Anesthesiology, Perioperative and Pain Medicine

Ask Alex

Q&A with Stanford Anesthesia's Residency Director

2014 match results!

A fabulous group of people matched here! Congratulations and we look forward to having you join the Stanford Anesthesia family,
thank you
Alex


CATEGORICAL INTERNS/RESIDENTS
FRANCESCA BETTI, WASHINGTON UNIVERSITY
DAVID CREIGHTON, COLUMBIA UNIVERSITY
EMMETT CULLIGAN, UNIVERSITY OF ILLINOIS
NICHOLAS EGLITIS, OREGON HEALTH SCIENCES
SARAH STONE, CHICAGO MEDICAL SCHOOL
SOPHIA TURKMANI-BAZZI, WAYNE STATE UNIVERSITY
MELISSA VOGELSONG, UC SAN FRANCISCO
JESSICA ZVARA, UNIVERSITY OF NORTH CAROLINA

ADVANCED RESIDENTS 2014
AHLIA KATTAN, STANFORD UNIVERSITY
MICHAEL LIN, UC SAN FRANCISCO (COMBINED IM/ANESTHESIA)

ADVANCED RESIDENTS 2015
NOELLE FABIAN, LOYOLA UNIVERSITY
IGOR FEINSTEIN, STONY BROOK UNIVERSITY
KAREEN JONES, UNIVERSITY OF MIAMI
WENDY MA, UC SAN FRANCISCO
DANIEL MOY, GEORGETOWN UNIVERSITY
SEAN PASCHALL, UNIVERSITY OF TX, MEDICAL BRANCH
FELIPE PEREZ, STANFORD UNIVERSITY
ASHLEY PETERSON, ST. GEORGE’S UNIVERSITY
REID PEYTON, UNIVERSITY OF SOUTHERN CALIFORNIA
SARA SMITH, MEDICAL UNIVERSITY OF S. CAROLINA
TENILLE SMITH, UNIVERSITY OF NEVADA
CHELSEA TESSLER-VERVILLE, MEDICAL COLLEGE OF WISCONSIN
JOCELYN WONG, DARTMOUTH

COMBINED PEDIATRICS/ANESTHESIA
ANDREW GIUSTINI, DARTMOUTH
JEWEL SHEEHAN, UNIVERSITY OF NORTH CAROLINA

COMBINED INTERNAL MEDICINE/ANESTHESIA
AMY KLOOSTERBOER, UNIVERSITY OF WISCONSIN
JASON LEONG, ALBERT EINSTEIN
JAI MADHOK, STANFORD UNIVERSITY

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

Some questions (with answers) that applicants have asked since the end of the interview season

Question: What is the trauma experience like at Stanford and what is the role of the anesthesia resident?
Answer: For the most recent graduating class data from the ACGME reports shows an average of 34 trauma cases were done by each resident by the end of training. The required minimum by the ACGME is 20. Trauma is also a point of emphasis for some of the simulation sessions. A formal trauma experience exists at Stanford Hospital through our ortho trauma rotation, which includes blunt trauma from motor vehicle and cycling accidents for example. At the Santa Clara Valley County Hospital, many emergent trauma cases come in including penetrating trauma. Anesthesia residents are intimately involved with the care of trauma patients from the moment they arrive in the OR to the time they are dropped off in the ICU.

Question: Is there a difficulty airway team or is their an airway pager that the resident carries and what exactly does that mean?
Answer: Our department is the cornerstone of Code Teams at all of our training hospitals. At all sites, the anesthesia resident who carries the emergency airway pager is primarily responsible for securing the airway. Once the airway is secured, we contribute to patient management by placing lines and getting access. “Running the code” is a role usually reserved for ICU fellows and attendings.

Question: Does the program provide money for food at the hospital or provide meals to the residents?
Answer: The hospital-wide graduate medical education office provides a small stipend ($10) to any resident who works more than 12 hrs/day (based on duty hours reports). In addition, our department provides breakfast on weekdays and there are a number of afternoon and evening lectures that provide food to attendees.

Question: This question was for Jorge Caballero one of our Chief Residents. Why did you choose to do you residency at Stanford?
Answer: By Jorge--“Having trained at Stanford from undergrad through residency, I’m often asked why I’ve opted to stay on the Farm for so many years. There are plenty of reasons but they all boil down to one thing: the people. From the time I stepped foot on campus in 2002, I’ve met one remarkable individual after another. Interacting with students, faculty, and staff who are committed to making a difference is inspiring and invigorating. What’s more, the culture at Stanford encourages collaboration rather than competition, which makes it easy to explore novel ideas and discover new interests. As a resident, I’ve enjoyed the camaraderie of my co-residents, many of whom I consider among my closest friends. Given how much support I’ve received from Stanford Anesthesia, it should be no surprise that I’m looking forward to contributing to our department as a member of our research and clinical faculty.”

Question: What training do Stanford residents get as anesthesia "managers" and with supervision?
Answer: The issue of supervision is an important one and wrt to the manager function several rotations come to mind:
1) VA Chief Resident where resident runs the board, helps start cases, does blocks, teaches junior residents etc
2) ASC periop rotation which is similar but is in the ambulatory surgery center here on stanford campus
3) Byers practice management a new rotation in a freestanding surgery center with 2-3 CRNAS
4) VA ICU which has interns on the team
5) EVOLVE, a multi- year simulation-based curriculum for anesthesia residents transitioning into supervising anesthesiologists.
6) The Stanford Anesthesia interns do 1 month of anesthesia and are paired with a resident for a week at a time. The resident supervises the intern delivering anesthesia care in the OR.

Question: Does the Stanford training program have CRNAs?
Answer: There are CRNAs at the County Hospital and at the VA hospital where the residents rotate. At Stanford Hopsital there are CRNAs in the cardiac cath lab, IR lab, and endoscopy suite.

Thank you,
alex_small.jpg

Where do Stanford Anesthesia residents live?

We have finished interviewing this year's applicants and are excited for the results of the Match coming up. The class will be a spectacular group of people. One of the questions that arises is where do Stanford Anesthesia residents live.
A quick survey revealed the following distribution.

Palo Alto (29% of residents)
Mountain View (17%)
Menlo Park (14%)
Redwood city (14%)
San Francisco (5%)
Sunnyvale (5%)
Los Altos (3%)
Santa Clara (3%)
and the remaining 12% in one of the following:
Portola Valley, Belmont, San Jose, San Carlos, Cupertino, and Burlingame

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,
alex_small.jpg

Bios for Chief Residents for 2013-2104

Jorge Caballero, M.D.
Jorge was born in the Mexican colonial city of Morelia and grew up in sunny southern California before moving to the Bay Area. He met his college sweetheart, LeeAnn, as a senior at Stanford and they married while he was a student at the Stanford School of Medicine. Since he’ll be sticking around next year as a FARM Fellow, he’s earned the label of being a “Stanford Lifer” – and he’s all too willing share his knowledge of all the great opportunities Stanford has to offer. As a FARM Scholar, Jorge’s scholarly pursuits are driven by a desire to merge his interest in computing with his passion for medicine. His research focuses on improving anesthesiology and perioperative care by leveraging clinical data to catalyze translational research. In his spare time, he enjoys spending time with friends, attending Stanford Football games, traveling, and day tripping to wine country.

Marie McHenry, M.D.
Marie grew up on the East Coast in Annapolis, Maryland. She went to Johns Hopkins University, earning a degree in biomedical and electrical engineering. The first of many adventures with her husband Rob was to head west to San Diego California, where he was stationed on a Navy Nuclear Submarine. Although trained as an engineer, she quickly realized that she was a little too social for that field and followed an opportunity into the financial services industry where she worked with retirement investment funds. After eight years in finance, in what was perhaps an early midlife crisis, she pursued her dream of medical school at Georgetown University School of Medicine. A little older and hopefully wiser, anesthesia was a clear choice and a perfect fit. After an internship at INOVA Fairfax in Northern Virginia and with fond memories of the west coast, she came to Stanford for anesthesia residency where she is currently a chief resident. Having chosen to pursue fellowship training in cardiac anesthesia, Marie will be heading to The Texas Heart Institute in July 2014. Who knows where the adventure will take her after fellowship, but she is hoping to come back to the San Francisco Bay Area. When not at the hospital, she can be found enjoying all that the Bay Area has to offer, including great wind, great weather, and great wine!

Matthew Wagaman, M.D.
Matt was born just down Hwy 101 in San Jose CA where his Dad came in the late 70’s trying to pitch the idea of an electronic medical record for dental offices. Given the size and expense of the personal computer at the time not many were interested and so the Wagaman’s moved to be near family in Utah which is where Matt grew up. After graduating from Brigham Young University with a B.S. in Exercise Physiology he spent 1 yr. working as a dialysis technician for DaVita Dialysis. During this time he had his first child, Elizabeth (Ellie, 7). He completed his medical degree at the University of Michigan and became an avid Michigan sports fan. Matt completed a Transitional Year Internship at St. John’s Hospital in Detroit. It was during this time in Michigan that Noah (5) and Rowena (Row, 2) were born. Although very fond of the mid-west, Matt and his family were searching for a warmer location to complete residency training and were immediately captivated by the idea of coming to Stanford. He feels privileged to be part of this great program and to represent his co-residents as a Chief Resident. Matt will be joining a private practice in Colorado Springs, CO beginning in July 2014. When he is not fulfilling his role as a parent and husband Matt enjoys watching and playing most sports, music, snow skiing, golf, and Thai food.

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 Medicine Resources:

Footer Links: