The PGY-4 (CA-3) year consists of the following rotations:

2 mos. Surgical Intensive Care Unit	1 mo. Veterans Administration Hospital
1 mo. Thoracic & Cardiovascular Anesthesia	1 mo. Nights (Trauma)
1 mo. Day Call Team Leader	6 mos. Electives

Electives can consist of any combination of the following:

Senior Obstetrical Anesthesia	Des Moines Cardiac Center
Any Subspecialty	Ortho Blocks
Research	Pain Medicine
Other Outside	Echocardiography
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Case Mix

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.

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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.

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A popular part of the anesthesia residency at The University of Iowa consists of rotation through the Anesthesia Service at Iowa City Department of Veterans Affairs Medical Center.

The VA Medical Center is a 198 bed hospital located immediately adjacent to the University of Iowa Hospitals and Clinics. The eight operating rooms of the VA suite provide a variety of services for veterans. Approximately 2,000 anesthetics are performed each year by the anesthesia service at the VA. Residents perform a broad mix of anesthetics for surgical cases ranging from craniotomies and thoracotomies to complex pain management procedures. A strong emphasis on regional anesthesia is maintained. The well-staffed service allows anesthesia residents a great deal of latitude in choice of case and patient mix.

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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.

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New to the senior resident curriculum is a cardiovascular rotation at Iowa Methodist Medical Center, in Des Moines. We are privileged to have so many of our alumni practicing in Iowa and have appreciated the many offers by alumni (as well as honorary alumni!) for teaching assistance at off-campus practice sites. We recently found a need for additional cardiac anesthesia experience, and the Iowa Methodist group was kind enough to help.

The University of Iowa is an educational partner with Iowa Methodist in the Des Moines Area Medical Education Consortium, Inc. This affiliation made it particularly easy to meet national Residency Review Committee requirements for an off-campus rotation. Each senior resident travels twice a year to Des Moines for a two-week rotation in the heart rooms. The rotation has been very well received, and is one of the high points of the final year. Our thanks to the Des Moines Methodist anesthesia group and their surgical and nursing colleagues.

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