Department of Anesthesiology & Perioperative Care: School of Medicine: University of California, Irvine

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Clinical Rotations

Fundamental Clinical Skills Education (PGY-1)

The Fundamental Clinical Skills Education year is designed to create well-rounded perioperative physicians, with a wide variety of clinical specialties and clinical environments. Residents rotate through these locations in four week blocks, concluding together as an intern class with the anesthesiology rotation in the month of June.

left quotation  Clinical base anesthesia resident This year provided a great basis for my anesthesiology residency. I cared for a wide variety of patients with many different disease processes including CHF, COPD, renal failure and septic shock among the many. This allowed me to better understand the pathophysiology of these diseases and how they may effect how I will care for patient at the OR in the future. Additionally, I developed my bedside manner during this year while interacting with patients from a wide variety of backgrounds. This included even very serious family meetings that I was charged with leading and learned how to discuss these sensitive issues with my patients. Finally, I was able to get to know many of the other residents from different programs who I now work with both inside and outside the OR.  left quotation

Margaret (Peggy) Riso, MD (Resident Class of 2019)

UC Irvine Anesthesiology

This rotation is designed to provide residents an early introduction and orientation to the university anesthesia practice. The focus is on the following areas: fundamentals of preoperative evaluation, proper airway assessment and introduction to airway management options, intraoperative monitoring, anesthesia pharmacology and basics of postoperative issues, including pain control.

UC Irvine Emergency Medicine

The emergency medicine rotation is a four-week rotation through the UC Irvine Health Department of Emergency Medicine. UC Irvine Medical Center is the primary trauma hospital for Orange County and the resident will experience a broad range of both acute trauma and medical emergency room admissions. The resident will work with members of the emergency medicine faculty and residency to gain an understanding of the diagnosis and initial treatments of common critical emergencies.

VA Long Beach Healthcare System Critical Care

The VA Long Beach Healthcare System critical care rotation consists of 12 weeks: eight weeks in Medical Intensive Care Unit (MICU) and four weeks in Surgical Intensive Care Unit (SICU). The purpose of the critical care rotation is to teach residents the major aspects of understanding and managing patients with critical medical illnesses and to apply these principles to management of the post-surgical critically ill patient. The physiologic, psychosocial, diagnostic and treatment aspects of critical illness will be addressed. The resident is expected to gain and expand their cognitive knowledge, procedural and interpersonal skills.

VA Long Beach Internal Medicine

This rotation consists of six four-week blocks on the medical wards and intensive care unit (ICU) at the VA Long Beach. The resident will be responsible for admitting and managing patients on the internal medicine service, teaching medical students, providing feedback to medical students and doing post hospital follow up on their patients. Residents also have the opportunity to participate in electives in GI, cardiology, pulmonology, and infections disease, which will further their understanding of the management of patients in the perioperative environment. At least one rotation will be at the VA Long Beach Healthcare System MICU.

Long Beach Memorial High-Risk Obstetrics

The resident will undergo a four-week rotation at Long Beach Memorial Medical Center (LBM) with the high-risk obstetrical service. In house faculty and fellows in maternal fetal medicine supervise the high-risk obstetrics service. Patients include private practice patients, maternal regional transports from Los Angeles County and Orange County and transfers for patient consultations. The resident will work with the primary team consisting of the PGY-2 OB/GYN resident, fellow and attending.

Long Beach Memorial Surgery

The resident will spend four weeks on the general surgery service at Long Beach Memorial Medical Center. The resident is primarily on the general service, but will also participate in subspecialty and trauma consults. Therefore, residents will also be exposed to a broad volume and variety of operative cases, including general, vascular, laparoscopic, colorectal, surgical oncology, thoracic, pediatric and ENT/endocrine.

Long Beach Memorial Pediatric ICU

Residents also have a unique focused experience caring for patients in the Pediatric Intensive Care Unit (PICU). The purpose of this elective is to teach residents the major key points of understanding critically ill pediatric patients and to apply these principles to management. The physiologic, psychosocial, diagnostic and treatment aspects of critical illness will be addressed. Residents will work under the direct supervision of physicians with expertise in caring for pediatric patients in the PICU.

Clinical Anesthesia Years

Clinical Anesthesia Year 1 (CA-1)

The CA-1 year is designed to give residents a firm foundation in basic anesthesiology and perioperative care. UC Irvine Medical Center serves as the primary teaching site for clinical anesthesia. Residents gain experience with providing anesthesia for a variety of cases including orthopedics, gynecology, ENT, neurosurgery, trauma, vascular and general surgery. Residents also rotate in the preoperative clinic, PACU, ICU and acute pain service to broaden their experience with perioperative care.

Clinical Anesthesia Year 2 (CA-2)

After obtaining a strong foundation in anesthesiology, residents in the CA-2 year focuses on the subspecialties of anesthesiology. Residents have the opportunity to rotate not only in subspecialties such as obstetrics, pain management, regional and cardiac anesthesiology at UC Irvine Medical Center, but also subspecialty experience at our affiliated teaching institutions.

Clinical Anesthesia Year 3 (CA-3)

The CA-3 year focuses on creating physician leaders and preparing residents for independent practice. Residents are preferentially assigned high-acuity and complex cases and participate in advanced Point-of-Care Ultrasound, operating room management and a supervisory rotation. Residents also have the opportunity to choose electives and participate in our Global Outreach Initiative.

left quotation  Clinical years anesthesia resident I have been exposed to a wide variety of surgical cases and pathology during my clinical anesthesia rotation. This has helped me be comfortable in managing all aspects of a patient's perioperative care from the healthy to the critically ill. This residency has an appropriate progression of autonomy from years CA-1 to CA-3 that has allowed me to build confidence in my skills as an anesthesia resident. A unique aspect about the rotations here is the collegial environment created amongst the faculty and residents. During the rotation, I was also able to strengthen my leadership and teamwork abilities through various responsibilities such as senior call and being team leader.  left quotation

Michael Ross, MD (Resident Class of 2017)

Acute Pain

Acute pain is a four-week experience primarily at Douglas Hospital, during which residents will rotate with the Acute Pain Service. The rotation will focus on the knowledge, skill, and experience requisite to provide optimal care for patients in acute or acute on chronic pain. Residents obtain expertise in the ability to provide care in a manner that is both compassionate and capable. Competency in diverse medical, interventional and behavioral modalities available for patients in acute pain is emphasized.

Residents gain experience in optimizing peri-procedural pain, including the concept of preemptive analgesia. In addition, residents serve as consults for the evaluation and management of acute on chronic pain resulting from a variety of pathologies in the hospital setting. Placement and management of lumbar and thoracic epidural continuous catheters as well as peripheral regional nerve block catheters for various acute pain conditions are included as treatment techniques. Residents learn optimization of multimodal analgesic care plans for seamless postoperative discharge.

Ambulatory

Residents rotate on ambulatory anesthesia for one month during which they care for patients receiving outpatient procedures and learn the distinction of caring for this group of patients. At the Outpatient Surgical Services (OSS) patient care area, they house four ambulatory surgery operating rooms. This experience is excellent for a mixture of cases that include orthopedic, pediatric, head and neck, oncologic and ophthalmologic surgical cases. The OSS is fully equipped with the same state-of-the-art anesthesia equipment as the main hospital operating rooms to provide consistency between anesthetizing locations. Residents rotating through OSS are exposed to high-volume, rapid turnover schedules.

Cardiovascular Anesthesia

Residents spend a total of two months rotating in cardiac anesthesia. One month at UC Irvine Medical Center and a second month at Kaiser Permanente Los Angeles Medical Center. At UC Irvine Medical Center, there are a wide spectrum of adult cardiac surgical procedures being performed, including coronary artery bypass procedures on and off cardiopulmonary bypass, valve repairs and replacement, open and endovascular repairs of aortic dissections and aneurysms and congenital cardiac defect repairs. As a tertiary care center, our patients are usually complicated and high risk compared to the local community hospitals.

All of our cardiac anesthesia operating rooms are state-of-the-art. Transesophageal echocardiography (including 3D TEE) is routinely utilized for cardiac surgical procedures. The anesthesiology faculty member makes the TEE report, not an outside cardiologist.

Residents are trained in evaluating a patient with heart disease, cardiovascular physiology, placing and interpreting invasive monitors (PA catheters), TEE, cardiopulmonary bypass, circulatory arrest and ventricular assist devices.

In addition to the procedures performed in the main operating rooms, our anesthesiologists also provide anesthesia services for procedures performed in the cardiac cath lab, neonatal intensive care units and electrophysiologic interventions. Senior residents can rotate at Kaiser-Sunset Medical Center on a month-long customized cardiac rotation.

Chronic Pain

Truly interdisciplinary, the chronic pain rotation occurs during a one-month block during the CA-1 year, with optional elective time during the CA-3 year. The resident will become an expert at interventional pain management, opioid and adjunctive medication management, as well as non-interventional pain management. Personalized physical and occupational therapy, offloading therapy, acupuncture, advanced interventional procedures, electrodiagnostics, psychological and cognitive therapies and regional anesthesia are common treatment modalities used at the UC Irvine Medical Center.

The resident exposure provides both outpatient chronic pain clinical care and procedures in a busy outpatient patient pain service that provides residents with exposure to a high volume and large variety of ultrasound guided nerve blocks as well as fluoroscopic-guided injections. Our group of unique faculty has additional expertise in pediatric pain, practice management and quality and safety, including leading in safe opioid prescribing. The team includes ACGME Pain Medicine fellows, nursing, physiatrists, anesthesiologists, neurologists as well as strong relationships with surgeons.

The rotation emphasizes a very busy interventional experience with appropriate and safe medical management of pain medications, including safe opioid prescribing. The resident will develop a skill set in diagnosing and managing a wide array of pain conditions, as well as psychological co-morbidities, cancer pain, pelvic pain, spasticity and orthopedic injury. The curriculum fosters scholarly development in pain for the resident and hopes to develop a strong interest in the study of pain medicine.

Critical Care Medicine

Being the only Level I trauma center in Orange County, UC Irvine Medical Center has a very busy Surgical Intensive Care Unit (SICU). Residents rotate through the SICU for one month during the CA-1 year and are supervised by a mixture of a critical care anesthesiologists and surgical critical care physicians. During this month, residents have the opportunity to care for sick patients from many surgical services, to understand the breadth of preoperative care, and to work closely with their surgical colleagues. As CA-3’s, residents complete a senior ICU rotation in SICU, MICU, or Neonatal ICU. The resident feedback about these rotations has been phenomenal, particularly citing their supervisory roles and the chance to manage multiple patients simultaneously, flexing their evolving perioperative medicine skills. The ICU rotations offer significant clinical experience and great teaching about common critical care issues. They also offer a great opportunity to coordinate patient care with the surgical colleagues on a daily basis.

Neuroanesthesia

Neuroanesthesia encompasses experiences in neurosurgery and neuro-radiological interventions in radiology suites. The neurosurgical anesthesia service has expanded over the last several years and provides an opportunity to gain experience in anesthetic management of complex intra- and extra-cranial neurosurgical procedures. Multiple neurosurgeons operate four to five days each week. They cover a broad range of neurosurgical procedures including stereo-tactic surgery, intracranial masses, cerebrovascular diseases, pituitary techniques, spine, movement disorders, and epilepsy. As a tertiary care center, residents will experience providing anesthesia for advanced techniques such as intraoperative CT, away stereotactic procedures, and awake craniotomies. Additionally, UC Irvine Medical Center places implants in patients suffering from movement disorders that offer residents very valuable experience in the asleep, awake, asleep pattern of anesthesia.

Our residents also interact with neurologists and electrophysiology technicians during intra-operative monitoring of somatosensory and motor evoked potentials, EEG, electromyography, and brain stem auditory evoked potentials. Various intraoperative monitoring allows the residents to learn about managing patients with total IV techniques and/or avoiding muscle relaxants.

Residents are assigned a dedicated Neuroanesthesia rotation for two months during residency, but also participate in neurosurgical cases on a regular basis during general OR months. To provide the best education and experience in neuroanesthesia, changes will be made as need arises.

Obstetric Anesthesia

The division of obstetric anesthesia at the UC Irvine Medical Center is a core component of residency training and anesthesia care. Each anesthesiology resident spends one month on obstetric anesthesia rotation in the CA-1 year and acquires basic knowledge of obstetric and neuraxial anesthesia, specifically epidural anesthesia and spinal anesthesia. Anesthesia residents will be closely supervised by attending staff and receive hands-on teaching. Each resident then spends another month at the Long Beach Memorial Medical Center during the CA-2 year to refine techniques.

The labor and delivery suites at UC Irvine Medical Center have an average of 120 deliveries per month with two dedicated operating rooms for obstetric cases. Although the number of total deliveries is modest, there are large numbers of high-risk obstetric patients because of our Newborn Intensive Care Unit (NICU). The 45-bed NICU at UC Irvine Medical Center is one of only two Level III Newborn Intensive Care Units in Orange County and the team has vast experience in taking care of sick newborns. Partly for that reason, UC Irvine Medical Center takes many high-risk parturient referrals from other community hospitals. We routinely manage high-risk conditions such as prematurity, pre-eclampsia/eclampsia, labile diabetes mellitus, placenta accreta, and both maternal and fetal cardiac problems.

The anesthesia department provides 24-hour coverage for labor analgesia, cesarean sections, and post-partum procedures. Since UC Irvine Medical Center has high number of sick mothers, it is sometimes necessary to place invasive monitors and perform extensive volume resuscitation.

In the CA-3 year, there is an option of another one month rotation at Long Beach Memorial Medical Center for additional obstetric anesthesia experience for residents interested in an obstetric emphasis.

OR Management and Supervisory Rotation

This two-week course for CA-3 residents is designed to recognize the progressive authority and responsibility and assist with the transition to attending anesthesiologist. Senior residents will have the privilege to supervise, educate and assist junior residents intra-operatively with faculty oversight. This supervisory role allows residents to further refine their clinical decision-making skills as they progress towards independence. Residents will also play a key role as a member of the operating room management team. Throughout the rotation, residents will gain insights into the knowledge necessary to manage complex and variable operating room logistics, coordinate resources and delegate responsibilities in crisis situations and understand the various components that make up creating an operating room schedule on a daily basis.

Pediatric Anesthesia

Anesthesia for neonates, infants and children requires an understanding of the manner in which pediatric patients differ, anatomically, psychologically, physiologically and pharmacologically, from adults. The anesthesiologist must further understand how these differences affect the anesthesiologist’s ability to maintain homeostasis and provide necessary operative conditions during surgery and the post-anesthetic recovery period.

The pediatric anesthesia experience is comprised of a two month rotation at Children’s Hospital Los Angeles (CHLA) in the CA-2 year, as well as numerous opportunities to care for pediatric patients undergoing outpatient and inpatient diagnostic and surgical procedures during general OR rotations starting as a CA-1 (often paired one-on-one with a pediatric anesthesiologist). The CA-1 resident will also participate in a difficult airway workshop that includes a station devoted to the pediatric airway during the CA-1 year.

The CA-1 residents is expected to attain a basic understanding of the physiology and pathophysiology of infants and children. The resident shall demonstrate the ability to apply this knowledge in various clinical settings. The CA-2 resident will continue to build on knowledge and experience.

For CA-3 residents, two weeks is spent at CHOC Children’s and may elect to do additional months at Children’s Hospital Los Angeles (CHLA). They may also elect a one month rotation in the Pediatric Intensive Care Unit (PICU) at CHLA, CHOC Children's, or UC Irvine Medical Center. In addition, CA-2 and CA-3 residents, after the initial two month rotation at CHLA, will be assigned to high risk neonatal and pediatric patients at UC Irvine Medical Center. Because UC Irvine Medical Center is a high-risk obstetrical and neonatal referral center, senior residents in anesthesia have the opportunity to care for premature babies with routine as well as unusual problems. Cases include PDA ligation, laparotomy for necrotizing enterocolitis, and bowel atresias, repairs of esophageal atresia/tracheoesophageal fistula, abdominal wall defects, examination and repair of airway anomalies, repair of urological anomalies and EXIT procedures.

Perioperative Medicine

During the CA-2 year, residents will have the opportunity to build upon foundations that were developed during the previous clinical experiences and further define their role as an expert in perioperative medicine. This four-week rotation, residents will establish the specific skills involved with identifying a known Perioperative Surgical Home (PSH) patient, and the importance of implementing patient centered evidence-based protocols and clinical pathways. The manifestation of this practice will, in turn, lead to learning the skills involved with reducing risk, increasing patient satisfaction and precluding preventable complications and cancellations. Additionally, residents will be the core of our Longitudinal Perioperative Experience, where they will have the unique opportunity to follow individual patients throughout the perioperative process, including the initial preoperative assessment and optimization, intraoperative anesthetic management and postoperative consultative medicine until discharge.

Point-of-Care Ultrasound (POCUS)

The Point-of-Care Ultrasound (POCUS) rotation is a two-week rotation designed to give residents an introduction to the basics of ultrasound. Resident will learn how to begin integrating POCUS into their practice. The rotation consists of daily learning sessions taught by CA-3 resident and self-directed, online learning modules accompanied by hands-on practice on actual patients. Residents have access to hand-held ultrasound machines to practice scanning patients across clinical settings. There is also the opportunity to practice with the TTE and TEE trainers to gain experience with cardiac imaging. During the rotation the residents will also practice placing intravenous lines with and without ultrasound guidance. The rotation is a great opportunity for the residents to gain a foundation in POCUS and feel comfortable doing ultrasound exams in a clinical setting.

Preoperative Care

Anesthesia residents will spend two weeks during their CA-1 year working in the preoperative clinic under the supervision of an attending. The objective of this rotation is to become familiar with all aspects of pre-surgical management of common patient conditions.

Residents will work in conjunction with the Center for Perioperative Care team, which consists of a full-time faculty member, a nurse practitioner and support staff. The clinic is open from 7 a.m. to 5 p.m. on weekdays, and the rotating resident will see patients in clinic, perform telephone interviews and act as a consultant to surgical services.

The specific objectives of this rotation are that the resident will:

  • Build a solid working knowledge of pre-procedure management and risk stratification
  • Be able to consult patients regarding their anesthetic options and the various risks and benefits of each
  • Perform problem-based, focused pre-surgical laboratory and other testing and determine when such testing is warranted
  • Be able to consult with surgeons and other medical staff regarding the management and optimization of their patients

Regional Anesthesia

The regional anesthesia rotation is a one month rotation for all CA-2 residents and may also be taken as an elective during the CA-3 year. Residents will focus on the use of regional techniques (including both neuraxial and peripheral blocks) as both primary anesthetic methodologies and as an approach to post-operative pain management.

All of the most common and useful regional blocks will be covered, including the interscalene, supraclavicular, and axillary approaches to the brachial plexus, sciatic blocks, popliteal blocks, femoral blocks, and many of the adjunctive blocks like the musculocutaneous nerve and saphenous nerve blocks. Residents will perform most blocks using ultrasound guidance and direct visualization of the nerve, but traditional nerve-stimulator technique may be utilized along with anatomic landmarks.

The rotation is designed so that the regional resident will get maximum exposure to available block cases and will be part of a "floating" block team, helping to place blocks in pre-op holding in advance of other teams taking over for the surgical portion of the case.