthesia. In addition to these regional anesthesia cases there a variety of procedures, including emergent and non-emergent cesarean deliveries, that are performed under general anesthesia, monitored anesthesia care, or conscious sedation. In addition, the anesthesia residents will be involved in pain management in some patients unable to receive regional anesthesia, in special monitoring including invasive hemodynamic monitoring in selected patients, and as consultants in the management of patients with complex medical conditions. Education
In addition to regular departmental didactic lectures and conferences there are computer-based lessons and lectures, and conferences and discussions during the rotation. Daily sign-out rounds as residents transfer responsibilities provide additional opportunities for teaching and discussion. The extensive use of regional anesthesia in labor and delivery provide ample opportunity for residents to become comfortable and proficient in spinal and epidural anesthesia. In addition residents will learn associated techniques such as combined spinal-epidural anesthesia, patient-controlled epidural anesthesia, "walking epidurals", management of epidural and intrathecal narcotics, and the special anesthetic considerations necessary for obstetric patients. Research
The University of Iowa has a long tradition of cooperation and collaboration in research between Obstetrics and Anesthesia. Residents can participate in clinical or laboratory
research directed by faculty in either department, and residents will find a helpful and cooperative environment for designing and conducting research protocols of their own. Residents and fellows at the University of Iowa have been finalists and winners of several Gertie Marx awards given by the Society for Obstetric Anesthesia and Perinatology. Return to top |
| Surgical Intensive Care Unit |
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Visit the SICU web site The Surgical Intensive Care Unit is medically directed and staffed by faculty members of the Department of Anesthesia and Surgery who are skilled in the care of acutely ill surgical patients and have extensive experience in managing complex emergencies. These faculty members, having completed Fellowship training in Critical Care Medicine, are responsible for the administrative and medical supervision of the SICU, which serves 2,000 patients annually. The SICU is a 26-bed unit which affords firsthand experience for residents and fellows in the care of patients suffering from respiratory failure, sepsis, multi-system trauma, peri-operative complications, acute neurological injuries, and post-organ transplantation care. The SICU emphasizes a team approach to teaching and clinical service which affects close professional relationships between specialties and optimal patient care. The Surgical Intensive Care Unit is the major academic referral center for support of critically ill patients in Iowa. In turn, the SICU’s development has been well supported by UIHC through the work of Nursing, Respiratory Care, Hospital Pharmacy, Rehabilitation Therapies, Radiology and Pathology. The SICU is in close proximity to the Operating Rooms and the Critical Care Laboratory, enhancing operational efficiencies. The Department of Anesthesia is committed to the development of anesthesiologists skilled in the practice of critical care. Nationally, there is increased demand for intensivists—a function of studies showing enhancement of outcomes in ICU’s directed by critical care trained physicians. To accomplish this goal, the Department of Anesthesia has developed and continuously fine-tunes the training program to provide residents, fellows, and medical students a broad exposure to critical care. Multi-disciplinary rounds are standard among physicians, pharmacists, respiratory care practitioners, critical care nurses, and ICU dieticians, effectively contributing to the overall training experience. Regular didactics, which include lectures, mechanical ventilation laboratories, and journal clubs, emphasize evidence-based practice. There are ample experiences in critical care procedures, including emergency airway management, mechanical ventilation, fiberoptic bronchoscopy, echocardiography, and broad aspects of hemodynamic monitoring. Physiciansin- training have ample opportunity to closely interact with the broad based critical care faculty of the SICU who have training in Anesthesia, Surgery, Hyperbaric Medicine, Internal Medicine, Pulmonary Medicine, Trauma, Pharmacology, Cardiovascular Physiology, Nutrition, and Critical Care Medicine. Surgical Intensive Care The Department of Anesthesia has provided the medical direction for the Surgical Intensive Care Unit for over 20 years, affecting superior critical care training for over 200 anesthesiology residents. During the SICU training rotation, residents and fellows benefit from exposure to life threatening illnesses with supervised training. With graded levels of responsibility during the training process, physiciansin- training develop the expertise and confidence to provide acute critical care. Return to top |
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Pain Medicine Rotation
The Center for Pain Medicine and Regional Anesthesia is a very active rotation for the Anesthesia residents. Anesthesia residents rotate through the Center for Pain Medicine and Regional Anesthesia for a total of four weeks during the CA-2 year. Anesthesia residents may elect to rotate through the Center for Pain Medicine and Regional Anesthesia during the CA-3 year. At the beginning of the CA-2 resident rotation, one fellow will provide a two-hour orientation regarding the chronic and acute pain services (the residents also receive a packet to refer to throughout their rotation). This orientations also includes training on the Navicare system, electronic patient notes, consultations, acute pain rounds, call schedules, weekend call, and teaching activities During fiscal year 2003/2004, the Center for Pain Medicine and Regional Anesthesia saw treated 5,561 patients, the Acute Pain Service treated 1,492 patients, and the Pain Service treated 73 cancer patients. Please see Clinical Experience for description of treatment/procedures provided to patients.
Clinical Experience
The Anesthesia Resident rotation in the Pain Medicine Service will gain experience in chronic, acute and cancer pain management (see below). Our center utilizes a computerized system (Navicare), which shows the geographic distributions of patients in clinic from the time they arrive in the waiting room until they are discharged from the Pain Center. It organizes the patients into two separate categories; patients assigned to a procedure room and expected to receive a procedure and patients checked into an exam room. Mobilization of patients from one category to another is feasible if decided differently. In order to facilitate seeing the patients in a timely manner and prevent unnecessary waiting period for the patient, which is afflicted on this computer system, the patients are seen on a first come first seen basis by all the fellows and residents rotating in the pain service. There a mutual agreement between fellows and residents if a certain fellow/resident has deficiencies in a particular procedure then he/she would be given the priority to do that procedure.
Residents are also educated by the Pain Medicine Psychologist and Pharm.D. during their rotation. Chronic Pain Medicine Service (chronic and cancer pain patients)
The Center for Pain Medicine and Regional Anesthesia serves patients with chronic pain, cancer related pain and nerve or musculoskeletal injuries. The interventional procedures performed within the Center for Pain Medicine and Regional Anesthesia include trigger point injections, local anesthetic injections of peripheral nerves, epidural steroid injections, stellate ganglion blocks and intravenous anesthetic blocks. (maybe add link to view photos/video of procedures) Fluoroscopic guided procedures include neurolytic celiac plexus blocks, selective nerve root injections, lumbar sympathetic blocks, radiofrequency ablation, discography and facet injections among others. In addition, cryoablation is performed in select patients. Training in intrathecal infusions and spinal cord stimulators is provided in conjunction with the Department of Neurosurgery. Acute Pain Medicine Service
The acute pain medicine service actively manages acute postoperative and cancer pain in the inpatient setting. It also provides consultations and serves as a resource for other services. The service commonly utilizes PCA pumps, thoracic and lumbar epidural catheters, intrathecal catheters, brachial plexus catheters, and peripheral nerve plexus catheters. Pain call is approximately every fourth night. This is a pager call, which can be taken from home. However, the pain fellow or resident on pain call is expected to come into the hospital to assist with epidural placements and/or infusion therapy if required. An attending anesthesiologist is also on pain call and will be available for questions or to come into the hospital as needed. On weekends, the call person will round with the attending on pain call in the morning. Education
The educational program is multifaceted and includes clinical teaching and practice, didactic lectures, research and teaching of residents and medical students. Participation in activities such as the Monday Pain Didactic Lecture series (weekly), Monday morning Pain Medicine Morbidity and Mortality conference (monthly), Wednesday evening Morbidity and Mortality conference (weekly) and Pain Medicine Didactic Journal Club (monthly) are an important part of the educational experience. Education skills are an important part of developing a successful pain practice. Residents rotating through the Pain Medicine service are encouraged to attend pain medicine lectures and morbidity and mortality presentations, and participate in journal clubs. Residents who indicate an interest in attending the journal clubs can request that they be put on the monthly distribution list. Research
There are numerous areas of research which are being developed. Return to top |
| Otolaryngology/Ophthalmology/Oral Surgery |
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Otolaryngology
We are privileged to provide anesthesia services for this department that is consistently ranked within the top 3 in the country by US News. While on this rotation, residents will become experts at airway management. We emphasize alternative airway management techniques such as fiberoptic intubation, use of the bougie and fast-trach aids, light-wand intubation, retrograde intubation and use of alternative laryngoscopes. Jet ventilation with heliox has been extensively used in pediatric airway management. Residents will learn how to evaluate the compromised airway and plan appropriate anesthesia techniques. Head and neck cancer surgery is a major component and residents become familiar with management of fluid, electrolytes and blood replacement during extended surgeries. Oral Surgery
Because oral surgeons need unimpeded access to the mouth, residents become expert at nasal intubation, both blind and under direct vision. Residents will gain expertise in blood pressure control with vasoactive agents as many of the jaw advancement surgeries also require induced hypotension. Ophthalmology
This department is ranked within the top 10 in the country by US News. While on this rotation, the resident will become expert at balancing the need for a quiet operating field and yet be able to wake the patient up in a timely fashion. Many of the patients are diabetic and control of the manifestations of this disease carries high importance. Residents will also learn to manage as many as ten cataract surgeries in one day, thus gaining valuable “private practice” like experience Return to top |
| Anesthesia Presurgical Evaluation Clinic |
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Providing a centralized location for completion of outpatient preoperative evaluations, the Anesthesia Pre-Surgical Evaluation Clinic opened in August 1995. This area consists of a reception area, seven examination rooms, a consult room, and a shared nurse-physician work area. The PEC has been designed to provide an attractive and efficient facility for the completion of histories and physicals, anesthesia evaluations, laboratory testing, electrocardiograms, nursing assessments, and patient teaching. It also serves as the preoperative preparation area for patients undergoing same-day admission or outpatient procedures. Return to top |
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The Neurosurgical Anesthesia service at The University of Iowa does more than 1,700 neurosurgical anesthetics per year, at all levels of complexity, ranging from the simplest lumbar laminectomy to the most complex intracranial vascular or craniovertebral/skull base procedures. Anesthesia for all of these procedures is provided by anesthesia residents, supervised by a group of highly experienced neuroanesthesia faculty. A resident in the U of I program can expect to gain extensive experience in the management of patients undergoing craniotomies for a wide variety of disease states, including tumors, vascular malformations and aneurysms. Almost 20 percent of our neurosurgical patients are in the pediatric age range, ranging from ventriculoperitoneal shunts in premature infants, to craniofacial reconstructions and anesthesia for complex posterior fossa surgery. We also care for a large number of patients with skull base and craniovertebral junction disorders as well as lower cervical spine disease. Many of these cases provide an enormous opportunity to gain experience in management of the difficult airway, including almost daily performance of fiberoptic endoscopy. Residents will also be exposed to subspecialized monitoring modalities, such as processed EEGs or evoked responses, and to clinical research projects being performed by the group. Return to top |
| Thoracic & Cardiovascular Anesthesia |
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Approximately 700 adults and children undergo anesthesia for cardiopulmonary bypass and corrective cardiac surgery at the University of Iowa Hospitals and Clinics each year. During their cardiovascular anesthesia rotations, residents care for patients with ischemic, valvular, and congenital heart diseases. During this rotation, anesthesia residents are exposed to the pathophysiology of heart disease and gain familiarity with inotropic, antiarrhythmic and vasoactive medications. They evaluate critically ill patients and formulate thorough anesthetic plans for a wide variety of cardiac procedures. Residents also gain an in-depth understanding of the complex physiology of cardiopulmonary bypass and develop proficiency with a variety of invasive monitoring techniques, including arterial pressure monitoring, central venous and pulmonary artery pressure monitoring, transesophageal echocardiography (TEE), and transcranial doppler. Faculty assignments are one-on-one and allow for intensive resident/faculty interaction. In addition to open heart cases, residents on this rotation also provide anesthesia for patients undergoing thoracic surgery. Anesthetic management in these patients requires a clear understanding of “one lung” physiology and the important techniques of single lung ventilation, fiberoptic bronchoscopy, and central neural-axis analgesia. Intra-operative transesophageal echocardiograms are formally reviewed and interpreted each week by members of our cardiac anesthesia group. TEE reading sessions are open to all residents. Consultation is readily available from both the adult and pediatric cardiology echocardiography service. Didactic material is presented as part of the morning lecture series. In addition, a variety of “cardiac” conferences are available on a weekly basis, including pediatric surgical indications conference, adult cardiology echo conference, cardiothoracic lectures, and anesthesia TEE conference. Return to top |
| Regional Anesthesia/Orthopedics |
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Pain Medicine Rotation
The Center for Pain Medicine and Regional Anesthesia is a very active rotation for the Anesthesia residents. Anesthesia residents rotate through the Center for Pain Medicine and Regional Anesthesia for a total of four weeks during the CA-2 year. Anesthesia residents may elect to rotate through the Center for Pain Medicine and Regional Anesthesia during the CA-3 year. At the beginning of the CA-2 resident rotation, one fellow will provide a two-hour orientation regarding the chronic and acute pain services (the residents also receive a packet to refer to throughout their rotation). This orientations also includes training on the Navicare system, electronic patient notes, consultations, acute pain rounds, call schedules, weekend call, and teaching activities During fiscal year 2003/2004, the Center for Pain Medicine and Regional Anesthesia saw treated 5,561 patients, the Acute Pain Service treated 1,492 patients, and the Pain Service treated 73 cancer patients. Please see Clinical Experience for description of treatment/procedures provided to patients.
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Mondays/Tuesdays
0700 Attend morning lecture
0745 Go to Center for Pain Medicine and Regional Anesthesia’s Procedure rooms to assist with blocks (fellow’s may page resident if needed earlier)
?? Acute Pain Rounds – which may include the follow types of patients:
0830 Clinic starts (below are some typical patients you may see during the day)
??? Start afternoon rounds if you are the assigned acute resident/fellow of the day
1700 Pain Medicine lecture (Cullen Conference Room)
1830 OR on third Monday Journal Club at 1830 (location varies)
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Clinical Experience
The Anesthesia Resident rotation in the Pain Medicine Service will gain experience in chronic, acute and cancer pain management (see below). Our center utilizes a computerized system (Navicare), which shows the geographic distributions of patients in clinic from the time they arrive in the waiting room until they are discharged from the Pain Center. It organizes the patients into two separate categories; patients assigned to a procedure room and expected to receive a procedure and patients checked into an exam room. Mobilization of patients from one category to another is feasible if decided differently. In order to facilitate seeing the patients in a timely manner and prevent unnecessary waiting period for the patient, which is afflicted on this computer system, the patients are seen on a first come first seen basis by all the fellows and residents rotating in the pain service. There a mutual agreement between fellows and residents if a certain fellow/resident has deficiencies in a particular procedure then he/she would be given the priority to do that procedure. Residents are also educated by the Pain Medicine Psychologist and Pharm.D. during their rotation. - Chronic Pain Medicine Service (chronic and cancer pain patients)
The Center for Pain Medicine and Regional Anesthesia serves patients with chronic pain, cancer related pain and nerve or musculoskeletal injuries. The interventional procedures performed within the Center for Pain Medicine and Regional Anesthesia include trigger point injections, local anesthetic injections of peripheral nerves, epidural steroid injections, stellate ganglion blocks and intravenous anesthetic blocks. Fluoroscopic guided procedures include neurolytic celiac plexus blocks, selective nerve root injections, lumbar sympathetic blocks, radiofrequency ablation, discography and facet injections among others. In addition, cryoablation is performed in select patients. Training in intrathecal infusions and spinal cord stimulators is provided in conjunction with the Department of Neurosurgery. - Acute Pain Medicine Service
The acute pain medicine service actively manages acute postoperative and cancer pain in the inpatient setting. It also provides consultations and serves as a resource for other services. The service commonly utilizes PCA pumps, thoracic and lumbar epidural catheters, intrathecal catheters, brachial plexus catheters, and peripheral nerve plexus catheters. Pain call is approximately every fourth night. This is a pager call, which can be taken from home. However, the pain fellow or resident on pain call is expected to come into the hospital to assist with epidural placements and/or infusion therapy if required. An attending anesthesiologist is also on pain call and will be available for questions or to come into the hospital as needed. On weekends, the call person will round with the attending on pain call in the morning. Education
The educational program is multifaceted and includes clinical teaching and practice, didactic lectures, research and teaching of residents and medical students. Participation in activities such as the Monday Pain Didactic Lecture series (weekly), Monday morning Pain Medicine Morbidity and Mortality conference (monthly), Wednesday evening Morbidity and Mortality conference (weekly) and Pain Medicine Didactic Journal Club (monthly) are an important part of the educational experience. Education skills are an important part of developing a successful pain practice. Residents rotating through the Pain Medicine service are encouraged to attend pain medicine lectures and morbidity and mortality presentations, and participate in journal clubs. Residents who indicate an interest in attending the journal clubs can request that they be put on the monthly distribution list. Research
There are numerous areas of research which are being developed. Return to top |
| General Surgery/Urology/Gynecology |
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Urology
You might expect that urology cases would be dull, but don't be fooled. First, the camaraderie among the urology nurses, faculty and resident surgeons and the anesthesia faculty is something we enjoy and nurture. Team spirit and quality patient care in a light-hearted atmosphere are encouraged. Second, we provide anesthesia to a diverse patient population from neonates to the elderly, otherwise healthy to the very ill. Finally, the surgical procedures vary from the simple hydrodistension, ESWL (extracorporeal shockwave lithotripsy) and cystoscopy to complicated nephrectomy with tumor invasion into major blood vessels, adrenalectomy for pheochromocytoma, and urinary bladder cystectomy. We use a variety of anesthetic techniques including monitored anesthetic care (sedation), neuraxial blocks, general anesthetics and combined general anesthesia with epidural catheters. Monitoring can be the simple standard ASA monitors or extensive: including invasive arterial blood pressure, central venous catheters/pulmonary artery catheters or even intraoperative ECHO. Our surgeons perform many procedures laparoscopically and even use robotic technology for some procedures. Urology does offer a diverse experience. General Surgery and Gynecology
Anything from stem to stern can be expected in this rotation, including burns, trauma, thyroidectomy, cholecystectomy, bowel resection, liver resection, transplants (kidney, liver, pancreas), Whipple, hernia repair, appendectomy, hysterectomy (vaginal or abdominal approach), hysteroscopy, pelvic exenteration, D and C, myomectomy. The patients can be severely ill or otherwise healthy. Cases often require invasive monitoring procedures (arterial lines and central venous lines) and can be done with straight regional techniques, monitored anesthesia care, general anesthesia or combined regional/general anesthesia. Expect the unexpected. Return to top |
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