Anesthesiology & Pain Medicine >> Education >> Fellowship in Pediatric Pain Medicine

Fellowship Training Program:
Pediatric Cardiac Anesthesia Fellowship
at Seattle Children's Hospital, Anesthesiology and Pain Medicine,
University of Washington

Fellowship Goal

The Pediatric Cardiac Anesthesia Fellowship (PCAF) at Seattle Children’s Hospital (SCH) is a one-year non-ACGME accredited program for an Acting Instructor.  It is developed and structured to provide the clinical experience and associated didactics to allow program graduates to function at a consultant level in all aspects of pediatric cardiac anesthesia. This is a special clinical track of the University of Washington (UW) faculty-fellow program and has been developed for graduates of an American College of Graduate Medical Education (ACGME) accredited Pediatric Anesthesia Fellowship program to develop consultant level proficiency in cardiac anesthesia for neonates, infants and children.

Program Faculty

  • Latham, Gregory J., MD Director, Pediatric Cardiac Anesthesia Faculty Fellowship, SCH
    Regular Faculty
    photo of faculty member

    Gregory J. Latham, MD

    Director, Pediatric Cardiac Anesthesia Faculty Fellowship, Assistant Professor,
    Anesthesiology & Pain Medicine

    gregory.latham@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Professional Interests: Teaching, pediatric cardiac anesthesia.

  • Eisses, Michael J., MD Associate Professor, SCH
    Regular Faculty
    photo of faculty member

    Michael J. Eisses, MD

    Associate Professor, Anesthesiology & Pain Medicine

    michael.eisses@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Professional Interests: Anesthesia for congenital heart disease, hemostatic problems during pediatric surgery.

    Personal Interests: Mathematics and computer programming.

  • Geiduschek, Jeremy M., MD Acting Director, Pediatric Anesthesia, SCH
    Regular Faculty
    photo of faculty member

    Jeremy M. Geiduschek, MD

    Acting Director, Pediatric Anesthesia at SCH & Director, Pediatric Cardiovascular Anesthesiology,
    Clinical Professor, Anesthesiology & Pain Medicine;
    Acting Director, Department of Anesthesiology
    & Pain Medicine, Seattle Children's;
    Director, Cardiovascular Anesthesiology, SCH

    jeremy.geiduschek@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Professional Interests: Anesthesiology for children with congenital heart disease, cardiovascular anesthesiology (pediatric), anesthesiology for neurosurgery (pediatric).

  • Joffe, Denise C., MD Associate Professor, SCH
    Regular Faculty
    photo of faculty member

    Denise C. Joffe, MD

    Associate Professor,
    Anesthesiology & Pain Medicine

    denise.joffe@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Clinical Interests: Adult and pediatric congenital heart disease.

    Research Interests: Use of dexmetetomidine in patients with single ventricle physiology and patients post-heart transplant.

  • Richards, Michael J., BM, MRCP, FRCA Associate Professor, SCH
    Regular Faculty
    photo of faculty member

    Michael J. Richards, BM, MRCP, FRCA

    Associate Professor, Anesthesiology & Pain Medicine;
    Director, Pediatric Anesthesia Fellowship, SCH;
    Program Director, Anesthesia Residency, SCH

    michael.richards@seattlechildrens.org

    Primary Location: Seattle Children's Hospital

    Clinical Interests: Congenital cardiac anesthesia and pediatric anesthesia.

    Teaching Interests: Education, Director of the ACGME certified Pediatric Anesthesia Fellowship Program.

    Personal Interests: Family, friends and the great outdoors.

  • Ross, Faith, MD Pediatric Cardiology Faculty Fellow, SCH
    Faculty Fellow
    photo of faculty member

    Faith Ross, MD

    Pediatric Cardiology Faculty Fellow
    Anesthesiology & Pain Medicine

    faithross@uw.edu

    Primary Location: Seattle Children's Hospital

Annual Rotation Strategy:

The fellow’s clinical daytime activity will be divided as follows:

60% pediatric cardiac anesthesia fellow
40% general OR faculty

This division of duties between fellowship time and general OR attending time will be allocated in 1- to 2-week blocks. Fellowship rotations will include:

  1. Pediatric cardiac anesthesiology (including cases requiring cardiopulmonary bypass, diagnostic and interventional cardiology, anesthesia for non-cardiac surgery in patients with congenital heart disease)
  2. Pediatric cardiac perfusion
  3. Pediatric echocardiography and diagnostic imaging
  4. Pediatric cardiac intensive care
  5. Research

The general OR faculty time will be at sites of care managed by the Department of Anesthesiology at Seattle Children’s Hospital.  This will include the general operating rooms, gastroenterology suites, diagnostic and interventional radiology, hematology clinic, and possibly off campus sites including but not limited to the pediatric radiation oncology suite at University Hospital and the Proton Beam Center at Seattle Procure. Clinical assignments are at the discretion of the charge anesthesiologists, though requests are welcome and encouraged. Call is an obligation, commencing in month 3 of the faculty-fellowship. Call will be in the general pediatric anesthesiology service.

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Fellowship Objectives:

Patient Care

PCAF shall provide patient care that is compassionate, appropriate, and effective for the treatment of the child with heart disease. Patient care activities shall be carried out under faculty supervision.

By the end of this advanced fellowship program, the trainee is expected to:

  1. Gather pertinent patient information and perform advanced synthesis of data and anesthetic plan for children who have congenital heart disease and require anesthesia. Information will include relevant preoperative history and physical, laboratory workup, diagnostic tests and other medical data. Anesthetic plan will consider preoperative, intraoperative and postoperative phases.
  2. Provide compassionate, appropriate, and effective advanced medical care for pediatric patients presenting for cardiac surgery, cardiac catheterization, electrophysiologic studies, echocardiography, and procedures including the placement of pacemakers and internal defibrillators as well as patients with congenital heart disease for non-cardiac surgery.
  3. Have advanced understanding and effectively communication to patients, families, and other care team members the risks and benefits of the anesthetic for the procedure/intervention. Be able to answer family and patient questions about their heart disease, anesthetic, and procedure with appropriate communication skills. 
  4. Respond appropriately to the patients’ and their families’ reactions and responses in a caring and respectful demeanor.
  5. Formulate an attending-level anesthetic management plan for children with congenital/acquired heart disease. PCAFs shall be expected to develop plans for anesthetic induction, hemodynamic monitoring, maintenance, and emergence, and postoperative care in the cardiac intensive care unit (CICU).
  6. Formulate an advanced management plan for initiation, maintenance, and separation from CPB; recognize when separation from CPB will likely not be successful; and articulate alternative plans with the attending surgeon.
  7. The PCAF shall be able to efficiently and completely prepare all equipment, supplies, and medications needed for the case when no other staff is available.
  8. Recognize perioperative problems, develop an advanced differential diagnosis, and synthesize multiple management options. Execute selected management plan in an advanced manner and be prepared with alternative plans.
  9. Have advanced technical skills and perform procedures in an appropriate, safe, and efficient manner. PCAF will be able to expertly perform placement of intra-arterial, central venous, and peripheral venous catheters. PCAF will demonstrate advanced understanding of congenital cardiac anatomy implications of central venous and arterial catheters.
  10. Have advanced skills in acquisition and interpretation of hemodynamic data and utilize this information in ongoing patient anesthetic management in children with congenital heart disease. 
  11. Transport pediatric cardiac patients in the immediate postoperative period from operating room to the CICU or recovery area with advanced care provided in hemodynamic monitoring, sedation, and pain control. 
  12. Provide advanced anesthetic and perioperative management of patients with mechanical assist devices, including extracorporeal membrane oxygenation (ECMO), left or right ventricular assist devices, and biventricular assist devices.
  13. Provide advanced anesthetic care for the patient with severe cardiomyopathy, including communication and execution of an advanced plan for mechanical support back-up and cardiac arrest management.
  14. Effectively communicate with the operating room staff, including perfusionists, surgeons, and nurses.
  15. Demonstrate advanced airway management skills including the management of difficult airways, use of double lumen endotracheal tubes, and bronchial blockers. PCAFs are expected to become expert in the management of one-lung ventilation particularly in reference to hypoxia, hypoxic pulmonary vasoconstriction, and the use of selective pulmonary vasodilators.
  16. Demonstrate advanced skills in development and execution of postoperative pain management, using regional techniques when appropriate and in context of congenital heart disease.

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Medical Knowledge

The PCAF shall demonstrate medical knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care.

By the end of this advanced specialty training program, the trainee is expected to:

  • Have advanced understanding of embryological development, morphology, and nomenclature of the cardiothoracic structures.
  • Demonstrate advanced understanding of the pathophysiology, pharmacology, and clinical management of pediatric patients with cardiac disease, including congenital heart disease, cardiomyopathy, heart failure, cardiac tamponade, ischemic heart disease, acquired and congenital valvular heart disease, electrophysiologic disturbances, and infectious cardiac diseases.
  • Demonstrate advanced understanding of pathophysiology, pharmacology, and clinical management of patients with respiratory disease, including pleural, bronchopulmonary, infectious, and inflammatory diseases.
  • Provide advanced and sophisticated evaluation of cardiovascular diagnostic tests: electrocardiography, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiovascular imaging. Understand the mechanism of ultrasound and Doppler technology (qualitative and quantitative). 
  • Display basic skills related to TEE management including insertion of TEE probe, identification of basic structures, and evaluation of ventricular function and of pericardial effusion.
  • Identify contraindications, complications, and indications for the use of TTE in patients with and without congenital heart disease in the operating room.
  • Demonstrate advanced understanding of cardiac catheterization procedures, the anesthetic impact on hemodynamics, and be able to perform advanced diagnostic interpretations of catheterization data.
  • Demonstrate advanced understanding of pharmacokinetics and pharmacodynamics of medications prescribed for medical management of pediatric cardiac patients.
  • Demonstrate advanced understanding of the indications, application, and analysis of different modalities of perioperative monitoring of patients with congenital heart disease including non-invasive and invasive modalities (intra-arterial, central venous, pulmonary artery, mixed venous saturation, brain oximetry, and TEE).
  • Demonstrate advanced understanding of the effects of CPB on pharmacokinetics and pharmacodynamics; the cardiothoracic, respiratory, neurologic, metabolic, endocrine, hematologic, renal, and thermoregulatory effects of CPB; and the coagulation system before, during, and after CPB.
  • Demonstrate advanced understanding and sophisticated skills in use of the pharmacokinetics and pharmacodynamics of medications prescribed for management of hemodynamic instability: inotropes, chronotropes, vasoconstrictors, vasodilators, and anti-arrhythmics.
  • Understand and implement the current American Heart Association Pediatric Advanced Life Support (PALS) guidelines for resuscitation.
  • Demonstrate advanced understanding of the mechanism of circulatory assist devices: ECMO and the various ventricular assist devices used in children. Develop and execute advanced perioperative anesthetic plans for patients with circulatory assist devices.
  • Have advanced understanding of indications for and the process of pacemaker/automated implantable cardioverter defibrillator insertion and modes of action. Develop and execute advanced perioperative anesthetic plans for patients with pacemaker/automated implantable cardioverter defibrillator devices.
  • Have advanced understanding of the anesthetic implications and perioperative management of cardiac surgical procedures with and without CPB.
  • Demonstrate advanced understanding of the physiology and pathophysiology of myocardial and neurologic protection during CPB, including deep hypothermic circulatory arrest, retrograde cerebral perfusion, methods of cardioplegia, and advanced neuromonitoring with near infrared spectroscopy.
  • Exhibit advanced knowledge of the postanesthetic care in the CICU of the pediatric cardiothoracic patient.
  • Develop and execute advanced postoperative pain management strategies in the pediatric cardiothoracic surgical patient.
  • Demonstrate advanced understanding of perioperative ventilator management techniques.
  • Demonstrate advanced understanding of the principles of oxygen transport and utilization, especially in children with cardiac disease.
  • Understand the principles of research methodology and statistical analysis.
  • Explain legal and ethical issues that are relevant to the pediatric cardiothoracic patient.
  • Understand the process of clinical quality improvement.

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Interpersonal and Communication Skills

The PCAF shall demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.

By the end of this advanced specialty training program, the trainee is expected to:

  1. Demonstrate advanced skills in teamwork and communication with all teams involved in the care of the patient with congenital heart disease – preoperative staff, intraoperative nursing, Blood Bank & laboratory staff, perfusionists, critical care technicians, surgical and anesthesia care providers and the postoperative ICU team.
  2. Have advanced skills to communicate and describe the nature, risk, and benefits of the cardiovascular anesthetic options and alternatives in a manner that is understandable to the patient/family.
  3. Employ effective listening skills and answer questions appropriately in the process of obtaining informed consent.
  4. Deliver concise, organized case presentations to the faculty that include pre-anesthetic/pre-procedure concerns and management, evidencing the thought processes of a consultant in anesthesiology.

Professionalism

By the end of this advanced fellowship program, the trainee is expected to:

  • Continuously conduct the practice of medicine with integrity, honesty and accountability
  • Demonstrate a commitment to life-long learning and excellence in practice
  • Show consistent subjugation of self-interest to the good of the patient and the health care needs of society
  • Show a commitment to the ethical principles in providing care, obtaining informed consent and maintaining patient confidentiality
  • Interact with all health care professionals including CRNAs, nurses, other house staff, and attending physicians, reflecting interpersonal integrity and behavior fitting of a doctor.
  • Create an intellectual and patient oriented environment by actively consulting with the other health care providers to formulate patient care plans
  • Maintain a respectable and professional appearance at all times
  • Demonstrate advanced ability to express concern, care and be respectful to patients’ culture, age, gender and disability.
  • Comply with all policies regarding documentation in accordance with departmental and/or hospital policy.

Practice-based Learning

By the end of this advanced fellowship program, the trainee is expected to:

  • Work with faculty to recognize and correct the PCAF’s deficiencies in knowledge and expertise.
  • Participate in clinical research as a major activity of the PCAF, with a goal of presenting an abstract at a major national meeting.
  • Create and present a lecture for the Division of pediatric anesthesia weekly meeting at SCH, covering a topic or case relevant to pediatric cardiac anesthesia
  • Prepare a resident education lecture specific to a topic in pediatric cardiac anesthesia
  • Attend weekly cardiac didactic sessions with the pediatric anesthesia fellows, and create and present at least one didactic session to the pediatric anesthesia fellows.
  • Evaluate and apply evidence from scientific studies, and expert guidelines, and practice pathways to their patients’ medical conditions
  • Use information technology to obtain and record patient information, access institutional and national policies and guidelines, and participate in self-education
  • Evaluate their practice with respect to patient outcomes and compare to available literature.

Systems-based Practice

By the end of this advanced fellowship program, the trainee is expected to:

  • Effectively balance the need for operating room efficiency with a high quality of patient care in the setting of a teaching program.
  • Have advanced understanding of how the anesthetic plan impacts patient outcomes.
  • Understand the economic ramifications of the anesthetic plan.
  • Demonstrate advanced skills in cooperation and implementation of multidisciplinary teams in order to optimize patient care for the patient with congenital heart disease.

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Curriculum

Didactic

The PCAF will be expected to:

  1. Participate in required department faculty meetings
  2. Create and present one lecture or research results for the Division of pediatric anesthesia weekly meeting at SCH, covering a topic or case relevant to pediatric cardiac anesthesia
  3. Prepare a resident education lecture specific to a topic in pediatric cardiac anesthesia
  4. Attend weekly cardiac didactic sessions with the pediatric anesthesia fellows, and create and present at least one didactic session to the pediatric anesthesia fellows.
  5. Attend departmental weekly meetings and education sessions, and attend pediatric cardiac anesthesia division QI meetings.
  6. Participate in the faculty fellowship seminar program (quarterly evening seminars)

Clinical

The clinical rotations and durations during the PCAF are described above.
Upon request and upon approval from the PCAF director, pediatric anesthesia fellowship director, and division chief, alterations to the clinical schedule can be made to meet certain goals, such as additional clinical rotations in areas of specific clinical interest.

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Evaluation Strategy and Documentation

  1. Daily or weekly evaluations will be completed by the pediatric cardiac anesthesia attending to whom the fellow is assigned during clinical rotations.
  2. The fellowship director will review these evaluations with the fellow on a monthly basis.
  3. The fellowship director will perform a comprehensive performance review at 6 months and generate a written summary.
  4. The fellow will complete quarterly program and faculty evaluations. The fellowship director and division chief will review these.

Academic Productivity

Research

In preparation for a successful career that involves critical appraisal of the literature and constant assessment of methods to improve outcomes of children with heart disease, it is important to develop research acumen.

During the first fellowship year, the PCAF will:

  1. Identify a research project and a research mentor
  2. Will either:
    1. Conduct one research project during the first year of PCAF, with the goal of at least one abstract prepared and delivered at the departmental academic evening and, if accepted, at a national meeting (for example: SPA, CCAS, ASA). Submit abstract for publication in a reputable journal if possible. Or
    2. Initiate a larger, longer-term research project. This larger, longer-term project would have the expectation of demonstrated academic productivity, including abstract presentation locally and nationally, as well as publication in a reputable journal when the research is completed (i.e., no timeline requirement).

Teaching

The PCAF will be expected to:

  1. Create and present one lecture or research results for the Division of pediatric anesthesia weekly meeting at SCH, covering a topic or case relevant to pediatric cardiac anesthesia
  2. Prepare a resident education lecture specific to a topic in pediatric cardiac anesthesia
  3. Attend weekly cardiac didactic sessions with the pediatric anesthesia fellows, and create and present at least one didactic session to the pediatric anesthesia fellows.
  4. Attend departmental weekly meetings and education sessions, and attend pediatric cardiac anesthesia division QI meetings.

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Graduation Requirements

  1. Demonstration of fulfilment of the goals and objectives as outlined above, including demonstration of satisfactory clinical competence as described in this document.
  2. Satisfactory completion of all areas of mandatory program requirements, as described above.
  3. Completion of satisfactory evaluations throughout the clinical year.

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
  • 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)

The next deadline for applications to the faculty fellowship program is December 1, 2017 for positions beginning in the fall of 2018. Preference will be given to applicants completing their application before this date, and to applicants for two-year positions.

Inquiries and applications should be directed to:

Faculty Fellowship Program Coordinator
Department of Anesthesiology & Pain Medicine
University of Washington, Box 356540
1959 NE Pacific Street
Seattle, WA 98195-6540

e-mail: anesfell@u.washington.edu

Fellowship Director

photo of fellowship director

Greg Latham, MD
Assistant Professor

Seattle Children's Hospital
4800 Sand Point Way NE/P.O. Box 5371
Mail Stop MB.11.500.3
Seattle, Washington 98105
Phone: (206) 987-2052
Fax: (206) 987-3935
Email: gregory.latham@seattlechildrens.org

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