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Rotations

CA-1 year:

8.5 months general OR experience

1 month obstetric anesthesia

1 month pain management (focus on acute pain management; evaluation, examination and consultation of acute and chronic pain patients).

1 month preadmission testing

2 weeks post anesthesia care unit

CA-2 year – One month rotations in the following subspecialties:

Pediatrics

Cardiothoracic anesthesia

Pain management (focus on regional anesthesia for post-op pain, catheter techniques, chronic pain and procedures).

Obstetrics

Neuroanesthesia

Pediatric ICU

6 months general OR experience

CA3 year – One month rotations in:

Advanced neuroanesthesia

Advanced cardiothoracic anesthesia

Surgical intensive care unit

Advanced clinical anesthesia

Non-operating room (“outside”) anesthesia- 2 weeks (includes MRI, endoscopy, pain management, cardiac cath, peds oncology, interventional radiology).

In the remaining 8 months residents may choose to do 1-3 months of cardiac, obstetrics, pediatrics, pain management, neuroanesthesia, regional anesthesia, or critical care.

Preadmission Testing: ( Jonathan Markley, Director)

During this one month CA1 rotation, the resident evaluates, prepares, optimizes and educates the patient who will be coming in for scheduled surgery. Residents will become adept at history taking and physical exam, learn how co-existing diseases affect and are affected by surgery and anesthesia, and create an anesthetic plan appropriate for the patient. The PAT resident will learn the appropriate and cost effective ordering of lab studies, medical and subspecialty consultation prior to surgery. Complex patients will be presented to the attending in charge for additional consultation and planning.

Cardiothoracic Anesthesia: (Suhaib Akhtar, Director, SJUMC< Harish Nandigam, Co-Directors, SMMC)

Cardiothoracic anesthesia training occurs primarily during the CA2 and 3 years at both the St. Joseph’s Cardiac Institute and St. Michael’s Medical Center where over 1500 cardiac and thoracic surgical procedures are performed each year. Residents will learn management of on and off pump cardiac bypass, valve replacement, trans-aortic valve repair (TAVR), thoracic aneurysm repair, open thoracotomy and video-assisted thoracoscopy (VATS), cardiac catheterization and electro physiologic ablation. Residents will become adept at the insertion and interpretation of invasive monitors, transesophageal and transthoracic echocardiography (TEE/TTE), placement of double lumen tubes and bronchial blockers and management of one-lung ventilation.   

Critical Care Medicine: (Alan Sori, Director Surgical Intensive Care Unit)

The Critical Care rotation takes place during the CA2 and CA3 years. Our residents are fully integrated into the SICU care team at SJUMC learning the hemodynamic and ventilatory management of critically ill patients with a wide variety of surgical and coexisting medical issues.

  Neurosurgical anesthesia: (Daria Costa, Director)

For a month in both the CA2 and CA3 years, residents participate in a variety of intracranial, neurovascular and spine surgeries. They will learn principles of EEG and evoked potential monitoring, brain protection, total intravenous anesthesia, controlled hypotension, management of increased intracranial pressures, the awake craniotomy and traumatic brain injury. Residents will also manage endovascular procedures in the neurointerventional suite.

Obstetric Anesthesia: (Seth Landa, Director)   

St. Joseph’s Regional Medical Center has a high-risk obstetrics department with over 3,700 deliveries each year. Residents care for parturients with preeclampsia, hemorrhage, cardiac disease and multiple births (including one set of quintuplets!). CA1 residents quickly become adept at performing spinal and epidural anesthesia, managing labor analgesia, elective and urgent cesarean section and post-operative pain.  CA2 and 3 residents become adept at handling the most challenging regional anesthetics and become expert in the management of the pregnant patient with co-existing disease. Residents are expected to formulate an anesthetic plan for the medically complicated obstetric patient together with the patient’s obstetric team and medical consultants. The team approach is emphasized throughout training and simulations will involve nursing and obstetric personnel. Residents are also expected to teach the basics of obstetric anesthesia to our rotating medical students.

 Pain Management: (Harini Krottapalli, Director)

Under the guidance of our Board-certified pain management physicians, residents will rotate for a month in each of their 3 years with an option for additional CA3 training for those interested. In addition to our busy hospital-based acute pain practice, residents will have the unique opportunity of rotating through local outpatient pain centers providing a variety of services and procedures in a private practice setting. The CA 1 experience focuses on learning the examination and evaluation of the pain patient, and formulating a plan for acute and post-operative pain management; the CA 2 rotation emphasizes regional blocks and pain procedures as well as developing a multi-disciplinary approach to chronic pain management; while the CA 3 will learn office–based management of chronic pain and advanced procedures.   

 Pediatric Anesthesia: (Stephen Winikoff, Director)

St. Joseph’s has a state designated 120-bed Children’s Hospital.  During the CA2 and CA3 rotations residents will be exposed to the full gamut of routine and advanced pediatric cases and neonatal surgeries, as well as pediatric intensive care, pediatric cardiac surgery, neurosurgery, ENT, craniofacial repairs, and genitourinary surgery. Our residents participated in the first (and only!) separation of conjoined twins in New Jersey history. Residents will also learn pediatric pain management including regional techniques and participate in sedations for MRI, cardiac cath, endoscopy and oncology procedures. With our pediatric specialty-trained attendings providing supervision and training, and an abundance of cases, graduating residents take with them the needed skills and knowledge to be comfortable with both basic and advanced pediatric surgery.

Postanesthesia Care Unit :  

The goal of this rotation is to provide residents with the knowledge skills and clinical experience to provide care for patients recovering from general, regional and monitored anesthesia care. Residents will become competent at recognizing and managing common PACU problems and more serious crises, with emphasis on effective communication with the appropriate surgical, medical, nursing services and the primary anesthesia team.  Residents will round and receive regular lectures on a variety of topics relating to PACU care. Residents will become familiar with ventilator management and weaning and acute post-operative pain management.

Regional Anesthesia: (Jonathan Markley, Jared Miller, Co-directors)

 With busy orthopedic, trauma, vascular, podiatric and plastic surgery services, our residents will have plenty of exposure to regional techniques throughout training as well as during their CA2 pain rotation and CA 3 regional month. Residents will learn central neuraxial anesthesia and a wide variety of peripheral nerve blocks done under ultrasound guidance.  They will hone their skills in the Simulation Lab on models and experience an ultrasound visualization workshop with live volunteers. Our faculty includes several fellowship-trained regional specialists and many others who share a passion for providing optimal intra and post-operative care utilizing regional techniques. Throughout training, residents will receive lectures on the latest cutting edge techniques and outcome studies on the benefits of the various procedures. Our residents become adept not only at providing expert intraoperative care but will also recognize the importance of regional anesthesia in providing enhanced recovery after surgery (ERAS). Minimum required numbers are met early in training and our graduates are very comfortable with these valuable, essential skills.  

Non-operating Room Anesthesia: (Jeffery Lake, Director)

Residents will learn to safely deliver anesthetics in a variety of non-operating room settings with unique challenges including MRI, interventional radiology, cardiac cath, endoscopy, bronchoscopy, pediatric oncology and more.