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91ɫƵ Anesthesiology Residency Program Information

Didactics

Intern

  • Anesthesiology Professional Development Week (August & September)
  • Intern "Introduction to Anesthesia" lectures (second half of the year)

CA-1

  • Orientation Week
  • Summer Bootcamp Lecture Series
  • CA-1 Lecture Series on Wednesday didactic half-days (2 weeks/month)
    • BASIC exam content lectures
    • Workshops & simulation
    • Intro to Quality Improvement
  •  CA-1 Retreat
  • Personalized study plan development with Educational Specialist

CA-2 & CA-3

  • CA-2/3 Lecture Series on Wednesday didactic half-days (2 weeks/month)
    • Lectures
    • PBLDs
    • Board review
    • Oral board prep
    • Journal Club
  • Mock oral board sessions (1:1 with faculty) and mock OSCE exam (CA3s)
  • CA-2 QI project

All-Class Sessions

  • Wednesday Grand Rounds
    • Morbidity & mortality (M&M)
    • Visiting professors
    • Case conferences
    • Subspecialty
    • QI & patient safety
  • Questions of the Day

Yearly block diagram


Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Block 11 Block 12 Block 13
PGY-1 MICU Vascular Surgery Pain Pre-op SICU SICU Consult ED General Anesth Med Wards Med Wards Med Wards
PGY-2 General Anesth General Anesth General Anesth General Anesth OB General Anesth SICU Ped Anesth Ped Anesth Neuro Pain General Anesth Vacation
PGY-3 RAAPS Cardio Anesth Neuro Anesth CVICU General Anesth Ped Anesth Pre-op General Anesth RAAPS / OB Ped Anesth OB General Anesth Vacation
PGY-4 General Anesth RAAPS / OB Elective PACU / Elective General Anesth Cardio Anesth General Anesth General Anesth Ped Anesth Ped Anesth OB General Anesth Vacation

PGY-1 year consists of 12 1-month rotations; PGY years 2 through 4 consist of 13 4-week blocks.

Yearly Overview

Our residents receive excellent clinical experience at our Level 1 adult and pediatric trauma hospitals, busy VA Medical Center, and Pain Clinics. In an average 3-year program, each resident will have had the opportunity to perform 500-600+ general anesthesia or monitored anesthesia cases, 100+ neuraxial anesthetics, 120+ regional nerve blocks, 150+ anesthetics in pediatric patients, 100+ obstetric anesthetics, and 40+ cardiac cases.

Our CA-1 and CA-2/3 residents have two didactic half-days per month on Wednesdays, with four hours of didactics including lectures, workshops, oral boards practice, problem-based learning discussions, wellness and professional development topics, and community outreach activities at local schools and community sites.

The CA-1 and CA-3 classes each have a day-long retreat during the year, which focuses on professional development topics and incorporate a meal and/or fun activity to promote class bonding. The CA-2s have a weekend retreat at a local waterpark resort for a transition-to-practice focused experience.

all
Clinical Base Year (PGY-1)

Rotations

One-month rotations typically consisting of:

  • Anesthesiology
  • Anesthesia pre-op clinic
  • Anesthesia-directed SICU
  • Anesthesia pain clinic
  • Emergency medicine
  • CT and vascular surgery

Rotation sites

Three to four months of medicine wards, one month of medicine consult.

  • Froedtert Hospital
  • Clement J. Zablocki VA Medical Center
  • Aurora Sinai Hospital

Mentorship

Our residents are matched with a faculty mentor with shared interests/backgrounds at the beginning of their intern year. The mentoring relationship is designed to provide the resident with personal and professional support throughout residency; mentors check in at least twice a year if not more.

Peer-to-peer mentoring also occurs via “Anesthesia Families,” groups consisting of one resident from each class who meet for meals and/or social activities (generously funded by our faculty via the Resident Wellness Fund) to promote inter-class bonding.

CA-1 Year (PGY-2)

Rotations

One-month rotations typically consisting of:

  • Anesthesiology - General
  • Anesthesia subspecialty rotation including OB, regional, pediatrics
  • Anesthesia-directed SICU
  • Anesthesia pain clinic

Career focus

Given in the first month of the two-month lecture series, the following management topics and techniques essential to successful career in anesthesiology are given:

  • Sleep deprivation
  • Work-life balance
  • Substance abuse
  • Professionalism
  • Ethics
  • Malpractice issues

Drug & equipment practicum

The practicum gives residents the opportunity to familiarize themselves with the following topics.

  • Medical dilution and labeling
  • IV tubing
  • Blood transfusions
  • Infusions
  • Infusion pumps

Simulation

A two-part simulator experience provides residents an opportunity to hone their abilities in a safe and realistic environment.

  • Anesthesia induction
  • Maintenance and emergence
  • Tracheal intubation
  • Call readiness

ABA BASIC exam (June of CA-1 year) prep lectures

  • Anesthetic pharmacology
  • Neuromuscular blockade
  • Monitoring
  • Autonomic nervous system
  • Pre-op and post-op management
CA-2 Year (PGY-3)

Subspecialty rotations

  • Pain
  • Obstetric
  • Pediatric
  • Regional
  • Neuro
  • Ambulatory
  • Trauma
  • Airway
  • Critical care anesthesia

Rotation-specific lectures

We find learning is best achieved with rotation-specific lectures presented during the resident's time in that subspecialty. The following lectures will be provided while specializing in each area.

Children's Wisconsin

  • 3 mornings per week pediatric care lectures

Pediatric anesthesia

  • Bimonthly multidisciplinary case or topic-based conference with pediatric surgery and pediatric critical care

OB anesthesia

  • Weekly conferences
  • Monthly online grand rounds broadcast for resident evaluation and commentary

Neuro anesthesia

  • Weekly problem-based learning session

Pain

  • Weekly case-based learning sessions and high yield topics

Regional

  • Weekly case-based learning sessions

Critical care

  • Weekly case based-specific lectures and high-yield topics

CA-2 Transitioning to Practice Curriculum

We offer a weekend retreat to our CA-2 residents, addressing topics essential to a successful transition into independent practice. Sessions include:

  • CV preparation
  • Private vs. academic practice models
  • Financial planning and insurance
  • Malpractice and legal considerations
CA-3 Year (PGY-4)

Rotations

CA-3s have a mix of general OR and subspecialty rotations, along with some rotations in ambulatory/community settings. The subspecialties have their own focused lectures. In addition, the senior resident lecture series incorporates APPLIED exam (oral board) review practice preparation sessions.

Rotation descriptions

General Anesthesia

General Anesthesia

Locations: Froedtert Hospital, VA Medical Center

Residents will be involved in the management of a wide variety of cases covering a spectrum of simple to complex degree. Cases would be, minimally invasive laparoscopic and robotic procedures like hernia repairs and gastric bypass procedures. They will participate in the evaluation and management of complex general surgery and surgical oncology patients such us ones with pheochromocytoma, and metastatic intraperitoneal cancer. Management of such patients may involve advanced procedures such as HIPEC, robotic assisted interventions and ERAS protocols.

Cardiac Anesthesia

Cardiac Anesthesia

Locations: Froedtert Hospital, VA Medical Center

This rotation is designed to introduce the anesthesiology resident to the practice of cardiac anesthesiology. Acquisition of medical knowledge will result from the combination of one-to-one teaching, directed reading in major cardiac anesthesia textbooks, and informal discussions with cardiac anesthesiologists and cardiothoracic surgery faculty.

Residents rotating on cardiac anesthesia will be exposed to a wide variety of clinical conditions not encountered in other types of surgical procedures. Hemodynamic instability, severe left or right ventricular dysfunction, malignant ventricular arrhythmias, and profound hypovolemia resulting from bleeding from the heart, great vessels, or other major thoracic structures are often encountered and require rapid intervention to prevent morbidity and mortality. Operations encountered during the rotation may include routine CABG and valve repair/replacements as well as VA and VV ECMO, temporary and durable VAD placement, heart transplant, lung transplant, and transcatheter valve interventions.

Community-Based Anesthesia

Community-Based Anesthesia

Locations: Froedtert Menomonee Falls Hospital

This 2-week rotation for CA-3 residents occurs at one of our community-based hospitals (FMFH). Residents will be involved in the management of a wide variety of cases including elective joint surgery, and participate in the preoperative assessment and management of patients requiring all types of anesthesia. Residents primarily function in a consultant role rather than an in-OR anesthesia provider, and gain experience in perioperative management, regional anesthesia, and supervision of anesthesiology advance practice providers.

Critical Care Anesthesia

Critical Care Anesthesia

Locations: Froedtert Hospital, VA Medical Center

Froedtert Hospital

Rotations are four weeks long at Froedtert Hospital in the CVICU. A typical rotation consists of 20 shifts in 28 days with two blocks of night shifts. Residents, APPs and fellows work together with an attending on teams to manage patients. A typical day includes accepting sign out, seeing patients and lab/imaging/chart reviews in preparation for rounding with the CVICU attending. On weekends and night shift, a single team and attending see all of the patients. On weekdays, the team is split into two, with one attending and team in each hallway. Teaching rounds with the attending usually last between two and five hours depending on volume and acuity. Communication with nursing, primary teams & consultants, as well as procedures, occur throughout the day. New admissions to the ICU are staffed with the faculty as they arrive from the cardiac ORs. The populations we manage include Cardiac and Thoracic surgical patients, Vascular surgical patients, Advanced Heart Failure (end stage heart failure, VAD and Transplant), and critically ill general cardiology patients. Most patients will have multisystem disease. Regularly scheduled educational activities (Wednesday lectures) are always prioritized over patient care except in a true emergency. Faculty are present in house 24/7 for teaching and supervision.

 

VA SICU

The surgical intensive care unit (SICU) rotation that is offered at the VA Medical Center was developed to provide an environment in which the resident’s primary clinical responsibility will be for the care of the patient in the ICU. The resident in Anesthesiology training will learn to act both as a primary caretaker of medical and surgical patients and as a consultant to the surgeon. They will receive supervised training in the diagnosis and treatment of life-threatening diseases as well as medical/surgical conditions that develop as complications in the ICU. A syllabus is provided for reading and didactic sessions, focused on the clinical component of care as well as practice management issues. Senior residents in the SICU have the opportunity to experience the full spectrum of perioperative care on a continuity rotation, where they care for patients in the OR then return to the SICU to follow the remainder of their post-operative course.

Neuroanesthesia

Neuroanesthesia

Locations: Froedtert Hospital

The neuroanesthesia rotation at Froedtert Hospital is meant to guide the resident through appropriate reading for a full understanding and incorporation of the principles that are necessary to manage patients with neurosurgical pathology. With an increase in the complexity of management of neurologic disorders, anesthetic management of these cases has become increasingly specialized. The principles that govern the protection of the brain and/or spinal cord at risk must be at the center of patient care. Failure to pay close attention to the physiology, pathology and anesthetic management in these patients can result in more significant adverse outcome events than might occur during other surgical procedures. CA-1 and 2 residents will have staff present during all key events - induction, positioning, intraoperative events (e.g., aneurysm clipping, shunting of a carotid and unclamping, etc.), and most importantly, emergence. CA-3 residents should discuss the need for staff presence on an individual basis and are expected to demonstrate greater independence.

Obstetric Anesthesia

Obstetric Anesthesia

Location: Froedtert Birth Center

Residents in Obstetric Anesthesia will learn to provide anesthetic care during pregnancy, delivery and the postpartum period. The OB rotations at 91ɫƵ offer extensive clinical experience in caring for both low and high-risk patients. In addition, residents will participate in didactic sessions, including informal bedside instruction, lectures, practice on a task trainer, problem-based learning, and discussion of online material. This rotation offers the opportunity to hone interpersonal communication skills while helping our vulnerable patients get safely through one of the most intense experiences in a lifetime.

A High-Risk OB Anesthesia Elective (two weeks) is designed to aid senior anesthesia residents in their transition from supervised providers to confident managers of a busy and high-risk labor and delivery unit and consultant anesthesiologists in obstetric practice. The senior resident will be exposed to various forms of pathophysiology in high-risk obstetric patients on labor and delivery and the Maternal Fetal Medicine service.

 
Out-of-OR (OOR)

Out-of-OR (OOR)

Locations: Children's Wisconsin, VA Medical Center

VA “Safari” Rotation
All CA-3 residents complete a two-week assignment at the VA Medical Center with supervised experiences providing general and MAC anesthesia in GI, Radiology, EP, Cath lab and Pulmonary procedural areas in adult patients. The rotation includes in-OR teaching and self study material. Each resident trainee participates in a 2-week rotation in the major (standalone) non-operating room anesthesia sites during their CA-3 year of training.

Children’s Wisconsin
The purpose of this advanced elective rotation is to provide Anesthesiology Residents with hands-on experience in administering anesthetics to children undergoing radiographic, diagnostic, therapeutic, and interventional procedures in Out-of-OR locations at Children’s Wisconsin. This includes pre-operative assessment, intra- operative management, safe transportation and hand-off of patients, and any post-operative management & documentation for CA3 trainees. The role of the anesthesia team is more flexible and potentially more comprehensively involved in peri-procedure care.

Froedtert Hospital Non-OR Anesthesia (NORA) Rotation 
CA-2 or CA-3 residents on a NORA elective participate in cases in the major stand-along NORA sites at FH, including GI Endoscopy, Radiology, Brachytherapy, Cath Lab, Electrophysiology/Cardioversion, Pulmonary/Bronchoscopy, Interventional Radiology, and Transesophageal Echo Lab procedures. Clinical experiences include shadowing faculty supervising APPs, providing hands-on administration of anesthesia care in NORA locations, and assistance in medical direction of APP team members.

 
Pediatric Anesthesia

Pediatric Anesthesia

Locations: Children's Wisconsin

Pediatric anesthesiology training is conducted throughout the entire duration of residency. The initial pediatric anesthesiology experience consists of a two-block rotation in the late CA-1 year, two one-block rotations during CA-2 year, and two two-week rotations during CA-3 year. Residents may elect to participate in additional pediatric anesthesiology rotations of variable duration up to six months. Children’s Wisconsin provides the clinical base for all pediatric anesthesiology rotations at 91ɫƵ. CA-3 residents also may elect to participate in subspecialty pediatric anesthesiology rotations, such as Pediatric Out-of-the-OR, Pediatric Cardiac Anesthesiology, and Pediatric ENT Focus (ENT procedures are the most common surgeries in children - an optimal anesthetic management provides an uncomplicated, safe perioperative process with as little discomfort for the child as possible. Senior residents may select the ENT rotation as a two week elective).

Perioperative Evaluation and Testing

Perioperative Evaluation and Testing

Locations: Froedtert Hospital

The Perioperative medicine experience is a required one-month rotation that takes place at the Froedtert Hospital in the Center for Advanced Care. Residents will see patients whose peri-operative care requires specialized techniques, including a broad spectrum of airway management techniques, to include laryngeal masks, fiberoptic intubation, and lung isolation techniques, such as double lumen endotracheal tube placement and endobronchial blockers. These goals and objectives are intended to assist residents in achieving the PET milestones. These goals can be met through customary methods including fulfillment of supervised clinical assignments, attendance and participation in didactic activities, and personal study.

Post-Anesthesia Care Unit

Post-Anesthesia Care Unit

Locations: Froedtert Hospital

The PACU is an area where anesthesiologists have primary responsibility for managing patients in the immediate postoperative phase. Anesthesiologists are the physicians responsible for the patients in this critical time of emergence and recovery. At the Froedtert Hospital, this rotation is a two contiguous week rotation where the residents will be provided with the clinical experience in the postoperative management of patients admitted to the PACU before being discharged to home, to the floor or to an ICU. Residents will act as consultants to recognize, diagnose and treat common perioperative problems. This clinical experience will be supplemented by self-directed learning and didactic sessions as time permits.

Regional Anesthesia/Acute Pain Service

Regional Anesthesia/Acute Pain Service

Locations: Froedtert Hospital, VA Medical Center

Froedtert Hospital

The RAAPS rotation provides residents with a unique opportunity to improve their skills in placement of both peripheral nerve blocks and neuraxial blocks for patients undergoing surgery or experiencing acute pain at Froedtert Hospital. Both single shot and continuous regional techniques are learned in order to provide intraoperative anesthesia, postoperative analgesia, and pain relief following trauma to the limbs or torso. Residents review core topics with regional anesthesiology faculty during their rotation didactics.

 

VA

The RAAPS elective rotation at the VA Medical Center provides the senior level resident interested in performing regional anesthesia as part of their practice with a unique opportunity to improve their skills in the placement of both peripheral and neuraxial nerve blocks in a typically elderly and comorbid population of United States veterans. Both ultrasound guidance and nerve stimulation will be utilized to perform single shot and continuous regional techniques in order to provide intraoperative anesthesia, postoperative analgesia, and pain relief following trauma. In addition to increasing the number of peripheral and neuraxial nerve blocks performed, residents will care for these patients throughout the perioperative period including preoperatively, intraoperatively, and postoperatively. Residents may also assist in providing consultation for physicians requesting assistance with inpatient acute pain.

Other electives

Other electives

Locations: Froedtert Hospital, Froedtert Surgery Center, Drexel Town Hall Surgery Center

Residents receive up to two weeks of elective time as a CA-2, and up to four weeks of elective time as a CA-3. Aside from those described elsewhere, currently offered elective experiences include:

Ambulatory Anesthesia: Four-week elective in providing anesthesia, including regional anesthesia, to patients undergoing ambulatory procedures at standalone surgery centers.

Anesthesia Research: Two-week elective designed to facilitate completion of a scholarly work product including a manuscript, research project, etc.

Diagnostic Point of Care Ultrasound (POCUS): Two-week elective performing and interpreting diagnostic POCUS imaging under faculty guidance in the CVICU, PACU, and ORs.

Education in Anesthesia: Two-week elective focused on providing education to junior residents in the ORs and simulation sessions, as well as completed an education-focused project (past projects have included development of teaching slides for CA-1 residents, oral boards preparation lectures, and development of a preoperative IV insertion curriculum for the CA-1s).

Global Health Rotation: A two- to four-week elective. Location and faculty must be identified by interested residents. Previous residents have provided anesthesiology education and/or direct patient care in Peru and Uganda, and future trips are planned to Indonesia and Vietnam.

Perfusion Medicine Focus: Two-week elective offering residents an opportunity to learn the physiology and mechanics of cardiopulmonary bypass and mechanical circulatory support devices now in use in the Froedtert Hospital ORs and CVICU.

Transesophageal Echo (TEE): Two-week elective performing and interpreting TEE imaging guided by PTE board-certified Cardiac Anesthesiology faculty.