Anesthesiology, Perioperative and Pain Medicine

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Residency News

Congratulations Stanford Anesthesia class of 2015 graduates

The Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University is delighted to graduate 24 new anesthesiologists !

They are listed below with their next position. Congratulations.

Sarah Clark: Regional Anesthesia Fellowship, Northwestern
James Flaherty: Regional Fellowship, Virginia Mason
Lauren Friedman: Pain Fellowship, UCSF
Chrystina Jeter: Pain Fellowship, Stanford
Jason Johns: Regional Fellowship, Stanford
Stephanie Jones: Cardiac Fellowship, University of Washington
Stephen Kelleher: Pediatric Anesthesia Fellowship, Children’s Hospital, Boston
Barrett Larson: Industry and Attending, Stanford
Ken Lau: Private Practice, San Diego
James Li: Critical Care Fellowship, Stanford
Joshua Melvin: Private Practice, Sacramento
Chris Miller: Pediatric Anesthesia Fellowship, Stanford
Kristen Noon: Pain Fellowship, UCSD
Anil Panigrahi: Transfusion Fellowship, Stanford
Justin Pollock: Cardiac Fellowship, UCSD
Jennifer Potter: Regional Fellowship, University of Virginia
Chris Press: Cardiac Fellowship, Stanford
Amit Saxena: Attending, Stanford
Jan Sliwa: Cardiac Fellowship, Brigham and Women’s Hosp, Boston
Shaina Sonobe: Private Practice, Hawaii
Meghan Tieu: Attending, Stanford
Rachel Wang: Private Practice, Santa Cruz
Vicky Yin: Attending, Stanford
Jennifer Zocca: Pain Fellowship, Cornell

RWANDA February-March 2015 Christopher Miller MD, MPA CA-3 Anesthesia Resident

Senior resident Chris Miller just got back from a month in Rwanda. He has written the nice essay below to summarize his experience which I wanted to share with you. Thank you Alex

Thanks to exceptional support and the strong backing of the Department of Anesthesia, Perioperative and Pain Medicine at Stanford, my month long trip to Rwanda from February 7th to March 7th proved to be one the most educational experiences of my life, and for that I will be eternally grateful.

Starting in 1996, the Canadian Anesthesiologist’s Society International Education Foundation (CAS IEF) has had as its central mission the idea that safe, effective anesthesia and intensive care medicine should be available to all people, regardless of geography or financial ability. It was through this organization that a Stanford anesthesiologist and critical care medicine attending, Dr. Ana Crawford, and I traveled to Kigali, Rwanda with the goal of teaching and learning from the country’s anesthesia residents and anesthesia technicians. In a land of 14,000,000 people, there are currently 17 anesthesiologists, making the education of the current residents critical, as they will be charged with caring for hundreds of thousands of patients in their careers and will most certainly shape the future of the profession in their country.

During each of the four weeks we were in country, we followed the residents from hospital to hospital to teach intra-operatively as much as possible. Every Monday, however, was a full day of didactic teaching located at the main hospital in Kigali, granting us an opportunity to teach the entire residency class and structure our lessons to acknowledge their clinical strengths and improve on self-reported and observed weaknesses. Given that CAS IEF operates in Rwanda 12 months a year, a set curriculum had been developed to make sure all areas of anesthesiology are covered over the course of a resident’s four years of training. Our month was dedicated to critical care medicine, and we were able cover multiple topics, including: sepsis, fluid and vasopressor management, interpretation of EKGs, ventilator physiology, neuro-critical care and the skills involved with transthoracic echocardiography.

In addition to teaching the residents, we also had the opportunity to teach at the largest anesthesia technician school in the country, whose students are high school graduates who then participate in a 3-year anesthesia-training program and then graduate to provide the majority of anesthetics in Rwanda. Every Tuesday and Thursday we lectured on topics ranging from the management of Traumatic Brain Injury to Acute Respiratory Distress Syndrome, both of which are seen in exceedingly high numbers in Rwanda. In all situations and settings, we found residents and students with truly impressive dedication to their patients and education and were a joy to be with.

Our month ended in the Southwestern Province, teaching in a 3-day course on Obstetric Anesthesia and the management of critically ill pregnant women. A total of 30 participants (physicians, nurses, emergency department staff) completed this S.A.F.E. (Safer Anesthesia From Education) course and were then made responsible for teaching their colleagues throughout the next year with support from CAS IEF and their local hospital administration.

Without a doubt, this month was one of the most tremendous of my life and I am thankful for the opportunity. As CAS IEF and Stanford continue to support the advancement of anesthesia and critical care in Rwanda, further trips have been planned for this October and next February. I plan to pursue every chance to return to this incredible place and continue to push forward the educational objectives outlined by our Rwandan counterparts. Thank you!

Successful 2015 match results!

An article that just was published studied applicants' self-reported priorities in selecting a residency.(1)
The five factors with highest rating of importance were:
-- the program's ability to prepare residents for future training or position
-- resident esprit de corps
-- faculty availability and involvement in teaching
-- depth and breadth of faculty
-- variety of patients and clinical resources.

With that in mind happy to provide results of Match. A fabulous group overall.

CATEGORICAL INTERNS/RESIDENTS
NICOLE ARKIN, STANFORD UNIVERSITY
ROBERT ARRIGO, STANFORD UNIVERSITY
HANNAH BECHTOLD, UNIVERSITY OF CALIFORNIA, LOS ANGELES
TYLER EWING, UNIVERSITY OF CALIFORNIA, DAVIS
KAITLIN FLANNERY, UNIVERSITY OF IOWA
ZENA KNIGHT, HARVARD MEDICAL SCHOOL
EMILY STOCKERT, UNIVERSITY OF CHICAGO
BRIAN TSE, UNIVERSITY OF CALIFORNIA, LOS ANGELES

ADVANCED RESIDENTS 2016
DAVID ALLAIN, LOUSIANA STATE UNIVERSITY, NEW ORLEANS
PANDORA CHUA, UNIVERSITY OF PENNSYLVANIA
CLARITY COFFMAN, UNIVERSITY OF CALIFORNIA, SAN DIEGO
CEDAR FOWLER, TUFTS UNIVERSITY
LEEANNE GRIFFITH, DREXEL UNIVERSITY
JAMES MCAVOY, UNIVERSITY OF VERMONT
PATRICK MINOT, UNIVERSITY OF COLORADO
LYNN NGAI, UNIVERSITY OF SOUTHERN CALIFORNIA
CHRISTOPHER RISHEL, UNIVERSITY OF CHICAGO
JOSIANNA SCHWAN, UNIVERSITY OF COLORADO
JEFFREY SKANCHY, UNIVERSITY OF TEXAS, HOUSTON
LINDSEY STEPHENS, MOUNT SINAI
ERIN STEWART, GEORGETOWN UNIVERSITY

COMBINED INTERNAL MEDICINE/ANESTHESIA
NATALIE BODMER, UNIVERSITY OF ILLNOIS
TIFFANY LEE, UC IRVINE
ADAM TIAGONCE, UNIVERSITY OF ILLINOIS

COMBINED PEDIATRICS/ANESTHESIA
AIDEN TAIT, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
MICHAEL O’HARA, RUTGERS NEW JERSEY MEDICAL SCHOOL

1. Roy Phitayakorn, E. A. Macklin, J. Goldsmith, and Debra F. Weinstein (2015) Applicants' Self-Reported Priorities in Selecting a Residency Program. Journal of Graduate Medical Education: March 2015, Vol. 7, No. 1, pp. 21-26.

Education Committee Meeting Highlights

Some highlights from the Education Committee Meeting

Announcements: Dr. Meredith Kan has been appointed Rotation Director of the Orthopedic Anesthesia elective. Dr. Tanaka welcomed Dr. Sheila Pai Cole as the newest member of the Education Committee. He also welcomed the newly named chief residents for 2015-16: Drs. Quentin Baca, Chris Clave & Amanda Kumar.

Publishing on Ether: Nicole Green from the Stanford Anesthesia Informatics and Media Lab (http://aim.stanford.edu/) updated the group on the education resources available at http://ether.stanford.edu/.
If anyone is interested in adding content or other functions to website please contact her.

Clinical Base Year: 8 categorical anesthesia interns complete a preliminary medicine year at Stanford. Every year some changes are made to improve the educational experience. Based on input from this yr’s interns several items were discussed and the following were agreed on for next year:
• replacing the 2 week geriatrics rotation with a 2 week elective (for example, TEE, acute pain, QI, Research, or perioperative medicine based on preference of intern)
• preferentially have the Anesthesia interns scheduled on rotations which are more relevant (e.g. Cardiology or Pulm consult) than others which may be less relevant (e.g. Rheumatology) when on non-call rotations.
• determine if it is possible that no jeopardy (cover for other intern unexpected absences) be allowed during the 4 week Anesthesia rotation
• add a faculty advisor (attending to be named this Spring) to act as another resource for interns beyond Drs. Tanaka, Harrison, Chu and the ImPRINT resident leaders.

Stanford Anesthesia Senior Resident Teaching Scholar: This is a resident leadership position in the Department of Anesthesiology with main goal to enhance the educational experience for residents and medical students. The appointment is for 12 months. Dr. Louise Wen was voted to be the Stanford Anesthesia Senior Resident Teaching Scholar for 2015-16, following in the footsteps of Dr. Chris Miller this year.

PRIME Scholars: Last year four Stanford Anesthesia residents were awarded PRIME (Peer Support and Resiliency In MEdicine Scholarship) funding to promote trainee wellness and resiliency. Drs. Lindsay Borg and Louise Wen updated the committee on their PRIME scholarship projects.
Dr. Borg surveyed all the Stanford housestaff across all departments for their mental health care needs. She now has the data and is currently analyzing it to identify barriers and potential solutions to access this care. She aims to publish the results working with her faculty advisor Dr. Mickey Trockel.

Dr. Wen’s project included attending a mindfulness and wellness course and bringing back the skills learned to the anesthesia interns. Four of the eleven sessions this year with the interns are wellness focused.

The two other awardees Drs. Chris Miller and Adam Was will update the committee later this Spring.

Transesophageal Echocardiography (TEE) Training: The residency would like to aim to have graduating residents have the knowledge and skills to pass the Basic exam (http://www.echoboards.org/content/basic-pte%C2%AE). It will be up to the individual resident to decide if they want to actually take the basic exam currently offered every two years and the next one is in 2016. Senior residents Drs. Sliwa and Potter presented 1) results of the needs assessment resident survey on TEE, and 2) their work under the mentorship of some of the cardiac anesthesia faculty to develop a web based TEE curriculum so it can be accessed by residents as needed. They will return in June to update committee on curriculum.

Medical Student Clerkship in Anesthesia at Stanford: Dr. Marianne Chen updated the committee on the medical student rotation. Some of the upcoming modifications to rotation include: 1) more formal first day orientation, 2) changing the student final evaluation to a mock oral type exam with an attending or senior resident, and 3) reinstating “Lunch and Learn” sessions were students present a topic to other students with faculty mentor present.


Update on some residency activities!

Faculty advisor meeting twice a year
An updated medhub form (https://stanford.medhub.com/functions/evaluations/index.mh?p=anes) has been created to document this mtg. The new Faculty Advisor job description is in Appendix A.

Chief Resident QI project
The GME Chief resident committee has sharps/exposure prevention as the QI project for the year. Suturing needles account for the majority of sharps exposures across the institution.
The Anesthesia Chief Residents surveyed the housestaff to better understand the problem. Suggestions mentioned include:
• More blunt needles for drawing up meds
• More sharps containers on wheels
• Getting rid of glass vials
• Self-capping TB needles for local anesthetic administration
• Anesthesia safe zone – a mayo stand dedicated with anesthesia line placement
These data are to be presented to GME Chief council with further system changes in hospital and OR to be discussed.

Resident Clinical Dashboard
Dr. Kadry has been working on creating a dashboard of data extracted from epic for residents to use that includes clinical data that housetaff can use to change and improve their practice. The data will also include procedures and cases performed. Residents in the committee agreed that these report cards are beneficial (great tool to discuss with advisor). Would like to do a trial run. The goal is to have report sent to house staff weekly starting in January.

Pediatric Anesthesia Rotation Update
Dr. Julie Mendoza is new rotation director for pediatric anesthesia. Orientation is held on the first day of rotation. Milestones are being updated with Dr. Adriano with special emphasis on delineating junior from senior resident milestones. The senior residents are asking for opportunity to do Peds before graduation so some senior rotation 4 week blocks may be broken into 2 week blocks.

Milestones
Dr. Adriano is working with rotation directors on milestones (http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf) as well as with their use by the Clinical Competence Committee. Levels of scoring (1-5) were reviewed as different from prior resident evaluation forms. The milestones assessments for each rotation may be modified by each rotation director to be more focused.

VA ICU
Dr. Brun updated the committee on the VA ICU rotation. Anesthesia are paired with an intern to provide supervisory and teaching opportunity. There are daily 1 hour lectures. Dr. Brun and ICU team are updating learning goals and objectives and milestones assessment instrument and aim to make that available to residents before the rotation.

New Program: the Stanford Anesthesia Innovation Lab (SAIL)
Dr. Barrett Larson CA3 is creating a new program which he will direct as faculty beginning next yr. The mission of SAIL is to drive medical device innovation and education in the Department of Anesthesiology. The goal is to create a community where innovation can flourish. The department has provided some seed funding.

Anatomy Sessions for Residents
Dr. Outterson presented a plan for use of prosection cadavers during lecture time so that residents can work on cadavers and learn anatomy especially for nerve blocks. She is working with Melissa Cuen to schedule this.

UC Irvine Airway Teaching Course
CA2s Lindsay Borg, Ann Ng, and Louise Wen and Fellow Tammy Wang were invited to teach an advanced airway workshop at the California Anesthesiology Medical Student Symposium hosted by UC Irvine. Kudos for a wonderful job. Residency fair was held as well.

Feedback tool
Dr. Tanaka has been working on mechanisms to increase feedback to residents by faculty. An easy medhub link is available at https://stanford.medhub.com/functions/evaluations/index.mh?p=anes
A trial pilot in the MSD was successful (one resident had 12 feedback entries) but it requires both attendings and residents to initiate feedback discussion and documentation. One way to start is to state that the following conversation is meant to be feedback.
The faculty can ask for the resident’s self-assessment of performance.
The faculty can tell the resident what they observed. “I saw/noticed/ observed…” and move on to “I am concerned/impressed…”
The faculty can inquire: “What was on your mind at the time?” “I wonder how you saw it?” and respond to the resident’s self-assessment and then formulate teaching point based on response to inquiry. Ask for resident’s understanding and strategies for improvement (action plan). Give suggestions, offer alternatives.

Libero lecture offered 3 times a day
A survey was distributed to the residents by CA2s Lena Scotto and Lindsay Borg to help assess the lecture series. The impression is that the lecture series is a valuable tool to help with preparing for the boards (has lessened study time on some topics) and want to make content more easily accessible on website on Ether by AIM Lab with slides and podcasts. Proposal to link each Libero lecture to keyword (title of Libero has to be the keyword). The keywords will be alphabetized. Clicking on each keyword will open a drop down menu with a link to the pdf of the PowerPoint presentation, an MP3 recording of the lecture (possible, need to pilot to see if it's going to be used), 2-3 flash cards (future addition).

Update Society of Academic Anesthesiology Association meeting
Dr. Adriano updated the committee of the SAAA in Chicago. A couple of items are that the BASIC Exam is now scheduled for Friday, June 12, and Saturday, June 13, per requests from Program Directors to move the original July dates forward to avoid creating scheduling challenges. Also, the regional anesthesia fellowship is likely to become an ACGME accredited fellowship.

Lead Apron QI Final Report
CA3 Dr. Wang summarized that an initial survey demonstrated that there was a need for more lead aprons (particularly in the Stanford MOR) and radiation safety education. With the support of Stanford OR management, many of the previously locked aprons were unlocked to increase availability. Also, the OR administration purchased 5 sets of small size aprons for anesthesiology use which are kept by the anesthesia techs. Dr. Wang also wrote a review article and designed a Powerpoint presentation on radiation safety which Tanya Travkina is incorporating into the EP rotation curriculum. These educational materials were distributed to the residents, and prelim results from a final survey show that residents feel that the lead apron situation has improved.

Chronic Pain rotation
Dr. Singh proposed and will be trialing a 1255-110 pm teaching session for the A2 faculty (faculty assigned to the resident in the chronic pain clinic) with protected time. She will report back in 6 months to see impact of this change.

Acute Pain Call
Currently the 2 acute and 2 chronic pain residents take q4 call from home on pain patients. There is an interest in having this resident be in house and with a full day after call to be able to respond to inpatient needs more quickly. This requires a call room which may not be readily available so will work with hospital to see if there are any options. Other resident call combinations are being studied. Also, a second NP is being hired to help with the work on the acute pain service.

Conference attendance
One of the metrics used for milestones is conference attendance. The committee discussed what an acceptable level of attendance would be given vacations, day after calls, etc and the group recommend 50% of grand rounds and 70% of the weekday didactic lectures as baseline minimum expectations for the residents in the MSD rotation. This will be measured starting next month.


Appendix A

Faculty Advisor Job Description
The faculty advisors are a core group of educators from the department faculty responsible for counseling and guiding the resident through residency processes and learning objectives.

Each faculty advisor has one resident per year (PGY 2, 3 and 4) of training. Having 3 resident advisees per attending allows the faculty to more easily gain advising expertise including evaluating milestone progression.

A meeting between advisor and resident occurs at least twice a year with completion of the online Medhub instrument (https://stanford.medhub.com/functions/evaluations/index.mh?p=anes) by the faculty advisor. A best practice is to send this Medhub instrument to the resident a week before the meeting so the resident can prepare for the meeting with their faculty advisor.

The meeting that occurs between the faculty advisor and resident advisee serves administratively as the Semi-Annual Meeting with Program Director. With more than 80 housestaff in the Stanford Anesthesia residency more individualized advising for each resident is possible from the faculty advisors.

Any resident is also free to ask to meet with any of the program directors at any time, and can ask to change faculty advisor if needed. A resident can have multiple faculty mentors, but a resident shall have a single faculty advisor at any one time.

The job description of the faculty advisor includes:
Listener: please meet with each resident advisee at least twice a year to listen to any personal or professional concerns that residents have and to provide advice and guidance.
Goal setter: please assist advisees in creating an individualized learning plan, including career goals, self-identified strengths and weaknesses, and explicit training objectives. For each objective, identify resources to help the resident and ideally determine how the resident will measure achievement. This goal setting function includes encouragement with respect to scholarship opportunities including research and QI. The Medhub form helps document and keep track of this.
Residency planner: please work with advisees to plan educational activities related to specific learning needs (for example, a global health experience). Please make sure the resident is on track to complete all required rotations and surpass the minimum case requirements. Please promote self-directed learning and personalize the educational experience of trainees. This includes linking advisees with mentors (e.g., for planning for postresidency career).
Evaluator and problem solver: examine monthly evaluations on the resident via medhub and review with residents to assess the trainee's educational progress and provide insights and feedback. If there are informal comments from other faculty about the resident, these will be provided to the advisor to discuss with the resident. Advisors assist trainees in identifying strategies for addressing any problem areas (as might be identified in milestones assessments by each rotation). Advisors, on occasion, need to work with the clinical competence committee and program director on corrective action or remediation plans. Please provide recognition for work well done by the resident.
Collaborator and scholar: please work with other faculty advisors work to enhance all aspects of the residency. This includes working with the education committee on curriculum, assessment, and teaching methods. Please also disseminate any innovations you develop through local, regional, and national meetings such as the SEA or ASA.

Advisors are liaisons to the residency program director. Faculty advisor is a way to join the residency administrative team and build experience in advising.
Characteristics of an effective advisor include:
• honesty, integrity, enthusiasm, and patience
• open-minded
• a resident advocate
• have the respect of other residents and faculty
• possess a high level of emotional intelligence and well-developed organizational and time management skills

Fall 2014 Education Update

Here are some bullet points to update you on Stanford Anesthesia Education activities:

Record Libero daily lecture series:
The daily lectures series for residents in the Multispecialty division which began in July 2013 and offered 3 times each day has helped improve the MSD “overall teaching quality of rotation scores” as rated by the residents from 3.88 out of a maximum of 5 to 4.26 out of 5. CA2 residents Dr. Scotto and Borg are working with Dr. Tanaka to help write up a manuscript. Dr. Tanaka is trialing recording the lectures every day and web archiving for residents on other rotations but not clear how often would be watched.

VA ICU rotation:
The residents do 7-9 overnight calls per 4 wks (q3-4) and there have been no duty hr violations. When the resident is on call gain they gain more supervisory time with an intern as they care for the ICU patients.

Faculty Teaching Scholars:
This academic year there are 4 faculty teaching scholars who are awarded non-clinical time to develop their skills in teaching and education theory and to develop an education project.
Dr. Jung Hong from the Palo Alto VA presented his project related to developing a private practice curriculum that includes basic information on disability/malpractice insurance/financial planning/ home buying/proper case documentation. Dr. Hong will serve as a resource for interested senior residents to help with this transition. The project planned is to possibly create web based content based on input from recent graduates in private practice as to what is most useful. Currently, Dr. Hong is in the beginning stages of creating surveys for those in private practice.

A second faculty teaching scholar is Dr. Ethan McKenzie who is further developing the ENT teaching curriculum and formalizing the content to co-inside with the new milestones. There will be an eventual webpage including topics to teach to residents, targeted how to’s, intubation (fiberoptic for example) videos, links of evaluations to the resident’s medhub portfolio, and pre & post test questions.

Trauma Rotation Update:
The new trauma anesthesia rotation has rotation director Dr. Chris Painter. He is building curriculum including use of milestones for assessment.

The Faculty Advisor will have increased formal responsibilities including meeting with resident serving as the Semi-Annual Meeting with Program Director:
Each resident has a faculty advisor to counsel and guide the resident through the residency processes, procedures, and now the key learning milestones. Going forward the plan is to have each faculty have one resident per year PGY2, 3 and 4 of training, unlike now where some faculty have just one resident. Having 3 residents per attending will allow the faculty to more easily evaluate milestone progression, and report back to the clinical competence committee. The medhub instrument template for the meeting is being redone with the expectation that the mtg between advisor and resident will occur at least twice a year. The committee discussed ideas for formalizing when the meetings between resident and faculty advisor should occur. Any resident is also free to ask to meet with any of the program directors at any time.

ACGME Milestones:
The 30 different rotations in the residency have milestones based evaluations and curriculum which is available on medhub and sent to each resident before a rotation starts. The program directors are meeting with Dr. Steve Howard chair of the CCC to further determine how dashboard of milestones will be best utilized.

Education Committee Meeting Minutes August 15, 2014

In Attendance: Drs. Adriano, Aggarwal, Angelotti, Chang, Djalali, Fanning, Gross, Hassan, Hennessy, Hsu, Jeter, Johns, Joseph, Kalra, Kulkarni, Lau, Macario, McCage, Miller, Newmark, O’Hear, Painter, Press, Saw, Schwab, Steffel, Tanaka, Travkina; Ahearn, David, Roberts

Welcome: Dr. Tanaka welcomed the new resident members of the Education Committee and reviewed the purpose and areas of oversight for the Education Committee. (Appendix A)

QI Projects: All residents must participate in QI projects during their residency training to meet ACGME requirements and to also obtain knowledge and application for their future practice. Dr. Ruth Fanning pointed out that QI is already embedded in much of our daily practice at Stanford but is often not recognized as such. A new initiative to launch this academic year is to divide the CA2 resident class into 4 groups of 6-7 with each group tackling a QI project for the next 12-18 months. Dr. Ruth Fanning will be the Faculty Director and will lead one of the 4 groups. Dr. Sam Wald (OR Medical Director), Dr. Bryan Bohman (Chief Medical Officer for University HealthCare Alliance) and Dr. Tom Caruso (Pediatric anesthesia) will each lead one of the 3 other groups. The plan is to first have the residents complete an online survey to list and prioritize QI projects they would like to see addressed. Then each group will choose a project that likely will be of highest yield and then invite other potential stakeholders such as from nursing to join the working team. The results of the project will be presented at a resident conference.

Feedback Tool: A feedback tool is available on MedHub and is being piloted with the residents. It is designed to promote daily feedback between attendings and residents in a brief, concise format. This is not meant to be a summary of the day but an opportunity for concrete, behavior specific, on the day of feedback. Residents can initiate this feedback form and/or they can ask their attending to initiate. To try out please go to: https://stanford.medhub.com/functions/evaluations/index.mh?p=anes

New Cardiac Electrophysiology Rotation: Drs. Eric Gross and Tanya Travkina are rotation directors for a new 2 week rotation based in the multispecialty division. This rotation will be offered to CA2 residents and CA1 residents near the end of their first year and is intended to fill a perceived education gap (e.g., radiation, pacemakers). There will be 10 topics, one per weekday, covered while the residents work in the Cath Lab that should be beneficial given the increase in these out-of-OR cases around the country.

MSICU Rotation Review: Dr. Tim Angelotti is the new rotation director of the MSICU rotation and he reviewed the upcoming plans for the rotation. A summary of the rotation evaluations was reviewed. Dr. Angelotti indicated the critical care faculty is moving away from daily noon lectures to online lectures with a plan to carve out some time for residents to view these lectures. They are also planning a series of applied learning lectures with dedicated teachers for specific subjects to be taught during each month. Dr. Angelotti will report back in 6 months for an update.

STARTprep Update: Amy Ahearn reviewed the STARTprep program (http://www.startprep.org/), a year-long, online, micro-learning course designed to instruct residents in the anesthesia basic sciences. Based on feedback, the program has made several changes including that questions are now available to CA2 and CA3 residents to use in their daily studies.

Pain Simulation Project: Dr. Jordan Newmark has developed a pain medicine simulation experience for the residents. This three hour simulation course will be scheduled twice during the 2014-2015 academic year with eight residents participating in each session. The plan is to schedule this during a CA3 resident lecture time period.

Chief Resident Update: The chiefs are currently working on scheduling the resident schedule several months in advance, and are finishing November and December schedules. A separate issue raised wrt the yearly rotation schedule is that once residents are finished with their subspecialty months such as cardiac anesthesia or pediatric anesthesia, they may not take care of those types of patients again during the residency. Such cases are available at the Valley for instance if a resident has a senior rotation there. There are existing senior electives in peds and cardiac but not every resident will do such an elective. The chief residents have proposed that it made possible for the 4 week senior electives on VA cardiac and pediatric anesthesia at Packard to occasionally be split into 2 week blocks for a few months in the yr so that two senior residents interested in a repeat experience can rotate through.

Transform Program: Dr. James Lau (Surgery) attended the meeting to inform the residency of the Transform Program that will soon rollout beginning with the E2ICU. The goal of the Transform Program is to emphasize interprofessional communication and teamwork on patient wards. A 45 minute health stream course introducing the language of teamwork will be followed via in-situ simulation training and debriefs, as well as quarterly patient safety conferences.


Appendix A.
EDUCATION COMMITTEE
Pedro Tanaka, M.D.
Committee Chairman

This committee oversees educational needs and programs for residents. The overall goals of the Committee are:
• earnest and helpful advocate for residents and their education
• to critically evaluate and change our teaching program as needed including clinical curriculum, workshops, and didactic conferences
• elicit feedback from residents and faculty about quality of curriculum
• remain informed about accreditation requirements, and recommend and implement program changes as necessary for compliance, such as with the milestones
• to support educational efforts to facilitate the transition from medical school to residency training and then from residency training into practice
• to promote a supportive milieu to ensure the best environment for educational experiences and optimal educational outcomes
• work together on fixable problems by combining ideas and efforts of housestaff and faculty
• to encourage and provide methods for faculty development in teaching and evaluation
• advise the Chairman and Program Director on above issues

The committee consists of faculty members, the chief residents and representatives from each residency class. Meetings are held every month, usually the second Thursday of the month. Please speak to your representative or any faculty on the committee with suggestions or comments that may improve the education for you and your fellow residents.

Stanford Anesthesia Class of 2014 graduates

Congratulations to the Stanford Anesthesia Class of 2014!

Nick Anast ------- Cardiac Anesthesia Fellow, Stanford
Kevin Blaine ------- Critical Care Medicine Fellow, NIH
Jorge Caballero ------- Research Fellow, Stanford
Trevor Chan ------- Pediatric Anesthesia Fellow, Stanford
Craig Chen ------- Critical Care Medicine Fellow, Stanford
Adam Djurdjulov ------- Community Practice, Southern California
Marc Dobrow ------- Community Practice, Colorado
King Ganguly ------- Pain Medicine Fellow, Cornell
Robert Groff ------- Critical Care Medicine Fellow, Stanford
Leslie Hale ------- Critical Care Medicine Fellow, Stanford
Reed Harvey ------- Cardiac Anesthesia Fellow, UCLA
Joseph Kwok ------- Pain Medicine Fellow, Stanford
Marie McHenry ------- Cardiac Anesthesia Fellow, Texas Heart Institute
Eric Mehlberg ------- Pain Medicine Fellow, UCSF
Ryan Mountjoy ------- Regional Anesthesia Fellow, Duke
Rafee Obaidi ------- Community Practice, Arizona
Christopher Painter ------- Faculty, Stanford
Carter Peatross ------- Cardiac Anesthesia Fellow, Mayo Clinic
Shelly Pecorella ------- Pediatric Anesthesia Fellowship, Duke
Alex Quick ------- Community Practice, San Diego
Lindsay Raleigh ------- Critical Care Medicine Fellow, Stanford
Eric Sun ------- Research Fellow, Stanford
Jimmie Tan ------- Regional Anesthesia Fellow, Stanford
Natacha Telusca ------- Pain Medicine Fellow, Stanford
Matt Wagaman ------- Community Practice, Colorado
Tammy Wang ------- Pediatric Anesthesia Fellow, Stanford

Stanford Anesthesia Education Committee Meeting Minutes May 8, 2014

In Attendance: Drs. Adriano, Jeter, Kelleher, Kim, Macario, McHenry, Press, Ratner, Shafer, Sun, Telischak, Telusca; Cuen, David, Roberts

Introduction: Melissa Cuen was introduced as the new administrative associate to the Education and Training Office. Melissa is a UC Berkeley graduate and comes to us from industry and also worked at the California Society of Anesthesiologists. She will be handling the resident lecture series, resident reimbursements and research fellow appointments, among other things. She will work at an off-site location at Arastradero Road.

The Peer Support and Resiliency in Medicine (PRIME) program: Dr. Ratner and the leadership of the resident wellness program have changed the name of the program to PRIME (Peer Support and Resiliency in MEdicine).

PRIME Scholarship: Donations made to the Amy Wang Memorial Fund are used to promote resident well-being. For example, some of those monies are used to support the CA1 rafting team building trip in the summer. Dr. Ratner and the wellness group proposed a new initiative whereby Stanford residents can apply for a $1,500 PRIME scholarship. Up to two of these scholarships will be awarded each year to promote trainee wellness and resiliency through one of the following ways:
1- Attendance by the resident at a national or international meeting/program focusing on the promotion of physician resiliency/wellness followed by a verbal presentation or written report to the residents, fellows and/or faculty.
2- Implementation of a program by the resident that focuses on the promotion of physician health that is targeted towards trainees and may include trainee’s family members. Program evaluation via surveying participants would be completed.
3- A research project that studies or promotes physician trainee health/resilience.
4- Other activities may be submitted for consideration and all require a faculty advisor
If interested please email Dr. Macario a one page proposal by June 15, 2014. A full scholarship description including selection committee is below in Appendix.

Pediatric Advanced Life Support (PALS) course: Based on interest by the housestaff, Dr. Naiyi Sun updated the group that the first PALS certification course for anesthesia residents was held on Saturday April 26, 2014. 16 residents attended the course including 5 CA-1, 4 CA-2, and 7 CA-3 residents. The format was a condensed 1 day course specifically designed for anesthesia MDs. The 12 evaluations received back showed all residents rated the course 4/4. In response to, "Do you think this course should be offered to anesthesia residents every year?" all residents answered yes. Since the course feedback was positive the department will fund it for next year. The chief residents will survey residents to see how many are interested for a Saturday course next yr and the plan is to offer either 1 or 2 courses per yr.

Weekday afternoon lecture Series: The 2014-15 CA2 lecture resident representatives are Drs. Quentin Baca and Chris Clave and the CA3 representatives are Drs. Stephanie Jones and Jan Sliwa. Dr. Basarab-Tung is the new Director of the CA2-CA3 lecture series and is finalizing the lecture schedules based on meetings with residents to obtain input as to format and content.

Western Anesthesia Residents' Conference (WARC): The 52nd annual WARC resident research conference took place at the Intercontinental Hotel in Century City, CA on May 2-4, 2014. Dr. Tawfik reports that 24 abstracts were presented by 19 residents, two medical students and one fellow. Included were six research abstracts by the residents who received research months in 2013-2014. Drs. Justin Pollock and Jason Johns had verbal presentations. Dr. Barrett Larson won first prize in category Science & Technology for a new ultraportable fluid-cooling device. Next year WARC is in Seattle. All residents receiving research time during the academic yr are required to present at WARC.

Outcomes after residency: Dr. Macario reviewed data on board certification rates, fellowship choices, and practice type for alumni.
Board Certification rates: The 2008-2012 alumni graduates (n=106 over those 5 yrs) of Stanford Anesthesia residency have an overall board certification rate of 97% as compared to the national average of 89%.
Practice type: For the 106 graduates between 2008-2012 where are they now? 31% are in academic practice at one of the 4 affiliated hospitals (Stanford 11%, Santa Clara Valley 8%, Palo Alto VA 7%, Packard 5%), 20% are in community practice in the Bay Area, 20% are in community practice outside California, 20% are in community practice in California outside the Bay Area, and 8% are at an academic medical center not Stanford.
Fellowship choices: For Stanford Anesthesia graduates for this year 2014, 75% will go on to a postgraduate fellowship with cardiac (n=4), pediatrics (n=4), research (n=3), ICU (n=3), regional (n=2), and pain (n=2) as the choices.

Medical Humanities: Drs. Audrey Shafer and Yeuen Kim, Clinical Assistant Professor in the Dept of Medicine, proposed a Medical Humanities experience for the CA3 class titled, “Rodin and Physical Diagnosis: Medical Humanities to Improve Visual Observation and Communication Skills.” This will take place during a normally scheduled CA3 lecture period and involve a guided tour of the Cantor Arts Center and exercises in observing and describing. Dr. Kim indicated the goal is to expose residents to art education and apply what is learned at the gallery to improve clinical skills through tolerance of ambiguity, visual observational skills and building community. This program has been well received at SCVMC. Dr. Kim will work with Janine to schedule the session.

Chief Resident Update:
The new chief residents are working on the block 13 schedule and their plan is to get the future block schedules out at least two months in advance.
The CA1 river rafting trip will be on July 19-20.


Appendix
We are happy to announce a new scholarship called the Peer Support and Resiliency In MEdicine (PRIME) Scholarship whereby Stanford Anesthesia residents can apply for funding up to $1500 to promote trainee wellness and resiliency in one of the following ways.

1. Attendance at national or international meeting/program focusing on the promotion of physician resiliency/wellness.
The resident would propose a meeting they want to attend and rationale to the Selection Committee. Ideally, the meeting should grant CME credit, but this is not required. The resident may wish to include in the application how after the meeting, they will present salient points relevant to residents, fellows and/or faculty. Alternatively, for example, a written report can be produced. Conference week or absence days could be used to attend.
Examples of meetings:
• AMA-CMA-BMA International Conference on Physician Health
• Canadian Conference on Physician Health
• Mindful Living Programs for Health Professionals
• Mindfulness Based Stress Reduction (does not offer CME)
• University of Mass. Center for Mindfulness in Medicine, Health Care and Society conferences
• International Research Congress on Integrative Medicine and Health

2. Implement a program that focuses on the promotion of physician health that is targeted towards trainees and may include trainee’s family members.
Example: Wellness on Wheels programs are available through Stanford University’s Health Improvement Program (HIP) for groups >10 people. These may include stress reduction, nutrition, exercise, yoga or pilates classes. http://hip.stanford.edu/classes/wellness-wheels.html
The application would specify program and budget needed. Afterwards, the awardee would prepare an abstract/summary of the program, and ideally, include before and after data, representing program evaluation.

3. Perform a research project or participate in an ongoing research project that promotes physician trainee health/resilience. Funds may be requested to assist in data collection, analysis supplies, research assistant time or other approved activities pertinent to the project.

4. Other activities may be approved, if proposed to and accepted by a Selection Committee.

Selection Process:

1. Applicants will submit no more than a one page proposal of how the funds will be used and explain how this activity could promote physician resiliency.
2. Each applicant will identify a faculty member mentor for the proposal.
3. A selection committee will review the applications, and determine which 2 applicants will receive funds.

Selection Committee Members:
Program Director, Associate Program Director, Program Coordinator
Co-Directors of PRIME program or 2 faculty participants in the PRIME program (Emily Ratner, MD and Tara Cornaby, MD)
Chief Resident representative (1), One Resident Education Committee Representative from CA-1,CA-2, CA-3 class

Education Committee Meeting Minutes April 10, 2014

In Attendance: Drs. Adriano, Djalali, Fanning, Harrison, Hasan, Howard, Johns, Kalra, Kelleher, Kulkarni, Lemmens, Macario, McHenry, Miller, Quick, Press, Tanaka, Telischak, Telusca, Wagaman, T. Wang, Williamson; David, Roberts

Stanford Anesthesia Senior Resident Teaching Scholar: Dr. Chris Miller will be the 2014-15 Senior Resident Teaching Scholar, after Dr. Tammy Wang who has done an outstanding job this academic year. Dr. Miller’s duties will include being the Co-Director of ImPRINT with full job description in Appendix 1.

Medical Student Symposium: The weekend of September 20th, 2014 will be the 3rd annual California Anesthesiology Medical Student Symposium at UC Irvine. Dr. Pedro Tanaka will represent Stanford and he is able to take three CA-2/3 residents, travel expenses for the one day program funded by the Department. The residents will be teaching an airway workshop to medical students as well as answering questions about our residency program. Please contact Dr. Tanaka if interested.

Milestones Update: Dr. Aileen Adriano has been working with the rotation directors on mapping out rotation evaluations according to the 25 milestones and Janine will be programming these evaluations into MedHub. Dr. Adriano will visit each resident class during a lecture period to introduce the milestones and inform residents of the changes to the evaluation process. She will also be attending division meetings to introduce faculty to the new process. https://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/AnesthesiologyMilestones.pdf
Under the new evaluation system the resident can demonstrate milestones at one of 5 levels:
Level 1: expected of a resident who has completed internship.
Level 2: expected of a resident prior to significant experience in the subspecialties of anesthesiology.
Level 3: expected of a resident after having experience in the subspecialties of anesthesiology.
Level 4: is ready to transition to independent practice. This level is designed as the graduation target.
Level 5: The resident has advanced beyond performance targets defined for residency, and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level for selected milestones.

ABA Staged Exams: Dr. Kyle Harrison updated the group on the new ABA Staged Examination system. Beginning with the current CA-1 class, the new examination system will be in three parts. The Basic exam will be given the end of July following the completion of the CA-1 year. It will be offered every six months after that and a trainee must pass this exam to successfully proceed through the training program. Following the Basic exam and residency training, there is the Advanced written exam and then the two-part Applied Exam that includes the Objective Structured Clinical Examinations and an oral exam. The ABA is currently completing the building of a new facility in Raleigh North Carolina where all the Applied exams will take place.

SICU Update: The anesthesia resident on SICU will be acting as chief for some part of the rotation in the next few mths as a pilot and will get feedback from them on that experience.

CA2-CA3 Lecture Series Update: Dr. Alex Quick has helped improve the lecture series and will help identify junior resident representatives to work on a committee with Drs. Basarab and Harrison for next year. They will work together to select lecture topics and presenters for the class lecture series. Changes include that the faculty lecture will be first on the schedule at 4pm followed by the resident presentation such as journal club and PBLDs.

Chief Resident Update: The senior class lottery was held on Monday, April 14th and the chiefs will release the 2014-15 master rotation schedule shortly.

Libero Update: Dr. Tanaka has established a working group of residents (Lena Scotto, Phillip Wang, Sarah Clark, and Lindsay Borg) that will help to evaluate and suggest improvements for the Libero Program. Also this group will organize lectures in themes.

Rwanda Medical Mission: Dr. Natacha Telusca gave a presentation on her recent Global Health experience to Rwanda. Dr. Stephanie Jones also was a member of the team. It was a rewarding experience and encourage other residents to take advantage of this opportunity in the future.

The Annual Program Evaluation Meeting chaired by Dr. Kyle Harrison will be on Tuesday, May 13th in the Anesthesia Conference Room beginning at 5pm.

Next Education Committee Meeting: Thursday, May 8th, 2014 at 3:30pm


Appendix 1
Stanford Anesthesia Senior Resident Teaching Scholar

Summary: A resident leadership position to promote the education mission in the Department of Anesthesiology, Perioperative and Pain Medicine with main goal to enhance the educational experience for Stanford anesthesia residents and medical students
Appointment: 12 months beginning in and around April 1
Eligible: CA1 or CA2 (preferred) at time of appointment
Election: by vote of Education Committee after 1 page proposal (deadline February 15) by interested residents submitted to chair of Education Committee
Vision: The objective is for the department to be a leader in anesthesia medical education and research (e.g., simulation, informatics, blended learning, and classroom innovations).

Job description potential duties available:
Administration/leadership
• Course co-director for ImPRINT (the monthly curriculum for anesthesia interns)
o Pair CA1 graduates from ImPRINT with next years ImPRINT interns for mentorship
• Ex officio member of Education Committee
• Work with rotation directors to improve resident rotations

Curriculum
• Develop and implement an innovative curriculum for anesthesia residents with goal to publish or present results at national meeting

Teaching
• Teach in anesthesia simulation courses (EVOLVE, ACRM)
• Help organize the medical student anesthesia rotations at Stanford (resident mentors, scheduling, check list for goals)
• Medical students in the OR and on other clinical rotations

Advising/mentoring/recruitment
• Promote anesthesia, critical care, and pain rotations to medical students
• Recruit residency applicants in general, & specifically those interested in medical education
• Facilitate participation of other housestaff in activities to promote education
• Further develop the CA1 mentor/bigsib program for first year anesthesia residents

Professional Development
• Department funding available to attend a formal course such as the Society for Education in Anesthesia (SEA), Stanford Faculty Development Center Training for Clinical Teaching, or Stanford Simulation Instructor Course
• Attend Medical Education Seminar Series put on by the Stanford Center for Medical Education Research and Innovation (SCeMERI) http://med.stanford.edu/md/mdhandbook/mededresearchinitiative.html
• Participate in Dept. Faculty Teaching Scholar Program and attend those monthly meetings

Budget: Available

Prior Scholars:
Ankeet Udani MD (2012)
Tammy Wang MD (2013)

Stanford anesthesiologists in Rwanda improving health through education

Every year members of the department participate in global health activities. For example, Dr. Ana Crawford, clinical assistant professor and director global health in the dept of anesthesiology, perioperative and pain medicine at Stanford, Melanie Gipp Stanford pediatric anesthesia fellow, and Chris Press Stanford anesthesia chief resident are in Kigali, Rwanda for a teaching program at two hospitals of the National University of Rwanda.
They are teaching local anesthesiologists, residents and staff about anesthesia, including critical care medicine, procedural skills in a new simulation center, and pediatric anesthesia. An additional focus is the education of anesthesia technicians, the most common anesthesia care providers across Rwanda.
The program, in partnership with the Canadian Anesthesiologists’ Society International Education Foundation, has worked in Rwanda since 2006 to build and strengthen the medical teaching capacity in Rwanda. The goal is to build capacity for anesthesia training in Rwanda so that, over time, there will be enough local staff physician anesthesiologists to run the program with minimal international support.


Upcoming Events 2014

For those of you planning ahead for department events:

May 9 Research Awards Dinner, 6:00 – 10:00 p.m., Sheraton, Palo Alto

May 28 Arts & Anesthesia Soirée, 5:30 – 7:00 p.m., Li Ka Shing, Berg Hall

June 21 Resident Graduation, 5:30 – 11:00 p.m., Law School - Paul Brest Hall - Munger Bldg 4

July 13 Resident Welcome, 11:00 a.m. – 2:00 p.m., Thomas Fogarty Winery, Woodside

August 30: UC Davis Football Game Tailgate

September 6: USC Football Game Tailgate

September 13: Army Football Game Tailgate

October 12 ASA Alumni Reception 6:00 p.m., New Orleans

December 13 Holiday Party, 6:00 – 11:00 p.m., Arrillaga Alumni Center – McCaw Hall

Stanford is #2 ranked anesthesia dept in country for NIH funding for 2013

The Blue Ridge Institute for Medical Research (BRIMR.ORG) provides ranking tables of NIH Funding to US Medical Schools and Principal Investigators and includes direct plus indirect costs but excludes R & D contracts.

The website reports that Stanford is the number 2 ranked anesthesia department in country for NIH funding ($7,887,305) for 2013! as per http://www.brimr.org/NIH_Awards/2013/NIH_Awards_2013.htm
This is up from number 4 ranking in 2012. Congratulations.

I believe that how great the education is in a department depends on how great the clinical care is and how great the scholarship and research is in an anesthesia department.
Thank you,
alex_small.jpg

The Stanford Anesthesia Fellowship in Global Health

We would like to announce that the Stanford Anesthesia Fellowship in Global Health is accepting applications.

This postgraduate Fellowship after residency is tailored to the individual physician's background and goals but has several core components:
---- Up to 12 weeks working in a medically under-served low or middle-income country.
---- Scholarship project in global health focused on improving infrastructure through improvements in medical education or by forming and answering an appropriate research question.
---- A core curriculum at the crossroads between the multiple disciplines that comprise global health and considerations for delivering peri-operative care in austere environments. Many of the included lectures and seminars throughout the year are available via Stanford's Center for Innovation in Global Health (http://globalhealth.stanford.edu/).
---- Clinical work as an anesthesiology attending in the Stanford Operating Room suite one day a week with 1-2 calls per month
---- Attendance at Global Health Outreach conference in Halifax, Nova Scotia or Seattle, Washington addressing the challenges of administering anesthetics in austere environments.

Upon completion, the fellow will become a global patient advocate with the ability to improve peri-operative healthcare delivery in low resource settings. As opposed to service oriented or volunteer mission trips, the focus is on capacity building through advancement of global health research and educational partnerships. Graduates of this one year fellowship will be poised for program development, policy work, and research within the burgeoning field of global health.

Goals and Objectives for the Global Health (GH) fellow include:
1) Understand and promote global patient advocacy
2) Gain knowledge of the complexities of issues contributing to health care disparities on a global scale
3) Recognize the economic, political, policy, cultural, epidemiology, and infrastructure factors that influence health care delivery in low and middle income countries.
4) Understand the factors contributing to the surgical component of the global burden of disease and then develop and implement effective solutions to the problems.
5) Develop knowledge of the differences in assessing patient needs and delivering peri-operative care in settings with limited resources.
6) Incorporate the global health knowledge and skill set into a career in anesthesia

If interested in applying please contact Fellowship Director Dr. Ana Crawford at ana9120@stanford.edu. Please note a California medical license is required. More information about Stanford Anesthesia Global Health is also available at globalanesthesia.stanford.edu

Thank you,
alex_small.jpg

2013 Stanford Anesthesia Graduates: What are they doing after residency?

Jennifer Basarab-Tung, Stanford Faculty
Marianne Chen, Critical Care Medicine Fellowship, Stanford
Samuel Chen, Community Practice, Oregon
Morgan Dooley, Faculty, Emory University
Roy Esaki, Pain Medicine Fellowship, Stanford
Estee Garazi, Cardiac Anesthesia Fellowship, University of Miami, Miami, FL
Brice Gaudilliere, FARM Research Fellowship, Stanford
Melanie Gipp, Pediatric Anesthesia Fellowship, Stanford
Annie Goodrich, Pediatric Anesthesia Fellowship, Houston
Natalya Hasan, Stanford Faculty
Ashley Hawrylyshyn, Community Practice, San Francisco Bay Area
Boris Heifets, FARM Research Fellowship, Stanford
Calvin Lew, Community Practice, San Francisco
Michael Marques, Cardiac Anesthesia Fellowship, Stanford
Ethan McKenzie, Stanford Faculty
Vanessa Moll, Critical Care Medicine Fellowship, Stanford
Megan Olejniczak, Cardiac Anesthesia Fellowship, Stanford
Jared Pearson, Pediatric Anesthesia Fellowship, Denver, Colorado
Catherine Reid, Faculty, University of Bern, Switzerland
Loren Riskin, Management Fellowship, Stanford
Vivianne Tawfik, FARM Research Fellowship, Stanford
Tatyana Travkina, Stanford Faculty
Ankeet Udani, FARM Research Fellowship, Stanford
Luis Verduzco, Critical Care Medicine Fellowship, Stanford

Another awesome class!
Congratulations,
Thank you,
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Education Committee Meeting Minutes October 10, 2013

In Attendance: Drs. Caballero, Djalali, Ingrande, Kalra, Kan, Kelleher, Kulkarni, Macario, Newmark, Oakes, Sliwa, Tanaka (chair), Udani, Wagaman; Marissa David, Janine Roberts

Welcome to the Committee: Dr. Praveen Kalra.

New simulation program for Anesthesia and General Surgery housestaff: Dr. Udani is working with a small group from our department, as well Dr. Lau and the general surgery chief residents, on a simulation course to practice communication and teamwork skills between surgery and anesthesia personnel in the operating room. This multi-disciplinary simulation-based crisis resource management training will eventually involve nurses and others in the surgical team. The goal is to have 3-4 residents from each of the anesthesia and surgery departments participate in a half-day course with a projected March 2014 launch with one course this academic year to get started.

Echo track for residents interested in sitting for the Basic Perioperative Transesophageal Echocardiography Exam (PTExAM): By way of background, the Stanford Anesthesia vision is to provide the environment and resources to help fulfill the resident’s highest professional potential. The goal is to produce outstanding clinical anesthesiologists and leaders who also have additional areas of expertise such as Research via the FARM program, Global Health, Medical Education, Quality Improvement/Management/IT, combined clinical training in pediatrics and anesthesia, combined training in internal medicine and anesthesia, or indepth training in some clinical subspecialty.
CA2 Jan Sliwa and the cardiac anesthesia division are working on a 1-2 yr echo track for those residents specifically interested in sitting for the Basic Perioperative Transesophageal Echocardiography Exam (Appendix has summary). The preliminary curriculum includes completing 8 modules, use of online video lectures, dept provided book (Basic and Perioperative TEE by Savage and Aronson), monthly TEE lectures, and the TEE Simulator at LKSC. If curriculum completed, there may be an opportunity to attend the Annual Intraoperative TEE review course (Basic Session) and sit for the Basic PTE Exam (fees possibly covered in part or whole by the department). Residents will need to start on this early in their CA1 year to reach the required numbers for the exam: 50 Category 1 exams (TEE performed) and 100 Category 2 exams (TEE reviewed). The echo service currently is looking for more opportunities to teach and show the benefits of using echo for noncardiac cases. All Stanford attendings and trainees should feel free to contact the cardiac fellow or cardiac attending on call for echo service, even after hours and on weekends for echo consults. Several current CA2s are committed to finishing this echo track.

Stanford Anesthesia Medical Education Summit Meeting: The summit was held on September 26th, 2013 and was an opportunity for people to present different projects, receive feedback, and solicit participants and collaboration. The summit was one part of effort to help build a community of education scholarship in the dept. The plan is to have FNR session held every third Thursday of the mth 5pm to focus session on education and faculty development. Please contact Dr. Tanaka if interested in participating. Residents are invited to attend.

Rotation Milestones Update: Dr. Meredith Kan, orthopedics rotation director, has been working on the milestones for the rotation and she presented the milestones to the Committee. A planned piloting of rotation milestones will begin soon. This is also true for the bariatric rotation (Dr. Ingrande rotation director). The milestones should result in better direct teaching and assessment. Specific assessment forms customized to the learning goals and milestones are being developed such that by the end of 2014 each rotation will have a new resident evaluation form with questions specific to that rotation and level of training. Having a rotation specific evaluation on MedHub that addresses rotation specific milestones is part of the dept’s overall Milestones Program led by Dr. Adriano.

Airway Workshop: This year’s workshop will be held November 16th and 17th, 2013


Appendix. Basic TEE Exam Content Outline (NBE Website)
1. Patient Safety Considerations
2. Echocardiographic Imaging: Acquisition & Optimization
3. Normal Cardiac Anatomy & Imaging Plane Correction
4. Global Ventricular Function
5. Regional Ventricular Systolic Function & Recognition of Pathology
6. Basic Recognition of Cardiac Valve Abnormalities
7. Identification of Intracardiac Masses in Non-Cardiac Surgery
8. Basic Perioperative Hemodynamic Assessment
9. Related Diagnostic Modalities
10. Basic Recognition of Congenital Heart Disease in the Adult
11. Surface Ultrasound for Vascular Access

Module 1: Ultrasound Physics, TEE Safety
• Key Topics: Patient Safety and Ultrasound (absolute/relative contraindications to TEE, infection control), Physics principles (Doppler shift, aliasing, Nyquist limits, pulsed wave vs. continuous wave Doppler & their applications, M-mode, gain, depth, wavelength/frequency/resolution/artifacts)
Module 2: The Probe & Standard views
• Key Topics: Probe capabilities (degrees of freedom), Recognizing normal anatomy & Imaging optimization in each view
• Toronto TEE website
• Intro to the exam with Simulator sessions
Module 3: Ventricular Function
• Key Topics: Recognizing normal/abnormal ventricular function (hypokinesis/akinesis/dyskinesis, quantification of systolic function), Ischemic changes (views for visualizing all 16 LV segments, recognizing ischemic segments), coronary blood supply, LVH/DCM/HOCM
• Pathology on Simulator sessions
• Archived TEE exam review
Module 4: Valvular Function
• Key Topics: Recognizing normal valve anatomy, Characterization of leaflet motion (normal, restricted, prolapsed, flail), recognizing severe valve lesions (regurgitant/stenotic), Nyquist limits
• Pathology on Simulator sessions
• Archived TEE exam review
Module 5: Great Vessel pathology/Intracardiac Masses/Pericardium/Pleural spaces
• Key Topics: Ao dissection/aneurysm, Normal vs Abnormal intracardiac masses (Chiari network, Eustachian valve, Crista terminalis, Lambl’s excrescences, Nodule of Arantius, Moderator band, LV bands, papillary mulscles, Abnormal masses eg. myxoma, fibroelastoma, IVC thrombus, pulmonary embolism), Pericardial effusion, Pleural effusion
• Archived TEE exam review
Module 6: Introduction to Hemodynamics
• Key Topics: Measuring CO (views for obtaining LVOT/RVOT VTI, calculation), techniques for monitoring volume status, RVSP, Qp/Qs
• Moodle lectures
• Moodle online quiz
• Archived TEE exam review
Module 7: Congenital Heart Disease
• Key topics: Recognition of ASD (PFO, Secundum ASD, Primum ASD, Sinus Venosus ASD, Unroofed coronary sinus), Performing a bubble study, Bicuspid Aortic Valve disease, Recognition of VSD (inlet, membraneous, intramuscular, supracristal), Coarctation of the Aorta, Patent Ductus Arteriosus
• Archived TEE exam review
Module 8: Surface Ultrasound for Vascular access
• Key topics: Surface anatomy of central venous access (IJ, femoral, subclavian/axillary long axis), arterial access (radial, ulnar, brachial, femoral), peripheral venous access (deep brachial), guiding IABP placement, confirming central line placement

Suggested Curriculum:
• 1-2 year track to complete all modules (starting as CA-1 or CA-2)
• 1-2 months per Module
• Online video lectures/course materials
• Book provided by department for residents starting TEE track
• Access to fellows’ TEE review course materials
• Access to archived TEE exams for review
• Attendance at monthly TEE lectures
• Attendance at TEE Simulator at LKSC
• Continuation of 2 week Cardiac/TEE rotation prior to 2 month Cardiac rotation
• Continuation of GOR/TEE rotation to get more exams
• If curriculum completed, an opportunity to attend the Annual Intraoperative TEE review course (Basic Session) and sit for the Basic PTE Exam. (Fees possibly covered in part or whole by the department).
• Basic Certification requires 50 Category 1 exams (TEE performed) and 100 Category 2 exams (TEE reviewed)

Stanford Anesthesia Education Committee Meeting Minutes August 8, 2013

NeoSim: Dr. Hilton presented a brief summary. Approximately, 10% of newborns require some degree of resuscitation immediately after delivery. Residents on the OB anesthesia rotation attend one 4-hour session and earn Neonatal Resuscitation Provider [NRP] certification. Our program’s participation in the NeoSim program was put in place by Dr. Lipman in 2003. It is an immersive simulation program meant to be completed once during residency. Certification is good for two years and the department pays for the resident’s participation. The department will continue to financially support this important program.

MSD Libero Initiative: The new Libero program is receiving universally positive feedback. This program was designed to improve resident education in the Stanford general operating room multispecialty division (MSD) based on daily review of actual In-Training Exam keywords. All residents are invited. A topic for a talk no longer than 15 min (including questions) is chosen from this link: https://docs.google.com/document/d/1lWPDZOSeey-fVkG-ukCmPjtX8Yohu1qdGDIl_k2uS-4/edit Available keywords are listed in black. The faculty give the same talk at 10AM, noon and 2 PM in the anesthesia conference room. Once the initial pilot is completed feedback will be taken to further improve the program. For example, attendance and results of the lectures are being tabulated for a possible consolidation of lectures from 3 to 2 per day.

New 2 week ASC Scheduling Rotation in MSD: Feedback from survey data and from town hall discussions and the annual review of program revealed need for an OR management scheduling experience. A new rotation is being piloted in the MSD. Dr. Painter presented his experience as the first resident on this rotation. The resident carries the Stanford ASC scheduling phone and runs the board and he has been well supported by the ASC staff and attendings. He learned to manage different types of staff and was provided a self-assessment tool to identify his leadership style and this involves writing a narrative of his style. The residents on this rotation attend the twice daily scheduler meeting. Dr. Painter thought this an eye-opening, great learning experience. There is also the opportunity for supervision of junior residents to help get cases started. Dr. Painter is following up with residents as they rotate through. The faculty supervisor for this resident is the Main OR scheduler.

Acupuncture Elective Curriculum: Dr. Golianu has taken over the directorship of this elective from Dr. Ratner. Dr. Golianu has rewritten the curriculum with goals and objectives for a two-week experience. The expectation for residents on any rotation is direct responsibility for patients. It will be tricky to provide more hands-on clinical work because the skills take a while to acquire. The chief residents and Dr. Golianu will coordinate the timing of this elective. Medhub evaluations of elective by resident will be reviewed at end of yr for further feedback. As with all rotations we are transitioning to the rotation specific evaluations of residents that specify and focus on the milestones appropriate for that rotation.

OB ultrasound: Dr. Carvalho discussed a new addition of ultrasound skills to the OB rotation which is now integrated in the rotation.

Chief Resident Report: The new CA1 residents are integrated and are having a smooth start with the Orientation Program. The Chief Residents will provide input to improve Orientation Program for next yr at the next education committee meeting. The new CA1 lecture start time of 3:30pm will be changed back to 4pm. All in attendance agreed.

Weekly Lecture Series: The lecture series for the CA1 class was recently revamped to accommodate the new ABA testing procedures. Senior resident Dr. Quick thought this also would be a good time to review and suggest changes to the CA2 and CA3 lecture series. After analysis it was determined that one third of lecture time was spent on administrative and wellness sessions and more faculty mentorship of journal club and case presentations is needed. The residents were polled for feedback:
1) Most residents do not want only written board prep, but rather a combination of test prep and other materials in an interactive format.
2) Change timing of practice and professional presentations to the end of the CA2 year.
3) Increase lecture series topics that are not commonly seen in the OR.
4) Use lecture time for 1-2 study halls the weeks prior to the ITE.
It was concluded that residents should be more involved in development of their own lecture series, working with Drs. Adriano and Harrison who will take these recommendations and plan changes for next year. Dr. Fanning is preparing an M&M series separate from the lecture series that would also fulfill resident educational needs. Dr. Ingrande will be invited to present plan for journal club for next year.

Generational Workshop: The Department sponsored a workshop on August 22, 2013 on “Generational Differences: How we learn, how we work”. The main learning objectives were to describe characteristics that define generational styles and differences from pre-boomers to millennials, identify two personal characteristics that define the attendees style of teaching, identify two learning styles of residents, and create list of changes in teaching practice or strategies that would bridge the gap between the two teaching/learning styles and expectations of teacher and student.

Anesthesia Knowledge Test: As of this year the AKT1 scheduled for August, and the AKT6 six mths into residency now will be practice tests only (and not reviewed by the clinical competence committee). The test results are known to the resident and faculty advisor and to be used to help assess knowledge. The ABA intraining exam is in February and the new basic ABA test for CA1s is in summer 2014.

Combined internal medicine-anesthesia residency at Stanford: accepting applications now

Please do apply to the combined internal medicine-anesthesia residency at Stanford to start in 2014.

We are looking for applicants with outstanding clinical abilities who show potential to be leaders in internal medicine and anesthesiology.

The program consists of 12 months medicine internship, followed by 12 months of anesthesiology. Then, in years 3-5, six months/year is devoted to each specialty. Graduates will be Board-eligible in both.

Residents in this combined program are full and totally included members of both departments including advising, mentoring, research opportunities, resident colleagues, etc.

Candidates apply to (and need to interview at) both Internal Medicine and anesthesia residencies via ERAS as if they were applying solely to that one residency. This Stanford Medicine-Anesthesiology program NRMP code is 1820742C0.

PGY1s in combined program participate in once a month online module: the Stanford Successful Transition to Anesthesia Residency Training (START) program http://start.stanford.edu along with the other anesthesia interns

PGY1s along with all other local Stanford Anesthesia interns also participate in the simulation workshop Intern PReparedness using INnovations in Teaching Program (ImPRINT) held third Tuesdays of each month from 1-5pm
http://askalex.stanford.edu/archives/2012/10/imprint-an-inno.html

Residents in combined program will have
- 3 or 6 months medicine residency immediately after CA1 year so as to not do 18 months of anesthesia straight.
- an IM continuity clinic throughout the 5 year period

Vacation time is taken proportionally equal to time spent in each residency in a given year.

The core Anesthesiology conferences occur on Monday mornings (Anesthesia Grand Rounds, 6:45-7:45 AM) and weekly didactics/case-based learning from 4:00-5:30 PM on Monday, Tuesday, or Wednesday afternoons (depending on the year of training). During the Internal Medicine portion of the training in years 3-5, residents attend one of these sessions monthly at a minimum, with the plan/expectation that residents attend these sessions on a more frequent basis. Since the timing of the conferences listed above is early & late in the day, it will be feasible for residents to attend other conferences weekly.


FAQs
Question: What will graduates of this program do?
Answer: We don’t know for sure what positions will be of most interest to program graduates given the ongoing and future changes in medicine and healthcare. Certainly, graduates will be trained broadly to play an important role in organizing and providing care to the sickest and most complex patients. On one end of the spectrum the graduate could practice anesthesia full time and at the other end could practice internal medicine full time. In between are other exciting possibilities: for example, critical care medicine, pain medicine, hospitalist work, and perioperative management of surgical patients including organizing clinic for high risk patients.

Question: Will residents in combined program have faculty mentors?
Answer: Yes Stanford faculty members dual boarded in medicine and anesthesiology can serve as mentors.

Question: For the application itself, is there a preferred number of letters of recommendation and distribution between anesthesiology letters, medicine letters, or letters from other specialties?
Answer: Please apply as if you were applying to each residency separately with separate letters and essay (you can mention interest in combined program of course). This is because the faculty in both departments will want the applicant to fully fit in their own residency, and because if the person doesn’t match in the combined program they will end up in either a medicine only residency or an anesthesia residency only.

Question: What is the process for coordinating the application process between the two departments?
Answer: Once both residencies invite you for an interview we work with the applicants to facilitate interview dates.

Thank you

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Update on CA3 residents and Fellowships

I hope everyone is having a good summer.

Last year 70% of Stanford Anesthesia residency graduates went on to a fellowship, which was an alltime high, and this yr the % is likely to be even higher.

Many of the current CA3s have secured fellowships for next yr and we are delighted with the results so please join me in congratulating them! The list is below.

Other CA3s are interested in pediatric anesthesia and pain medicine fellowships and the match for those is in the Fall so when we know the results will let everyone know, as well with the CA3s that go on to community or academic practice.


Nick Anast, Cardiac Anesthesia, Stanford
Kevin Blaine, Critical Care Medicine, National Institutes of Health, Bethesda, MD
Jorge Caballero, FARM Research, Stanford
Craig Chen, Critical Care Medicine, Stanford
Estee Garazi, Cardiac Anesthesia, University of Miami, Miami, FL
Robert Groff, Critical Care Medicine, Stanford
Leslie Hale, Critical Care Medicine, Stanford
Reed Harvey, Cardiac Anesthesia, UCLA
Ryan Mountjoy, Regional Anesthesia, Duke
Marie McHenry, Cardiac Anesthesia, Texas Heart Institute, Houston, TX
Carter Peatross, Cardiac Anesthesia, Mayo Clinic, Rochester, MN
Lindsay Raleigh, Combined Cardiac Anesthesia/Critical Care Medicine, Stanford
Eric Sun, FARM Research, Stanford
Jim Tan, Regional Anesthesia, Stanford


thank you
Alex

Stanford Anesthesia Medical Student Symposium


I am delighted to announce that the Stanford Anesthesia Interest Group is putting on a Medical Student Symposium on Sept 21, 2013.

The goal of the symposium is to provide an opportunity for medical students (MS 1-4) to experience the interdisciplinary nature of anesthesiology with a variety of lectures and hands-on workshops and to network with other students and residency programs.

Please email Jai Madhok (jaimadhok@gmail.com) to register.

Tentative Schedule
8:30 ­ Registration and Coffee

9:00 ­ Welcome and Overview: Dr. Myer Rosenthal (Stanford)

9:15 ­ Critical Care: Dr. Manny Pardo (UCSF)

9:35 ­ Global Anesthesia: Dr. Ana Crawford (Stanford)

10:00 Workshops
Students will have either:
Full Simulation Session
OR
Basic Airway, Regional, U/S+TEE, Vascular

10:00 Residency Fair

12:00 ­ Lunch

1:00 ­ Keynote: TBD

1:30 ­ Private vs. Academics: TBD

1:50 ­Pain Management: TBD

2:20 Workshops
Full Simulation Session
OR
Advanced Airway, Regional, U/S+TEE, Vascular

We look forward to seeing you,
Thank you.

Top 10 Reflections After Going Through Interview Season and the Match from a 2013 applicant

Dr. Meghana Yajnik just this month graduated medical school here at Stanford and will be staying on to do the anesthesia residency at Stanford.

She was kind enough to put down in writing some of her thoughts on the interview season and match that I hope will be helpful to applicants gearing up for the 2014 NRMP. Below she lists her top 10 reflections on the whole residency application process.


Residency application season can be a tough and nerve wrecking time. Here are some things I learned along the way that I think would be helpful to those who are just about to start the application process.

1) Apply early
After all, this is a rolling process. The earlier you get your application in, the earlier programs are likely to read it and the earlier you’ll get your choice of interview dates for many of the programs. Interview dates do fill up, and if you delay your application you may only get choices for days you cannot make. The biggest hurdle to this is your personal statement and your letters of recommendation. The earlier the better!

2) Know your CV/Application
While you are filling out your ERAS application, make sure you know your own background backwards and forwards. The worst situation is to be asked in an interview about some research project from a summer in undergrad that you can barely remember. Don’t let them catch you unprepared.

3) Take Step 2 Early
Some schools require you to have Step 2 scores, some don’t. I would advise taking Step 2 CS as early as possible to get it out of the way (after all, there is a 97% pass rate so this shouldn’t be a problem). It’s a good idea to get Step 2 CK out of the way before you start interviews. This just makes it easier to focus on interviews, plus you won’t have to worry about studying while you’re flying all over the country. You can always take the test early and send out the score to programs at your discretion. There is a place within the ERAS application that lets you select if you want your scores automatically forwarded to programs or not. Some applicants who feel that their Step 1 score is not strong might choose to take Step 2 early and use that score to improve their application.

4) Practice Interviewing
Some interviews are conversational and some are interrogations. Luckily in anesthesiology, most are conversational. Interviews always go smoother if you take the time to practice some of your answers in advance. Stock questions like “why anesthesia?” or “tell me about yourself” are good examples of questions you will definitely be asked. It’s the uncomfortable ones that you really want to practice – “tell me a joke” or “teach me something non-medical in 5 minutes” can throw you off if you’re not used to thinking on your feet. Mostly practice being put on the spot and keeping your cool.

5) Do Your Homework
Read up on each program before your interview. It will give you specific talking points during your interview and impress the program that you’ve researched them. Some programs might also ask specific questions about their curriculum assuming that you already know all about them.

6) Get Contact Information
On your interview day, take the contact information (i.e. business card) of everyone you talk to. You never know when you might need to talk to that person again. Plus, it’s a great way to build up your professional network. This includes co-interviewees – they’ll be your colleagues some day!

7) Say Thank You
Send a thank you email right after your interview to all your interviewers. If you wait to write those emails, you won’t remember your interviewers well and they might not remember you. It’s also nice to put something specific in your thank you note so it reminds them of your conversation. You may or may not get a response. But I wouldn't read in to that too much either way.

8) Write down your reflections
After each interview day, write down how you felt. Reflect on what you liked and what you didn’t like. This might seem silly, but by the end of interview season they all start to blend together. It’s nice to have something to look back to when you’re making your rank list.

9) Remember to Smile
After the first few times, interviews can start to get tedious. Try to stay refreshed and excited for each one of your interviews. Each program only gets a tiny snapshot of what you are really like, and you want to make sure you put the best foot forward. Even though you might be coming straight off of a red-eye flight, stay enthusiastic and remember to smile.

10) Go With Your Gut
When the time comes to finally make your rank list, go with your gut. It might seem important to create an algorithm or exhaustive excel spreadsheet to balance all of the variables of different programs, but in the end none of those small details matter. Try to rank based on how well you think you fit into a program. In my experience this is based on an overall feeling about a program, not on how good the dental benefits were or what the cafeteria looked like. This is where reading over your reflections on the interview day can really come in handy (see #8).

Oh, and don’t forget to have fun! Be yourself, keep your cool, and have a good time. Good luck!

Thank you Meghana for writing this nice piece!
Alex

Stanford Anesthesia Abstracts at the 2013 Western Anesthesia Resident Conference

Every year the West Coast residency programs have a meeting where housestaff can present their research projects, and other scholarship activities.
This year the University of New Mexico’s Department of Anesthesiology hosted a very nice Western Anesthesia Resident Conference (WARC).

The Stanford Anesthesia Abstracts are listed below:


AIRWAY

Intraoperative Diagnosis of Tracheobronchomalacia Leading to Difficulty in Ventilation
Nicholas Anast, MD. Rosario Garcia, MD. Hendrikus Lemmens

Hemoptysis from a 2 Month Tracheostomy (What should your anesthesia plan be?)
Kingsuk Ganguly, MD, John Brock-Utne

Acute tracheal stenosis with respiratory distress. What to do when endotracheal intubation fails?
Eric Mehlberg MD, Jorge Caballero MD, Kevin Malott

Proposal for routine use of airway exchange catheter during tracheostomy
Megan Olejniczak, Geoffrey Lighthall

A Surprising Solution to an Airway Emergency in the Endoscopy Suite
Rachel R. Wang, John G. Brock-Utne


CARDIOVASCULAR

Does Hyperoxia During Deep Hypothermic Circulatory Arrest Affect Patient Outcomes?:
A Retrospective Analysis
Esther Garazi, Robert Lobato


ICU

Severe Thrombocytopenia After Massive Intraoperative Tranfusion: A Case of Posttranfusion Purpura Management
Justin Pollock, Carlos Brun


ORAL RESEARCH PRESENTATION

Preadmission opioid use is associated with increased hospital length of stay in Total Knee Arthroplasy Patients.
Bassam Kadry; Sean Mackey, Natacha Telusca; Ken Lau; Hassan Alosh; Alex Macario


PEDIATRICS

Neonate for Congenital Diaphragmatic Hernia Repair
Shelly Pecorella

Characteristics of data registry cohort studies in published in the anesthesia literature
Kevin P. Blaine, Bassam Kadry, Sesh Mudumbai

Endotracheal tube cuffs: does education help achieve optimal pressures?
Marianne Chen, Richard Jaffe

Role of Myeloid Derived Suppressor Cells in the Immune Response to Surgical Trauma.
Brice Gaudilliere, Gabi Fragiadakis, Martha Tingle, Julian Silva, Christine Yeh, Garry Nolan, Martin Angst

IMPROVING DEEP BRAIN STIMULATION THROUGH TARGETED SYNAPTIC MODIFICATION.
Boris D. Heifets, Karl Deisseroth, Robert Malenka., M. Bruce MacIver

Reducing Anesthetic Pollution: A Catalytic Converter for the Anesthesia
Workstation
Ashley Micks, Catherine S. Reid, John Brock-Utne, Brian Cantwell

A Dramatic SEDLine Reading Increase During a Change in Position. Should You Be Concerned?
Amit R. Saxena, Vivianne L. Tawfik, John G. Brock-Utne


SYSTEM and PRACTICE BASED PROJECTS

Raising Anesthesia Provider Awareness of Intraoperative Ocular Ionizing Radiation Exposure
Samuel T.C. Chen, John G. Brock-Utne, Harry J. Lemmens

Assessment of resident physician wellness: Survey tool development, data analysis, and lessons for future wellness curricula
Morgan Dooley

Prior to a Femoral Peripheral Nerve Block Placement, why not check for Femoral Vein Deep Vein Thrombosis?
Natalya Hasan, John Brock-Utne, Lindsey Vokach-Brodsky

Installation of an anesthesia information management system increases the number of
arterial line supply charges per day by 35%
Bassam Kadry,Ken Lau, Natacha Telusca Cliff Schmiesing, Alex Macario

Monitored Anesthesia Care for Vitreoretinal Surgeries: Which Technique is Safest?
Jody C. Leng, Ruwan A. Silva, John Brock-Utne, David Drover, Theodore Leng

A novel anesthesia needs assessment tool to actuate academic partnerships
Vanessa Moll, Peter Schmidt, Ana Crawford

Morbidly Obese Patients Undergoing Primary Hip Arthroplasty Require Forty-
Four More Minutes of Operating Room Time
Bassam Kadry, Christopher D. Press, Hassan Alosh, Issac M. Opper; Joe
Orsini; Igor A. Popov; Alex Macario, Jay B. Brodsky

A Quality Improvement Project Reconfiguring the Anesthesia Workspace: Lessons Learned
Bassam Kadry, Alex Macario, Alex Quick, Richard A. Jaffe, John G. Brock-Utne

How Safe is Your Lead Apron?
James P. Tan, John G. Brock-Utne

Wow! a lot of good projects here,
Alex

Event Planning for Next Year Has Started

Now that we are almost done with the academic year, we are preparing for next year and special events for the residents. The preliminary schedule looks like:

CA1 Resident Team Building Excursion-Whitewater Rafting (July 13-14, 2013). The Chief Residents organize this every summer.

Welcome BBQ for new residents (July 20th, 2013) at the Cantor Art Museum. Beautiful location!

Wellness Retreat (Aug. 23-25, 2013) at the Chaminade Resort in Santa Cruz led by Drs. Ratner and Cornaby.

Airway Workshop (Nov. 16-17, 2013) run by Dr. Nekhendzy.

Mock Oral Exams: Oct. 30th, Nov. 4th, Nov. 19th

Resident Tahoe Retreat: Jan. 25-26, 2014

Thank you,
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Department Update!


This is an update (http://deansnewsletter.stanford.edu/#4) of the Department of Anesthesiology, Pain and Perioperative Medicine as presented on Friday September 7th, 2012 by Dr. Ron Pearl, the Chair, to the Executive Committee of the Medical School:

In recognition of the expanding involvement of anesthesiologists outside the operating room, the Department of Anesthesia has been renamed the Department of Anesthesiology, Pain and Perioperative Medicine. Overall, it is one of the three largest departments in the medical school with 155 faculty, 80 residents, 35 fellows, 40 administrative staff, and an additional 50 people involved in research. The annual budget is over $71 million, primarily in healthcare services and research.

The department has maintained clinical growth at 7% per year throughout the past decade, and now has over 100 clinical FTEs at Stanford and Packard Hospitals. The majority of the faculty growth has been in the Clinician Educator Line, which accounts for over half the current faculty.

The department is divided into eight clinical divisions: the general OR group (renamed the multispecialty division), pediatric anesthesia, pain management, critical care, cardiovascular anesthesia, obstetrical anesthesia, and medical acupuncture, plus the VA group. In addition to increasing patient numbers there has been an increase in patient acuity and in the complexity of surgical procedures, which has required increasing sub specialization within the anesthesia divisions. The pain management division has had the greatest percentage growth, and is one of only four programs in the country to receive two Center of Excellence awards from the American Pain Society.

In resident education, the 80 anesthesia residents are involved in 26 rotations at four hospitals. The majority of the residents continue with fellowship training after residency, and half continue in academic anesthesia. The residency program at Stanford has been highly innovative, including an iPad-based curriculum, a research track, a resident wellness program, a global health program, combined residency programs with pediatrics and with internal medicine, and the extensive use of information technology, simulation, and blended multimedia experiences for training. A Faculty Scholars Teaching Program has trained 26 faculty in curricular theory during the past 5 years.

Nationally, simulation in medicine developed from the efforts of David Gaba, Associate Dean for Immersive and Simulation-based Learning at Stanford, and the anesthesia residents participate in simulation programs, often in collaboration with other departments, in anesthesiology, critical care, obstetrics, pediatrics,
and neonatology. Many of the departmental educational innovations, including the use of advanced information technology, have been published. Larry Chu organizes the annual Medicine X symposium at Stanford, which is attended by over 500 national and international experts on the use of information technology to advance health care.

At the fellowship level, Stanford is the only anesthesia department in the country to offer all five ACGME-approved fellowships (critical care, pain, pediatrics, cardiac, and obstetrical anesthesia).

During the past five years, departmental NIH funding has tripled, and the department now ranks third in the country. The department has 20 active federal awards, including 9 new grants this year, for a total of $44.3 million in total costs over the award periods. In addition, there are 19 non-federal awards. Overall, there are 21 different principal investigators. Areas of research include pain, mechanisms of anesthesia, neuroscience, cardiopulmonary research, adult and pediatric clinical pharmacology, patient safety, health care economics and outcomes research. Approximately half the departmental research is in the area of pain. A $17 million P01 grant to Sean Mackey uses deep phenotyping and genotyping to determine which individuals will respond to one of four different treatments for low back pain.

Other ongoing pain studies include the use of low dose naltrexone to modulate microglia to decrease pain in fibromyalgia, an EGR-1 DNA decoy to prevent the progression from acute to chronic pain after surgery or injury, the use of brain imaging as an objective marker for pain, and basic mechanisms, including epigenetic modifications, underlying complex regional pain syndrome, postsurgical pain, and response to opioids. In the area of anesthetic mechanisms, electrophysiological studies have examined effects of alcohol and anesthetics on specific ion channels and neural circuits. Modeling of molecular dynamics has described the details of binding between anesthetics and relevant ion channels and has begun to identify new anesthetic molecules that may have greater specificity and safety. A study of identical and fraternal twins demonstrated the role of genetic variability in the effects of narcotics, and subsequent studies will examine candidate genes. The use of computational mouse genetics demonstrated the role of the 5HT3 receptor in opioid withdrawal, and an NIH-funded multi-center study is examining the use of ondansetron to prevent narcotic drug withdrawal in neonates born to mothers taking narcotic drugs.

Many of the complications of anesthesia and surgery are due to perioperative inflammation. In collaboration with Gary Nolan, Mark Davis, and Mike Longaker, Martin Angst is using CyTOF mass cytometry to perform a comprehensive, system-based quantitative and functional evaluation of the circulating immune system in the context of surgery. Based on data from cytokine changes in the wound fluid of patients, Gary Peltz is studying the ability of anakinra, an IL-1 receptor antagonist, to decrease postoperative wound pain. In other work, his transformative RO-1 uses human hepatocytes to replace the native liver in Tk-NOG mice, allowing in vivo pharmacokinetic studies applicable to human metabolism and providing a potential method for human liver regeneration from differentiated human adipocytes obtained from liposuction.

Finally, although the Department of Anesthesiology, Pain and Perioperative Medicine has been successful in clinical care, education, and research, resource constraints (money, billets, and space), the impact of new health care reimbursement systems such as accountable care organizations, and the increasing role of mid-level practitioners will need to be addressed to continue this success in future years.

New Program: Combined internal medicine-anesthesia residency at Stanford

We are pleased to announce that we are offering a combined internal medicine-anesthesia residency at Stanford of 5 years duration.

Year one = 12 months medicine internship. More information at http://medicine.stanford.edu/education/residency.html
Year two = 12 months of anesthesiology.
In years 3-5, six months/year is devoted to each specialty.
Graduates will be Board-eligible in both.

Candidates apply to (and need to interview at) both internal medicine and anesthesia residencies via ERAS as if they were applying solely to that one residency. This Stanford Medicine-Anesthesiology program NRMP code is 1820742C0.

Curriculum details:

MEDICINE
• A minimum of 4 months of critical care (MICU, CCU) rotations (maximum six months) with at least one additional month in a surgical ICU.
• A minimum of 1/3 of Internal Medicine training occurs in ambulatory setting, and minimum of 1/3 in inpatient setting.
• A longitudinal continuity clinic of 130 one half day sessions over the course of training. The continuity clinic includes evaluation of performance data for resident’s panel of patients.
• Exposure to each of the internal medicine subspecialties and neurology, and an assignment in geriatric medicine.
• An emergency medicine experience of four weeks in the PGY1.
• Electives available: psychiatry, allergy/immunology, dermatology, medical ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, palliative medicine, sleep medicine, and rehabilitation medicine.

ANESTHESIOLOGY
• Two one-month rotations in obstetric anesthesiology, pediatric anesthesiology, neuro anesthesiology, and cardiothoracic anesthesiology.
• A minimum of one month adult intensive care unit during each of the last 3 years.
• Three months of pain medicine = one month in acute perioperative pain, one month in chronic pain, and one month of regional analgesia/peripheral nerve blocks.
• One month in a preoperative evaluation clinic.
• One-half month in the post anesthesia care unit.
• No single subspecialty, excluding critical care medicine, exceeds six months total.
• During the Anesthesiology rotations, residents attend a minimum of one Internal Medicine continuity clinic session per month.

A sample rotation schedule for Medicine internship at Stanford is:
Dates Intern
6/25 - 7/06 Stanford Night Team
7/7 - 7/20 Geriatrics
7/21 - 8/3 Stanford Wards
8/4 - 8/17 Stanford Wards
8/18 - 8/31 VA Wards
9/1- 9/14 VA Wards
9/15 - 9/28 Infectious Disease VA
9/29 - 10/12 Cardiology Consult
10/13 - 10/26 Stanford Wards
10/27 - 11/9 Stanford Wards
11/10 - 11/23 Vacation
11/24 - 12/7 Gastroenterology VA
12/8 - 12/21 Elective
12/22 - 1/4 Elective
1/5 - 1/18 Vacation
1/19 - 2/1 Stanford Night Team
2/2- 2/15 Stanford Wards
2/16 - 3/1 Stanford Wards
3/2 - 3/15 Oncology
3/16 - 3/29 Oncology
3/30 - 4/12 Stanford ED
4/13 - 4/26 Stanford ED
4/27 - 5/10 VA ICU
5/11 - 5/24 VA ICU
5/25 - 6/7 Hematology
6/8 - 6/24 Hematology

Also, PGY1s in combined program will participate in once a month module: the Stanford Successful Transition to Anesthesia Residency Training (START) program http://start.stanford.edu.

Residents in combined program will do 3 or 6 months medicine residency immediately after CA1 year so as to not do 18 months of anesthesia straight.

The core Anesthesiology conferences occur on Monday mornings (Anesthesia Grand Rounds, 6:45-7:45 AM) and weekly didactics/case-based learning from 4:00-5:30 PM on Monday, Tuesday, or Wednesday afternoons (depending on the year of training). During the Internal Medicine portion of the training in years 3-5, residents attend one of these sessions monthly at a minimum, with the plan/expectation that residents attend these sessions on a more frequent basis. Since the timing of the conferences listed above is early and late in the day, it will be feasible for residents to attend other conferences weekly.


Thank you,
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Quality and Safety Rotation: A New Elective for Stanford Anesthesia Residents

The practicing anesthesiologist is often expected to be a problem solver for the hospital. This is particularly true for perioperative quality and safety. This new rotation is an opportunity to have a real and meaningful impact on quality, safety and effectiveness at Stanford.
Dr. Ruth Fanning is the rotation director, and will provide fundamental concepts via a syllabus to the resident 6 months prior to the rotation.
This rotation gives the resident experience with competencies for Practice-based learning and Improvement and Systems-based Practice, including Practice Performance Assessment and Improvement as required by the ABA Maintenance of Certification in Anesthesiology (MOCA) Part 4.
Residents can enlist up to 2 other residents on a QI project.
The resident on this rotation (1/month) participates in the Stanford Medical Center Quality curriculum led by Dr. Clarence Braddock whose program includes housestaff from other departments. This core curriculum includes weekly seminars on quality, safety, and system change, attendance at several department-level and hospital-level quality committees (e.g. Quality, Safety, and Effectiveness Committee, Care Improvement Committee), 1:1 meetings with key organizational leaders as needed, and support including data gathering and analytics.
The resident submits a one page proposal 6 months ahead of time for a safety or quality improvement project they want to work on under direction of a faculty mentor. The idea for the project can either be the resident’s or one of the department’s ongoing priorities for quality and safety. The expectation is that preliminary work on the project would be done before officially starting the rotation. The project idea and plan is presented prior to the rotation to the department's Committee on Quality, Efficiency and Patient Satisfaction chaired by Dr. Lemmens for feedback. The resident also sits in on the Pediatric Anesthesia Safety/Peer review and Quality committee at LPCH.
The resident submit results of project to Western Anesthesia Residents Conference for the Spring after the elective, and present results to housestaff and faculty at an appropriate venue (e.g., Grand Rounds, the Stanford anesthesia department research evening).

Thank you,
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Stanford Anesthesia senior resident describes his experience with the SEA/HVO Travelling Fellowship

As you may know anesthesia residents who have finished their first year of training and are interested in spending a month teaching in a developing country may apply for the Society for Education in Anesthesia Health Volunteers Overseas (aka SEA HVO) Traveling Fellowship. (www.hvousa.org and www.seahq.org)

This year Stanford Anesthesia senior resident Dr. Rohith Piyaratna participated in this wonderful Global Health opportunity. I asked him to tell us a bit about his experience there. Dr. Joshua Landy Visiting Scholar with me at Stanford then edited the below.

When Rohith Piyaratna was leaving Ethiopia to return to California, he decided it wouldn’t be his last visit there. Over the previous four weeks, which had gone by a lot faster than expected, he worked with and taught local Anesthesiology trainees, gave lectures on theoretical and clinical topics in anesthesia, and developed friendships with many of the hospital’s consultants.

Rohith was placed at Black Lion Hospital, the largest general hospital in Ethiopia, as a member of Health Volunteers Overseas (HVO). In conjunction with the Society for Education in Anesthesia and Stanford’s Department of Anesthesiology, the HVO-SEA participants are invited to spend one month working and teaching at various under-serviced areas in the world, including Vellore, India; Blantyre, Malawi; Lima, Peru, and several other places.

In his daily journal, Rohith describes the diverse case mix including general, thoracic, obstetrical and gynecological, orthopedic, pediatric, trauma, and urologic cases. For example:

A 23-year-old male was stabbed in the chest 2 months ago. He now presents with chest pain and tachypnea. His chest x-ray showed a large L layering effusion. When the left hemithorax was opened, we found that the abdominal contents had herniated through a defect in the diaphragm causing a left-sided pneumonia and empyema. The stomach was necrotic and had to be completely excised. The case took a long time. At the end the patient was saturating well with moderate tidal volumes, though was very tachypneic, thus precluding extubation. Luckily, there was a ventilator free in the SICU. At the end of the case, we switched the double-lumen tube for a regular tube and transported the patient to the ICU. By the time we left the hospital, it was 8 pm! Probably one of the longer days a volunteer will have at Black Lion but luckil, these are very rare. Still managed to go to the gym and have a good dinner at Adams pavilion and was quite exhausted.

The first case in the pediatric room was a 10-day-old neonate with Down’s syndrome, Tetralogy of Fallot (TOF) and suspected duodenal atresia who was scheduled for an exploratory laparotomy. When I first heard about the case, I was flabbergasted. I promptly told the students that I had never done a pediatric case involving TOF, especially one that sounded really sick.
He was tiny and was the bluest baby I have ever seen. He was on oxygen and I asked for a pulse oximeter to be placed to assess how bad his shunt was. His saturation while on oxygen was between 60-80% ! I looked through his echocardiography reports and found that he had a large VSD – so large in fact that you could barely hear the murmur through it! I basically told the anesthesiologist to talk to the surgeon and the patient’s family and inform them fully that this was a very high risk case. After a discussion with the family and surgeon, we decided not to [proceed].

Outside of the OR, both clinical and didactic teaching opportunities were readily available. Lecture topics were delivered weekly and included basic and advanced material, including acute pain management, blood gas analysis, special populations in anesthesia (pregnant and geriatric) patients, one-lung ventilation, and even neurosurgical anesthesia. Ample opportunity was present to help the local trainees improve their hands-on skills in airway management, regional and epidural techniques, and crisis management. The students are described as having “…a very good theoretical knowledge base…” and “eager to do neuraxial techniques.”

Rohith summarizes his trip as, “Overall, a wonderful experience! I felt like I made a difference after my time over there. I learned a lot myself from watching and teaching the students and it did help prepare me for my transition into an attending/consultant anesthesiologist. I would definitely go again.”

Residents that engage with this fabulous experience gain from a humanitarian perspective, and achieve personal and professional growth.

Ro is starting community practice in Sacramento. We wish him well.

Thank you,
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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,
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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,
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Match results 2012

Awesome group! Congratulations.

CATEGORICAL INTERNS/RESIDENTS

JESSICA ANSARI - UCSF
QUENTIN BACA - HARVARD
AMANDA KUMAR - JOHNS HOPKINS
BRITA MITTAL - UCLA
CHRISTINA STACHUR - STANFORD
LAUREN STEFFEL - HARVARD
ANNA SWENSON - COLUMBIA
LOUISE WEN - SUNY, STONYBROOK

ADVANCED RESIDENTS
GLORILEE BALISTRIERI - MEDICAL COLLEGE OF WISCONSIN
LINDSAY BORG - UCSF
KEVIN CHANG - UNIVERSITY OF CHICAGO
CHRISTOPHER CLAVE - UNIVERSITY OF HAWAII
SHARA COHN - UC SAN DIEGO
ERIN CRAWFORD - UCSF
VICTORIA FAHRENBACH - INDIANA UNIVERSITY
ALVIN GARCIA - HARVARD
AMIT JOSEPH - GEORGE WASHINGTON
MICHAEL KING - INDIANA UNIVERSITY
ANN NG - BAYLOR
CLAIR SECOMB - UNIVERSITY OF ARIZONA
PHILLIP WANG - UNIV OF TX, SOUTHWESTERN
LINDSEY WILLIAMS - UNIV OF TX, SAN ANTONIO

ANESTHESIA/CRITICAL CARE RESIDENTS
JED COHN - BOSTON UNIVERSITY
YELENA PRINTS - JOHNS HOPKINS

PEDIATRICS/ANESTHESIA RESIDENTS
GAVIN HARTMAN - UNIVERSITY OF MISSOURI
ADAM WAS - HARVARD

2011 was a great year for Stanford Anesthesia research funding


At the beginning of a new year it is nice to go back and review the previous year. Research is crucial to the Stanford Anesthesia mission and 2011 was a great year for funding. Stanford has moved into third place in the annual rankings of anesthesiology departments in terms of NIH funding. Last year the department received $30 million in new grants!

Leading the way with as far as I know the largest grant the department has obtained
is Sean Mackey’s P01(Stanford Complementary and Alternative Medicine Center for Chronic Back Pain).

Other 2011 awards include Gary Peltz's R01 (Human Pharmacogenetics and Human Liver Regeneration), Larry Chu's R01 (5HT3 Antagonists to Treat Opioid Withdrawal and to Prevent the Progression of Physical Dependence), David Clark’s R01 (Inflammasome Activation in Complex Regional Pain Syndrome), and Bruce MacIver’s R01(Anesthetic Actions on GABA-A Fast, Slow, Tonic and GABA-B Receptors).

Also impressive are the very good awards to Jerry Ingrande K23 (Adiponectin Polymorphisms, Insulin Resistance and Pharmacokinetics in Obesity), Kevin Johnson K23 (Research Training Using Transcranial Magnetic Stimulation to Study Pain Processing in Long-Term Opioid Use), and Eric Gross K99-R00 (Role of the TRPV1 Channel in Myocardial Salvage from Ischemia- Reperfusion Injury). These awards serve as excellent examples of the types of awards junior faculty can receive, and are an outstanding role model for residents focused on research careers. Certainly, innovation in the lab and at the bedside serves all the housestaff well to know the their faculty is leading in intellectual discovery.

And at the resident level our growing Fellowship in Anesthesia Research and Medicine (FARM) program serves as a springboard for residents interested in academic anesthesia careers. For more information please see our website: http://med.stanford.edu/anesthesia/education/residentresearch.html

Having a healthy research program requires a village. Three individuals who deserve credit include Michael Helms, PhD, MBA, Director of Strategic Research Development, Rona Giffard, PhD MD, Professor and Vice-Chair for Research, and Ronald Pearl, MD, PhD, Professor and Chairman of the Department of Anesthesia.

Lastly, overall Stanford Medical School is #1 in the nation in NIH dollars per faculty member.

Best wishes for 2012,
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Announcing the Stanford Anesthesia Fellowship in Global Health

I wanted to let you know about the new Stanford Anesthesia Fellowship in Global Health.

This postgraduate Fellowship after residency is tailored to the individual physician's background and goals but has several core components:
1) Up to 12 weeks working in a medically underserved low or middle income country.
2) Scholarship project in global health focused on improving infrastructure through improvements in medical education or by forming and answering an appropriate research question.
3) A core curriculum including lectures and seminars throughout the year available via Stanford's Center for Innovation in Global Health(http://globalhealth.stanford.edu/).
4) Clinical work as an anesthesiology attending in the Stanford Operating Room suite one day a week with 1-2 calls per month to gain additional clinical experience.
5) Attendance at Global Health Outreach conference in Halifax, Nova Scotia or Kampala, Uganda addressing the challenges of administering anesthetics in austere environments.

If interested in applying please contact Fellowship Director Dr. Ana Crawford at: ana9120@stanford.edu. Please note a California medical license is required. More information about Stanford Anesthesia Global Health is also available at globalanesthesia.stanford.edu.

Thank you,
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2012 Stanford Anesthesia Faculty Teaching Scholars

We are very pleased to announce the Stanford Anesthesia Faculty Teaching Scholars for 2012: Drs. Naiyi Sun, Brendan Carvalho, Jennifer Lee, Calvin Kuan, Sam Lahidji, Carlos Brun, and Rosario Garcia.

The proposals below are innovative and working with the Resident Teaching Scholars on the projects will help take the training program to the next level.

Dr. Pedro Tanaka has agreed to serve as Co-Director of the Teaching Scholar program.


Naiyi Sun (assisted by Resident Teaching Scholars Megan Olejniczak & Jared Pearson)
Project: Web based Curriculum for Pediatric Neuroanesthesia

Brendan Carvalho (assisted by Resident Teaching Scholars Javier Lorenzo & Luis Verduzco)
Project: Transthoracic Echo Curriculum for Obstetric Anesthesia

Jennifer Lee
(assisted by Resident Teaching Scholar Morgan Dooley)
Project: Wellness Curriculum for Residents Not Attending CA1 retreat

Calvin Kuan (assisted by Resident Teaching Scholars Christine Jette & Ethan McKenzie)
Project: Multimodal Curriculum for Pediatric Cardiac Anesthesia

Sam Lahidji (assisted by Resident Teaching Scholar Kingsuk Ganguly)
Project: New Pain Management Resident Lecture Series

Carlos Brun (assisted by Resident Teaching Scholars Alex Quick & Lindsay Raleigh)
Project: Transthoracic Ultrasound Curriculum

Rosario Garcia
(assisted by Resident Teaching Scholar Eric Mehlberg)
Project: CA1 Resident TEE Rotation Curriculum

Thank you,
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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 wouldn’t 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 wasn’t 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 year’s 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 month’s 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 Resident’s 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 OR’s 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! It’s 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 coroner’s office (a unique experience that I’d recommend to anyone who doesn’t 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!

Essay by visiting medical student

Louise Wen is a fourth year medical student at Stony Brook University Medical School and is from New York City. She conducted research this past summer with Dr. Brendan Carvalho in the obstetric anesthesiology division of Stanford Anesthesia through the Foundation for Anesthesiology Education and Research Medical Student Anesthesia Research Fellowship (FAER MSARF) . She was kind enough to write an essay about her time here.

As I made my preparations for my summer at Stanford, I was filled with excitement and curiosity for my very first visit to California. My introduction to California was a weeklong visit to Yosemite Park with my partner of seven years and his parents. After creating a wealth of memories on this family vacation, we drove a few short hours to downtown Palo Alto. We found the area vibrant with innovative businesses that catered to the uniquely artistic, technological, and health and environmentally conscientious culture of Palo Alto.

At Stanford, I was struck by the universal friendliness of the hospital staff. Even though Stanford is a major academic medical center, I was surprised by the warmth and intimacy more commonly found at a community hospital. The nurses offered suggestions on ways to improve our study, which examined the role of oxytocin on pain in breastfeeding patients. By my second week, they would approach me to offer valuable information on potential study subjects. Through our daily interactions, we became friends.

On weekends and evenings, we exercised at a walking trail just south of campus called the Dish, enjoyed meals at delicious yet affordable dining options, and shopped at the weekend farmers’ markets that are open year-round.

Friendships also developed with the residents, who provided excellent guidance and mentorship for my goals of pursuing a career in anesthesiology as a researcher and educator. They introduced me to Stanford’s unique FARM track, which integrates an additional 9 mths of protected research time in the residency training. Additionally, FARM residents enjoy a university-wide network of support through the Stanford Society of Physician Scholars, which hosts a monthly seminar series on topics ranging from research funding to academic appointments.

Every afternoon, the ob anesthesia attendings give intimate seminar-style lecture in one of the hospital’s outdoor flowering alcoves. Occasionally, I would even spot a hummingbird as it zipped between blossoms. I especially enjoyed these lectures, as they were engaging and intellectually challenging, yet informal and fun. I marveled at the expertise of the attendings who shared their experiences of managing complex and high-risk cases, cited details from landmark studies to support their management strategies, and described medical-legal lessons from their experiences as expert witnesses.

During my last few weekends at Stanford, I explored the greater Bay Area. In the bustling streets of San Francisco’s Chinatown, friends and I enjoyed an authentically prepared Szechuan dinner. Another weekend, we visited the Santa Cruz beach boardwalk and the deafening rumbles of roller coasters and watched the golden sunset from the cool beach sand. My favorite weekend excursion however was a camping trip at Castle Rock State Park. The majestic Santa Cruz mountains are a perfect backdrop to conversations shared with fellow backpackers.

My summer was incredible and I am grateful to have had such a positive experience. Amidst Stanford’s warm and supportive environment, I further developed research skills that I will use in my future career as an academic anesthesiologist.

I would highly recommend the FAER MSARF program to any medical student interested in pursuing a career in anesthesia research, as it has both solidified my commitment to and clarified my personal goals in research.

thanks Louise for the nice letter!

Thank you,
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Categorical Stanford Anesthesia Positions

We are delighted to report that we are well underway in being able to offer a Clinical Base Year as part of our Anesthesia Residency.

This means we have 8 Categorical Stanford Anesthesia positions.

The yr is divided into thirteen 4 week rotations structured similarly to the Stanford preliminary medicine year. Typical rotations include one each of the following Emergency Medicine, ICU, Anesthesiology, as well as 7 Medicine Inpatient rotations (e.g., General Medicine or specialty inpatient rotations such as Cardiology), and 1 consult service (e.g., pulmonary). Stanford Anesthesia Interns also spend approximately 2-3 half-days per month in the Stanford Anesthesia Preoperative Evaluation Clinic or in a simulation session approximately once a month.

There are 4 wks vacation, in 2 week blocks. There is 1 unpaid week off at next year's end from June 25-June 30.

Thank you,
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Resident Research Presentations at the Western Anesthesia Resident Conference

The ACGME and Residency Review Committee for Anesthesiology expects resident involvement in research. This scholarship is necessary because anesthesiologists now and in the future need to be problem solvers for the institution (e.g., need to use QA data to improve clinical care). As a result, we believe experience and understanding of the scientific method, intervention, data collection, and analysis are needed.

Part of the Stanford Anesthesia curriculum is to advance resident knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care. We also expect that that the outcomes of resident investigations will be suitable for presentation at local, regional, or national scientific meetings and that many will result in peer-reviewed abstracts or manuscripts. Next academic year every month there are two residents on research rotations.

Dr. John Brock-Utne, former Program Director, wrote the following summary of the Western Anesthesia Resident Conference (WARC) conference held from April 29 - May 1, 2011 hosted by the Dept of Anesthesiology, University of Arizona. John has been a long standing supporter of resident research.
The venue was the West La Paloma Resort, in Tucson. Travel expenses for Stanford housestaff are funded by the Department of Anesthesia.

WARC is specially designed for anesthesiology residents, medical students and fellows from the 19 anesthesiology residency programs in the Western US. Its objective is to promote and encourage academic pursuits by future leaders in anesthesiology.

This year’s WARC had 338 abstracts and oral presentations. This is just two abstract less than the biggest number ever.

Abstracts accepted for presentations by Stanford Anesthesia residents were:
1. Sarah Bain: Prolonged neuromuscular blockade following cardiac surgery in a patient with ESRD after administ4ratin of Clindamycin.
2. Ioana Brisc: A diagnostic dilemma in PACU.
3. Carlos Brun: Paralyzed by beauty or if chins could kill.
4. Michael Charles: Rocuronium induced tachycardia.
5. Jay Jay Desai: Clinical and Cultural perspective: Establishing an immersive international rotation for anesthesia residents.
6. Jay Jay Desai:Ultrasound Popliteal nerve block in a patient with malignant degeneration of neurofibromatosis.
7. Laura Downey: Anesthetic management for a patient with anterior horn disease undergoing serial electroconvulsive therapy.
8. Erin Hennessey: Improving resident education on the post-operative anesthesia care unit rotation.
9. Christine Jette: The sensitive button: Intraoperative diagnosis of a cardiac paraganglioma.
10. Matthew Jolley: Optimization of electrode configuration for subcutaneous ICD using Finte element modeling.
11. Shaun Kunnavatana: The severely agitated ECT patient- An alternative treatment option
12. Vanessa Moll: Three cases of failure to ventilate with the Drager Apollo Anesthesia Workstation.
14. Andy Neice: A case of serotonin syndrome after methylene blue administration.
15. Andy Neice: Design considerations for video bronchoscopes suitable for the developing world.
16. Cat Reid: No laughing matter: Inadvertent exposure to waste anesthetic gas due to machine failure. Is there a solution?
17. Vikas Shah: Pseudohyperkalema in the setting of chronic lympocytic leukemia.(Vikas was at last minute unable to attend)
18. Becky Wong: Thoracic irrigation can produce transient EKG changes that may not be consistent.

Anesthesia Faulty involved with the above abstracts were in no particular order: Vivek Kulkarni, Brendan Carvalho, Jenna Hansen, Jonay Hill, Pedro Tanaka, Jeremy Collins, Suma Ramzam, Vidya Rao, David Soran, Jay Brodsky, Alex Macario, Gillian Hilton, Richard Jaffe, Jon Bradley, Jennifer Lee and John Brock-Utne.

Matthew Jolley did very well and got a first Prize for his oral presentation.

At the same time as the WARC judges were judging, the CSA judges were hard at work to establish the winner for the best CSA Resident presentation. There were 3 awards and I am very pleased that Matthew Jolley got 2nd place. He will collect his price on Saturday May 14 at 11 am at the Annual meeting of CSA in the Fairmont Hotel in San Jose.

Next year WARC will be hosted by UCLA and will be held in Marina Del Rey. It promises to be a great venue and a lot of fun.

Thank you John!


Stanford Opportunities in Global Health

Anesthesia department
Please visit our new website
https://www.stanford.edu/group/globalanesthesia/cgi-bin/mediawiki/index.php/Main_Page
which summarizes a lot of the global health activity in the department.

Also, we have a new global anesthesia fellowship for physicians after residency who aim to spend a large part of their career in international work focused on education, service, volunteerism and the advancement of global health equality. Dr. Ana Crawford is the Program Director for this Fellowship.

Medical School
The Stanford Center for Global Health has a website
http://globalhealth.stanford.edu/
that lists opportunities for residents as well. For example, the center is debuting a new Fellowship, this one in Global Health Media in partnership with NBC News. This program provides practical training in global health reporting using a variety of media platforms including: radio, print, investigative journalism, photography, television and social networking.

Up to two fellows are selected to complete a 12-month fellowship with leading media companies, examples include: NBC News, ProPublica, NING, and the Journal for Health Affairs. Fellows complete training programs through the Stanford University Graduate Program in Journalism and the Kaiser Family Foundation. A documentary filmmaker and an award-winning photographer will train fellows in the impact that still photographs and short films can have on global health. The Fellow may intern with ProPublica learning how to report and work on stories with “moral force”. S/he will also be embedded with Dr. Nancy Snyderman, Chief Medical Editor for NBC News and her producer to research the ‘news of the day’ and learn how Nightly News stories are chosen to be highlighted in the US.

Combined residency training in anesthesiology and pediatrics at Stanford/Packard

We are very pleased to announce a new and innovative combined residency training in anesthesiology and pediatrics at Stanford/Packard.

It is a true integrated program which requires the first (PGY-1) year to be all pediatrics, the second year all anesthesia, and each of the three subsequent years to be evenly divided, 6 months pediatrics alternating with 6 months anesthesia.

We have matched one person for this to start July 2011 and want to spread the word about this program nationally to recruit great applicants. Two people have started July 2012 and we will have two spots per yr.

This integrated program will require five, not six, years as would be necessary if these two residency programs were completed sequentially.

Please note:
---Application to the program requires applications and interviews to both the anesthesia and pediatrics residency.
---Physicians completing this training will be competent pediatricians and anesthesiologists capable of professional activity in either discipline.
---We expect that many graduates will develop careers focused on caring for children with complex medical and surgical conditions who are hospitalized and/or require perioperative/periprocedural management.
---Since the pediatric training largely occurs in the independent, Lucille Packard Children’s hospital, the program director of the combined program is the Director of the pediatric residency program as required by the The American Board of Pediatrics and The American Board of Anesthesiology, Inc.
---The Program Director is Rebecca Blankenburg, MD, MPH, Clinical Assistant Professor, Pediatrics - General Pediatrics. email = rblanke@stanford.edu
---I am the Associate Program Director.
---After completion of the combined residency, the candidate is qualified to take both the ABP and ABA certification examinations.
---For the NRMP match the program is Stanford Univ Progs-CA: Pediatrics-Anesthesiology C 1820726C0


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Stanford Anesthesia Match Results 2011

We had a great match! Congratulations class entering 2012.

Sarah Clark, Northwestern University
James Flaherty, Northwestern University
Lauren Friedman, USC
Chrystina Jeter, UCLA/Drew
Jason Johns, Loyola University
Stephanie Jones, Loma Linda University
Stephen Kelleher, Yale University
Barrett Larson, Stanford University
Kenneth Lau, University of Illinois
James Li, University of TX, San Anthonio
Josh Melvin, UC Davis
Christopher Miller, Harvard University
Kristen Noon, University of Toledo
Anil Panigrahi, University of Pennsylvania
Justin Pollock, Jefferson Medical College
Christopher Press, Tulane University
Amit Saxena, UCSF
Jan Sliwa, Tufts University
Shaina Sonobe, University of Hawaii
Timothy Sweeney, Duke University
Meghan Tieu, Stanford University
Rachel Wang, University of Pittsburgh
Victoria Yin, Loma Linda University
Jennifer Zocca, Georgetown University

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Stanford Faculty Anesthesia Teaching Scholars for 2011

We are pleased to announce the six faculty members who will be the Stanford Anesthesia Teaching Scholars for 2011. Congratulations!
This is the 3rd cohort of attendings so designated.

StanfordAnesthesiaTS2011.pdf

Teaching Scholar Program Description:
Faculty charged with teaching aspire to achieve the same high level of expertise (in education) as that expected of research faculty (in clinical or laboratory investigation).
Expanding and refining the teaching toolbox of faculty is required by the many and changing demands of graduate medical education.
To help meet this challenge the Dept. of Anesthesia at Stanford supports the Teaching Scholars Program to further train and empower faculty to improve residency education.
This one-year faculty career development award provides:

  • Funding for travel expenses/tuition (up to $2000) and up to three days non-clinical time for theTeaching Scholar to attend and education related meeting or workshop. Possible conferences include the Society for Education in Anesthesia Meetings or the ACGME Annual Educational Conference.
  • Recognition. The Teaching Scholar designation can be added to the CV as a formal title.
  • Opportunity to work with others interested in teaching.The Teaching Scholar will work on one project during the year to improve resident education. The
    Teaching Scholar works with 1-2 anesthesia residents to help with the project.

      Happy New Year!

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    2010 NRMP Match Results

    I am quite pleased to present to you the members of the newest class of the Stanford Anesthesia Residency due to start July 1, 2011.

    Anast, Nicholas, University of New Mexico
    Blaine, Kevin, Case Western
    Chan, Trevor, Stanford University
    Chen, Craig, UCSF
    Djurdjulov, Adam, University of TX, Medical Branch
    Dobrow, Marc, George Washington
    Finger, Lindsay, University of Chicago
    Ganguly, Kingsuk, UMDNJ, New Jersey Med School
    Groff, Robert, University of Pittsburgh
    Harvey, Reed, Emory University
    Kwok, Joseph, University of Pittsburgh
    McHenry, Marie, Georgetown University
    Mehlberg, Eric, University of Illinois
    Mountjoy, Ryan, George Washington
    Obaidi, Rafee, UCLA
    Painter, Christopher, Yale University
    Peatross, Carter, University of Virginia
    Pecorella, Shelly, Duke University
    Quick, Alexander, UCSD
    Sun, Eric, University of Chicago
    Tan, James, Loma Linda University
    Telusca, Natacha, Tulane University
    Vilkhu, Leslie, University of Rochester
    Wagaman, Matthew, University of Michigan

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    Class of 2009

    Last night June 13, 2009 was the Graduation Party for the Class of 2009. 12 of the 21 graduates will be doing fellowships, 5 will be going into academics across the country, and 4 will be entering private practice. Congratulations!

    Dondee Almazan ------ Peds Anesthesia Fellow, Stanford
    Rich Cano ------ Faculty, University of Iowa
    Ellen Choi ------ Peds Anesthesia Fellow, Stanford
    Ben Conrad ------ OB Anesthesia Fellow, UCSD
    Mark Gjolaj ------ Pain Fellow, Stanford
    Jennifer Hah ------ Pain Fellow, Stanford
    Alyssa Hamman ------ Private Practice, Colorado
    Jerry Ingrande ------ Research Fellow, Stanford
    Marshal Jones ------ Peds Anesthesia Fellow, Stanford
    Nate Kelly ------ Cardiac Anesthesia Fellow, Stanford
    Eddie Kim ------ Regional Anesthesia Fellow, UCSD
    Gary Lau ------ Private Practice, Southern California
    Jennifer Lee ------ Regional Anesthesia Fellow, Stanford
    Allegra Lobell ------ Attending, Palo Alto VA
    Julianne Mendoza ------ Peds Anesthesia Fellow, Stanford
    John Nguyen ------ Attending, Stanford
    Katie Polhemus-Soto ------ Private Practice, Chico, CA
    Jodi Sherman ------ Faculty, Yale University
    Jennifer Wagner ------ Peds Anesthesia Fellow, Stanford
    Jerrin West ------ Private Practice, OConnor Hospital, San Jose, CA
    Karl Zheng ------ Attending, Stanford

    thank you,
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