Pediatric Anesthesiology Rotations and Call Assignments

Core General Pediatric Anesthesiology (5.5 months) - The fellow is exposed to various cases, from healthy children undergoing routine procedures to the most challenging cases. The fellow is given priority in daily case selection.

One block toward the end of the year is devoted to developing as a clinician-educator and perioperative leader, with the fellow serving as the board runner under direct faculty supervision.

On another block, the fellow has the opportunity to spend time in non-OR locations, including diagnostic imaging, interventional radiology, GI procedures, and neuroradiology. This allows the fellow to understand the special techniques needed and the pitfalls involved in working in an off-site location.  The remainder of that block is spent with a focus on Airway.  During this time, the fellow is assigned to the best airway cases daily. Specifically, cleft lip/palates, infant direct laryngoscopies and bronchoscopies, and dental cases. The airway faculty have agreed to supervise non-traditional techniques if specific airway cases not available on certain days.

Cardiac Anesthesiology (2 months) - The fellow works in the Cardiac operating rooms and the cardiac catheterization lab. Most fellows do approximately fifteen cardiopulmonary bypass cases per month.

Pain Medicine/Regional Anesthesia (2.5 months total, separated) - This rotation has three priorities:

• Management of acute perioperative pain
• Performance of ultrasound-guided peripheral nerve blocks and neuraxial blocks
• Exposure to chronic pain patients

On the pain medicine block, the fellow has the responsibility for managing patient-controlled analgesia and epidural catheters and evaluating consults requested by medical services. The fellow may also see chronic patients in the clinic with the attending physician.

On the regional anesthesia block, the fellow is primarily in the operating rooms performing peripheral nerve and neuraxial blocks.

Critical Care/Post-Anesthesia Care (1 month) - The fellow functions as a core member of the ICU and PACU teams, with direct patient care responsibility, writing notes and making management decisions on the patients. The fellow may also deliver anesthesia-related didactic/bedside teaching as indicated.

Elective (1 month) - the fellow may choose to do a month at our community elective (West Campus or Woodlands), CV OR, Pain, CVICU, or a unique elective - which must be approved by the program director.

Call Assignments

All call assignments meet compliance with the ACGME's 80-hour duty limits, the requirement for the rest periods between shifts and the opportunity for days off during the month.

• In the Main operating room rotations, fellows share the general call burden with anesthesiology residents. Both first and second-call trainees will start at noon and remain in-house until 7 a.m. the following day.
• On weekends, both first and second-call trainees will begin at 7 a.m. At 7 p.m., first-call and second-call trainees switch designations (i.e. first call becomes second call, second call becomes first call) for the remainder of the shift.
• There is an additional optional third volunteer call (3V) that has been attached to the second call position on weekends, requiring any trainee who has elected to serve as 3V to remain in-house during the shift. This shift is then compensated.
• Otherwise, the second-call trainee is usually relieved and allowed to go home once the cases are completed, with possible activation before 7 a.m.
• There is no call at night or on weekends on the Pain Service, as the service is covered during those times by the attending on service.
• In the PICU, the anesthesiology fellows do not take in-house night call. Shifts will be 6:30 a.m. - 6 p.m. with at least two weekends off per month.
• On the Cardiac anesthesiology rotation, hours can vary considerably depending on the caseload and the number of trainees rotating on the service. Fellows are given the next day off after a late call.
• Index Call – a separate call for fellows (call from home) to equitably share the fellow level cases after hours. These include emergent neonatal cases (life or limb) and solid organ transplants (renal transplants under 20 kg and all liver transplants). Fellows can be 2nd call and index call simultaneously.