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Residency Program Clinical Rotations
Residents gain valuable experience during clinical rotations at UCI Medical Center and at various outside healthcare systems caring for a diverse patient population.
UCI Medical Center is the primary teaching site and offers a high level of complexity of cases for residency training during the clinical anesthesia years. Residents will also gain valuable experience rotating at various healthcare systems such as the VA Long Beach Healthcare System, Children’s Hospital Los Angeles (CHLA), CHOC Children’s, Kaiser Permanente Los Angeles Medical Center and Long Beach Memorial Medical Center.
Residents gain experience with providing anesthesia for a variety of cases including orthopedics, gynecology, ENT, neurosurgery, trauma, vascular and general surgery. In addition, residents rotate in the preoperative clinic, post-anesthesia care unit, intensive care units and the acute pain service to broaden experiences with perioperative care.
Fundamental Clinical Skills Education (PGY-1)
The PGY-1 year is designed to create well-rounded perioperative physicians by training in a wide variety of clinical specialties and exposure to different clinical environments. Residents rotate through these locations in four-week blocks, concluding together as an intern class with the anesthesiology rotation to ensure a smooth transition into the first clinical anesthesia year.
Sample PGY-1 Rotation Sechdule
Anesthesiology
PGY-1 Rotation (4 weeks)
Location: UCI Medical Center
This rotation is designed to provide residents to an early introduction to the anesthesia practice. The focus is on the following areas: fundamentals of preoperative evaluation, proper airway assessment, introduction to airway management options, intraoperative monitoring, anesthesia pharmacology and basics of postoperative management.
Emergency Medicine
PGY-1 Rotation (4 weeks)
Location: UCI Medical Center
Residents will experience a broad range of both acute trauma and medical emergency room admissions. Residents will work with UCI Emergency Medicine faculty and residents to gain an understanding of the diagnosis and initial treatments of the diagnosis and initial treatments of common critical emergencies.
Medical Intensive Care Unit / Internal Medicine
PGY-1 Rotation (24 weeks)
Location: VA Long Beach Healthcare System
Residents will spend significant time in the medical wards and medical intensive care unit (MICU) where they will be responsible for admitting and managing patients on the internal medicine service. Residents obtain experience in managing patients who are critically ill as well as those with complex medical conditions. Residents also have the opportunity to teach and provide feedback to medical students. Electives in GI, cardiology, pulmonology, infectious disease are available to residents to further their understanding of the management of patients in the perioperative environment.
Obstetrics (High-risk)
PGY-1 Rotation (4 weeks)
Location: Long Beach Medical Center
Residents will rotate through the high-risk obstetrical service supervised by faculty and fellows in maternal fetal medicine. 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 obstetrics team consisting of a PGY-2 OB/GYN resident, fellow and attending.
Pediatric Intensive Care Unit (PICU)
PGY-1 Rotation (4 weeks)
Location: Long Beach Medical Center
Residents will have a focused experience in understanding caring for the critically ill pediatric patients in the PICU and apply these principles to management. The physiologic, psychosocial, diagnostic and treatment aspects of critical illness will be addressed.
Perioperative Care
PGY-1 Rotation (2 weeks)
Location: UCI Medical Center
Residents will work one-on-one with the anesthesia faculty at the Center for Perioperative Care (CPC) during the rotation to become familiar with all aspects of presurgical management of common patient conditions and prepare patients for surgery. Residents will build a solid working knowledge of pre-procedure management and risk stratification, consult with patients on anesthetic options, perform problem-based, focused pre-surgical labs and consult with surgeons and other medical staff regarding the management and optimization patients.
Point-of-Care Ultrasound (POCUS)
PGY-1 Rotation (2 weeks)
Location: UCI Medical Center
The PGY-1 POCUS rotation is designed to give residents an introduction to the basics of ultrasound, how to begin integrating POCUS into daily practice and to gain a foundation to feel comfortable performing ultrasound exams in clinical settings. The rotation consists of daily learning sessions taught by a CA-3 resident and self-directed, online learning modules accompanied by hands-on practice on live patients.
Residents will have access to hand-held ultrasound machines to practice scanning patients across different clinical settings as well as the use of TTE and TEE trainers to practice cardiac imaging. In addition, residents will have hands-on practice with placing intravenous lines with and without ultrasound guidance. Skills learned during this POCUS rotation will be used throughout the remainder of residency training and well into clinical practice.
Surgery
PGY-1 Rotation (4 weeks)
Location: Long Beach Memorial Medical Center
Residents will rotate through the general surgery service to understand care of the surgical patient. Residents will primarily be on the general surgery service, but will also participate in subspecialty care and trauma consults. This experience allows residents to be exposed to a broad volume and variety of operative cases including general, vascular, laparoscopic, colorectal, surgical oncology, thoracic, pediatric, and ENT/endocrine.
Surgical Critical Care
PGY-1 Rotation (4 weeks)
Location: VA Long Beach Healthcare System
Residents will spend four weeks in the Surgical Intensive Care Unit (SICU). During this rotation, residents will gain an understanding of the major aspects of managing the critically ill patient and how to apply these principles to management of the critically ill post-surgical patient. The physiologic, psychosocial, diagnostic and treatment aspects of critical illness are addressed. The resident is expected to gain and expand their cognitive knowledge, procedural and interpersonal skills.
Clinical Anesthesia Year 1 (CA-1)
During the Clinical Anesthesia Years, residents have the opportunity to rotate through all of the below rotations at UCI Medical Center and at affiliated teaching institutions. The CA-1 year is developed to provide residents a firm foundation in basic anesthesiology and perioperative care. After a year of obtaining a strong foundation in anesthesiology, the CA-2 year focuses on different subspecialties of anesthesiology. In the final year of residency training, the CA-3 year focuses on preparing residents for independent practice and creating physician leaders. CA-3 residents are preferentially assigned high-acuity, complex cases and have the opportunity to experience international anesthesia practice, participate in the Global Outreach Initiative and choose electives to supplement their education.
Sample Clinical Anesthesia Years Rotation Schedule
Acute Pain
CA-1 Rotation (4 weeks)
Location: UCI Medical Center
Residents will rotate with the Acute Pain Service and will gain experience in optimizing plans for peri-procedural pain, preemptive analgesia and multimodal analgesic care for postoperative discharge. Residents will become knowledgeable in providing optimal patient evaluations and treatment modalities such as lumbar or thoracic epidural continuous catheters, peripheral regional nerve block catheters and intravenous controlled analgesia. In addition, residents serve as consults for the evaluation and management of acute on chronic pain resulting from a variety of pathologies throughout the hospital.
Ambulatory
CA-1 Rotation (4 weeks)
Location: UCI Medical Center
Residents will learn the distinction of care for patients receiving outpatient procedures in high volume, rapid turnover environments. The Outpatient Surgical Services (OSS) provides an excellent mixture of surgical cases that includes orthopedic, pediatric, head and neck, oncologic and ophthalmologic cases.
At the UCI H.H. Chao Comprehensive Digestive Disease Center (CDDC), residents will provide care for a wide range of outpatient gastrointestinal (GI) and hepatobiliary patient population, where patients can have significant comorbidities and pose unique clinical challenges.
Cardiovascular Anesthesia
CA-2 Rotation (8 weeks)
Location: UCI Medical Center, Kaiser Permanente Los Angeles Medical Center
The cardiovascular anesthesia rotation will provide residents equal time at UCI Medical Center and Kaiser Permanente Los Angeles Medical Center. With the combination of teaching locations, residents will care for a range of high-risk complicated patients undergoing cardiac surgical procedures such as coronary artery bypass, cardiopulmonary bypass, valve repairs and replacement, open and endovascular repairs of aortic dissections and aneurysms, congenital cardiac defect repairs and ventricular assist devices.
Residents will experience evaluating patients with heart disease, cardiovascular physiology, placing and interpreting invasive monitors, transesophageal echocardiography (TEE) and circulatory arrest.
Chronic Pain
CA-1 Rotation (4 weeks)
Location: UCI Medical Center, UCI Center on Pain & Wellness
Residents will be exposed to a high volume of a variety of cases in the outpatient clinics and will learn the assessment and management of patients with chronic pain as well as hands-on procedural skills. The rotation will provide residents the skill sets in diagnosing and managing a wide variety of pain conditions as well as psychological comorbidities, cancer pain, pelvic pain, spasticity and orthopedic injury.
Residents will become experts in interventional pain management, safe opioid prescribing, adjunctive medication management, non-interventional pain management as well as common treatment modalities.
Critical Care
CA-1, CA-3 Rotation (4 weeks)
Location: UCI Medical Center
The critical care rotation offers clinical experiences and teaching opportunities on common critical care issues and coordinate patient care with other surgical colleagues. Residents will manage critically ill patients from multiple surgical services to understand the breadth of perioperative care.
CA-1 residents will rotate through the Surgical Intensive Care Unit (SICU) for four weeks under the supervision of critical care anesthesiologists and critical care surgical physicians. CA-3 residents will have the opportunity to choose between multiple intensive care units, such as the Medical Intensive Care Unit (MICU) or the Cardiovascular Intensive Care Unit (CVICU) to manage patients with complex cardiac surgical issues.
Global Outreach Initiative
CA-3 Rotation (1 week)
Location: Various Sites
The Global Outreach Initiative is an elective rotation for the senior resident to arrange with a faculty member to join a volunteer group to travel to an underserved area of the world to provide anesthesia care to a local community. Through this experience, residents can develop a sense of compassion for persons disadvantaged through disease and access to safe and effective healthcare. The goal is for residents to become advocates for the advancement and safe practice of anesthesia all around the world.
Neuroanesthesia
CA-1, CA-2 Rotation (8 weeks)
Location: UCI Medical Center
The neuroanesthesia rotation provides a unique experience for residents to be proficient in the perioperative care of a patient undergoing neurosurgical procedures as well as neuroradiological interventions in radiology suites. Residents will learn and practice anesthetic management of complex neurosurgical procedures including stereotactic surgery, intracranial masses, cerebrovascular diseases, pituitary techniques, simple and complex spine, neuromuscular, epilepsy and neuro trauma.
Non-operating Room Anesthesia (NORA)
CA-3 Rotation (2 weeks)
Location: UCI Medical Center
The NORA rotation will provide residents the experience of administering anesthesia beyond the operating room for certain radiologic procedures, bedside transthoracic echocardiography, NICU procedures and psychiatric treatments. Residents will gain understanding of the nature of NORA procedures, from patient positioning, procedure time, pain level, resources, contingencies for emergencies and adverse outcomes.
Obstetric Anesthesia
CA-1, CA-2 Rotation (8 weeks)
Location: UCI Medical Center, Long Beach Memorial Medical Center
The obstetric anesthesia rotation will expose residents to patients with low-risk and high-risk conditions such as prematurity, preeclampsia, eclampsia, labile diabetes, mellitus, placenta accreta and maternal and fetal cardiac problems. Residents will acquire a deep understanding of maternal and fetal physiology, routine and emergent obstetric cases, comprehensive anesthetic management plans, comorbidities and the impact on monitoring risks associated with neuraxial and general anesthesia. 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 anesthesiology attendings.
OR Management and Supervisory
CA-3 Rotation (4 weeks)
Location: UCI Medical Center
The OR management and supervisory rotation will allow senior residents to be a key member of the operating room management team and the privilege to supervise junior residents intraoperatively with faculty oversight. This supervisory role allows residents to further refine their clinical decision-making skills as they progress towards independent practice.
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
CA-1, CA-2, CA-3 Rotation (8 weeks, 2 weeks)
Location: UCI Medical Center, Children’s Hospital Los Angeles (CHLA), CHOC Children’s
The pediatric anesthesia rotation will provide residents an understanding in providing anesthesia for children of all age groups including neonates and infants. Residents will care for pediatric patients who are undergoing a wide range of procedures including general surgery, burn, cardiothoracic surgery, otolaryngology, urology, plastic surgery, dermatology, neurosurgery and orthopedic surgery.
Residents will have multiple opportunities to care for pediatric patients throughout residency training at UCI Medical Center. CA-2 residents will spend 8 weeks at CHLA, while CA-3 residents will spend 2 weeks at CHOC Children’s. With advanced knowledge, CA-2 and CA-3 residents will care for high-risk neonatal and pediatric patients. Senior residents care for premature babies with routine as well as unusual problems including PDA ligations, laparotomies for necrotizing enterocolitis, bowel atresias, repairs of esophageal atresia/tracheoesophageal fistulas, abdominal wall defects, examination and repair of airway anomalies, repair of urological anomalies, and EXIT procedures.
Point-of-Care Ultrasound (POCUS)
CA-3 Rotation (2 weeks)
Location: UCI Medical Center
The senior POCUS rotation will focus on advanced uses of ultrasound, such as the transthoracic and transesophageal cardiac exam, as well as the basics of ultrasound use in the perioperative period. To solidify ultrasound skills and gain experience in education and mentoring, CA-3 residents will have the opportunity to teach PGY-1 residents at the intern level POCUS rotation. Residents will have access to hand-held ultrasound machines to practice scanning patients across different clinical settings as well as the use of TTE and TEE trainers to practice cardiac imaging. In addition, residents will have hands-on practice with placing intravenous lines with and without ultrasound guidance.
Regional Anesthesia
CA-2, CA-3 Rotation (4 weeks)
Location: UCI Medical Center
Residents will focus on the use of regional techniques (including both neuraxial and peripheral blocks) as primary anesthetic methodologies and as an approach to postoperative pain management. During this rotation, residents will be a part of a floating block team providing regional anesthesia services to patients undergoing a variety of procedures. Residents will learn and perform blocks that include interscalene, supraclavicular, axillary, sciatic, popliteal, femoral, musculocutaneous nerve and saphenous nerve blocks. Residents will become comfortable in ultrasound guided approaches supplemented by landmark and nerve stimulation techniques.