2011 Neuroanesthesia Fellows

Fellowship Training Program:
Fellowship in Neuroanesthesiology

The Neuroanesthesia Fellowship of University of Washington offers a one-year neuroanesthesia fellowship for trainees who have completed a three-year anesthesia residency training program in an accredited program in the U.S. or an equivalent program. This clinical fellowship is based at Harborview Medical Center. The general goal is to provide advanced training in all aspects of neuroanesthesia including monitoring techniques. The program is flexible and can accommodate candidates with different areas and levels of interest.

Description

This flexible neuroanesthesia training program primarily include:

• Clinical experience with a variety of neurosurgical procedures
• Clinical research and training.

Although primarily clinical, opportunities exist within the University of Washington to pursue training in laboratory research as part of the fellowship training. Some clinical duty functioning as an attending physician is required as part of the program.

Clinical Experience

All four teaching hospitals (UW Medical Center, Harborview, VA Puget Sound HCS, and Children's Hospital) have neurosurgical procedures although the majority of them are conducted in the first two hospitals.

UWMC

• epilepsy surgery
• tumor surgery
• transphenoidal pituitary tumor
• carotid endarterectomy
• limited opportunity for clinical research

Harborview

• trauma, 150 / year
• aneurysm, 200 / year
• AVM, 20-30 / year
• tumor, 40-50 / year
• sitting position, 10 / year
• ICP monitors are placed routinely in all postoperatively

Children's Hospital

• Experience in pediatric neuroanesthesia can be arranged with rotation through Children's Hospital

Drs. Michael Souter, Miriam Treggiari, and Steven Deem, direct and participate in the in the Neurocritical Care Service. The Neuroanesthesia Fellowship can be structured to incorporate neurocritical care training.

Research Interest

Clinical Research

	Lorri Lee, MD Associate Professor of Anesthesiology Perioperative ischemic optic neuropathy. Influence of position on intraocular pressure. Vascular and CO2 reactivity of ophthalmic artery. UW Medicine Bio
	Monica Vavilala, MD Professor of Anesthesiology Pediatric head injury. Cerebral autoregulation UW Medicine Bio Community of Science Bio
	Michael Souter, MB ChB, FRCA Professor of Anesthesiology Neurocritical Care UW Medicine Bio Community of Science Bio

Basic Science Research

Alan Artru, MD Professor and Head of Research Committee Major interest in CSF absorption and production, cerebrovascualar hemodynamics and influence of pharmacological agents, brain protection. UW Medicine Bio Community of Science Bio

Clinical Responsibility

Faculty fellows responsibilities will involve a 40 /60* division of time between clinical service work (40%) and fellowship activities (such as working with their faculty supervisors and mentors, teaching and research)(60%). * In certain cases this time may be flexible or negotiable depending on the educational needs and research interests of the individual fellow, and particularly if the fellow wishes to undertake a 2 year commitment.

Clinical Service Work (40%)

Faculty fellows will work in the capacity as a junior faculty (acting instructor) in the operating rooms at UWMC and HMC or the appropriate consult service (pain, ICU, OB etc). In this role the faculty fellow will be work as an attending anesthesiologist supervising CRNAs, supervising and teaching residents, and on occasions as a solo attending for their own cases. The junior faculty commitment will consist of 92 clinical days (920 credits) in the OR and three 15-hour in-house calls (495 credits) per month.

As a faculty clinician, faculty fellows will have membership and employment with University of Washington Physicians (UWP) and must obtain medical staff privileges at University of Washington affiliated hospitals. Information on the credentialing and orientation process is provided in the orientation policy. Faculty fellows will be employed as an Associate with incentive. Incentive pay will consist of evening or overnight/weekend OR call beyond the expected clinical day commitment and your three in-house calls. Incentive is distributed twice yearly on October 1 (for January-June credits) and April 1 (for July-December credits).

Fellowship Activities (60%)

Activities that faculty fellows undertake will vary depending on the type of fellowship being pursued. (See relevant goals and objectives for each fellowship). These activities may include working clinically in the subspecialty area related to the fellowship, being supervised and taught by the fellowship directors for the relevant subspecialty, undertaking research, teaching residents, developing curricula etc.

Faculty Supervision and Educational Resources

The Division of Neuroanesthesia consists of the following faculty members: Dr. Michael Souter (head), Dr. Monica Vavilala, Dr Miriam Treggiari, Dr. Deepak Sharma and Dr. Armagan Dagal. Immediate questions regarding the training program should be directed to Dr. Souter.

The department maintains an excellent library and all major textbooks on neuroanesthesia are available either from the department library or from Dr. Souter's own collection. A neuroanesthesia manual maintained and updated for use by residents is also available for use by the fellow.

Learning will occur from active participation in discussions with senior faculty and reading of recommended texts and publications. The fellow is expected to pursue some areas of interest in depth. Participation in other educational activities including presentation of cases at mortality/morbidity conferences and teaching of residents and medical students are required.

Medical conferences of educational value include the following:

• Twice-monthy neuroanesthesia rounds held at 0600 on second and fourth Thursday morning of each month. Current topics and journal articles are discussed.
• Departmental M and M conference on Wednesdays at UWMC at 0630.
• Neurosurgical Grand Round on Wednesdays at HMC at 0700. (Harborview R and T Building). Note the time conflict with the above anesthesiology conference.
• Monthly Neurosurgery M and M conference held on the second Saturday of every month at 0830 at HMC (This covers all four teaching hospitals)
• Neurosurgery radiology rounds held every Wednesday at 1630 at UWMC. (All patients in all four teaching hospitals are presented and discussed)

Fellows are encouraged to attend these conferences when they are not in direct conflict with clinical responsibilities.

Educational Objectives

1. Academic Objectives
   1. Basic Knowledge Acquisition
      1. Understanding of basic cerebral physiology (control of CBF, CBV, ICP, CPP, CO2 reactivity etc.)
      2. Understanding of influence of anesthetic agents and techniques on the normal control mechanisms.
      3. Understanding of the influence of disease pathology on normal cerebral physiology and pharmacology.
   2. Research Experience
      1. Understanding of basics of hypothesis formulation, literature review, experimental design, methodology, data acquisition, statistical analysis, interpretation of data, penmanship, peer-review process, and publication of results.
      2. Participation in clinical research in neuroanesthesia.
2. Practical Objectives
   1. Patient Management Skills
      1. Understanding of anesthetic management of acute head injury.
      2. Understanding of anesthetic management of cerebral vascular surgical procedures including aneurysms, arteriovenous malformations, carotid endarterectomy, extracranial-Intracranial bypass procedure.
      3. Understanding of anesthetic management of supratentorial tumors.
      4. Understanding of anesthetic management of posterior fossa lesions.
      5. Understanding of anesthetic management of the seated position.
   2. Technical Monitoring Skills
      1. Proficiency in cannulation of the jugular bulb.
      2. Proficiency in the use of transcranial Doppler ultrasonography
      3. Proficiency in the use of EEG, somatosensory and brainstem auditory evoked potentials for interested parties. The Department of Anesthesiology & Pain Medicine does not actively participate in the monitoring program, but arrangement can be made with Department of Rehabilitation Medicine for such experience.

Note: Actual experience and knowledge acquired during the fellowship is variable, and is dependent on the fellow's own learning objectives, area of interest, level of motivation, enthusiasm and efforts put into it.

Application Process

The application process for all the faculty fellowships requires that interested applicants send the following information:

• Current Curriculum Vitae
• Application for Faculty Fellowship
• Letter of intent/personal statement
• Three current reference letters, including one from the residency program director or current director. The third letter MUST be from a departmental faculty member.
• Copy of medical school diploma
• Copy of anesthesia degree (if applicable)
• Current medical license
• USMLE all three steps
• ECFMG documentation (if applicable)
• Documentation supporting citizenship status (if applicable)

Inquiries and applications should be directed to:

Fellowship Director

Dr. Deepak Sharma, MBBS, MD, DM Associate Professor of Anesthesiology & Pain Medicine Chief, Division of Neuroanesthesiology & Perioperative Neurosciences Program Director, Neuroanesthesiology Fellowship Neuroanesthesiology Education Director Adjunct Associate Professor, Department of Neurological Surgery Professional Interests: Transcranial Doppler (TCD) Ultrasonography, Cerebrovascular physiology, Traumatic Brain Injury, Education in Anesthesiology. Harborview Medical Center Box 359724 325 Ninth Avenue, Seattle, WA 98104 Phone: 206-744-7241 Fax: 206-744-8090 Email: dsharma@uw.edu UW Medicine Bio