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

Description

Seattle Children's Hospital is a 350-bed pediatric facility affiliated with the University of Washington School of Medicine in Seattle, Washington. Seattle Children's is the only medical center to provide primary, secondary, and tertiary pediatric care for an extended, five-state referral area encompassing Washington, Wyoming, Alaska, Montana, and Idaho. Robust specialty pediatric cardiac, regional, and pain management programs, a well-rounded foundational clinical experience, and location in a verdant and vibrant city 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 24,000 anesthetics are administered each year to children of all ages, surgical conditions and severity of illness. All surgical subspecialties are represented, including cardiac surgery, solid organ transplantation (heart, liver, kidney, small bowel), and major craniofacial surgery. Additionally, we provide sedation and anesthesia for children undergoing diagnostic and interventional radiology procedures. The Department has over thirty-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 ACGME 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.

Training

The fellowship is divided into 24 half-month rotations:

• Ambulatory (1)
• General OR (13)
• Cardiac OR (4)
• Pediatric ICU (1)
• Neonatal ICU (1)
• 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. One fellow per night is on home call to cover high acuity cases from transplant, cardiac, and general ORs.

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 approximately 500 heart procedures including 400 cardiopulmonary bypass cases and for over 900 cardiac catheterizations in infants and children from the four-state referral region. Fellows are supervised by one of six cardiac-trained pediatric anesthesiologists. Weekly conferences conducted by the pediatric cardiologists, cardiac surgeons, and cardiac anesthesiologists supplement the operating room experiences.

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.

Sedation Service

Anesthesiology coverage is provided daily in the radiology suite for diagnostic tests (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 will also gain experience in the radiation oncology suite at the University of Washington, Proton therapy center, and in-patient moderate procedural sedation service.

Teaching Fellow

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

Pediatric Intensive Care Unit

Fellows do a one-month rotation in the Pediatric Intensive Care Unit, designed to provide trainees with experience in caring for critically ill patients and to further their understanding of the pathophysiology of a wide range of disease processes working with dedicated Pediatric Intensive Care physicians. Fellows on this service conduct morning rounds with the attending intensivist with input from the subspecialty teams, 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 critical care attending staff.

Education and Academic Experience

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. There are two longitudinal lecture series on Global Health and Equity, Diversity, and Inclusion. 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 presentation. Additionally, fellows may lead presentations at monthly quality assurance departmental conferences under the supervision of the Departmental quality assurance faculty, and lead the Departmental journal clubs.

Subspecialty Pediatric Anesthesiology Training

Fellows who wish to continue with second-year subspecialty pediatric anesthesiology training have the opportunity to do so right here at Seattle Children’s Hospital. Second-year subspecialty training programs include...

Pediatric Cardiothoracic Anesthesiology

Pediatric Regional Anesthesiology

Pediatric/Adult Pain Medicine (ACGME accredited)

Pediatric Ambulatory Anesthesiology

Global Health

Quality Improvement

The above listed fellowships that are not ACGME accredited are a combined faculty-fellowship and trainees will be given titles of Acting Instructors and will be compensated accordingly. Hiring for the second-year fellowships usually occurs during the December of the first-year fellowship.

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. 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. selected individuals have elected to continue their research training for an additional year.

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

Please apply via ERAs: https://students-residents.aamc.org/training-residency-fellowship/applying-fellowships-eras/

Deadline for applications: May 31st

All of our positions are in the NRMP match: http://www.nrmp.org/fellow/index.html

Eligibility Requirements:

• Completion of an Anesthesiology residency program accredited by ACGME, ACGME-I, RCPSC, or CFPC, or an AOA-approved anesthesiology residency program. Candidates completing residency training outside the US or Canada require an eligibility exception review as defined by the ACGME Review Committee for Anesthesiology.
• Completion of USMLE Steps 1, 2, & 3 (or equivalent)
• International Medical Graduates (IMGs): ECFMG Certification
• Foreign Nationals: The Pediatric Anesthesiology fellowship accepts J-1 visas sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG). The program will consider H-1B sponsorship only for applicants currently in the US on an H-1B.

Application Process and Questions

Inquiries and applications should be directed to:

Mr. Casey Jones
Education/Fellowship Coordinator
Department of Anesthesiology & Pain Medicine
Seattle Children's Hospital
4800 Sand Point Way NE, MB.11.500
Seattle, WA 98105
email: casey.jones@seattlechildrens.org
phone: 206-987-3996
fax: 206-987-3935

Program Director

Vincent Hsieh, MD

Associate Program Director

Trevor Adams, MD