Pediatric Anesthesiology Rotations and Call Assignments

Core General Pediatric Anesthesiology (26 weeks) - The fellow is exposed to various cases, from healthy children undergoing routine procedures to the most challenging cases. The fellows have "first dibs" at the most challenging cases on the schedule each day.

One block toward the end of the year is devoted to the fellow's development as a clinical educator, with mentored teaching of medical students, pediatric residents, and others. During this same block (on different days), the fellows are allowed to run the OR schedule with faculty back-up as a way of exposing them to the interpersonal and systems issues related to "making the schedule work."

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.

One block is designated as an Airway rotation, during which 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 (8 weeks) - 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 (10 weeks 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.

Pediatric Intensive Care Unit (4 weeks) - The fellow is a member of the ICU team, with direct patient care responsibility, writing notes and making management decisions on the patients. The fellow may also deliver anesthesia-related didactic/bedside teaching to the team and provide assistance with airway issues and line placement (central and arterial) on PICU patients.

Elective (4 weeks) - 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.

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. First call, which is an in-house call, begins at noon and ends at 7 a.m. the following morning; the trainee has no clinical duties post-call. The second call trainee begins the shift with a "regular" OR day and stays into the evening until the OR comes down to one location. The 2nd call trainee is usually relieved around 11 p.m. and allowed to go home -and has the next day off. It is unusual for that person to be called back to the hospital once relieved, but he/she must be prepared to do so.
• 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.