Ask Alex

Opportunity: internship at Kaiser Permanente Medical Center in San Francisco

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

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

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

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

Other information.

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

ACGME program number:   1400512060

Address         2425 Geary Boulevard, San Francisco, California 94115

Program Director email:      Michael.Coppolino@kp.org

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

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

# of available categorical positions:           12

Interview days: Tuesday, Wednesday, and Friday mornings

Rotation schedule: Wards=4-4.5 months (No continuity clinic during yr for prelims); ICU=2 months, Elective=3 to 4 months (two week blocks can be research at Stanford Anesthesia or OR anesthesia at Stanford); Night float= ½ to 1 month; ER=1 month "

Salary: $55,849 (for 2012)

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

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

Educational Stipend=$500 for PG-1

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

Thank you,
Alex

Minutes from April 2012 Education Committee Meeting

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

Below are the minutes of our most recent meeting fyi.

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

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

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

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

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

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

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

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

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

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

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

Research Update from Western Anesthesia Resident Conference

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

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

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

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

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

Congratulations to the housestaff who presented!
Thank you,

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,

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,

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,

Three Stanford Anesthesia Chief Residents

Crucial to any residency is the Chief Resident. At Stanford we have 3 Chief Residents every year elected by housestaff and faculty. As Program Director it is a real treat to interact with these young leaders.

This year the three Chief Residents (with a short bio) are: Drs. Javier Lorenzo, Laura Downey, and Jay Jay Desai.

Arjun "JJ" Desai, MD
JJ was born and raised in Southern California. Following in two generations of tradition, JJ attended the University of Oklahoma where he served as university president and held several leadership positions. During college, JJ worked on Capitol Hill as an intern for Congressman Christopher Cox and the House Policy Committee where he helped to shape emerging healthcare legislation. After college, JJ lived in Singapore as a delegate of the State Department and Rotarian Ambassadorial Scholar of Goodwill. In Singapore, he taught in the graduate school of International Health Economics at the National University of Singapore. Additionally, he traveled to over 11 countries to speak with village coalitions and local health ministries to develop sustainable vaccination programs and preventative health clinics. JJ attended the University of Miami school of medicine. In Miami, JJ helped to develop an international non-profit health system in Gujarat, India. Over 40 medical students from the University of Miami traveled to India with JJ to work and volunteer their services. Combined with an interest in clinical anesthesia, JJ continues here at Stanford with a research focus in operating room management and Anesthesia business development. Fun fact - while in Miami, JJ met his best friend and future wife - who is now also an Anesthesia resident at Stanford!

Laura Downey MD
I was born and raised in Atlanta, Georgia. I graduated from Duke University with a degree in Marine Biology in 2003. I then moved to California and spent a year working as a research assistant in an immunology lab here at Stanford. I decided to move back east to attend Duke for my medical degree. After graduation, I felt the pull back to the west coast and moved to Seattle, WA for my intern year as an internal medicine resident at University of Washington. Subsequently, I moved to Stanford for my three years of anesthesia residency. I am curently one of the chief residents and have really enjoyed getting to know our residents and the applicants this year. I will be starting a pediatric anesthesia fellowship at Children's Hospital of Boston next fall. Outside of the hospital, I enjoy many of the activities that they bay area has to offer, including SCUBA diving, traveling, hiking, rock climbing, and taking a trip to the wine country with friends.

Javier Lorenzo MD
Javier was born and raised in Cuba, and immigrated to the United States at the age of eleven. He attended Carnegie Mellon University where he graduated with a degree in Biological Sciences and Biomedical Engineering. Before attending medical school in Stanford University, he lived in Bethesda (MD) where he worked at the National Institutes of Health doing research elucidating molecular pathways of insulin resistance. He was also involved in public science policy and was a guest writer for the NIH Catalyst. Javier decided to stay in the Bay Area for his residency because he enjoys the "magical universe" of the region. He is an avid hiker and a self proclaimed 'foodie'. During his free time is catching up with his hobby as a cinema enthusiast, weightlifting, or discovering eateries in the area. He will soon be starting his fellowship in Critical Care Medicine here in Stanford.

Thank you Chiefs for a job very well done,
Thank you,

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,

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