Features
Fellowship in Trauma Anesthesia
University of Washington
Description
The primary goal of the fellowship is to provide a "hands-on" clinical experience in all aspects of perioperative trauma care, including:
- prehospital assessment and transport
- preoperative emergency room evaluation and stabilization
- operative trauma anesthesia care
- postoperative critical care and pain management.
In the operating room the fellow will be exposed to all types of trauma anesthesia/trauma surgery, including injuries to the head, spine, extremities, chest, and abdomen, with additional emphasis on pediatric trauma, burns, regional anesthesia for trauma, and trauma analgesia. This experience is supplemented with a variety of scheduled conferences and clinical rounds at Harborview Medical Center (HMC), most of which are interdisciplinary and emphasize the importance of the trauma anesthesiologist's role as a member of interdisciplinary trauma team. In addition, opportunities are provided for fellow participation in a variety of ongoing clinical research projects and related academic activities. The specific fellow responsibilities and departmental expectations for the 12-month fellowship period are outlined below, and should be reviewed with the fellowship director at the beginning of the fellowship year to assure that all requirments are met in a reasonable time frame.
In addition to the introductory meeting with the fellowship director, additional meetings are required on a quarterly basis. The purpose of these meetings is to assure completeness of the fellow's experience (i.e., fill in missing gaps in clinical operating room experience), to plan non-clinical time activities, to discuss problem areas, and to career plan. Evaluation of the fellow will be through both formal (written) and informal (verbal) communication between the fellow and attending staff/fellowship director/hospital chief/department chairman on a regular basis.
Clinical Responsibilities and "Non-Clinical" Time
In general, the fellow's clinical time commitment to the Department of Anesthesiology is 75%, translating into a clinical responsibility of 170 days per year. Fellows will satisfy this clinical requirement in a one of three ways:
- providing operating room anesthesia under attending supervision (in a resident capacity)--in-house weeknight or weekend call may be included
- providing coverage (in a resident capacity) on the HMC Pain Relief Service (PRS)--out-of-house weeknight or weekend call may be included
- providing operating room anesthesia by supervising anesthesia residents or by independently providing anesthesia care (in a junior attending capacity)--in-house weeknight or weekend call may be included. The fellow's clinical responsibility will primarily be met in this capacity.
Clinical credit of one (1) day will be given for each day spent in the operating room as "resident" or "junior attending", or for each weekday spent on the PRS. In addition, clinical credit of up to one (1) day will be given for each on-call shift spent as a junior attending, according to the same schedule established for senior attending staff at HMC (the fellowship director will provide details of this semi-annually updated schedule).
When assigned to the operating room or PRS, the fellow will perform the usual duties expected for that service. Time off will not be given on those days for the purposes of attending interdisciplinary conferences or rounds, unless prior arrangements have been made by the fellow.
The fellow's remaining 25% time is "non-clinical" and can be utilized for a number of both required and optional education activities as described below. For individuals desiring a greater emphasis on research activities, non-clinical time can be increased to as much as 60% by mutual agreement made in advance.
Prehospital Trauma Care and Transport:
By virtue of the fact that HMC is the only Level I trauma center in the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region, a highly organized prehospital trauma care/transport system is utilized. Locally, the Seattle Fire Department's "Medic One" division is a field paramedic/transport service that is nationally recognized. Their training and supervision is a primary responsibility of Dr. Michael Copass (Director or the HMC Emergency Trauma Center) and other HMC physicians. Medic One paramedics provide primary trauma assessment in the field, as well as aggressive field trauma care including endotracheal intubation, peripheral and central venous line placement, and stabilization of spine and extremity fractures prior to and during transport. Observation of the crucial, life-saving role played by these individuals in the field and during transport is a priority of the fellowship experience. Therefore, the fellow will be strongly encouraged to ride with and observe Medic One paramedics on at least four (4) occasions during the year, completing a 12-hour shift on each occasion.
On the regional (WWAMI) scale, Airlift Northwest is the primary medical air-transport service serving HMC and four other Puget Sound hospitals. The service operates three fixed-wing (jet) and three rotary-wing aircraft out of Boeing Field in Seattle, with satellites in Puyallup, WA, Wenatchee, WA, and Juneau, AK. Although physicians are occasionally included on certain specialized transports, flights are typically staffed with two specially-trained, critical care flight nurses with the same skills/responsibilities as described for the paramedics. Scene transports and interhospital transfers together result in over 2500 rotary-wing and 700 fixed-wing transports annually. Air transport plays a key role in issues of both trauma triage and trauma outcome, and familiarity with the basic elements of air transport of trauma victims is a priority of the fellowship experience. Therefore, the fellow will be strongly encouraged to fly with and observe Airlift Northwest flight nurses on at least four (4) occasions during the year, completing a 12-hour shift on each occasion.
Emergency Room Assessment and Management:
The HMC Emergency Trauma Center is the only Level 1 (adult and pediatric) Trauma Center in the WWAMI region, and receives both adult and pediatric acute trauma and burn patients, as well as interhospital transfers via Airlift Northwest from other smaller hospitals in the region. HMC's position in providing such comprehensive trauma care results in a large patient census. In 1998 15,780 trauma patients (1258 pediatric) were evaluated, resulting in 4998 trauma admissions (590 pediatric) to HMC. The Center is under the direction of Dr. Michael Copass (Medicine) and Dr. Gregory Jurkovich (Surgery), and operates under a regimented and protocol-driven team approach to trauma care that relies heavily on the guidelines outlined in the American College of Surgeons' (ACS) Advanced Trauma Life Support (ATLS) course. It is here where the specific roles played by the general surgeons, subspecialty surgeons, nurses, paramedics, blood services personnel, radiologist, clinical laboratory, and anesthesiologist are learned and practiced to maximize efficient trauma management and patient outcome. Because the details of the trauma team approach in the emergency room are best learned with repetitive, intense exposure to acute trauma management, the fellow will be strongly encouraged to spend a ten-day block in the HMC Emergency Trauma Center (preferably in September or October). During this time, the fellow will function in the role of surgical housestaff, under direction of the "Trauma Doctor" (R2 surgery resident), evaluating and treating minor trauma, as well as participating in all major trauma resuscitation cases. During this ten-day period the fellow will be present for 24-hours-on/24-hours-off, like the rest of the Center's surgical housestaff, and will have no other clinical responsibilities.
Advanced Trauma Life Support (ATLS):
The structured, trauma team approach to the acute managment of major trauma is
learned in the ATLS course offered by the ACS to both practicing physicians and
housestaff at HMC several times annually. The two-day course provides didactic,
demonstration, and interactive teaching of the ATLS skills/principles, and
is taught by ACS-certified instructors in surgery, anesthesiology, and other
subspecialties. The fellow will be strongly encouraged to take this course at
HMC (as early in the year as possible) and pass the certification examination. The cost of the course will be borne by the Department.
Interdisciplinary Conferences and Didactics:
A variety of clinical rounds and clinical conferences are offered by both the Department and other trauma-related services at HMC on a regular basis. Attendance at these conferences is not mandatory, but rather it is recommended that the fellow attend each conference at least once, and then return to those that are most useful, depending on announced topic, fellow availability, and specific interests of the fellow. A partial conference list follows:
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In addition to these formal sessions, a recommended reading list will be distributed at the beginning of the year. The fellow is encouraged to discuss these readings with the appropriate subspecialty attendings throughout the year.
Research Opportunities and Other Scholarly Activities:
The limited amount of non-clinical time defined for the year dictates somewhat specific opportunities for research and other scholarly activities. Because of the limited non-clinical time available, the fellow should consider these opportunities carefully, and choose one (or two) for which they are highly motivated. These opportunities include:
- Participation in an ongoing clinical research project, under the direction of senior anesthesiology faculty at HMC. Specific opportunities can be discussed with the fellowship director, and currently include projects in neuroanesthesia, regional anesthesia/analgesia for trauma, cost analysis of tertiary trauma care procedures, analgesia for pediatric burn wound care procedures outside the operating room, and clinical practice guidelines for epidural analgesia after trauma. Participation may include enrolling patients, data collection, data analysis, manuscript preparation, and presentation of findings at regional/national meetings (e.g., the American Society of Anesthesiologists Annual Meeting, the International Trauma Anesthesia and Critical Care Society Annual Meeting, the Western Anesthesia Residents' Conference). Included in the fellowship benefit program is an academic allowance of $1500 that can be utilized for such meeting costs (as well as textbook purchase, etc.).
- Coauthorship of an invited review manuscript related to trauma
and/or anesthesia practice. This opportunity is dependent on:
- senior faculty being invited to write such a document, and
- making your intentions of wanting to participate in such an endeavor known. The fellowship director will help facilitate this opportunity.
- Assisting senior faculty in their review of manuscripts for peer-reviewed journals. This is probably one of the least glamorous, yet most educational efforts that the fellow can make in terms of learning to critically read and evaluate the literature, from hypothesis to experimental design to data interpretation.
Other Opportunities:
By virtue of being a member of the faculty of the University of Washington School of Medicine, an unlimited list of potential learning opportunities is made available to the fellow. The fellow is encouraged to use this year to their best career advantage by utilizing these opportunities offered by both the Department and the University. The fellowship director can direct you to the appropriate department and personnel to do this, but only if you speak up and make your intentions known.
Contact us
Inquiries and applications should be directed to:
Kati Koszegvari
Program Coordinator
Department of Anesthesiology
University of Washington
1959 NE Pacific Street, BB1415
Box 356540
Seattle, WA 98195-6540
E-mail: katibell@u.washington.edu
Phone: 206-221-6453
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Sam R. Sharar, MD |
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