Obstetrics Anesthesiology Fellowship

Our OB Anesthesia fellows complete several required and elective rotations during the course of the year, including maternal fetal medicine (required) neonatal intensive care (required), transfusion medicine, transthoracic echocardiography, and global health. While on the OB Anesthesia service, they are either the primary clinical fellow with increasing attending-level responsibility or they are assigned secondary or tertiary fellow and have time to recruit for and complete research projects.

The clinical experience includes management of low and high risk parturients, attendance at daily multidisciplinary rounds, weekly cardiology conference, development of patient care plans at a fellow-run prepartum anesthesiology clinic, attendance at patient specific multi-disciplinary team meetings, and hands-on management of patients undergoing fetal surgery, non-obstetric surgery during pregnancy, and high-risk deliveries in the main operating room.

Fellowship education consists of daily instruction and bedside teaching, with twice weekly lectures given by a dedicated attending not covering the service.  Fellows will have time to learn and interact with Obstetric Anesthesia specialist attendings many who are internationally and nationally recognized.

The research experience for obstetric anesthesiology fellows at Stanford is unparalleled. Fellows typically join an existing research project and have the opportunity to run their own project. Fellows will learn how to design, conduct, present and write their own original research. The Obstetric Anesthesiology Division is active in research that covers clinical, translational, outcomes-based, big data and quality assurance. Research domains include labor and cesarean acute pain, chronic pain, peripartum drug pharmacokinetic/dynamics, immunology, technology and equipment (e.g. virtual reality) etc. All fellows are highly encouraged to participate in research, even if they plan to enter private practice, because it helps them become well rounded, critically thinking, evidence-based, physicians. Fellows will receive research mentorship from some of the most respected and prolific researchers in the field, and have access to the extensive resources available at Stanford University.

Fellows will receive mentorship and guidance by a team of obstetric anesthesiologists who are all fellowship trained.  Fellows meet with the fellowship director both formally and informally regularly to discuss goals, progress, cases, future opportunities and anything else they deem beneficial. The research director meets the fellows monthly to discuss research and help with. Fellows will have mentors for life.

Fellows have extensive leadership and administrative opportunities. These include teaching at approximately 8 new parent lectures per year, attendance at multi-disciplinary patient safety meetings, participation in weekly QI conferences and quarterly morbidity and mortality conferences. Fellows are expected to lead select resident teaching sessions, to help refine education and presenting skills.

All fellows are given time off to attend the Society of Anesthesiology and Perinatology (SOAP) conference in the spring, the American Society of Anesthesiologists (ASA) conference in the fall, and other conferences where they are presenting or where they have particular interest. In the past fellows have attended maternal health symposiums, research courses, and maternal mental health forums. Fellows have 15 days of vacation, 5 days of conference (in addition to SOAP which they may attend provided they submit research), and 5 sick days.

• Help increase knowledge in obstetric anesthesiology, perioperative medicine, and maternal health.
• Learn and refine advanced patient care skills in the management of complex parturients anesthetic procedures. Fellows have the opportunity to manage high-risk parturients and follow them throughout their perinatal course.
• Grow as a professional through interaction with others in the Department of Anesthesia and other perinatal health specialties. Our curriculum may afford the opportunity for fellows to participate in overseas medical volunteer services, such as Kybele
• Receive mentoring and guidance from some of anesthesia’s most recognized experts in obstetric anesthesia, intensive care, pain management, cardiac anesthesia and human patient simulation education.
• Advance anesthetic practice and science. Stanford offers an active research community with opportunities for research in acute and chronic pain, cardiac anesthesia, and education along with many other projects, including clinical trials, simulation, and basic science research.
• Fellows will receive a POCUS and FATE course and have an opportunity to complete basic or advanced POCUS certification.

Lucile Packard Children’s Hospital at Stanford University is a tertiary obstetric center and has a busy Labor and Delivery Suite with 4,500-5,000 deliveries per year, many of which are high-risk. The hospital complex recently gained the addition of a new 521,000 square foot facility and surrounding 3.5 acres of healing green space and gardens, which opened in 2018.

Applicants gain experience in the anesthetic management of high-risk obstetric patients, and receive hands-on teaching in state-of-the-art technologies, including: advanced labor and cesarean analgesic techniques, ultrasound-guided neuraxial anesthetic techniques, transthoracic echocardiography, and point-of-care devices such as thromboelastography.

Stanford is a world-leader in obstetric emergency simulation and fellows will have the opportunity to gain experience in participating and teaching using low- and high-fidelity simulation techniques. All fellows will participate in at least one primary research project, which will incorporate research interests of the applicant with mentorship and guidance from the experienced obstetric anesthesia researchers within our group. Most fellows have the opportunity to present a research project at a major anesthesia or subspecialty meeting (including the Society for Obstetric Anesthesia and Perinatology and the American Society of Anesthesiologists). Fellows will also gain instruction in study design, data analysis, scientific writing and important aspects of peer review. Recent research interests in the group have included:

• Optimization of neuraxial techniques for labor and cesarean analgesia
• Predicting individual labor and cesarean pain and analgesic needs
• Local anesthetic potency and anesthetic requirements during labor and cesarean delivery
• Epidural and spinal opioid applications in obstetrics
• Peripartum hemostatic and coagulation changes
• Preventive and therapeutic strategies for hemorrhage management
• Management of maternal cardiac arrest and other obstetrical emergencies
• Patient attitudes and ethnic preferences towards obstetric analgesia

Other projects have been performed in conjunction with the Department of Fetal-Maternal Medicine and the Section of Perioperative Management and Pharmacokinetics within the Department of Anesthesia (such as, cost-analyses, pharmacokinetics and pharmacodynamics of drugs administered to pregnant women and interdisciplinary outcomes based research). We also offer opportunities to engage in global health projects. Opportunities for a 2-year fellowship may exist for candidates anticipating a career in academic medicine, with the second year spent in continuing clinical research and laboratory studies with other anesthesia department faculty. We also offer obstetric anesthesia research opportunities for more experienced researchers (e.g. sabbaticals) wishing to refine and expand their research repertoire and skillsets.

Clinical activities for fellows include primary responsibility for the management of high-risk parturients as well as involvement in routine obstetric anesthesia care. The fellows participate in intradepartmental educational activities and attend a Medical School lecture series for postgraduate fellows covering a variety of important topics over a three-semester period. Fellows organize the obstetric anesthesia journal club and participate in medical student and resident teaching under the supervision of the obstetric anesthesia faculty. Fellows interested in a career in academic medicine are also able to attend numerous workshops, seminars, and conferences at Stanford University, and receive mentoring from internationally recognized senior educators and researchers within and outside the Department of Anesthesia at Stanford University.