Medical College of Wisconsin Anesthesiology Residency Program Information

Locations: Froedtert Hospital, VA Medical Center

Residents will be involved in the management of a wide variety of cases covering a spectrum of simple to complex degree. Cases would be, minimally invasive laparoscopic and robotic procedures like hernia repairs and gastric bypass procedures. They will participate in the evaluation and management of complex general surgery and surgical oncology patients such us ones with pheochromocytoma, and metastatic intraperitoneal cancer. Management of such patients may involve advanced procedures such as HIPEC, robotic assisted interventions and ERAS protocols.

Locations: Froedtert Hospital, VA Medical Center

This rotation is designed to introduce the anesthesiology resident to the practice of cardiac anesthesiology. Acquisition of medical knowledge will result from the combination of one-to-one teaching, directed reading in major cardiac anesthesia textbooks, and informal discussions with cardiac anesthesiologists and cardiothoracic surgery faculty.

Residents rotating on cardiac anesthesia will be exposed to a wide variety of clinical conditions not encountered in other types of surgical procedures. Hemodynamic instability, severe left or right ventricular dysfunction, malignant ventricular arrhythmias, and profound hypovolemia resulting from bleeding from the heart, great vessels, or other major thoracic structures are often encountered and require rapid intervention to prevent morbidity and mortality. Operations encountered during the rotation may include routine CABG and valve repair/replacements as well as VA and VV ECMO, temporary and durable VAD placement, heart transplant, lung transplant, and transcatheter valve interventions.

Locations: Froedtert Menomonee Falls Hospital

This 2-week rotation for CA-3 residents occurs at one of our community-based hospitals (FMFH). Residents will be involved in the management of a wide variety of cases including elective joint surgery, and participate in the preoperative assessment and management of patients requiring all types of anesthesia. Residents primarily function in a consultant role rather than an in-OR anesthesia provider, and gain experience in perioperative management, regional anesthesia, and supervision of anesthesiology advance practice providers.

Locations: Froedtert Hospital, VA Medical Center

Froedtert Hospital

Rotations are four weeks long at Froedtert Hospital in the CVICU. A typical rotation consists of 20 shifts in 28 days with two blocks of night shifts. Residents, APPs and fellows work together with an attending on teams to manage patients. A typical day includes accepting sign out, seeing patients and lab/imaging/chart reviews in preparation for rounding with the CVICU attending. On weekends and night shift, a single team and attending see all of the patients. On weekdays, the team is split into two, with one attending and team in each hallway. Teaching rounds with the attending usually last between two and five hours depending on volume and acuity. Communication with nursing, primary teams & consultants, as well as procedures, occur throughout the day. New admissions to the ICU are staffed with the faculty as they arrive from the cardiac ORs. The populations we manage include Cardiac and Thoracic surgical patients, Vascular surgical patients, Advanced Heart Failure (end stage heart failure, VAD and Transplant), and critically ill general cardiology patients. Most patients will have multisystem disease. Regularly scheduled educational activities (Wednesday lectures) are always prioritized over patient care except in a true emergency. Faculty are present in house 24/7 for teaching and supervision.

VA SICU

The surgical intensive care unit (SICU) rotation that is offered at the VA Medical Center was developed to provide an environment in which the resident’s primary clinical responsibility will be for the care of the patient in the ICU. The resident in Anesthesiology training will learn to act both as a primary caretaker of medical and surgical patients and as a consultant to the surgeon. They will receive supervised training in the diagnosis and treatment of life-threatening diseases as well as medical/surgical conditions that develop as complications in the ICU. A syllabus is provided for reading and didactic sessions, focused on the clinical component of care as well as practice management issues. Senior residents in the SICU have the opportunity to experience the full spectrum of perioperative care on a continuity rotation, where they care for patients in the OR then return to the SICU to follow the remainder of their post-operative course.

Locations: Froedtert Hospital

The neuroanesthesia rotation at Froedtert Hospital is meant to guide the resident through appropriate reading for a full understanding and incorporation of the principles that are necessary to manage patients with neurosurgical pathology. With an increase in the complexity of management of neurologic disorders, anesthetic management of these cases has become increasingly specialized. The principles that govern the protection of the brain and/or spinal cord at risk must be at the center of patient care. Failure to pay close attention to the physiology, pathology and anesthetic management in these patients can result in more significant adverse outcome events than might occur during other surgical procedures. CA-1 and 2 residents will have staff present during all key events - induction, positioning, intraoperative events (e.g., aneurysm clipping, shunting of a carotid and unclamping, etc.), and most importantly, emergence. CA-3 residents should discuss the need for staff presence on an individual basis and are expected to demonstrate greater independence.

Location: Froedtert Birth Center

Residents in Obstetric Anesthesia will learn to provide anesthetic care during pregnancy, delivery and the postpartum period. The OB rotations at MCW offer extensive clinical experience in caring for both low and high-risk patients. In addition, residents will participate in didactic sessions, including informal bedside instruction, lectures, practice on a task trainer, problem-based learning, and discussion of online material. This rotation offers the opportunity to hone interpersonal communication skills while helping our vulnerable patients get safely through one of the most intense experiences in a lifetime.

A High-Risk OB Anesthesia Elective (two weeks) is designed to aid senior anesthesia residents in their transition from supervised providers to confident managers of a busy and high-risk labor and delivery unit and consultant anesthesiologists in obstetric practice. The senior resident will be exposed to various forms of pathophysiology in high-risk obstetric patients on labor and delivery and the Maternal Fetal Medicine service.

Locations: Children's Wisconsin, VA Medical Center

VA “Safari” Rotation
All CA-3 residents complete a two-week assignment at the VA Medical Center with supervised experiences providing general and MAC anesthesia in GI, Radiology, EP, Cath lab and Pulmonary procedural areas in adult patients. The rotation includes in-OR teaching and self study material. Each resident trainee participates in a 2-week rotation in the major (standalone) non-operating room anesthesia sites during their CA-3 year of training.

Children’s Wisconsin
The purpose of this advanced elective rotation is to provide Anesthesiology Residents with hands-on experience in administering anesthetics to children undergoing radiographic, diagnostic, therapeutic, and interventional procedures in Out-of-OR locations at Children’s Wisconsin. This includes pre-operative assessment, intra- operative management, safe transportation and hand-off of patients, and any post-operative management & documentation for CA3 trainees. The role of the anesthesia team is more flexible and potentially more comprehensively involved in peri-procedure care.

Froedtert Hospital Non-OR Anesthesia (NORA) Rotation 
CA-2 or CA-3 residents on a NORA elective participate in cases in the major stand-along NORA sites at FH, including GI Endoscopy, Radiology, Brachytherapy, Cath Lab, Electrophysiology/Cardioversion, Pulmonary/Bronchoscopy, Interventional Radiology, and Transesophageal Echo Lab procedures. Clinical experiences include shadowing faculty supervising APPs, providing hands-on administration of anesthesia care in NORA locations, and assistance in medical direction of APP team members.

Locations: Children's Wisconsin

Pediatric anesthesiology training is conducted throughout the entire duration of residency. The initial pediatric anesthesiology experience consists of a two-block rotation in the late CA-1 year, two one-block rotations during CA-2 year, and two two-week rotations during CA-3 year. Residents may elect to participate in additional pediatric anesthesiology rotations of variable duration up to six months. Children’s Wisconsin provides the clinical base for all pediatric anesthesiology rotations at MCW. CA-3 residents also may elect to participate in subspecialty pediatric anesthesiology rotations, such as Pediatric Out-of-the-OR, Pediatric Cardiac Anesthesiology, and Pediatric ENT Focus (ENT procedures are the most common surgeries in children - an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Senior residents may select the ENT rotation as a two week elective).

Locations: Froedtert Hospital

The Perioperative medicine experience is a required one-month rotation that takes place at the Froedtert Hospital in the Center for Advanced Care. Residents will see patients whose peri-operative care requires specialized techniques, including a broad spectrum of airway management techniques, to include laryngeal masks, fiberoptic intubation, and lung isolation techniques, such as double lumen endotracheal tube placement and endobronchial blockers. These goals and objectives are intended to assist residents in achieving the PET milestones. These goals can be met through customary methods including fulfillment of supervised clinical assignments, attendance and participation in didactic activities, and personal study.

Locations: Froedtert Hospital

The PACU is an area where anesthesiologists have primary responsibility for managing patients in the immediate postoperative phase. Anesthesiologists are the physicians responsible for the patients in this critical time of emergence and recovery. At the Froedtert Hospital, this rotation is a two contiguous week rotation where the residents will be provided with the clinical experience in the postoperative management of patients admitted to the PACU before being discharged to home, to the floor or to an ICU. Residents will act as consultants to recognize, diagnose and treat common perioperative problems. This clinical experience will be supplemented by self-directed learning and didactic sessions as time permits.

Locations: Froedtert Hospital, VA Medical Center

Froedtert Hospital

The RAAPS rotation provides residents with a unique opportunity to improve their skills in placement of both peripheral nerve blocks and neuraxial blocks for patients undergoing surgery or experiencing acute pain at Froedtert Hospital. Both single shot and continuous regional techniques are learned in order to provide intraoperative anesthesia, postoperative analgesia, and pain relief following trauma to the limbs or torso. Residents review core topics with regional anesthesiology faculty during their rotation didactics.

VA

The RAAPS elective rotation at the VA Medical Center provides the senior level resident interested in performing regional anesthesia as part of their practice with a unique opportunity to improve their skills in the placement of both peripheral and neuraxial nerve blocks in a typically elderly and comorbid population of United States veterans. Both ultrasound guidance and nerve stimulation will be utilized to perform single shot and continuous regional techniques in order to provide intraoperative anesthesia, postoperative analgesia, and pain relief following trauma. In addition to increasing the number of peripheral and neuraxial nerve blocks performed, residents will care for these patients throughout the perioperative period including preoperatively, intraoperatively, and postoperatively. Residents may also assist in providing consultation for physicians requesting assistance with inpatient acute pain.

Locations: Froedtert Hospital, Froedtert Surgery Center, Drexel Town Hall Surgery Center

Residents receive up to two weeks of elective time as a CA-2, and up to four weeks of elective time as a CA-3. Aside from those described elsewhere, currently offered elective experiences include:

Ambulatory Anesthesia: Four-week elective in providing anesthesia, including regional anesthesia, to patients undergoing ambulatory procedures at standalone surgery centers.

Anesthesia Research: Two-week elective designed to facilitate completion of a scholarly work product including a manuscript, research project, etc.

Diagnostic Point of Care Ultrasound (POCUS): Two-week elective performing and interpreting diagnostic POCUS imaging under faculty guidance in the CVICU, PACU, and ORs.

Education in Anesthesia: Two-week elective focused on providing education to junior residents in the ORs and simulation sessions, as well as completed an education-focused project (past projects have included development of teaching slides for CA-1 residents, oral boards preparation lectures, and development of a preoperative IV insertion curriculum for the CA-1s).

Global Health Rotation: A two- to four-week elective. Location and faculty must be identified by interested residents. Previous residents have provided anesthesiology education and/or direct patient care in Peru and Uganda, and future trips are planned to Indonesia and Vietnam.

Perfusion Medicine Focus: Two-week elective offering residents an opportunity to learn the physiology and mechanics of cardiopulmonary bypass and mechanical circulatory support devices now in use in the Froedtert Hospital ORs and CVICU.

Transesophageal Echo (TEE): Two-week elective performing and interpreting TEE imaging guided by PTE board-certified Cardiac Anesthesiology faculty.