MS-IV Clerkships/Electives
Several medical student clerkship/elective rotation opportunities are offered through the Department of Anesthesiology at Northwestern University's Feinberg School of Medicine, including:
Clinical Anesthesiology
Pain Medicine
Obstetric Anesthesiology
Critical Care Medicine
Katherine Gil, MD is the Director of the Medical Student Clerkships and Carolyn Betts is the coordinator. For more information about clerkship elgibility and application requirements, please e-mail or call:
visitingstudents@northwestern.edu
Phone: 312-503-1392
Fax: 312-503-0715
You can also click on the following Northwestern link:
http://www.medschool.northwestern.edu/education/visiting_students/index.html
Clerkship Catalog (Anesthesiology)
http://www.medschool.northwestern.edu/students/docs/clerkcatalog_2007_2008.pdf
Clinical Anesthesia Clerkship Overview & Curriculum
(Dr. Gil to medical students)
Our goal is to make this an excellent clinical learning experience for you. As a member of the anesthesia team, you will be involved in evaluating patients preoperatively, choosing types of anesthesia, administering anesthesia, monitoring and recording patient progress, and writing postoperative orders. You will develop skills in patient assessment, utilizing and knowing effects of sedatives, cardiovascular drugs, ventilatory support (being able to mask ventilate and insert various airway devices), and learning many other aspects of anesthetic management. The result will be of value to you during your senior year, internship, or residency even if for some reason you choose a specialty other than anesthesiology.
Goals & Learning Objectives
By the end of the rotation:
Preanesthetic Evaluation : You shall have conducted at least several preanesthetic evaluations including review of history, physical examination, and laboratory result. You should be able to determine appropriate preanesthetic requirements in these areas. You should be able to fully evaluate the airway and assess the patient’s ASA physical status.
Choice of Anesthesia Technique : You should be able to understand available anesthetic techniques for different surgeries and choose what might be the most appropriate for each patient, as well as alternatives. You should be able to demonstrate familiarity with all facets of informed consent.
Anesthetic administration : Under instructor guidance, you will have
Understood and will be able to describe most of the functions of the anesthetic machine and other monitors;
Chosen suitable alternative premedications and dosages according to the patient’s age, body habitus, underlying medical problems, and intended surgery/anesthetic;
Understood the pharmacology involved, and devised plans for and participated in delivery of sedatives, anesthetics, and cardiovascular drugs. You will be able to describe multiple actions of these agents;
Determined the need for and accomplished the following: placed appropriate monitors, mask ventilated, and inserted various airway devices;
Understood the necessity of and possibly administered regional anesthetics and placed invasive lines. You will be able to describe the reasons for choosing regional techniques, much of the anatomy involved, and many of the actions of local anesthetics. You will also be able to describe many indications for and complications of invasive monitors;
You will be able to demonstrate most principles of correct patient positioning.
Fluid Management : You should recognize and be able to suggest correct acute fluid management and transfusion concepts and have participated in their applications.
Postoperative Care and Anesthetic Complications : You should know what postoperative monitoring is necessary, the degree of pain management needed, and what laboratory studies might be requested. You will have written postoperative orders. You will also understand and be able to describe the mechanism of common postanesthetic complications and their management.
It is assumed that you will take the initiative to look up any medical conditions, terms, or drugs with which you are not familiar, as self-directed learning requires a substantial degree of intellectual curiosity.
Rotation Tips
Ideally, you will be placed with a single instructor +/- one other anesthesia team member for each week of your four-week rotation (excluding your non-subspecialty week). Your instructor may be an attending for one week and two different residents for the other two weeks. Conversely, you may have two attendings for two weeks and a resident for the third. It is possible that 1-2 days in a week your instructor may not be available (post-call days, e.g. are non-working days for attendings and residents). On those days, non-weekly instructors will be available for you.
Advantages:
Consistency of teaching
Instructors get to know you better and will let you do more on-hands learning, more advanced procedures
You will get to know them better and team membership will be easier for you
The cases start faster with more people helping and there will be more time allotted for you to perform different facets of anesthesiology (airway, invasive monitors, regional)
References are more easily given by attendings that know you well
Less work! You only have to give out ~ 1 evaluation form to your instructor per week
This, however, puts a burden on our staffing numbers. To be able to get instructors with you consistently, therefore, you will usually be paired with a fellow student. Your experience is NOT diluted since you get to do more and you also learn by observing your fellow students. If you have any difficulty with instructors, call Dr. Gil. This should be a good experience!
Scheduling
At 2:00 pm each afternoon, the next day’s printed schedule is available. Your name should be on the schedule on the right side next to the name of the attending staff and perhaps another anesthesia team member. If your name does not appear on the schedule, please contact the anesthesiologists in charge in the ready room. If your patients are in-patients, please see them the day before surgery. As always, introduce yourself as a member of the anesthesia team. If they ask questions and you do not know the answer (not unusual) explain that an anesthesiologist will eventually see them and be able to help them.
Restrictions
You must discuss with your attending/resident before writing any notes or orders and these must be co-signed.
Intravenous Practice
If you want more practice, speak to the nurses in ASU…but you usually have to come early ~6:30 a.m.
Operating Room Activities
Arrive prior to 6:45 a.m. the morning of surgery to help check the anesthesia machine, set up the room, and/or preop the patient. When in doubt, always check with your instructor.
All patients go to the ASU area EXCEPT: in-patients usually go to the east end of the PACU or directly to the OR. Some patients assigned to regional anesthesia or choice, often are at the west end of the PACU
Sterility
Always try to avoid sterile areas with non-sterile material. If something gets contaminated, let us know.
Equipment
I.V. usually on non-dominant arm, unless that is a problem with surgery or underlying patient disease.
BP usually on non-pulse oximeter, non-i.v. limb.
EKG leads on up side of body
Make Life Easier
Bring a stethoscope and pen.
Read about the type of anesthesia for proposed surgeries ahead of time. It shows you know something and your learning is reinforced in the operating room.
Try to memorize 7 or 8 commonly used i.v. anesthetic agents’ actions, concentrations and dosages as early as possible (e.g. Midazolam, Propofol, Fentanyl, Rocuronium, Cisatracurium, Ephedrine, Phenylephrine, Atropine, Glycopyrrolate, Neostigmine). Working with students who seem to know something makes it more likely that students will be allowed to perform a greater part of the anesthetic.
To get the most out of the study-guide questions, do the following:
First, read a set of questions to get the get the gist of them
Second, read the suggested page references in the text
Third, look up each question if you don’t already know the answers.
On the Friday of your first week, ask for the answer sheets from Allan Doeksen so that you can check your answers. They will be emailed to you unless you request a hard copy. No one will be reviewing the questions with you.
???????? trick questions ????????? Not really. It’s a test, so sometimes the entire answer isn’t in the text. Ask your instructor about any answer you can’t find.
Read the articles…they’re good.
Attend all conferences and simulator sessions (look for schedules and sites)
Moderate aggression is good…help to get patients in OR early and monitor them
Requests for Particular Types of OR Cases
If you want to be assigned to a certain type of case, let the OR Coordinators know TWO days in advance. Also try to keep requests down to a minimum. We average over 100 surgeries a day with all kinds of subspecialties, and requests. The OR coordinators need to keep their sanity.
Grade and Evaluation
There will be a mid-clerkship evaluation to give you feedback on your performance. We don’t wait until your last day to let you know you aren’t doing well. Criteria for honors, pass and fail are indicated on the Grading System handout sheet you receive at the beginning of your rotation. If you do not receive a Grading System Handbout on the first day, Dr. Gil will provide you with one when you receive your discussion lists. Worksheet evaluations by instructors make 90% of your grade, while the final exam constitutes 10%.
Examination
A written exam at the end of the rotation is meant to help grade you and to help us evaluate our program.
Senior Students Evaluate the Anesthesia Program, Including Attending and Resident Instructors
At the end of rotation, anonymously, you can help us change and improve our program for future students. By the same token, if you note anything that is seriously wrong, don’t wait until your last day to let us know we aren’t doing well. If you have a problem (personality or whatever) with any of your instructors, page Dr. Gil. Please remember that changing your instructor will not reflect badly on you (unless we have to change them every other day). Most attendings and residents appreciate students and the difficult role students sometimes have. You must fill out this sheet so that your school will receive a complete grade.
Sincerely,
Katherine Gil, MD
Director, Medical Student Clerkships