Resident Rotation Perspective
RESIDENT ROTATION PERSPECTIVE
The Thoracic Surgery rotation provides an opportunity to assist in surgical procedures, manage complex medical problems, and treat post-op pain. I appreciated that I was able to take care of so many patients that had a tenuous respiratory status and learn how to optimize their pulmonary regimen. I was able to hone decision making skills as this rotation allows more autonomy among interns. I learned what labs/imaging/follow up was important immediately post-op which has proved very valuable in my education as I enter my anesthesia rotations. Further, the anesthesiology team would often allow me to shadow during a case if I was not scrubbed in; it was good to be able to refresh some of my basic knowledge of anesthesia and learn new things specific to thoracic anesthesia. Finally, it was great to work side by side with the surgery residents and attendings that I will be working with in the operating room soon and build those relationships!
–Katie Schott, MD
Cardiology and General Medicine Rotations
During our inpatient cardiology rotation you will see a diverse range of pathology including ACS, dysrhythmias, and heart failure as well as many other disease processes. There are daily hands on teaching experiences by our attendings and fellows—so there was a lot of active learning opportunities which was great. Each day on cardiology you will review EKGs, ECHOs, Chest X-rays, and Stress Tests. There is an emphasis on understanding the anatomy and physiology of various disease processes and applying these concepts to the care of your patients. You will learn about cardiac catheterization, pacemakers, defibrillators, and chronic inotrope therapy, as well as advanced devices such as LVADs and aortic balloon pumps. You will also become more comfortable with cardiac specific medications. The evaluation and management of cardiorespiratory function and volume status from history, physical exam, labs, and imaging will all be useful in preparing you for the OR.
Our general medicine inpatient rotation also provides opportunities in managing patients with pulmonary, renal and liver disease, all of which provide their own unique teaching points and experiences that are applicable to anesthesiology. One thing that’s wonderful about our intern year program is that our rotations are meant to best prepare us for our anesthesiology years, and expose us to the most pertinent patients in the hospital. Our department has a great relationship with our medicine colleagues and we integrate within the team very well during each rotation. UNC serves a very diverse patient population and our clinical year provides a solid foundation for the transition to providing care in the OR.
–Adam Hill, MD
Combined Peds/Anes Intern Year
I’m loving the combined pediatric-anesthesiology program! Intern year is primarily pediatrics and I feel 100% like a general peds intern. They give us a taste of anesthesiology our first year by intermixing one day per month in the OR, i.e. our “anesthesia day,” where I go to the OR and intubate patients, start lines and IVs, and have some fun! I also participated in the Academic Medicine Rotation (AMR) with the rest of the anesthesia interns, which was one of the best months of intern year. The AMR month not only provides education on academic medicine, but it also was a great segue for me to continue building on relationships with my anesthesia colleagues. I can’t wait to join the fun anesthesia crew in July!
–Marley Burns Lawrence, MD
Chronic and Acute Pain Medicine Rotations
As UNC Anesthesiology residents, we get a very comprehensive pain experience through the course of our post-graduate training. Our clinical and didactic experience focuses on the medical, interventional, and behavioral aspects of acute and chronic pain management.
As an intern, you have the opportunity to rotate through the pain clinic which will introduce you to outpatient pain management. You will gain insight in chronic pain management and appreciate how patients are evaluated for interventional therapies at our UNC Spine Center. Interns have really appreciated the outpatient chronic pain rotation as they are able to use their insight and knowledge to help manage post-operative pain on their various inpatient rotations.
During the clinical anesthesia years, residents will do an additional month in the pain clinic which will include 1 week of inpatient chronic pain consults and 1 week of interventional procedures at the UNC Spine Center. As a senior anesthesiology resident, you will also have Acute Pain rotations which involve placement and management of perioperative epidurals (specifically thoracic epidurals). Lastly, as a CA-3 resident, you have the opportunity to participate in a pain elective to further advance your knowledge and skill set.
Our pain faculty is excellent and committed to resident education by way of a well-balanced clinical experience along with formal didactics. There are ample opportunities to participate in research, case write-ups, and national conferences.
–Bilal Lateef, MD
Pediatric Anesthesia Rotations
Pediatric anesthesia can be somewhat intimidating at first since it’s quite different from adult anesthesia! However, our attendings understand this and do a great job of being readily available to help and teach, while providing appropriate autonomy. Residents are exposed to a wide variety of cases over the general pediatric anesthesiology rotations ranging from more straightforward T&A or BMT cases, all the way to pediatric spine and surgeries involving critical care patients. We gain more exposure to cases with increasing complexity as we become more experienced—all while providing us with the opportunity to provide anesthesia to neonates, infants, children, and adolescents. Residents also become comfortable with NICU and PICU transports and hand-offs. Because dosing guidelines and anesthesia equipment are unique in the peds world, we are provided with plenty of readily available study resources to prepare for our cases. Many of our attendings come from all over the country, which gives us a great foundation on the many ways to provide pediatric anesthesia. Preoperative and postoperative assessments are also very unique in that they involve parents, so this rotation really enhances our communication skills with patients and their families!
–Lacey Straube, MD
General OR Anesthesia Rotations
The experience on the general OR blocks is diverse and challenging. It’s during this month that the breadth of cases performed at UNC really becomes evident. One morning you find yourself caring for a geriatric patient during a hip replacement, and the next day you are taking over complex trauma cases from the night before. In doing so, we care for many patients that require different airway techniques, special monitors or central lines and, at times, regional/neuraxial blocks. Furthermore, we participate in many cases that are managed through one of our enhanced recovery pathways. These pathways, termed ERAS (Enhanced Recovery After Surgery), are the culmination of best practices and cutting edge research all focused on improving the experience and outcome of our patients. The general OR rotation at UNC is so much more than just “bread and butter” anesthesia. After going through appropriate orientation months in the CA-1 year, residents are exposed to increasingly more complex patients throughout the years that all allow us to hone our skills with the most tenuous of patients.
–Dan Rosenkrans, MD
Cardiac Anesthesia and the TEE Experience
The cardiac exposure at UNC provides residents with a unique, hands-on experience. The absence of cardiac anesthesia fellows means that residents are the primary providers, both for transesophageal echocardiography (TEE) and for intraoperative management, working directly with trained cardiothoracic attendings. This is a huge positive to our program! The cardiac attendings are excellent clinicians and mindful teachers, and make being in the heart room a favorite place among our residents. The TEE experience is top notch too. We have dedicated TEE rotations and electives, a state-of-the-art Heartworks TEE simulator, and biweekly TEE case conference. We also have a joint Quarterly Triangle Echo Conference that we co-host with Duke throughout the year at a restaurant in the area, which is not only great exposure to interesting TEE cases but also allows us to build relationships with other colleagues in the area. Attaining basic TEE certification is easily done at UNC, and a number of our residents obtain this certification.
— Morgan Marino, MD
We do 2 months of OB Anesthesia during years CA-1 and CA-2, and then do 1 month of OB nights during our residency. We get a lot of experience with neuraxial anesthesia for labor and C-sections and plenty of volume, surpassing the ACGME minimums early on in residency. As a tertiary care center, most of our patients are high risk OB patients referred from all over the state. The OB faculty is among our best at teaching and the didactics are very well structured. Additionally, we are one of the few institutions in the US that utilizes nitrous oxide as an option for labor analgesia. The combination of volume, case mix and education allow us to be very well prepared to practice OB anesthesia after graduation from residency.
— Vishal Dhandha, MD
The critical care experience at UNC is robust and improving. Over the course of residency, we do four months of critical care in various units. During intern year, residents rotate through the medical ICU (MICU) and surgical/trauma ICU (SICU), which provides a great foundation for management of critically ill patients and learning procedures and ventilator management. As a CA-1 or early CA-2, we return to the SICU as an upper level resident, the “Bed Commander,” to care for the sickest patients, including those status post liver transplantation, polytrauma, and major oncologic procedures.
Subsequently, CA-3s complete their critical care experience by rotating through the Cardiothoracic and Vascular ICU (TICU), primarily caring for those undergoing heart and lung transplant, ventricular assist device placement, coronary artery bypass grafting and valve replacements. We also have a growing structural heart program and frequently care for patients status post transaortic valve replacement (TAVR) and MitraClip procedures.
We are fortunate to have multiple faculty trained in critical care medicine and two with both cardiac and critical care training who practice in our SICU and TICU and are very involved in unit leadership. We also have a great working relationship with our acute care and trauma surgeons who attend in the SICU.
UNC is a major referral center from rural areas of North Carolina, and truly functions as a quaternary care center, seeing a wide range of both fundamental and rare and complex pathologies and comorbidities. We have a significant and increasing volume of major organ transplantation (heart, lung, liver, pancreas, and kidney) and have an active ECMO program in both the SICU and TICU. Those interested in critical care are able to rotate through multiple other ICUs with elective time, including our busy Burn, Neurosurgical, Medical Cardiac, and Pediatric ICUs. Overall, we have a comprehensive critical care experience, which complements our intraoperative learning and provides an excellent foundation for all residents.
– Megan Henley, MD