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Rotation schedule and description

CA-1 year:
8 months general OR experience
1 month obstetric anesthesia
1 month pain management (focus on acute pain management; evaluation, examination and consultation of acute and chronic pain patients).
1 month preadmission testing
2 weeks post anesthesia care unit
CA-2 year – One month rotations in the following subspecialties:
Cardiothoracic anesthesia
Pain management (focus on regional anesthesia for post-op pain, catheter techniques, chronic pain and procedures).
Pediatric ICU
6 months general OR experience
CA3 year – One month rotations in:
Advanced neuroanesthesia
Advanced cardiothoracic anesthesia
Surgical intensive care unit
Advanced clinical anesthesia
Non-operating room (“outside”) anesthesia- 2 weeks (includes MRI, endoscopy, pain management, cardiac cath, peds oncology, interventional radiology).
In the remaining 8 months residents may choose to do 1-3 months of cardiac, obstetrics, pediatrics, pain management, neuroanesthesia, regional anesthesia, or critical care.

Preadmission Testing: ( Jonathan Markley, Director)
During this one month CA1 rotation, the resident evaluates, prepares, optimizes and educates the patient who will be coming in for scheduled surgery. Residents will become adept at history taking and physical exam, learn how co-existing diseases affect and are affected by surgery and anesthesia, and create an anesthetic plan appropriate for the patient. The PAT resident will learn the appropriate and cost effective ordering of lab studies, medical and subspecialty consultation prior to surgery. Complex patients will be presented to the attending in charge for additional consultation and planning.

Cardiothoracic Anesthesia: (Suhaib Akhtar, Salvatore Zisa, Co-Directors, SJUMC; Claudia Komer, Harish Nandigam, Co-Directors, SMMC)
Cardiothoracic anesthesia training occurs during the CA2 and 3 years at both the St. Joseph's Cardiac Institute and St. Michael's Medical Center where over 1500 cardiac and thoracic surgical procedures are performed each year. Residents will learn management of on and off pump cardiac bypass, valve replacement, trans-aortic valve repair (TAVR), thoracic aneurysm repair, open thoracotomy and video-assisted thoracoscopy(VATS), cardiac catheterization and electrophysiologic ablation. Residents will become adept at the insertion and interpretation of invasive monitors, transesophageal echocardiography (TEE), placement of double lumen tubes and bronchial blockers and management of one-lung ventilation.   

Critical Care Medicine: (Claudia Komer, Director; William De Bruin, Director, Pediatric Intensive Care Unit)
The Critical Care rotation takes place during the CA2 and CA3 years. The CA2 resident spends a month in the Pediatric Intensive Care Unit integrating into the peds critical care team. Residents will learn the fundamentals of pediatric intensive care, ventilator management, pain management and   invasive monitoring. They will also participate in a variety of procedures requiring sedation such as MRI or invasive radiology.
The second month of Critical Care takes place at St. Michael’s Medical Center, where the intensive care units are overseen by anesthesia. Claudia Komer, board certified in critical care, will round with the resident on patients in the med/surg ICU and the post-cardiac surgery ICU, discussing, planning and  managing their ongoing care. Residents will care for patients with a wide variety of life-threatening medical issues and post-operative complications.

Neurosurgical anesthesia: (Daria Costa, Director)
For a month in both the CA2 and CA3 years, residents participate in a variety of intracranial, neurovascular and spine surgeries. They will learn principles of EEG and evoked potential monitoring, brain protection, total intravenous anesthesia, controlled hypotension, management of increased intracranial pressures, the awake craniotomy and traumatic brain injury. Residents will also manage endovascular procedures in the new neurointerventional suite.

Obstetric Anesthesia: (Seth Landa, Director)   
St. Joseph’s University Medical Center has a high-risk obstetrics department with over 3,700 deliveries each year. Residents care for parturients with preeclampsia, hemorrhage, cardiac disease and multiple births (including one set of quintuplets!). CA1 residents quickly become adept at performing spinal and epidural anesthesia, managing labor analgesia, elective and urgent cesarean section and post-operative pain.  CA2 and 3 residents become adept at handling the most challenging regional anesthetics and become expert in the management of the pregnant patient with co-existing disease. Residents are expected to formulate an anesthetic plan for the medically complicated obstetric patient together with the patient’s obstetric team and medical consultants. The team approach is emphasized throughout training and simulations will involve nursing and obstetric personnel. Residents are also expected to teach the basics of obstetric anesthesia to our rotating medical students.

Pain Management: (Michael Umanoff, Director)
Under the guidance of our Board-certified pain management physicians, residents will rotate for a month in each of their 3 years with an option for additional CA3 training for those interested. The CA 1 resident focuses on learning examination and evaluation of the pain patient, and formulating a plan for acute and post-operative pain management; the CA 2 rotation emphasizes regional blocks and pain procedures as well as developing a multi-disciplinary approach to chronic pain management; while the CA 3 will learn office–based management of chronic pain and advanced procedures.   
Our pain management center ( www.totalpaincarenj.com) focuses on restoring function and improving quality of life for those suffering from acute and chronic pain including disorders of the spine, cancer pain and neuropathic pain.  Some of the procedures done in the pain center include epidural injections, facet injections, sacroiliac joint injections, nerve blocks, trigger point injections, radiofrequency ablation, discography, spinal cord stimulation, intrathecal pumps, percutaneous discectomy, insertion of interspinous spacers for spinal stenosis, stellate ganglion and lumbar sympathetic blocks for CRPS, celiac plexus and neurolytic injections for cancer pain.
St. Joseph’s is nationally recognized for promoting opioid-free pain care through the ALTO program (Alternatives to Opioids) and our pain center has been at the forefront of this effort promoting utilization of blocks, non-opiate medications and other alternative therapies in the ER and throughout the hospital. Residents will be educated in this important trendsetting approach to pain management.

Pediatric Anesthesia: (Stephen Winikoff, Director; William De Bruin, Director Pediatric Intensive Care)
St. Joseph's has a state designated 120-bed Children's Hospital.  During the CA2 and CA3 rotations residents will be exposed to the full gamut of routine and advanced pediatric cases and neonatal surgeries, as well as pediatric intensive care, pediatric cardiac surgery, neurosurgery, ENT, craniofacial repairs, and genitourinary surgery. Our residents participated in the first (and only!) separation of conjoined twins in New Jersey history. Residents will also learn pediatric pain management including regional techniques and participate in sedations for MRI, cardiac cath, endoscopy and oncology procedures. With our pediatric specialty-trained attendings providing supervision and training, and an abundance of cases, graduating residents take with them the needed skills and knowledge to be comfortable with both basic and advanced pediatric surgery.

Postanesthesia Care Unit :  
The goal of this rotation is to provide residents with the knowledge skills and clinical experience to provide care for patients recovering from general, regional and monitored anesthesia care. Residents will become competent at recognizing and managing common PACU problems and more serious crises, with emphasis on effective communication with the appropriate surgical, medical, nursing services and the primary anesthesia team.  Residents will round and receive regular lectures on a variety of topics relating to PACU care. Residents will become familiar with ventilator management and weaning and acute post-operative pain management.
Regional Anesthesia: (Jonathan Markley, Georgina Sesana, Co-directors)
 With busy orthopedic, trauma, vascular, podiatric and plastic surgery services, our residents will have plenty of exposure to regional techniques throughout training as well as during their CA2 pain rotation and CA 3 regional month. Residents will learn central neuraxial anesthesia and a wide variety of peripheral nerve blocks done under ultrasound guidance.  They will hone their skills in the Simulation Lab on models and experience an ultrasound visualization workshop with live volunteers. Our faculty includes several fellowship-trained regional specialists and many others who share a passion for providing optimal intra and post-operative care utilizing regional techniques. Throughout training, residents will receive lectures on the latest cutting edge techniques and outcome studies on the benefits of the various procedures. Our residents become adept not only at providing expert intraoperative care but will also recognize the importance of regional anesthesia in providing enhanced recovery after surgery (ERAS). Minimum required numbers are met early in training and our graduates are very comfortable with these valuable, essential skills.

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