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Anesthesiology

Program Information

Didactics

Intern

  • Intern Curriculum Days
  • Weekly readings on 2-month Anesthesia rotation

CA-1

  • Orientation Week
  • Summer Lecture Series
  • CA-1 lecture series
  • Monthly CA-1 half-day workshops

CA-2 & CA-3

  • Scheduled didactics:
    • Lectures
    • PBLDs
    • Board review
    • Jeopardy
  • Mock oral boards
  • Question of the Day
  • CA-2 Group Research / Presentations

All-Class Sessions

  • Journal Club
  • Friday Conference
    • Mortality and Morbidity
    • Visiting Professor
    • Case Conference
    • Subspecialty

Yearly block diagram


Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Block 11 Block 12 Block 13
PGY-1 MICU Vascular Surgery Pain Pre-op SICU SICU Consult ED General Anesth Med Wards Med Wards Med Wards
PGY-2 General Anesth General Anesth General Anesth General Anesth OB General Anesth SICU Ped Anesth Ped Anesth Neuro Pain General Anesth Vacation
PGY-3 RAAPS Cardio Anesth Neuro Anesth CVICU General Anesth Ped Anesth Pre-op General Anesth RAAPS / OB Ped Anesth OB General Anesth Vacation
PGY-4 General Anesth RAAPS / OB Elective PACU / Elective General Anesth Cardio Anesth General Anesth General Anesth Ped Anesth Ped Anesth OB General Anesth Vacation

PGY-1 year consists of 12 1-month rotations; PGY years 2 through 4 consist of 13 4-week blocks.

Yearly Overview

In an average 3-year program, each resident will have had the opportunity to perform the following procedures: 450-500 general anesthesia or monitored anesthesia cases, 100 spinal/epidurals, 120 other regional nerve blocks, 50 PA catheterizations, and 75 difficult airway cases.

all
Clinical Base Year (PGY-1)

1-month rotations typically consisting of

  • Anesthesiology
  • Anesthesia pre-op clinic
  • Anesthesia-directed SICU
  • Anesthesia pain clinic
  • Emergency medicine
  • CT and vascular surgery

Three to four months of medicine wards, one month of medicine consult.

Rotation sites

  • Froedtert Hospital
  • Clement J. Zablocki VA Medical Center
  • Aurora Sinai Hospital
CA-1 Year (PGY-2)

1-month rotations typically consisting of

  • Anesthesiology-General
  • Anesthesia subspecialty rotation including OB, regional, pediatrics
  • Anesthesia-directed SICU
  • Anesthesia pain clinic

Introductory lecture series

Given in the first month of the two-month lecture series, the following management topics and techniques essential to successful career in anesthesiology are given.

  • Sleep deprivation
  • Work-life balance
  • Substance abuse
  • Professionalism
  • Ethics
  • Malpractice issues

Drug & equipment practicum

The practicum gives residents the opportunity to familiarize themselves with the following topics.

  • Medical dilution and labeling
  • IV tubing
  • Blood transfusions
  • Infusions
  • Infusion pumps

Simulation

A two-part simulator experience provides residents an opportunity to hone their abilities in a safe and realistic environment.

  • Anesthesia induction
  • Maintenance and emergence
  • Tracheal intubation
  • Call readiness

Core lectures geared for success on the ABA part 1 exam given at the end of the CA-1 year

Learn more about the American Board of Anesthesiology BASIC (Staged) Exams

  • Anesthetic pharmacology
  • Neuromuscular blockade
  • Monitoring
  • Autonomic nervous system
  • Pre-op and post-op management

Anesthesia Knowledge Test

Given on day 1 of residency training and again after one and six months of training, the AKT assesses the areas of greatest deficiency in residents and allows implementation of learning strategies to assist with resident success.

CA-2 Year (PGY-3)

Subspecialty rotations

  • Pain
  • Obstetric
  • Pediatric
  • Regional
  • Neuro
  • Ambulatory
  • Trauma
  • Airway
  • Critical care anesthesia

Rotation-specific lectures

We find learning is best achieved with rotation-specific lectures presented during the resident's time in that subspecialty. The following lectures will be provided while specializing in each area.

Children's Hospital of Wisconsin

  • 3 mornings per week pediatric care lectures

Pediatric anesthesia

  • Bimonthly multidisciplinary case or topic-based conference with pediatric surgery and pediatric critical care

OB anesthesia

  • Weekly conferences at St. Joseph's Regional Medical Center
  • Monthly online grand rounds broadcast for resident evaluation and commentary

Neuro anesthesia

  • Weekly problem-based learning session

Pain

  • Weekly case-based learning sessions and high yield topics

Regional

  • Weekly case-based learning sessions

Critical care

  • Weekly case based-specific lectures and high-yield topics

Workshops

We offer two workshops for CA-2 residents: conflict resolution and transitioning to practice.

Transitioning to practice

  • Job interviews
  • CV preparation
  • Private vs academic practice
  • Money management
  • Malpractice
  • Disability
  • Life insurance
CA-3 Year (PGY-4)

Rotations

CA-3s have a mix of general OR and subspecialty rotations, along with some rotations in private practice settings. As stated above (CA-2 year), the subspecialty rotations offer their own focused lectures. In addition, residents have weekly problem-based learning discussions from September through March, followed by three months of Board review lectures.

Board preparation

We strive to provide every opportunity for residents to successfully complete their board exams.

  • Keyword reviews
  • Mock oral exams
  • Journal club
  • Workshops
  • Board review course
  • Visiting professor lecture series

Friday conference series

As part of the scholarship and discovery experience and to encourage collegiality, we have a Friday Conference series and faculty, residents, and medical students are encouraged to attend.

  • Morbidity and mortality conferences
  • Grand rounds
  • Case conferences
  • Anesthesia board Jeopardy
  • Quality improvement topics

Research

In addition to the didactic program, residents who express interest will find ample opportunity to conduct research and complete scholarly projects in their area of interest. This can be in the form of 3-9 months of protected time during the 48 month curriculum (intern through residency).  We also provide support to present scholarly work at scientific meetings. The Department is proud of its NIH funded T-32 grant providing significant research support for residents wishing to invest up to 23 months of research time in a 60-month curriculum. For more information on research opportunities refer to the Anesthesiology Physician Scientist Development Program.

Mentorship

We encourage professional networking by matching 3-5 residents and a mentor with shared interests. The mentoring relationship is designed to provide the resident grouping with personal and professional support throughout the residency.

Rotation descriptions

General Anesthesia

General Anesthesia

Locations: Froedtert Hospital, Milwaukee 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.

Cardiac Anesthesia

Cardiac Anesthesia

Locations: Froedtert Hospital, Milwaukee 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, formal lectures during the educational curriculum, 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.

Critical Care Anesthesia

Critical Care Anesthesia

Locations: Froedtert Hospital, Milwaukee VA Medical Center

Froedtert Hospital

Rotations are four weeks long at FH in the CVICU (3 rd floor E elevators). A typical rotation consists of 20 shifts in 28 days with two blocks of night shift. Residents, APPs and fellows work together with an attending on teams to manage patients. A typical day includes accepting sign out, seeing patients and review lab/imaging/chart review in preparation for rounding with the CVICU attending. On weekends and night shift a single team and attending see all of the patients. On week days the team is split in to two, with one attending and team in each hallway. Teaching rounds with the attending usually last between 2 and 5 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 (cardiac ORs arrive in the early afternoon). The populations we manage include Cardiac and Thoracic surgical patients, Vascular surgical patients, Advanced Heart Failure (end stage heart failure, VAD and Transplant) as well as general cardiology patients. Most patients will have multisystem disease. Regularly scheduled educational activities (Wednesday lectures and Friday conferences) are prioritized over patient care except in a true emergency. Faculty are present in hours 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. S/he 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.

Neuroanesthesia

Neuroanesthesia

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.

Obstetric Anesthesia

Obstetric Anesthesia

Locations: Froedtert Hospital, Wheaton Franciscan St. Joseph

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.

Pain Medicine

Pain Medicine

Locations: Froedtert Hospital, Milwaukee VA Medical Center

The Medical College of Wisconsin (MCW) and the VA Medical Center (VA) offer Pain Medicine rotations. Both pain clinics have a multidisciplinary character, staffed by anesthesiologists who hold added qualifications in Pain Medicine, as well as a physiatrist, psychologist and advanced practice providers. Additionally, the MCW Pain Medicine Division provides an inpatient pain service at Froedtert Hospital.

During their MCW Pain Medicine rotation, the residents will spend time on the inpatient pain service at Froedtert Hospital. Residents will understand and demonstrate application of the biopsychosocial model of pain in the acute care facility. The residents will be expected to formulate multidisciplinary treatment plans for these patients and coordinate care amongst the various disciplines. Assisting with discharge planning for pain will also be expected when needed. All of this will be done in conjunction with the Pain Medicine faculty on service.

The MCW pain clinic is a multidisciplinary clinic staffed by anesthesiologists with added qualifications in Pain Medicine, a physiatrist, psychologists and advanced practice providers. Additionally, the MCW Pain Medicine Division provides an inpatient pain service at Froedtert Hospital. Each month we train four fellows, four to five residents from the Department of Anesthesiology, one resident from the Department of Physical Medicine and Rehabilitation and occasionally a Palliative Care fellow.

During their time with the inpatient pain service at Froedtert Hospital, residents will understand and demonstrate application of the biopsychosocial model of pain in the acute care facility. The residents will be expected to formulate multidisciplinary treatment plans for these patients and coordinate care amongst the various disciplines. Assisting with discharge planning for pain will also be expected when needed.

Perioperative Evaluation and Testing

Perioperative Evaluation and Testing

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.

Practice Management

Practice Management

Locations: Froedtert Community Memorial in Menomonee Falls

This 2-week rotation for CA3 residents provides a foundation in practice management issues they are likely to encounter as they enter practice. Through a standardized curriculum and experiential learning in management the rotation is designed to generate life-long interest in practice management and prepare residents to understand on their first day of employment concepts related to quality reporting, perioperative management, effective communication and patient safety.

Post Anesthesia Care Unit

Post Anesthesia Care Unit

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 FH, 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.

Regional Anesthesia Acute Pain Service

Regional Anesthesia Acute Pain Service

Locations: Froedtert Hospital, Milwaukee 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. 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. In addition to performing regional blocks, RAAPS performs consults for physicians requesting assistance with their inpatients with acute pain in a RAAPS rotation assignment called FH Acute of Chronic Pain or (FH AoC). All residents are expected to complete the basic and advanced modules in the Anesthesia toolbox while on the rotation. Compliance is monitored and those with inadequate progress will have time away from procedures to catch up.

 

VA

The Regional Anesthesia and Acute Pain (RAAPS) elective rotation at the Clement J. Zablocki Veterans Affairs 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. Residents may have Froedtert weekend and/or holiday call obligations on a limited basis during this elective VA rotation in order to help out their colleagues.

Airway Focus

Airway Focus

Locations: Froedtert Hospital

Patients will be properly selected (ASA 1&2) with normal airways (for CA-1s) and the in-charge faculty chooses the best room for the resident and their trainer on the prior day taking patient selection into consideration. For CA-3s, more complex and challenging airway management cases will be assigned to them during their airway block.

Residents will get to use:

  1. Flexible fiberoptic bronchoscope (at least 10/month)
  2. Different types of laryngoscope blades, stylets, Eschmann introducers
  3. Different types of Videolaryngoscopes

Airway residents will also be given the priority to manage patients in whom awake intubation is indicated. Airway blocks as well as nasal and oral awake FO intubation will be taught.

Perfusion Medicine

Perfusion Medicine

Locations: Froedtert Hospital

This rotation offers residents interested in cardiothoracic or critical care fellowships an opportunity to learn the physiology and mechanics of cardiopulmonary bypass and mechanical circulatory support devices now in use in the FMLH ORs and CVICU.

Pediatric Anesthesia

Pediatric Anesthesia

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 or early CA-2 year. CA-2 and CA-3 residents may 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, and Pediatric ENT.

Pediatric ENT Focus

Pediatric ENT Focus

Locations: Children's Wisconsin

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. While on this rotation, residents are exposed to the evaluation of pediatric patients in the outpatient setting, inpatient consults, and in the operating room.

Out of the OR

Out of the OR

Locations: Children's Wisconsin, Milwaukee VA Medical Center

Pediatric

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 (OOR) 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.

 

VA

A two-week assignment at the Zablocki VA Medical Center with self study material and mentored experiences in GI, Radiology, EP, Cath lab and Pulmonary procedural areas in adult patients. Each resident trainee participates in a 2-week rotation in the major (stand-alone) non-operating room anesthesia sites during their CA-3 year of training.