Rotation Locations
Anesthesia residents rotate at three hospitals, all within the greater Philadelphia area: Hahnemann University Hospital, St. Christopher's Hospital for Children, and Abington Memorial Hospital. Each institution offers different clinical experiences to the resident.
Learn more about the Anesthesia residency rotation locations.
Anesthesia Residency Clinical Rotations
About the Anesthesia Residency Clinical Education Program
The clinical education program is composed of three years of training, organized by year. First year anesthesiology residents are given a six-week orientation course covering the basic fundamentals of anesthesia. During these initial six weeks CA-1 residents are only paired with an attending. This allows the resident to develop a relationship with the attending while allowing the attending to better evaluate and understand the strengths and weakness of the individual resident. This allows us to tailor the orientation to each resident's needs.
During this period of time CA-1 residents are relieved at 3:00 p.m. so that they may have time to acclimate to their new environment and study. CA-1 residents do not take any calls for the initial eight weeks of their residency. We have a shadow program where, if residents wish, they may take call with another resident so that they are more comfortable on their actual day of call. CA-1 residents are also exposed to the simulation center to practice both procedural skills and life support algorithms. Each resident is evaluated at the end of the six weeks, allowing participants to express any concerns or weaknesses.
First year residents train in a variety of settings and are exposed to a variety of cases, including: anesthesia for general surgery, trauma, head and neck surgery, obstetrics, orthopedic surgery, ambulatory surgery, acute pain medicine, evaluation and preparation of patients for surgery, and postoperative care of patients in the PACU.
During the second year (CA-2), residents experience a variety of cases that involves training in subspecialty areas. The second year is designed for the resident to gain greater knowledge and improve on procedural skills. Residents rotate through anesthesia for cardiac and thoracic surgery, neurosurgery, acute and chronic pain, regional anesthesia, pediatrics, and critical care. The CA-2 year allows the resident to gain both experience and knowledge administering anesthesia to a variety of patient populations at different locations, including a private practice. During these rotations the resident is continually involved in monthly evaluations and feedback.
Residents in their final year (CA-3) are allowed flexibility in their rotation scheduling. Each resident determines how the last year of training will be formulated. Any combination of rotations may be chosen given that the ABA/ACGME requirements have been met. Many choose to focus on pediatrics, pain, cardiothoracic or obstetrics in preparation for a fellowship.
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Ambulatory Rotation
The Ambulatory Surgery Center at Hahnemann University Hospital is a busy multidisciplinary unit where residents rotate during their CA-1 and CA-3 years. Typically residents encounter a variety of general surgical, orthopedic, gynecologic, ophthalmologic, and urologic cases. In addition, residents are exposed to a large population of otolaryngology cases where alternative airway and ventilation techniques are often utilized. Finally, residents are exposed to the endoscopy suite to prepare them for the unique aspects of an office-based anesthesia practice. The cases encountered during this rotation require a broad range of anesthetic plans ranging from local with sedation and regional techniques to general anesthesia.
During the CA-1 year, residents will be assigned more simple cases that will serves as an introduction to the unique challenges that separate the ambulatory procedures from others seen in the general inpatient setting. The wide variety of cases and techniques performed in the Ambulatory Surgery Center offer ample opportunity for residents to master airway and regional anesthesia skills. Later, the more intensive rotation offered to CA-3 residents focuses on the more complex patients and airway procedures. Here residents develop clinical judgment as it pertains to candidates for ambulatory surgery and criteria for discharge. Residents can expect to be prepared for any situation they may encounter in the outpatient population after completing this rotation, as procedures have become more efficient with same day discharges. After the completion of this rotation residents are comfortable with working in a private setting that requires efficiency and quick turnovers.
View the ambulatory rotation manual.
View jet ventilation video.
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Cardiothoracic Rotation
The cardiothoracic anesthesiology core rotation is based primarily at Hahnemann University Hospital. This site offers a wide variety of cardiac surgical cases ranging in surgical technique (on- and off-pump coronary revascularization) and level of acuity. Examples range from minimally invasive valvular repair (Heartport technology) to insertion of right and left ventricular assist devices. Hahnemann was one of five centers in the United States to implant a self-contained total artificial heart for a patient in chronic heart failure.
The core cardiothoracic rotation consists of two months during the CA-2 year dedicated to caring for these patients with ischemic, valvular, and congenital heart disease. The application of cardiovascular physiology and pharmacology to hemodynamics and the sequelae of cardiopulmonary bypass are the major didactic goals. Clinical goals include proficiency in insertion of central venous and arterial catheters, regional anesthesia for cardiac surgery, and an introduction to transesophageal echocardiography (TEE).
Up to six months of additional elective training is available in the CA-3 year with one month dedicated to image acquisition and interpretation of TEE. The advanced training allows opportunities for greater autonomy and advanced techniques applicable to the CT patient. The overall emphasis then becomes the integration and interpretation of various sources of physiologic monitoring into well-articulated and executed therapeutic interventions.
View the cardiothoracic rotation manual.
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Critical Care Rotation
The Surgical Intensive Care Unit (SICU) is a multidisciplinary unit caring primarily for critically ill surgical patients. These patients include trauma, general surgery, neurosurgery, orthopedic surgery, vascular surgery, gynecologic and ENT patients. The mission of the SICU is excellence in patient care, education and research.
Daily rounds are made with an anesthesiology or surgical critical care attending where patient care and educational issues are discussed. Patient care responsibilities include all aspects of the critical care patient. Residents are expected to perform all invasive monitoring procedures (except intracranial line placement) including placement of central lines (IJ, subclavian, femoral), flow-directed PA catheter placement, A-lines (radial, DP, PT, femoral), tube thoracostomies, NG, Foley, etc. Residents assist attending surgeons in bedside operative procedures, which include tracheostomy, gastrostomy, laparotomies, fasciotomies, etc.
Bi-weekly educational conferences are part of the didactic curriculum of the SICU. One of these conferences each month will be multidisciplinary and include the Medical Intensive Care Unit. The MICU fellows and residents attend. Faculty for these educational sessions will be intensivists from the MICU, SICU, NICU and anesthesiology as well as leaders from traditional ICU support services (respiratory, pharmacy, nutrition, etc).
View the critical care rotation manual.
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Obstetrics Rotation
Anesthesiology residents at Drexel University College of Medicine begin participating in the anesthetic care of obstetric patients during their first year of anesthesia residency. They spend a month-long rotation caring for patients undergoing vaginal deliveries, Cesarean sections, and various other obstetrics-related procedures. More importantly, this first month rotation introduces the resident to maternal/fetal physiology and to its impact on anesthetic management. In addition, labor analgesia techniques and anesthetic techniques for Cesarean sections are stressed. Preanesthetic evaluations and analgesic/anesthetic plans are developed for each patient. This rotation often provides residents with their first major hands-on experience in neuroaxial conduction blocks such as spinal, epidural, and combined spinal-epidural techniques.
During the third year, residents have the opportunity to hone the skills introduced during their first obstetrics rotation. They are also expected to explore the implications of various pregnancy-related and non-pregnancy-related disease processes on the parturient patient, fetus and the management of delivery, especially as related to anesthetic management. Third year elective rotations are available for up to six months in order to continue the learning process as well as introduce the resident to opportunities in obstetric anesthesia research.
Faculty members with expertise in obstetric anesthesia closely supervise residents, discuss anesthetic plans and provide didactic instruction to all residents and medical students rotating on the labor floor.
View the obstetrics rotation manual.
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Off-Site Rotation
During this rotation senior residents learn to provide anesthesia in locations other than operating rooms, such as in the endoscopy suite, MRI, critical care units, cardiac cath lab and in the GI suites. Anesthetics will be primarily TIVA (total intravenous anesthesia) although occasionally general anesthesia will be required. By the end of the rotation residents are comfortable both providing anesthesia in a variety of "remote" locations and intervening in emergent situations with sound judgment and professional response. Residents also learn to evaluate patients scheduled for procedures in non-operating room locations and perform pre-operative evaluations to assure optimum medical status prior to the proposed procedure.
By the completion of this rotation senior residents understand how to manage and provide "rescue" anesthetics for procedures initiated as conscious sedation that ultimately require a deeper level of analgesia, and often educate non-surgical colleagues regarding the risks and benefits of different types of anesthesia.
View the off-site rotation manual.
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Neurosurgical Anesthesia Rotation
Residents spend two months in neurosurgical anesthesia in their CA-2 year and may elect additional months during their CA-3 year. The neurosurgical anesthesia rotation takes place at two sites: one month is spent at Hahnemann University Hospital and the second month is spent at Abington Memorial Hospital. Special attention is placed on management of increased intracranial pressure, posture, air embolism, cerebral protection, cerebral vasospasm, ventilation and fluid management. A wide range of cases are seen, including craniotomies, intracranial vascular malformations/aneurysms, spine surgery, and intracranial tumors.
During these month residents learn to develop skills necessary for maintaining adequate comfort and anesthesia with procedures involving continuous evaluation of motor and speech skills. Further, residents learn to build on their airway skills, which may include deep sedation prior to intubation or extubation to prevent increase in intracranial pressures. Residents learn extensively about vasopressors and titration in order to maintain appropriate blood pressures to improve surgical outcomes.
View the neurosurgical anesthesia rotation manual.
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PACU Rotation
Goals for this rotation include developing a level of competency for the evaluation and management of postoperative pain, ensuring that patients meet the requirements for discharge before being released, and facilitating patient discharge from the PACU when appropriate criteria have been met. Residents will also develop the capability to diagnose and manage anesthetic complications that are unique to the post-operative period.
View the post-anesthesia care unit rotation manual.
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Pain Management Rotation
During the pain rotation residents spend time primarily in the pain center at Hahnemann University Hospital. The center specializes in the assessment and development of long-term treatment plans for patients suffering from chronic pain associated with common disorders of the spine, cancer pain and neuropathic pain. Under the supervision of a pain faculty member, residents will be responsible for the medical management as well as determining the course of interventional therapy. Procedures done in the pain center include epidural injections, facet blocks, sacroiliac joint injections, trigger point injections, radio frequency ablative procedures, provocative discography, percutaneous spinal cord stimulator trials, intrathecal pump trials, and neurolytic injections in patients with cancer pain. Other responsibilities involved include inpatient consults and follow-up on post-operative pain patients. The residents' experience at the pain center includes evaluation of new patients and follow-up patients. Residents are expected to attend multidisciplinary chronic pain meetings. This experience is supplemented with weekly rounds by a neurology attending on the complex regional pain service.
View the pain management rotation manual.
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Pre-Admissions Testing Rotation
First year residents (CA-1) are involved in a two month rotation through the preoperative evaluation clinic. The preoperative evaluation unit is where patients are evaluated for ambulatory procedures and more complex surgery requiring postoperative hospital admission. In this setting residents learn the importance of evaluating patients in advance of their scheduled admission, most importantly the identification of at-risk patients so that interventions may be implemented to decrease perioperative risk prior to their presentation for surgery.
During these months residents evaluate a large variety of patients and learn to stratify anesthetic risks by taking a comprehensive history, recognizing important findings on physical examination and cost-effectively ordering additional studies or consultations when appropriate. Most imperatively the resident gains confidence in formulating an anesthetic plan for a given patient based on the type of surgery and information gleaned from the evaluation. Finally the resident should develop the communication skills needed to effectively and compassionately communicate this information to the patient as part of informed consent.
View the pre-admissions testing rotation manual.
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Pediatrics Rotation
Anesthesia residents rotate for one two-month block at St. Christopher's Hospital for Children during their second year of anesthesia residency. Residents learn pediatric anesthesia through didactic lectures, case conferences, bedside teaching, morning report, and patient care. In addition the staff anesthesiologists and fellows provide basic lectures in pediatric anesthesia. Conferences are held Monday, Wednesday and Friday mornings. The residents learn to perform preoperative evaluations and administer anesthesia under the supervision of a fellow and a staff anesthesiologist. Post-operative checks are also part of the education.
At the completion of the rotation, residents should understand basic anatomic, physiologic, pharmacologic and emotional differences between adults and children. They should be familiar with many of the common disease states unique to pediatric patients. Further they should learn the skills necessary for preoperative evaluation and preparation, induction and maintenance of anesthesia, vascular access, endotracheal intubation, IV fluid therapy, and vasoactive support of the circulation of the pediatric patient. Residents should understand the indications for and be able to interpret the data from non-invasive and invasive monitors. Residents are also taught regional anesthetics in children and become familiar with various modes of postoperative analgesia. As the residents progresses through their rotation they are given increasingly difficult airways associated with the many syndromes and congenital malformations of pediatric patients. The resident is under constant supervision with an attending during these difficult airways.
Anesthesia residents in their CA-3 year may use elective time to rotate and receive additional subspecialty training in pediatric anesthesiology. Third year residents are assigned the more challenging cases. Some CA-3s spend time on the critical care service in the pediatric ICU. CA-3s are also assigned to the post anesthesia care unit to handle early postoperative problems and to the pediatric pain service to gain familiarity with the diagnosis and treatment of acute and chronic pain. Residents during this month also rotate through off-site locations (MRI, GI-suite, etc.) in order to learn, manage and improve their anesthesia delivery and skills in different and unique environments.
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Regional Rotation
The practice of regional anesthesia has seen resurgence in recent years and is firmly established as an integral and important part in the practice of modern anesthesiology. Residents spend time on the regional service during the CA-2 and CA-3 clinical training years. During this time the focus is on identifying the appropriate patients, discussing the benefits/risks of regional techniques, and performance of effective blocks. By the end of the rotation, the resident should be proficient in techniques, indications and contraindications, clinical complications, and medications used in regional techniques. During this block residents learn in detail about peripheral nerve anatomy and local anesthetics appropriate for each unique procedure. Residents further learn to master techniques with the use of the ultrasound machine. Each resident is taught the mechanics and physics regarding the machine and methods that aid to visualize peripheral nerves.
View the regional anesthesia rotation manual.
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Research Rotation
An elective, the research rotation engages residents in research activities at Drexel University College of Medicine, with a minimum two-block continuous commitment and maximum of six blocks. Opportunities for basic and clinical research experience exist in the Department of Anesthesiology, and in other clinical and basic science departments in the College of Medicine and other schools and colleges of Drexel University. There are many opportunities for residents to either participate in an ongoing research project or develop their own project.
View the research rotation manual.
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