Fellowship Training Program:
Fellowship in Pediatric Anesthesiology
at Seattle Children's Hospital

Description

Seattle Children's is a 250-bed pediatric facility for the University of Washington School of Medicine in Seattle, Washington. Seattle Children's provides primary, secondary, and tertiary pediatric care for an extended referral area encompassing Washington, Alaska, Montana, and Idaho. Robust specialty pediatric cardiac and pain management programs, and a well-rounded clinical base make this an attractive opportunity for fellows.

The clinical services provided by the Department of Anesthesiology and Pain Medicine at Seattle Children's include the provision of inpatient and ambulatory anesthesia for infants and children in the general operating rooms and in other satellite locations such as radiology and the cardiac catheterization laboratory. Approximately 17,000 anesthetics are administered each year to children of all ages, surgical conditions and severity of illness. All surgical subspecialties are represented, including cardiac surgery, transplantation, and major craniofacial surgery. Additionally, we provide sedation and anesthesia for children undergoing diagnostic and interventional radiology procedures. The Department has over twenty-five board-certified anesthesiologists who have all received additional training in pediatric anesthesia.

Through its dedicated Pediatric Pain Management Team, the Department also provides a full range of diagnostic and therapeutic acute and chronic pain services, including postoperative pain management, outpatient pain clinic, and complementary/alternative medicine techniques. Seattle Children's serves as the primary site for pediatric anesthesia training for anesthesia residents from the both the University of Washington School of Medicine and the Virginia Mason Medical Center residency programs. Seattle Children's operating rooms see an excellent mix of routine and complex cases, and provide an efficient environment for trainees to hone their clinical skills. The size of the program (8 fellows/year) allows close interaction with faculty and a well-rounded case mix. Our program is known for providing a friendly and supportive atmosphere with a high degree of fellow satisfaction. Graduates of the program have chosen a range of career paths from academics to private practice.

The Fellowship Program, accredited by the ACQME since 1999, is designed to provide the trainee with the necessary skills and experience to safely deliver anesthesia to children from birth through adolescence with the full spectrum of childhood disease.

The Program has three distinct tracks available to trainees to meet their individual needs. For academically oriented trainees, a twenty-four month long program is available, with particular emphasis on training in the design, performance, and publication of creative investigative work in either the clinical or basic science arena. Individuals interested in clinical training only may select a fellowship of 12 months' duration. Finally, individuals uncertain about their career goals may select a 12-month clinical program initially, and opt to do a second, academically oriented year after beginning training.

Training

The fellowship is divided into 24 half-month rotations:

• General OR (13)
• Cardiac OR (10)
• Cardiac ICU (2)
• Pain management (2)
• Sedation (1)
• Teaching fellow (1)

General Operating Room

Ambulatory and inpatient anesthesia is provided for patients of all ages, severity of illness, and surgical subspecialty using all types of general and regional anesthetic techniques. The fellows are under the direct supervision of attending physicians within the Department, many of whom are also trained in pediatrics as well as anesthesiology. Increasing autonomy is given as more experience is obtained. Supervision of anesthesia trainees from residency programs at the University of Washington and Virginia Mason Medical Center occurs in the later stages of training. Night call on this rotation is from home.

Cardiac Anesthesia:

This rotation is designed to provide trainees with exposure to intraoperative management of children with all types of congenital heart disease. Emphasis is placed on the pathophysiology of the specific lesion(s) associated with the congenital heart disease, pharmacology of anesthetic drugs in the setting of congenital heart disease, preoperative evaluation, and operative management, which includes placement of invasive monitoring devices, cardiopulmonary bypass, transesophageal echocardiography, and inotropic support. Annually, this service provides anesthesia for over 250 open and closed heart procedures and for over 500 cardiac catheterizations in infants and children from the four-state referral region. Fellows are supervised by one of five cardiac-trained pediatric anesthesiologists. Weekly conferences conducted by the pediatric cardiologists, cardiac surgeons, and cardiac anesthesiologists supplement the operating room experiences. Night call for this rotation is from home.

Pain Service

Fellows on this rotation participate in both inpatient and outpatient evaluation and management of acute and chronic pain. These services include consultation, performance of diagnostic and therapeutic somatic and autonomic nervous system blocks, management of intravenous and regional analgesia for postoperative pain, and provision of sedation/analgesia for frequent and recurrent diagnostic and therapeutic procedures (bone marrow aspiration, lumbar puncture and radiation therapy). The pain management service sees over 700 new patient consults per year. Fellows are supervised by one of five pediatric anesthesiologists with expertise in pediatric pain. Night call for this rotation is taken from home.

Sedation Service

Anesthesiology coverage is provided daily in the radiology suite for diagnostic procedures (primarily MRI and CT scans). This is a very streamlined service which will provide the fellows with good experience in understanding delivery systems and hospital sedation policies. Fellows participate in general OR night call during this rotation.

Teaching Fellow

During this half-month rotation, fellows will supervise anesthesia residents with faculty oversight. The rotation is designed to help fellows develop skills in clinical teaching and supervision, and to move toward having more autonomy.

Cardiovascular Intensive Care Unit

Fellows do a one month rotation in the Cardiovascular Intensive Care Unit, designed to provide trainees with experience in caring for critically ill patients and to further their understanding of the pathophysiology of congenital heart disease working with dedicated Pediatric Cardiac Intensive Care physicians. Fellows on this service conduct morning rounds with the attending intensivist with input from the cardiac surgery and cardiology services, coordinate the daily care, and perform the necessary diagnostic and therapeutic procedures for this group of patients. Direct attending supervision is provided by a member of the division of cardiology or critical care attending staff.

Trauma/Burn Service Elective

This elective takes place at Harborview Medical Center (HMC) located in downtown Seattle. This is the regional burn and level one trauma center for Western Washington. This rotation is designed to expose the fellows to the intraoperative and postoperative management of infants and children who have experienced severe trauma or burns. Supervision is provided by the anesthesia attending staff at HMC. Night call for this rotation is from home.

The fellowship program has a comprehensive educational program, which includes weekly conferences addressing many facets of pediatric anesthesia. The core fellowship curriculum covers topics in general pediatric anesthesia, cardiac anesthesia, and pain management. Other departmental educational programs include journal club, quality improvement rounds, and case and research presentations at Seattle Children's, as well as joint Grand Rounds at the University of Washington.

All fellows are expected to gain expertise in academic and administrative aspects of pediatric anesthesia. As such, each fellow is expected to give 1-2 lectures in areas of personal interest in order to gain experience in lecture preparation and public speaking. Additionally, fellows prepare and lead monthly quality assurance departmental conferences under the supervision of the Departmental quality assurance faculty, and lead the Departmental journal clubs. One-year fellows are allowed approximately 30 nonclinical days, spread through the year, for preparation of academic projects.

The academic nature of the 2-year fellowship mandates research experience; therefore, fellows are expected to become involved in the research activities of the Department of Anesthesiology and Pain Medicine at Seattle Children's which include a broad range of both clinical and basic science research. The two-year fellowship curriculum is specifically designed to provide maximal non-clinical research time throughout the training period, although the first six months are primarily clinical in nature with increased research time in the remaining 18 months. Many members of the Department participate in collaborative research efforts with members of the Department of Anesthesiology or other departments at the University of Washington School of Medicine. Examples of current research activities include: developmental pharmacology of opioids, pediatric pain management, coagulation abnormalities and cardiopulmonary bypass. On occasion, selected individuals have elected to continue their research training for an additional year. Individuals selecting the one-year clinical fellowship have more limited opportunity for research activities, however many participate in ongoing projects within the department to gain experience in these.

The ACGME-approved Pediatric Anesthesia Fellowship Program at Seattle Children's has all of the necessary ingredients to provide an individual complete exposure to all aspects of a practice in pediatric anesthesia. Candidates for this program must have successfully completed an anesthesia residency and be board-eligible/certified in anesthesiology prior to beginning the program. Foreign Medical graduates must have ECFMG certification. Interested individuals are encouraged to apply as early as possible. We generally invite candidates for interview between April and September for the fellowship year to begin the following August.

Application Process

Application Form:

• Download the Pediatric Anesthesiology Fellowship Application here (pdf)

Important Deadlines:

Application Process and Questions

Inquiries and applications should be directed to:

Program Director

Michael Richards, BM, MRCP, FRCA