Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

May 2012

Opportunity: internship at Kaiser Permanente Medical Center in San Francisco

Because our residency applicants have consistently expressed an interest in Bay Area internships that are linked with Stanford Anesthesia we are looking to strengthen our relationships with local programs.
Stanford Anesthesia is pleased to announce a growing relationship with the internship at Kaiser Permanente Medical Center in San Francisco. Dr. Michael Coppolino is the Program Director and we are working on getting an NRMP # for two positions reserved for residents that match at Stanford Anesthesia. This adds to the 8 categorical positions with internship at Stanford, the four internship slots at the County Hospital Santa Clara (btw these Stanford/Santa Clara Valley positions are listed under Transitional Years in NRMP), and the 2 pediatric intern positions at Lucille Packard Hospital as part of the combined 5 year pediatrics anesthesia residency.

A couple of interns who are at SF Kaiser now wrote the following about their experience.

I chose Kaiser Permanente San Francisco Preliminary year program based on it's proximity to Stanford (36 miles) and the opportunity it provided to explore the world class city of San Francisco. I also had a personal curiosity to learn about the Kaiser Permanente systems of health care delivery. Little did I know that it was the best decision I could have made. The warmth and kindness I felt on my first day of orientation was a welcomed relief and helped to keep my my fears of internship at bay. Everything functions like a well-oiled machine, and coming from a county program at USC, it was a complete one-eighty. I feel like I actually have time to focus on medicine because the ancillary support is phenomenal. The clinical atmosphere is one of collaboration and support. The attendings are extremely nice and encouraging. The ICU experience is unparalleled and I feel like I am an integral part of a team and that my voice is heard. In addition, the flexibility in my schedule is a tremendous strength of the San Francisco Program. The Chief Residents are supportive and helpful in making the schedule work for everyone and the camaraderie amongst the class allows for flexible exchanges. There is a real effort to promote a balanced life for us. I?ve been able to attend every important event in my social life this year. However, something that I think is understated but incredibly essential and possibly the most important is the support we get from our Program Director, Dr. Coppolino, who works every day to better our schedules, workload, and education. He has a genuine interest in hearing our opinions and trying to put them into action. He knows each of us on a personal level, and he will support us in any way possible. I think that we sometimes take for granted that he is so accessible and innovative, but it is a rare gift in a residency and has definitely shaped my experience. If I were faced with the decision to do internship over again there is no doubt in my mind that I would pick Kaiser-SF in a heartbeat.

I chose to do my internship at Kaiser San Francisco because of the program's focus on resident learning and supportive environment. I was drawn to the curriculum, the wealth of clinical and research opportunities available to residents, and the diverse patient population. As a future anesthesiologist with an interest in cardiac anesthesia, the strong cardiology training also appealed to me. During my time here, I have been exposed to a wide spectrum of general internal medicine issues during my wards and ICU blocks and have also had the opportunity to delve deeper into various other specialties and internal medicine subspecialties through many electives. The faculty are excellent mentors who take time to teach, both in didactic sessions and at the bedside. Residents are given the right balance of supervision and support but also increasing independence as we progress through our training. The program takes ACGME guidelines seriously and is extremely responsive to resident feedback, and concerns are addressed in a timely manner. HealthConnect, our electronic medical system, is user-friendly, efficient, and streamlines patient care. Perhaps most importantly, there is a strong camaraderie among the residents, and I feel extremely fortunate to work with such a diverse, friendly, and helpful group of people.

Other information.

Name of Program:    San Francisco--Kaiser Permanente Medical Center

ACGME program number:   1400512060

Address         2425 Geary Boulevard, San Francisco, California 94115

Program Director email:      Michael.Coppolino@kp.org

Comments by previous interns:       Outstanding interns. Learn EPIC electronic medical record system which is same as Stanford. Strengths of the program include the cardiology attendings and the ICU rotation (it is referral center for bay area kaisers).  Critical care experience good fit for anesthesia. Prelims encouraged to continue/ finish projects from medical school.

# of available prelim positions:        8 (2 reserved for Stanford Anesthesia)

# of available categorical positions:           12

Interview days: Tuesday, Wednesday, and Friday mornings

Rotation schedule: Wards=4-4.5 months (No continuity clinic during yr for prelims); ICU=2 months, Elective=3 to 4 months (two week blocks can be research at Stanford Anesthesia or OR anesthesia at Stanford); Night float= ˝ to 1 month; ER=1 month "

Salary: $55,849 (for 2012)

Vacation: 3 wks plus 1 wk Educational Leave (flexible and need not involve conference)

Other info:      A joint Internal Medicine / Preventive Medicine residency exists with USCF/UC Berkeley and a new Patient Safety Fellowship which add to the academic opportunities.

Educational Stipend=$500 for PG-1

Website:
http://residency.kp.org/ncal/residency_programs/internal_medicine/san_francisco/index.html

Thank you,
Alex


Minutes from April 2012 Education Committee Meeting

Every month the Stanford Anesthesia Education Committee meets to discuss all aspects of the residency and how to improve training.

Below are the minutes of our most recent meeting fyi.

MedHub Portfolios: Janine Roberts informed that residents should submit all their scholarly work directly to MedHub as an eportfolio including grand rounds, keyword presentations, journal club, abstracts, PACU and other presentations, and an updated CV.

Formal Wellness Committee formed
: Our current Wellness Program was one of the first in the country and encompasses the CA-1 and CA-2 classes, and all 3 classes will be involved by the Fall of 2012. Currently, this involves a yearly retreat for the new CA-1 residents, and starting in July 2012, all 3 classes/~72 residents will have regular sessions built into the curriculum as part of the regular didactic series. With this rapid growth, an infrastructure to support the further development the program is necessary. The Education Committee was unanimous in support to form the Wellness Committee. Goals of the Wellness Committee will include developing and expanding the current program, exploring innovative ways to improve wellness while recognizing the demands and opportunities of a residency program, and recruiting additional faculty support. Also, another goal is to develop materials for the department’s website to showcase our innovative program, as well as potential research projects. Membership to include one of the Residency Program Directors, the co-Directors of the Wellness Program, representatives from each of the residency classes, a Chief Resident representative, a Psychologist/Psychiatrist or other mental health professional as well as additional faculty members.
Suggestions were to have 2 residents per class and to have them elected by their class. It was recommended that Dr Ratner and Dr Cornaby identify a process to select/elect the faculty representatives and that there be terms of 3 or 4 years duration that way faculty cycle on and of.

On-call pediatric pain coverage structure changed: Rotation Director Dr Williamson presented an update on pediatric rotation residents taking after hours pediatrics pain calls. Pediatric pain service triaging of phone calls rearranged so resident only deals with acute pain, not complex or cancer calls. Two lectures per rotation added on pediatric pain management. The number of calls now range from 1-10 per night when on call. Exit interviews suggest new structure implemented April 2012 working well.

Multispecialty division rotation keyword of the day pilot: This was introduced by CA1 Dr. Djurdjulov to the committee. The program is intended to facilitate OR teaching providing a structured method. It will be launched in block 13. Faculty and residents will receive all information electronically. Dr. Chu and AIM lab helping.

ACLS recertification for anesthesia house staff can be done online: Chief resident Dr. Reid reviewed the difficulty faced in scheduling ACLS recertification due to lack of courses on weekends/nights. The Continuing Medical Education office on campus now offers an online recertification course that can be paid for by the GME office and residents are only required to go in person to the CME office for a skills test that should only take a few minutes. This should simplify the process and ensure our residents are current in their certification.

Vacation week slots increased: Dr Harrison explained vacation schedule for next year - with the increased size of the residency program, there is need now for more vacation week slots. Almost a dozen more slots were opened mostly in the MSD during the Christmas holiday and New Years to help accommodate needs.

CA-2 lectures moved to Monday, and CA1 to Tuesday for next academic year. The committee unanimously approved moving CA-2 lectures to Monday, and CA1 lectures to Tuesday for next academic year. This would help cardiac anesthesia resident experience at Stanford.

Group evaluation of faculty housestaff approved. Even though resident evaluations of faculty are anonymous, residents state that sometimes describing a negative interaction with a faculty in any detail can give away who the resident is. A regular group evaluation of faculty by residents was proposed to increase anonymity. This will be lead by Chief Residents who will establish a communication pathway among classes. Also, a system for anonymous emails can be sent to chief resident. Program Director will serve as ombudsman and will address any issues.

STARR Teaching Scholar. Stanford Anesthesia senior Resident to Resident Teaching Scholar is a CA2 resident charged with promoting education activities in the department. The duties of the senior resident teaching scholar includes for example mentoring Stanford Anesthesia categorical and pediatric interns, implementing, evaluating, and changing curriculum to optimize medical education including during internship. Dr Udani CA2 will assume this position for this next academic year.

MICU rotation structure changes: Dr. Hennessey presented changes related to MICU rotation. The goal is to provide the residents more assessment ability of all admissions. Also, the didactic program is being improved and a better onboarding process is being created to orient the residents to the service, including EPIC the electronic medical record system. As a preparation for these changes the residents currently on service are being asked to log their MICU cases separately from the ACGME case log system and complete an assessment of their experience for each call day.

Chief Resident Update: Resident Call Scheduling: The resident call schedule is being transitioned to electronic scheduling software Amion and will now be done by the Department schedulers. The chief residents are working on the set-up now and the transition is expected to be completed by block 1.

Research Update from Western Anesthesia Resident Conference

We had a very successful weekend at the annual Western Anesthesia Resident Conference held May 4-6 2012 in Los Angeles. 19 anesthesia departments presented. More than 350 abstracts were submitted and there were 3 prices in each of three categories. (Oral, Poster Research and Poster case reports)

Dr. John Brock-Utne helped organize Stanford Anesthesia presentations.

Boris Heifets (CA2) got 2nd prize for his oral presentation on : "Improving Deep Brain Stimulation through Target Synaptic Modification". (coworkers Karl Deisseroth, Robert Malenka and Bruce MacIver).

Vivianne Tawfik (Ca2) received 2nd prize for her poster : "MicroRNA Modulation of Astrocyte Function in vitro". (coworker Rona G. Giffard).

Luis Verduzco (CA2) was awarded 2nd prize for his poster Subdural Hematoma After A Blood Patch. (Coworkers Scott Atlas, Ed Riley).

Congratulations to the housestaff who presented!
Thank you,
alex_small.jpg

Stanford Anesthesia Annual Research Awards Dinner



The Department of Anesthesia’s annual Research Awards Dinner was held April 30th, 2012 with Reception and abstract viewing from 5 to 6:30pm, dinner from 630-730pm, and then the Presentation and Awards.
We had 60 poster presentations and four oral presentations. Mervyn Maze UCSF Chair was the guest commentator. There were awards for the best abstract in six categories as below:
Best basic science abstract: Eric Gross (FARM research fellow), for “Abdominal Incision‐induced Cardioprotection in Rodents is Mediated By A Novel Neuronal Nociceptive Pathway Via an epsilon and gamma Protein Kinase C‐Dependent Mechanism”
Best clinical abstract: Debra Clay (et al.), for “Why Patients Consume Opioids Post Surgery”
Best abstract by a FARM Resident Fellow: Boris Heifets (et al.), for “Improving deep brain stimulation through targeted synaptic modification”
Best abstract by a T32 fellow: Robin White (et al.), for “MicroRNA-320 Induces Neurite Outgrowth by Targeting ARPP-1”
Best case study resident: Trevor Chan (CA1), for “A Case of Electroconvulsive Therapy-Induced Neurogenic Pulmonary Edema”
Best educational abstract: Erin Hennessey (Chief Resident last year), for “A Multi‐Media Educational Curriculum Targeting Housestaff Interactions With Patients and Families in the ICU.”

It is true that how great the education of housestaff is depends greatly on how great the clinical care is and how great the scholarship is (such as was exhibited in the above get together).
Thank you,
alex_small.jpg

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