As a large program with 80 clinical anesthesiology residents and 20 clinical base year residents, we are able to maintain a smaller feel with rotations focused at only a few sites throughout residency training including the Hospital of the University of Pennsylvania Penn Presbyterian Hospital, the Children's Hospital of Philadelphia, and the Tuttleman Pain Center.
The clinical base year (CBY) is predominantly spent at Penn Presbyterian Medical Center, with Associate Program Director Dr. Jason Ochroch supervising this experience. Our CBY entails a mix of surgical subspecialties, internal medicine, intensive care unit, emergency medicine, and anesthesiology rotations for a well-rounded experience that prepares our trainees to excel when progressing to CA1 year and beyond.
At the start of CA1 year, all new residents complete four weeks of direct attending supervision (known as “one-to-ones") in the operating rooms at both the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. Our one-to-one faculty are carefully selected to ensure that our new residents form good practice habits early, setting them up for future success. Following one-to-ones, our CA1s begin taking call, have continued operating room exposure, and begin early subspecialty exposure with our acute pain service, intensive care unit, and chronic pain clinic rotations. By midway through CA1 year, our residents begin true subspecialty exposure including cardiac, neurosurgery, pediatric, and transplant anesthesiology rotations.
This subspecialty exposure continues throughout CA2 year. As a program, we believe in early and continued subspecialty exposure to ensure that our graduates are capable and competent. It is common for all ACGME requirements to be completed by the beginning of CA3 year, allowing our CA3s flexibility to refine their skills with elective rotations prior to graduation.
Below is a brief overview of our clinical experience and call structure:
Main OR
While working in the Main ORs, residents rotate through blocks dedicated to specific surgical sub-specialties, ensuring broad exposure. These rotations include general surgery, gynecological surgery, neurosurgery, orthopedic surgery, otorhinolaryngology, non-operating room anesthesia, urology, thoracic surgery, transplant surgery, and vascular surgery. As residents gain experience, they participate in PRN rotations, providing coverage to all subspecialties as needed. This mimics the day-to-day routine of an attending.
Ambulatory anesthesia (PCAM)There are 7 operating rooms at the Perelman Center for Advanced Medicine. Non-orthopedic outpatient surgery procedures are performed for a variety of specialties, including general, colorectal, plastics, ENT, OB/Gyn and oncology. This rotation provides the resident with the ability to focus on efficiency and tailoring anesthetic care for rapid post-operative discharge home.
Cardiac anesthesia
We are one of the largest cardiac surgery centers on the east coast, achieving multiple 3-star rankings from the STS. Cases include CABGs, valve surgery, aortic surgery, LVADs, ECMO, and heart and lung transplantation. The volume and complexity of cases offers unmatched education and exposure to cardiac anesthesia.
Critical care medicine
Residents work in the surgical intensive care unit, which has both anesthesiology and surgical critical care faculty as attendings. This provides a broad perspective towards critical care. The ICU team is multidisciplinary, including anesthesiology and surgical critical care fellows, residents from multiple specialties, advanced practice providers, pharmacists, and therapists. This rotation includes one week of night float. Residents wanting more critical care exposure or experience leading a multidisciplinary team can choose a senior pseudo-fellow elective, where they are the acting fellow in the ICU. They can select this rotation in our anesthesiology-staffed Heart and Vascular Surgical ICU or our Surgical ICU.
Pediatric anesthesia (CHOP)
Residents spend two consecutive months at CHOP with the option of spending more time if they desire. While at CHOP, residents perform anesthesia for a wide variety of cases. One day may be spent providing anesthesia for common procedures like ear tubes, while another may entail providing anesthetic care for patients with extremely rare conditions that are only seen at a place like CHOP. Our residents work alongside trainees from other anesthesiology programs, but we highlight that CHOP attendings are University of Pennsylvania faculty, and we have a few attendings who work at both CHOP and HUP. Additionally, we offer the option of a senior elective rotation in pediatric cardiac anesthesia at CHOP.
Obstetric anesthesia (OB)
All residents spend two months on the HUP labor and delivery floor. There are four residents on the OB service each month, so residents are on call every fourth night. Trainees also gain additional OB exposure through a senior OB elective and the OB flex call position. Each morning on the rotation begins with a lecture on obstetric anesthesia by the attending covering the OB service that day.
Pain management
Pain management rotations provide trainees with the opportunity to care for acute and chronic pain patients in both inpatient and outpatient settings. Each resident completes one acute pain rotation. This rotation is split between HUP and PPMC and offers exposure to regional anesthesia in addition to managing acute pain consults and indwelling epidural and peripheral nerve catheters. Each resident also completes one outpatient pain medicine clinic rotation. Resident responsibilities include seeing both new patient referrals and existing patients and spending time in the procedural area, where trainees will complete a variety of interventional pain procedures alongside our pain medicine fellows and faculty.
Regional anesthesia
Each resident completes a dedicate regional anesthesiology rotation at PPMC under the supervision of our regional anesthesiology faculty and fellows. During this rotation, the resident becomes familiar with a variety of peripheral nerve blocks including, but not limited to, interscalene, supraclavicular, infraclavicular, axillary, femoral, adductor canal, sciatic, popliteal, and ankle. There is a dedicated holding room where patients are blocked by the regional team before the patients move to the operating room.
Residents can choose additional regional exposure through a senior regional pseudo-fellow elective, where they function as a fellow overseeing the regional anesthesiology team, and via time spent at our free-standing ambulatory surgery center at Penn Medicine University City. At Penn Medicine University City, our residents become familiar with fast-turnover cases that span orthopedics and general surgery. Many of these cases are performed under monitored anesthesia care with regional blocks. Additionally, the resident gains experience in supervising nurse anesthetists and working in a free-standing surgical center.
Call teams
There are two call teams nightly, one for the main operating rooms including cardiac and transplant and one for the OB floor. Each call team has an attending anesthesiologist overseeing all care with a dedicated cardiac anesthesiologist and liver transplant anesthesiologist available for these subspecialty cases. Except for holidays and weekends, all call team members are given late starts, either 11:00am or 4:00pm depending on assignment.
The main operating room call team includes an attending anesthesiologist, four residents, and one CRNA. This allows our residents to work in multidisciplinary teams throughout training. This team covers all cases overnight, including cardiac and liver transplants with the respective subspecialty attendings. There is an additional CRNA overnight covering airways and Gift of Life organ procurements.
The OB floor call team includes an attending anesthesiologist and two residents; one assigned to the OB rotation, and one assigned to another rotation. This provides consistent and early exposure to the OB floor and allows flexibility for refinement of skill sets.
1st call: The senior overnight position, typically a CA3 or end-of-year CA2. 1st call oversees the "running the board," responding to airways, and acts as “the attending” overnight with supervision. The goal of 1st call is to prepare the senior resident to become a true consultant in our field. They lead the call team, manage the operating rooms, and coordinate between surgerical services and OR nursing. The on-call attending is always present to supervise and support the 1st call resident. This shift starts at 4:00pm.
2nd call: Typically a CA2 or CA1 who has completed subspecialties. 2nd call tends to staff complex cases like liver transplants, craniotomies, major vascular, and thoracic surgeries. This shift starts at 11:00am.
Cardiac call: A resident who is either on, or has completed, their cardiac rotation. Cardiac call is prioritized for cardiac cases overnight and offers an additional set of experienced hands to the call team overnight if there are no cardiac cases. This shift starts at 11:00am.
3rd call: Typically, a CA1. 3rd call works alongside the other call team members and often sees many firsts during this assignment. It is not uncommon for this to be the first exposure to a liver transplant. This shift starts at 11:00am.
OB call: A resident assigned to the OB rotation, which provides consistent exposure throughout that rotation, solidifying knowledge and skills. This shift starts at 4:00pm.
OB flex call: Typically a CA1, though open to any resident looking for OB exposure. This assignment is not specific to the OB rotation and provides early and consistent exposure to the OB floor. This shift starts at 11:00am.