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  The PGY-1 year allows for incredibly more breadth of experience compared to a distinct preliminary medicine or surgery intern year. It was like being a third-year medical student again going through different rotations, from medicine to pediatric ICU to surgery. I’ve learned so much from the variety of rotations. Working with the UCI OB-GYN and general surgery residents established a familiarity and a good working relationship for the OR in the coming years. The best part of my intern year was celebrating and commiserating with our anesthesia co-intern class about the PGY-1 year. Going through the same rotations together allowed us to form a bond as a class. I am so excited to be starting anesthesia training with this group that already feels like family.  left quotation

Grace Lee, MD (Resident Class of 2021)

UCI 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.

UCI Emergency Medicine

The emergency medicine rotation is a four-week rotation through the UCI Health Department of Emergency Medicine. UCI 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. UCI 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 UCI 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

Residents rotate with the Acute Pain Service team for one month. 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. The Outpatient Surgical Services (OSS) patient care area has four ambulatory surgery operating rooms. This experience provides an excellent mixture of surgical cases that includes orthopedic, pediatric, head and neck, oncologic and ophthalmologic cases. Residents rotating through OSS are exposed to high-volume, rapid turnover schedules.

The Comprehensive Digestive Disease Clinic (CDDC) exposes our residents to the range of outpatient gastrointestinal (GI) procedures in the GI and hepatobiliary patient population, where patients can have significant comorbidities and pose unique clinical challenges.

The CDDC and OSS are fully equipped with the same state-of-the-art anesthesia equipment as the main hospital operating rooms to provide consistency between anesthetizing locations.

Cardiovascular Anesthesia

Residents spend a total of two months rotating in cardiac anesthesia. One month at UCI Medical Center and a second month at Kaiser Permanente Los Angeles Medical Center. At UCI 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.

Chronic Pain

Truly interdisciplinary, the chronic pain rotation occurs during a one-month block during the CA-1 year, with an 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.

The resident exposure provides both outpatient chronic pain clinical care and procedures in a busy outpatient patient pain service. This provides residents with exposure to a high volume and large variety of ultrasound guided nerve blocks as well as fluoroscopic-guided injections. The pain faculty have additional knowledge in pediatric pain, practice management and quality and safety, as well as safe controlled-substance prescribing adhering to the most stringent federal and local guidelines. The pain team includes ACGME Pain Medicine fellows, nurses, physiatrists, anesthesiologists and 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 which includes safe opioid prescribing. The resident will develop a skill set in diagnosing and managing a wide variety of pain conditions as well as psychological co-morbidities, cancer pain, pelvic pain, spasticity and orthopedic injury. The curriculum fosters scholarly development in pain medicine for the resident and strives to develop a trainee interest in the study and practice of pain medicine.

Critical Care Medicine

Being the only Level I trauma center in Orange County, UCI Medical Center treats more than half of Orange County’s traumas with a diverse patient population in the Surgical Intensive Care Unit (SICU). Residents rotate through the SICU for one month during their CA-1 year with supervision from both critical care anesthesiologists and surgical critical care physicians. During this month, residents have the opportunity to manage critically ill patients from multiple surgical services to understand the breadth of perioperative care and to work closely with their surgical colleagues. Residents in their CA-3 year will again have the chance to revisit the ICU, this time with the opportunity to choose between multiple units. This includes coordinating the care of patients with multiple medical issues in the Medical Intensive Care Unit (MICU) or managing complex post-cardiac surgery patients in the Cardiovascular Intensive Care Unit (CVICU). As seniors with a more refined knowledge of critical care services, residents will have the chance take on supervisory roles and manage multiple patients simultaneously, flexing their evolving skills in perioperative medicine. The ICU rotations offer significant clinical experiences and teaching opportunities about common critical care issues along with great opportunity to coordinate patient care with their 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, UCI 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.

Non-operating Room Anesthesia (NORA)

Non-operating room anesthesia (NORA) refers to administration of sedation and/or anesthesia outside the operating room to patients undergoing painful or uncomfortable procedures, or to patients unable to cooperate with the procedure. On this two-week rotation, our residents will provide NORA services for certain radiologic procedures, bedside transthoracic echocardiography, NICU procedures and psychiatric treatment such as electroconvulsive therapy. These procedures may be challenging due to absence of standard OR medical equipment and setup, proficiency of proceduralists, and medically challenging patients. In order to construct a safe and effective anesthetic plan, the anesthesia provider must understand the nature of the procedure, the position of the patient, how painful the procedure will be, and how long it will last, as well as the resources available. Prior discussion with the proceduralist must include contingencies for emergencies and adverse outcomes.

Obstetric Anesthesia

Resident will spend one month on the obstetric anesthesia rotation during their CA-1 year acquiring the basic knowledge of obstetric and neuraxial anesthesia, specifically epidural and spinal anesthesia. During the CA-2 year, residents will rotate at Long Beach Memorial Medical Center for one month to refine techniques. Residents will receive hands-on teaching, which includes Point-of-Care Ultrasound (POCUS) and ultrasonography for neuraxial procedures, and will be supervised by a mixture of obstetric anesthesiologist attendings.

Residents will gain deep understanding of the physiologic changes of pregnancy and the effects of anesthetic management, the physiology of normal and abnormal patterns of labor and delivery, common comorbidity and its impacts and monitoring, interpreting basic fetal heart rate, and learn the risks associated with neuraxial and general anesthesia. Interpersonal communication skills will be built upon by managing and discussing anesthetic care plans with patients and working closely with the perinatal team.

UCI Medical Center obstetric service receives approximately 150 deliveries per month and have a large number of high-risk obstetric patients with the active MFM referral service and the Newborn Intensive Care Unit (NICU). This makes for an exciting and dynamic rotation, with challenging and interesting cases with a balanced mix of complex high risk and low-risk patients. The rotation will expose residents to patients with high-risk conditions such as prematurity, pre-eclampsia, eclampsia, labile diabetes, mellitus, placenta accrete and maternal and fetal cardiac problems.

Residents in the CA-3 year who are interested in perusing an obstetric anesthesiology subspecialty will have the option of an additional rotation for obstetric anesthesia.

OR Management and Supervisory Rotation

CA-3 residents spend four weeks during this rotation designed to recognize their progressive authority and responsibility and assist with the transition to an attending anesthesiologist. Senior residents will have the privilege to supervise, educate and assist junior residents intraoperatively 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 a two month rotation at Children’s Hospital Los Angeles (CHLA) during 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). CA-1 residents are expected to attain a basic understanding of the physiology and pathophysiology of infants and children and shall demonstrate the ability to apply this knowledge in various clinical settings. Residents will also participate in a difficult airway workshop that includes a station devoted to the pediatric airway. 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 residents may elect to do additional months at Children’s Hospital Los Angeles (CHLA). After the initial two-month rotation at CHLA, CA-2 and CA-3 residents will be assigned to high risk neonatal and pediatric patients at UCI Medical Center. Senior residents in anesthesia have the opportunity to care for premature babies with routine as well as unusual problems at UCI Medical center, as it is a high-risk obstetrical and neonatal referral center. 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 Care

Anesthesia residents will spend two weeks during their PGY-1 and CA-1 year working in the perioperative 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, nurse practitioners 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.

During this rotation residents will:

  • Build a solid working knowledge of pre-procedure management and risk stratification
  • Be able to consult with 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 the patient

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.

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.