In Residency News, Uncategorized

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.

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