Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

November 2011

Stanford Anesthesia Intern reports on research month

I asked Jan Sliwa currently an intern to write about his research month at Stanford so that others that might be interested in this elective can learn more about what is available.

From Jan: When choosing elective rotations at the start of my internship, I thought it might be valuable to do a research month in the Department of Anesthesiology at Stanford. I wouldnít be rotating there at all until the beginning of CA-1 year, so I figured it might be a good way to get involved in a project or two and meet some of my future attendings, co-residents, and other members of the department. I wasnít sure whether any of this was possible, but it was an idea and I went with it.

After emailing our program director, Dr. Macario, I got several emails back from him indicating that there were plenty of research opportunities to get involved with, and that I could tailor these experiences towards my own interests. I got in touch with Dr. Brock-Utne and one of this yearís chief residents (Dr. Laura Downey), who had begun a study looking at the effect of PEEP on increasing internal jugular vein cross-sectional area & circumference in obese patients (BMI >30) under general anesthesia.

On the first day, Laura explained the study methods and helped me determine what types of cases on the OR schedule would likely have patients that would be suitable candidates to consent for the study. I arrived at Stanford around 6:30AM each day, met with the resident and attending whose patient I was interested in consenting for the first case to make sure they were on board, and with their blessing, I would meet the patient, describe the study, and obtain written informed consent. There are 2 Sonosite machines in the main Stanford OR suite capable of manually measuring cross-sectional area and circumference of structures being viewed under ultrasound, one of which is generally used by the regional anesthesia team for the 8-12 peripheral nerve blocks done per day. Therefore, every morning I tracked down an ultrasound machine to make sure I could use it.

After patients were brought to the OR, anesthetized, and intubated, I would take 3 ultrasound measurements of the RIJ at 0 PEEP (each patient acted as their own control). Then we cranked the PEEP up to 5, and I took 3 measurements at that setting. Finally, if the patients were hemodynamically stable on 10 of PEEP (most were), I took 3 final measurements.

Over the monthís time, I was able to recruit 16 more patients, run the preliminary statistical analyses, and began drafting a manuscript. Dr. Brock-Utne is confident that we can present this study at WARC (Western Anesthesia Residentís Conference), the ASA annual meeting, and will eventually even have a publication out of this research.

In the downtime between recruiting patients and taking measurements in the OR, I followed the CA-2 resident on the new echocardiography rotation as they performed exams in the ORís or had lectures from the Cardiac Anesthesia faculty about various aspects of TEE, including cardiac physiology, hemodynamics, and congenital heart disease. At the end of the month, I feel pretty confident with identifying the anatomy present on all 20 of the standard TEE views. I was also able to spend time manipulating the probe in the TEE simulator at the Stanford sim center, and actually got a chance to find the 20 views on my own.

Dr. Daryl Oakes, CV Anesthesia faculty and the coordinator of the TEE course at Stanford, also had me prepare a set of questions to be used as part of a Pre & Post-test for the residents on the TEE rotation to evaluate their progress. All in all it was a busy and very educational month, and a good way for me to meet many future anesthesia colleagues at Stanford.

I would absolutely recommend this type of experience for any of the future Stanford Anesthesia interns as a way to get plugged into the anesthesia department early on. Dr. Macario is extremely supportive of this and very helpful with finding research projects and activities tailored to our interests. Thanks again for letting me make this happen! Itís been one of the definite highlights of my intern year so far.
-Jan

Santa Clara Valley Medical Center Transitional PGY1 Year

Sarah M. Clark, M.D. is an Intern at Santa Clara Valley Medical Center this year and will start Stanford Anesthesia in July 2012. She was kind enough to write a description of her PGY1 year at the Valley up to this point. I hope it is useful information to applicants interested in learning more about the transitional year there.

Internship at the Valley combines the flexibility and variety in schedule that you expect from a transitional year with all of the perks and disadvantages associated with working at a county hospital. The year is divided into 13 four week blocks that include obstetrics, pediatrics, surgery, ED, ICU, medicine wards, and elective time.

The program director, Melissa Chin, works with each intern individually to create electives that are interesting and relevant to that intern. I was able to spend 2 weeks on cardiology, 1 week on echocardiography, 1 week in the coronerís office (a unique experience that Iíd recommend to anyone who doesnít get queasy around dead bodies!), and 4 weeks up at Stanford doing research and spending time in the anesthesia department. After all that, I still have 2 more weeks of elective later in the year that I can spend how ever I choose.

That being said, wards at the Valley can be pretty draining. Being a county hospital, the patients can be very sick and often have many social issues that can translate into difficult dispositions. In addition, the systems are not always the most efficient or logical and you can spend a significant portion of your day tracking down charts, looking for vitals binders, or filling out paperwork. However, working at a county hospital will also give you the opportunity to take care of patients with advanced medical conditions, and you will be able to do so from the perspective of the numerous different specialty services that you will work on throughout the year.

Another big advantage of being an intern at the Valley is the relationship with Stanford. Not only do you have the opportunity to spend time up at Stanford for electives and some ward months, but many of the residents, fellows, and attendings at Valley are affiliated with Stanford. This has allowed me to work with surgery and anesthesia residents, as well as residents and attendings in many other specialties. I have also had the opportunity to get to know my four co-interns who will also be heading up to Stanford for anesthesia in July 2012.

Overall, SCVMC is not the easiest or least stressful of transitional years, but it has numerous advantages that make it a great place to spend your intern year. Throughout the year I will work in a variety of departments and specialities that are all relevant to anesthesia. Furthermore, I was able to do exactly what I wanted during my elective time and the balance between difficult and easy months has been pretty reasonable thus far. At the end of the year I will be able to say that I worked hard and learned some medicine, but still had time to enjoy all that the bay area has to offer!

If you have any questions regarding SCVMC or intern year in general, please feel free to email me at sarahmclark11@gmail.com!

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