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The Department of Anesthesiology Residency Education ProgramOverviewThe Clinical Base Year (CBY) Clinical Anesthesiology - A Progression of Personal Growth Clinical Anesthesiology - The CA-1 Summer Orientation Program Clinical Anesthesiology - A Superior Clinical Case Experience Clinical Anesthesiology - The Faculty Clinical Anesthesiology - Subspecialty Rotations Ambulatory Anesthesia Cardiac Anesthesia Critical Care/Trauma Neuroanesthesia Obstetric Anesthesia Pain Management Pediatric Anesthesia Postanesthesia Care Preadmissions Evaluation Regional Anesthesia Thoracic and Vascular Anesthesia Liver Transplant Anesthesia OverviewThe anesthesiology residency consists of a minimum of four postgraduate years:
 The Clinical Base Year (PBY-1)Through the NRMP, we offer both four-year (Categorical) and three-year (Advanced) positions. Those who enter the three-year Advanced program arrange for their own PGY-1 training; preliminary programs in internal medicine are offered in Rochester at Rochester General Hospital (585-922-4440) and Unity Health System (585-723-7775). Students who enter our four-year categorical program spend the first year in the Department of Anesthesiology’s rotating internship. The PGY-1 is under the direction of the Anesthesiology Residency Program Director and the clinical experience is obtained through residency programs of the University of Rochester. Our PGY-1 is specifically designed to prepare the resident for subsequent anesthesiology training. Rotations include:
Additionally, each PGY-1 resident enjoys one month of vacation time.  Clinical Anesthesiology – A Progression of Personal GrowthThe first months of anesthesia training are spent learning and mastering basic anesthetic techniques including airway management and regional anesthesia. Thereafter, the resident is immersed in the various subspecialties of anesthesia through structured subspecialty rotations. As the resident gains experience, he/she manages increasingly difficult and complex cases. Residents are given more responsibility and freedom in planning and conducting anesthetics for their patients. In addition, residents gain greater independence in their supervisory roles as senior residents on-call. The CA-3 year is individualized within the guidelines of the American Board of Anesthesiology (ABA); the Department remains as flexible as possible in accommodating the needs of its residents in arranging their CA-3 year. Senior residents choose advanced clinical experiences or pursue interests in clinical or basic science research.  Clinical Anesthesiology – The CA-1 Summer Orientation ProgramThe first months of residency training in anesthesiology are the foundation for the three years of growth to follow. More than that, they are the foundation of your career in anesthesiology. These first months are a period of tremendous and rewarding personal growth! We have designed a Summer Orientation Program that eases the anxiety of the unknown and the new. The Program specifically facilitates the rapid development of the new trainee, in a supportive and nurturing environment. Our Summer Orientation Program enables the CA-1 resident with little or no previous experience to progress to a level of confidence and competence in basic pre-anesthetic evaluation and intraoperative anesthetic management in a short period of time. This is how we do it.
 Clinical Anesthesiology – A Superior Clinical Case ExperienceThe clinical cases that you will manage during your three-year training experience truly represent the cornerstone of your training. Your clinical case experience is vitally important! Clinical case exposure must be a top priority in considering anesthesiology residency training.  The University of Rochester Program offers an abundance of clinical cases in all surgical subspecialties. The Department provides over 30,000 anesthetics each year for every type of surgical procedure. The size of our residency program is appropriate relative to a very large surgical caseload. This ensures that each resident is assigned cases matched to his/her level of training, and to cases that are appropriate for his/her subspecialty rotation. By accepting a limited number of postgraduate fellows, we further ensure that the residents’ clinical experience is not adversely affected by competition for complex senior-level cases. These unique features of our program have been a major contribution to our graduates’ success and superior clinical training. The clinical anesthetic caseload experienced during training at this program includes the following: 
General SurgeryPediatric SurgeryOrthopedicGynecology/Oncology Obstetric CardiacNeurosurgeryThoracicMajor vascularOrgan TransplantationAmbulatory Plastic SurgeryTrauma"Out of OR" Anesthesia (2-3 sites daily) Clinical Anesthesiology – The FacultyDaily clinical supervision and instruction is provided in a faculty to resident ratio of 1:2 or 1:1, depending on each resident’s level of experience and the particular subspecialty rotation. Individualized clinical instruction occurs not only in the OR, but also in discussing the next day’s anesthetic cases, at bedside in the pre-anesthesia area, at the end of the day while reviewing the day’s cases, in the ICUs, Pain Management Clinic, and Pre-Admission Evaluation Center. The majority of the Department’s full-time teaching faculty are subspecialty-trained and most have research interests. The training backgrounds and experience of our faculty are highly diverse, providing the benefits of heterogeneity in clinical approach and techniques. The faculty are enthusiastic and energetic, committed to excellence in resident education. Clinical Anesthesiology -- Subspecialty Rotations After mastering basic anesthetic principles and techniques during the first few months, residents begin the first of many subspecialty rotations. In addition to the structured subspecialty rotations required by the Anesthesiology Residency Review Committee (RRC), we offer several subspecialty rotations that we believe are also critically important (preadmission evaluation, regional anesthesia, thoracic anesthesia, vascular anesthesia, and liver transplant anesthesia). During each subspecialty rotation, the resident focuses exclusively on that subspecialty. Formal subspecialty rotations include:  Each subspecialty has developed its own comprehensive curriculum to supplement the main didactic series. Subspecialty faculty have fellowship training and are subspecialty board-certified when such examinations are available. In addition, the subspecialty faculty actively publish articles in subspecialty journals and are active in subspecialty societies. A description of each subspecialty rotation follows. Ambulatory AnesthesiaResidents gain experience in ambulatory anesthesiology at both Strong Memorial Hospital (SMH) and the Lattimore Community Surgicenter. The Ambulatory Surgical Center (ASC) at Strong has several thousand visits per year, covering all types of surgery. From the first day of training, residents are exposed to ambulatory cases that are integrated into daily operating room assignments. Senior residents gain valuable experience in ambulatory anesthesia with full month rotations at Lattimore Community Surgicenter, where several thousand cases are performed each year. This experience offers our residents a unique training opportunity in a high volume, rapid turnover, private practice, day-surgery facility.  Cardiac AnesthesiaResidents rotating on the Cardiac Anesthesiology Service are exposed to an integrated program combining clinical experience and didactic teaching. The cardiac team provides coverage for approximately 1,000 open-heart operations per year. These operations include coronary artery bypass surgery (with and without the use of cardiopulmonary bypass), valve replacement and repair, operations involving diseases of the aorta, heart failure surgery (e.g., insertion and removal of ventricular assist devices), heart transplantation, and both pediatric and adult congenital heart defect repairs. Additionally, residents participate in the management of approximately 50 descending thoracoabdominal aortic repairs per year. Residents are exposed to many aspects of cardiovascular care of the surgical patient, including: During the introductory rotation, residents are exposed to the principles and practice of cardiac anesthesia and develop skills in the use of invasive and non-invasive monitoring of the cardiovascular system. The didactic program includes morning conferences twice a week and a comprehensive but manageable recommended reading. The curriculum provides residents with a thorough understanding of the principles of cardiovascular physiology, disease, and pharmacology and helps the resident develop sound clinical judgment in the management of patients undergoing cardiac surgery and those with severely compromised cardiac function. At the CA-3 level, the goal of elective rotations is to extend the application of the principles of cardiac anesthesia to patients with increasing degrees of cardiac pathology. The goals and program are flexible, and are developed with input from the resident who elects additional time on this service. Senior residents may spend time in specialized training for the use of transesophageal echocardiography. Critical Care/Trauma
The Critical Care experience is divided into two one-month rotations. The first month is spent in the SMH Surgical Intensive Care Unit (SICU), a high acuity 15-bed unit that provides care for transplant, thoracic, ENT, urology, and other critically ill patients. The extensive educational curriculum deals with critical care related entities as well as topics of special interest for anesthesiology residents. The didactic program includes formal daily lectures by the Critical Care faculty. The participation of Critical Care fellows, medical students, and residents from general surgery, emergency medicine, ENT, and urology makes this a rich and rewarding experience for our residents. The second critical care rotation is in the burn/trauma ICU. There, the CA-2 resident gains advanced experience in the management of critically ill trauma patients as well as ill orthopedic and neurosurgery patients. Residents are taught by ICU boarded anesthesiologists and surgeons on a rotating basis. For residents with even the slightest interest in critical care medicine as a career, this rotation offers a unique chance to examine firsthand the complete range of opportunities for anesthesiology-trained physicians in this field. Senior residents interested in research have an opportunity to participate in ongoing clinical trials or laboratory projects. Elective rotations in the SMH Pediatric ICU and Neonatal ICU are additional possibilities.  NeuroanesthesiaWhile rotating through neuroanesthesia, residents provide anesthetic care for diverse neurosurgical cases, including craniotomies for removal of tumors, arteriovenous malformations, and aneurysms. Because SMH is the region’s trauma center, residents gain valuable experience in the anesthetic management of head trauma and in airway management of cervical spine injuries. SMH is a leader in performing “awake” craniotomies for the surgical treatment of intractable epileptic seizures. The hospital cares for the majority of pediatric neurosurgical patients in the region. During the rotation, residents gain a complete understanding of the physiology and pharmacology of the brain, special considerations in neurosurgical patients (including monitoring and positioning), and safe anesthetic management for a variety of neurovascular diseases. Residents learn through hands-on operating room experience and formal structured didactics. In addition to traditional topics in neuroanesthesia, advanced subjects such as brain protection and intraoperative monitoring of neural tissue integrity are taught. This approach provides a comprehensive experience that should enable the graduate to provide quality anesthetic care to a wide variety of neurosurgical patients. Obstetric AnesthesiaThe obstetric (OB) anesthesiology service is responsible for the anesthetic care of pregnant women at Strong Memorial Hospital, which is the regional referral center for highrisk obstetrics. Therefore, residents gain extensive experience with both healthy and critically ill parturients. The annual delivery rate is approximately 3,200 patients, with a cesarean section rate of 30%. The majority of parturients elect neuraxial analgesia during labor. The core curriculum in OB anesthesiology consists of weekday didactic sessions provided by faculty and based on daily reading assignments. The core curriculum functions in parallel with the many educational experiences gained on this busy clinical service. During their rotation in OB anesthesiology, residents obtain a thorough understanding of maternal/fetal physiology and pharmacology, management of high-risk parturients, including the proper utilization of invasive monitoring and perioperative care of coexisting diseases that may occur during pregnancy. Senior residents electing additional experience in OB anesthesiology participate in an advanced curriculum. Many opportunities exist for resident participation in ongoing research, if desired. All of these factors contribute to a multitude of educational opportunities for residents rotating through OB anesthesiology. Pain ManagementThe Division of Pain Management focuses on the relief of the pain and suffering that afflicts postsurgical patients, as well as individuals experiencing trauma, cancer, and chronic pain syndromes. The Division’s faculty are all subspecialty board certified/eligible. There are three rotations offered for the anesthesiology residents: A twoweek introductory rotation for CA-1 residents is designed to teach the basics of acute postoperative and post trauma pain management in an inpatient setting. The residents are exposed to a huge variety of cases, getting initiated into a consultant role by providing consultations under the guidance of subspecialty trained faculty for all hospital based clinical services.  A mandatory one-month rotation is offered to residents in their CA-2 year. Residents are involved in both the outpatient pain clinic and the inpatient pain service. Daily Inpatient Pain Service Rounds give the resident a thorough and intensive experience managing a busy inpatient service that includes both acute and chronic pain patients. Residents are exposed to all modalities available for acute pain management in adults and children, and develop a thorough understanding the physiology of acute pain and the perioperative stress response. More than 1,000 patients of all age groups (neonates included) are admitted to the Acute Pain Service each year. Routine management methods include thoracic, lumbar, and caudal epidural analgesia, patient-controlled analgesia, intrapleural analgesia, and peripheral nerve and plexus catheters. The Outpatient Pain Clinic is scheduled several times each week, and approximately 100 new evaluations and 200 follow-up visits each month provide an outstanding opportunity to gain intensive experience in the evaluation of outpatients with various pain syndromes, and in the formulation and implementation of treatment plans. Residents learn about the physiology of chronic and cancer pain, and the use of invasive and non-invasive modalities for its treatment. Block Clinic is scheduled three times a week, and offers a hands-on experience performing many procedures designed to help alleviate pain, including neuraxial and peripheral blocks, sympathetic blocks, radiofrequency ablation, neurolytic blocks under fluoroscopic guidance and surgical implantation of spinal cord stimulators and intrathecal pumps. During the CA-3 year, residents may elect further advanced experience in pain management with individualized learning objectives, focused on learning the administrative, compliance and financial aspects of an academic pain practice. Residents spending 12-24 Pediatric Anesthesia weeks assume responsibilities of a junior fellow and are actively involved in teaching medical students and nursing staff. Residents interested in research in the field of pain management may join several ongoing projects in this Division. There are weekly three-hour didactic sessions covering the basics and the advanced topics in the field of pain management. These sessions are held every Monday morning and are provided by subspecialty trained faculty, fellows, clinical psychologists, and a variety of guest speakers from various disciplines involved in the field of pain management. The clinical activity during these sessions is minimal to optimize the resident’s learning experience. These sessions are in addition to the didactic lectures offered by the Pain Division as a part of the general morning lecture sessions for the residents. Pediatric AnesthesiaThe Golisano Children’s Hospital at Strong serves as the region’s only tertiary-care referral center for pediatric patients, including neonatal, burn and trauma. The Department of Anesthesiology cares for approximately 6,000 pediatric patients per year, of whom many are outpatients and approximately half are under two years of age. Residents receive a onemonth introduction to pediatric anesthesiology during their CA-1 or CA-2 year. Residents gain knowledge of pediatric physiology, common pediatric and neonatal surgical problems, regional anesthesia for children, pediatric airway management, and vascular access techniques. Like all other divisions, the Division of Pediatric Anesthesiology has its own active teaching program. The CA-3 resident may elect to spend up to six months dedicated solely to pediatric anesthesiology. This is arranged on an individual basis with the Director of Pediatric Anesthesiology to best meet the needs of the resident. The full-time pediatric anesthesiologists hold dual appointments in the Department of Pediatrics at the Golisano Children’s Hospital at Strong. Resident participation in the pediatric anesthesia clinical research program is available. 
Postanesthesia CareThis rotation provides clinical experience and directed independent study to allow the resident to manage patients recovering from general and regional anesthesia for all types of surgical procedures. The resident achieves competence in recognition and management of common PACU problems, as well as effective communication with the surgical and nursing services and the primary anesthesia team. When problems arise that require intervention, the PACU resident makes an initial assessment, institutes therapy in urgent situations, and presents the problem, assessment, and proposed interventions to the intraoperative attending anesthesiologist. The ensuing discussion provides continuous learning and direct feedback from the attending through resolution of the clinical problem. The resident consults pertinent reference sources during and after the management of specific PACU problems. During the month, each resident keeps a log of patients treated and discusses it with the rotation director. The resident presents patients whose cases serve to illustrate difficult and/or complex PACU management challenges. Each resident also prepares a formal didactic presentation for the PACU nursing staff. Preadmission Evaluation
The Department of Anesthesiology operates the 14-room Preoperative Evaluation Center for both routine and consultative evaluation of patients before surgery. The resident learns to effectively evaluate patients preoperatively and to modify anesthetic risks in patients with signifi- cant comorbid conditions. Residents become expert at ordering and interpreting appropriate laboratory and diagnostic tests to optimally prepare each patient for anesthesia. For example, our close relationship with the Department of Cardiology enables us to obtain quick preoperative testing (echocardiography, stress testing) or cardiology consultation when indicated. Residents also communicate with other physicians (e.g., PCPs, surgeons, specialists) to ensure each patient arrives optimally prepared on the day of surgery. Regional Anesthesia
The goal of the Regional Anesthesia rotation is proficiency in the delivery of effective and safe regional anesthesia. Residents gain experience with all regional anesthetic techniques, including intravenous (Bier blocks), epidural (thoracic and lumbar), peripheral upper extremity (interscalene, supra-/infraclavicular, axillary), lower extremity (femoral, sciatic, ankle), and cervical plexus blocks. Residents learn to perform upper extremity blocks with and without ultrasound guidance. Dedicated experts in regional anesthesia provide the daily supervision and guidance to residents during this 4-week CA-2 rotation. Didactic activities include a formal lecture series and informal one-on-one discussions with the faculty. Residents put to good use the regional anesthesia atlas they receive at the beginning of their training. Residents participate in this Division’s popular annual workshop on relational anatomy for central and peripheral regional anesthetics. The workshop includes cadaveric prosections and live human models. Thoracic and Vascular AnesthesiaThe Section of Thoracic Surgery at SMH covers the full spectrum of thoracic and esophageal disease. Residents provide anesthesia for lung and esophageal tumor resection, lung reduction surgery, tracheal surgery, laser bronchoscopy, and video-assisted thoracoscopic surgery. Our graduates are highly proficient in the management of these challenging cases, including the use of the fiberoptic videoscope and double-lumen endotracheal tubes. The Section of Vascular Surgery performs approximately 200 carotid endarterectomies, 150 aortic aneurysm repairs, and more than 250 lower extremity bypass operations per year. Many cases can now be performed with the new innovative endovascular stent procedures. More than 130 endovascular stent procedures on the aorta (50% of total stent procedures), carotid and peripheral arteries occur annually. This rich clinical experience provides our residents with the opportunity to perfect their skill in caring for patients with cardiac disease undergoing noncardiac surgery. The resident learns many basic skills, including central venous and pulmonary artery catherization, the use of potent vasoactive and cardiac drugs, and management of signifi- cant blood loss and its complications. In addition to general anesthesia, regional anesthesia is routinely used, including cervical plexus blocks for carotid surgery, regional blocks (femoral and sciatic) and continuous spinal techniques for peripheral bypass surgery, as well as thoracic epidural catheters for postoperative pain management in patients undergoing abdominal aortic surgery. Residents spend focused and concentrated two-week rotations on both thoracic and vascular services to prepare for the numerous thoracic and vascular cases they manage throughout the next two years.  Liver Transplant AnesthesiaStrong Memorial Hospital is a leader in liver transplantation. Highly skilled surgical and anesthesiology teams perform approximately 125 liver transplants per year, including 30 live donor transplants. Each resident spends about 4 weeks on the transplant service. During this time the resident becomes adept at monitoring and treating severe coagulopathies, massive blood loss, acid-base disorders, and acute life-threatening electrolyte abnormalities. |
