M4 Electives
Anesthesiology at the VA
Statement of goals:
- Be able to formulate an anesthetic plan for a healthy patient and conduct an anesthetic with assistance of the anesthesia care team
- Gain experience with invasive techniques, e.g., iv lines, arterial lines and central lines
- Develop skills in airway management
- Understand the risks and benefits of various anesthetic techniques
- Understand and interpret hemodynamic monitoring
Learning activities:
- Perform preoperative evaluations of patients coming for elective surgical procedures
- Anesthetize patients under the supervision of senior residents and faculty
- Oral presentation of an anesthesia related topic at the end of the rotation
- Most of the teaching will be done in the operating room based on the scheduled cases, complemented by lectures, PBLDs and teaching of hemodynamics by echocardiography
Evaluation methods:
The student will work under the guidance of anesthesiology faculty at the VAMC. (S)he will be evaluated by the staff on background knowledge in the basic sciences, clinical skills and presentation at the end of the rotation. An evaluation will be written by the Course Director.
Anesthesiology Sub-Internship
Statement of goals:
- Refresh and broaden the knowledge of anesthesiology gained in the Junior year
- Learn advanced hemodynamic monitoring and application of physiology and pharmacology during anesthesia
- Hands on experience in the technical aspects of anesthesiology; e.g., airway management, tracheal intubation, placement of venous and arterial catheters, etc.
- Understand risks/benefits of various anesthetic techniques
Learning activities:
- Perform preoperative evaluation of patients coming in for surgical procedures
- Formulate the anesthetic plan, with the help of an anesthesiology resident, from pre-op, through surgery, to discharge
- Anesthetize patients under the supervision of senior residents and faculty. The student will have the opportunity to take part in all types of scheduled and emergent procedures in all subspecialties of Anesthesiology.
- Write a short essay on a subject related to anesthesia. In depth reading will be required on the subject with an oral presentation to the Course Director on the last day of the rotation.
Evaluation methods:
The sub intern will work under the guidance of anesthesiology faculty at Froedtert. All faculty and residents who worked with the sub intern will evaluate his/her performance. The evaluation will be pooled at the end of the rotation and one evaluation will be written by the Course Director.
Anesthetics & Cardiac Signal Transduction - Research
Statement of goals:
This elective is intended to review cardiac electrophysiology and the effects of general inhalational anesthetics on the electrophysiology of cardiac muscle and mitochondrial bioenergetics. The student will be introduced to microelectrode techniques used to measure transmembrane potentials and patch-clamping in various types of cardiac muscle cells. The mechanism of action of anesthetics on these cells will be studied utilizing changes in the ionic composition of perfusing solutions and by the use of specific blocking agents known to produce their effects on sodium, potassium or calcium channels in cardiac muscle.
Evaluation methods:
The student generally works with only one researcher on a single project. (S)he will be evaluated by the staff and preceptor on background knowledge in the basic sciences and clinical skills.
Cardiac Anesthesia
Statement of goals:
- Integrative management of patients with heart disease for cardiac surgery
- Learn advanced hemodynamic monitoring and transesophageal echocardiography for patients with heart disease
Learning activities:
The student will be directed in the operating rooms by several Anesthesiology Faculty. Students will be assigned to the open-heart surgical procedure and the student will be expected to participate in all stages of anesthetic management.
Evaluation methods:
The faculty evaluations will be pooled and a grade assigned based on clinical performance.
Cardiovascular & Respiratory Regulation during Anesthesia – Research
Statement of goals:
The elective is intended to teach how to conduct clinical research and to participate in clinical research in Anesthesiology. The specific areas of interest are the vascular effects of anesthetic drugs in a human model, the influence of anesthetic agents on neuro-cognitive function in the morbidly obese and geriatric patient population, and the autonomic effects of sedative doses of anesthetics in volunteers and patients.
Learning activities:
The student will be introduced to the process of informed consent, laboratory preparation, equipment, conduct of experimentation, data collection and analysis, statistical analysis, data reduction and graphic displays. The advanced student might also become involved in literature searching and manuscript preparation.
Evaluation methods:
Direct observation by the Course Director. Key observation points include timeliness, productivity and creativity while in the laboratory setting. The ability to understand the research goals and provide innovative ideas are critical to successful completion of the rotation.
Anesthesiology at Froedtert Hospital
Statement of goals:
- Be able to formulate an anesthetic plan for a healthy patient, and conduct anesthetic with assistance of anesthesia care team
- Develop skills of IV placement and airway management techniques
- Other opportunities may include arterial line and central line placement
- Understand risks/benefits of various anesthetic techniques
- Understand and interpret homodynamic monitoring
Learning activities:
- Active participation in the perianesthetic course
- Participation in fluid/blood resuscitation
- Participation in select sub-specialties including Cardiovascular cases and Neurosurgical cases
Evaluation methods:
The student will work under the guidance of anesthesiology faculty at Froedtert. The student's performance will be evaluated by all faculty and residents who worked with the student. The evaluation will be pooled at the end of the rotation and one evaluation will be written by the Course Director.
Anesthesiology at Waukesha Memorial Hospital
Statement of goals:
- To refresh and broaden the knowledge gained during the junior anesthesia clerkship
- To attain further experience in the technical aspects of the specialty, such as maintenance of airway, spinal taps, starting of intravenous and intra-arterial lines
Learning activities:
Broad experience in the operating room in the Department of Anesthesiology with associated experience in the Recovery Room. This hands-on experience will enhance the understanding of the basics of the specialty.
Evaluation methods:
The student generally works with more than one staff depending on the schedule of the operating room. (S)he will be evaluated by the staff and preceptor on background knowledge in the basic sciences and clinical skills.
Obstetric Anesthesiology
Statement of goals:
- Students are expected to observe the practice execution of current standards of Obstetric Anesthesia
- Read and discuss the following topics: Physiology of normal pregnancy and anesthetic complications; Pain control in obstetrics; Perinatal physiology & pharmacology; Anesthesia consideration in high risk pregnancies
- Present a short discussion on a related topic or detailed case analysis
Learning activities:
- Attend the obstetric patient along with the Anesthesiology resident
- Learn preoperative evaluations and post operative follow up
- Learn to document and participate in all the didactics
Evaluation methods:
The student works with more than one staff. (S)he will be evaluated by the staff and preceptor on background knowledge in the basic sciences and clinical skills.
Pain Management
Statement of goals:
- Students will learn the assessment and management of patients in a variety of pain states, including chronic pain in a multidisciplinary setting, as well as acute and cancer pain whenever the opportunity arises
- The students learn through active participation in patient care
- The student will learn about many different types of pain syndromes
- The pharmacology of pain treatment and pain medications will be an integral part of the student's experience
- Text material will be available - recommend a review of their JMS materials on pain
Learning activities:
- Evaluation and treatment of various pain syndromes by participating in history taking, physical examination and discussion of treatment plans
- The student can be responsible for obtaining and recording family history, social history and review of systems with a focus on its impact on pain
- Students will attend lectures on pain topics
- Student are encouraged to observe, and whenever possible, to participate in interventional procedures
- Students become aware of psychological and alternative medicine options available in the treatment of chronic pain, as well as modalities available through physical therapy such as exercise programs and TENS
- Students will have the opportunity to have phone interactions with patients by answering their questions and helping to solve issues related to their pain management
Evaluation methods:
The student generally works with more than one staff depending on the patient schedule of the Pain Clinic. (S)he will be evaluated by each staff and preceptor on background knowledge and basic clinical skills. The specific criteria are as outlined on the rotations evaluation form.
Pediatric Anesthesiology/Pain Management
Statement of goals:
- Gain insight into perioperative physiology in infants and children
- Attain experience working with children in the technical aspects of pediatric anesthesiology, including airway management, intravenous cannulation, administration of sedatives and analgesics, and the conduct of a routine anesthetic
- Obtain a broader degree of understanding of pediatric perioperative medicine
- Introduction to acute and chronic pediatric pain management, including the setup and management of patient controlled analgesia systems
Learning activities:
- Attend daily didactic lectures to obtain a broader degree of understanding of pediatric perioperative medicine
- Pediatric Anesthesiology recommended reading via 3 texts loaned from the department
- Observation and participation in all clinical settings and anesthetizing locations
- Participation in acute pain service rounds
- Attend Comprehensive Pain Program Clinic
Evaluation methods:
The senior student will work under the guidance of an assigned group of anesthesiology faculty at Children's Hospital of Wisconsin. The student will be expected to give an oral case presentation to the assigned group near the end of the rotation. The faculty that has worked with the student will fill out an evaluation. These evaluations will then be pooled at the end of the rotation and one evaluation will be written by the Course Director. Students may elect to partition more or less time in pain vs. the general OR environment, based upon individual goals.
Regulation of Respiration – Research
Statement of goals:
- A review of reflex and chemical control of breathing with a special emphasis on physiological regulation, alteration of respiratory control in obstructive sleep apnea and during anesthesia and narcotic analgesia
- The student will be introduced to methods for the study of respiratory control in an in vivo animal model with an emphasis on the neuropharmacology of neurons within the central respiratory network
Learning activities:
Participation in in vivo animal experiments, including data gathering and off-line data processing and analysis. Reading and discussion of overviews of the current status of respiratory control mechanisms
Evaluation methods:
The student generally works with more than one researcher. (S)he will be evaluated by the staff and preceptor on knowledge in the basic science and research skills acquired during the course.
Trauma Anesthesia
Statement of goals:
- Comprehend the pathophysiologic response to the traumatic injury of specific organ systems
- Understand the goals and methods of resuscitation of a patient with single and multiple organ traumas; develop the ability to recognize often conflicting goals
- Learn different methods of evaluation and establishment of a definitive airway in both the controlled and emergency settings
- Acquire skills for obtaining basic vascular access
- Develop basic knowledge of methods of invasive monitoring (interpretation of arterial, central venous, and pulmonary artery pressures)
- Understand the pathophysiology of hemorrhagic/hypovolemic shock and basic methods of resuscitation: fluid and blood components; learn the pharmacology of the most commonly used resuscitation drugs and anesthetic agents in trauma patient
- Follow the trauma patient’s progress in the ICU as a member of a trauma team, acquire basic experience in critical care
Learning activities:
- The M4 student will work as a member of a trauma anesthesiology team
- (S)he will evaluate the trauma patient in the Emergency Department (ED) with the anesthesia attending or senior resident after receiving the “Trauma Alert” page
- The student will observe and assist in the resuscitation in the ED and follow the patient to the OR suite
- In the OR (s)he will acquire experience in placing invasive catheters, securing the airway, controlling hemorrhage, commencing resuscitation of the patient with any type and combination of injuries, including head and neck, maxillofacial, thoracoabdominal, orthopedic, vascular and urologic trauma
- The student will continue to follow the patient in the postoperative period in the ICU, supervised by the anesthesia or ICU attending and the anesthesia resident rotating in Intensive Care
- Students will learn through active involvement in the team including the trauma anesthesia attending and residents
- Students will be able to participate in the following scheduled activities: Tuesday morning: trauma conference; Wednesday morning: formal lecture on anesthesia topic; Friday morning: anesthesia M&M conference.
- At the end of their rotation, each student will present a case at the Joint M&M for the Departments of Anesthesiology and Trauma Surgery or at the Trauma Anesthesia Conference.
- All students will receive binders with the latest journal articles covering the most important areas of trauma anesthesia; it is anticipated that a trauma anesthesia teaching program will be available on the Angel website within a year
- The Director of the Trauma Anesthesia Division will supervise all medical students and make any adjustments in their schedules and assignments
Evaluation methods:
The student will be evaluated primarily by their efforts in clinical work, including acquiring knowledge through reading and practice based learning, effort to improve their technical skills, and development of clinical judgment. The quality of the case presentation at the M&M also will be evaluated.