Obstetrical Anesthesiology Fellowship Curriculum

Program Description

General

The modern anesthetic management of parturients requires an in-depth knowledge of not only anesthesiology, but also knowledge of obstetrics and the issues facing physicians involved in the care of high risk parturients.

Successful completion of a 4 year accredited program in anesthesiology is a prerequisite. The candidate must be American Board of Anesthesiology eligible or accredited.

Objectives

The obstetric anesthesiology fellowship will enable the fellow to acquire an advanced body of knowledge and level of skill in the management of parturients, particularly of high-risk parturients. This should allow the fellow to assume a future leadership role in academic or private practice in the field of obstetric anesthesiology.

The objectives include:
an understanding of the obstetric management of high-risk parturients.
an understanding of fetal heart rate measurement and interpretation.
an understanding of the anesthetic management and the interdisciplinary approach to the management of the high-risk parturient.
an understanding of neonatal resuscitation (American Academy of Pediatrics Neonatal Resuscitation Certification).
an understanding of the moral and ethical issues in the care of the parturient, including maternal vs. fetal well-being.
an understanding of the economic issues in obstetric anesthesiology.
the ability to organize a functioning obstetric anesthesiology service.
the ability to critically evaluate the clinical literature in obstetric anesthesiology.
the ability to teach obstetric anesthesiology to others.
the ability to carry-out a scholarly project, including study design, recruitiment of patients, carrying out of a study, analyzing and publishing the results.

Curriculum

Knowledge base
Knowledge of obstetric management of high-risk parturients, including patients with pregnancy induced hypertension, HELLP, morbid obesity, respiratory disease, neurologic disease, cardiac disease, endocrine diseases, hematologic diseases, patients with substance abuse or HIV infection, ante- and postpartum hemorrhage, maternal embolic events and other miscellaneous high-risk pregnancies.
Knowledge of the anesthetic management of the high-risk parturient and the interdisciplinary approach to management.
Knowledge of neonatal resuscitation.
Knowledge of fetal heart rate tracing interpretation.
Knowledge of alterative regional labor analgesia techniques, including ambulatory epidural analgesia and patient controlled epidural analgesia.
Skills
Invasive hemodynamic monitoring in the high-risk parturient.
Neonatal resuscitation.
Regional analgesia and anesthesia in anatomically challenging parturients (e.g., obese, previous back surgery).
Ability to teach technical skills (regional analgesia/anesthesia).
The fellow will spend three to four days a month in the general operating room to maintain general anesthesia skills.

Relationship to Anesthesiology Residency and Obstetric Anesthesiology Resident Rotation

The fellow will participate in daily resident/fellow didactic sessions. This includes preparing several lectures each month, organizing one Journal Club each month and participating in daily teaching discussions.

The fellow will serve as Anesthesia Coordinator for the Labor & Delivery Unit one-two days per week. This position involves coordinating anesthesia care on the unit, including assigning tasks to residents. When the attending anesthesia staff is busy, it may involve supervising residents in the provision of anesthesia care. If both the resident(s) and attending staff are busy, the fellow will provide direct patient care.

The integrity of the resident obstetric anesthesiology rotation will be maintained. Two to three residents are assigned to the obstetric rotation each month. The attending staffs provide direct patient care, without resident assistance, for approximately 10% of the patients. Residents cannot logistically participate in more care than the current level. Therefore, the attending and fellow staff can expect to provide even more care without resident input than the current level. In fact, resident teaching may improve, as the presence of fellows allows more time for attending staff to teach.

Application and Selection Process

Written applications, including a copy of the candidate’s curriculum vitae and letters of recommendation will be solicited.

Drs. Wong and Stock, at least one additional obstetric anesthesiology faculty member, and a current anesthesiology fellow will interview appropriate candidates.

Applicants will be selected by the interviewers based on past record of achievement, recommendations, and the interview process, without regard to gender or race.

Evaluation

Fellows are evaluated quarterly, and the Program Director will meet to review the fellow’s evaluation with him or her.

Successful completion of the program will be contingent upon meeting curricular and skills requirements as judged by evaluations. In addition, the trainee must 1) complete at least one scholarly project suitable for publication, 2) make one local presentation, and 3) show evidence of teaching medical students and residents.

Administrative Structure

The fellowship will be part of the McGaw Medical Center Graduate Medical Education Program. All policies of the McGaw Medical Center GME Program will apply to the fellowship, fellows and faculty.

2-3 fellows will be recruited each academic year.

The Department of Anesthesiology will fund the Obstetric Anesthesiology Fellowship.