CARDIOTHORACIC ANESTHESIOLOGY FELLOWSHIP

• INTRODUCTION
• CLINICAL CARE OPPORTUNITIES
• TEACHING OPPORTUNITIES
• CLINICAL RESEARCH OPPORTUNITIES
• LAB RESEARCH

The fellowship program consists of one or more years of training in anesthesiology and life support of adult patients undergoing cardiac, vascular and thoracic surgery. The fellowship year is structured to meet the needs of the individual fellow who seeks specialized training in cardiothoracic anesthesiology. Learning opportunities in clinical practice, teaching, and research are offered and involve a combination of the following activities:

1. Clinical experience in anesthesia and intensive care of patients undergoing cardiac, vascular or thoracic surgery. The training is at a level more advanced than usually available in a standard anesthesia residency program and includes training in transesophageal echocardiography.

2. Clinical research in anesthesiology and intensive care. Each fellow is given the opportunity to participate in clinical investigation during this fellowship year.

3. Teaching experience including lecturing and tutoring in cardiac, vascular and thoracic anesthesiology, cardiopulmonary resuscitation, critical care medicine, cardiovascular physiology and pharmacology.

4. Study and research in a basic science or clinical discipline closely related to cardiothoracic anesthesia

The goal of a fellow in this program is to become a specialist in the anesthetic management and life support of patients with cardiopulmonary disease. The fellow generally spends the major portion of his time and effort in anesthesia care and life support of adult patients during cardiac surgery. However, experiences are available in thoracic anesthesia, pediatric cardiac anesthesia, anesthesia for major vascular surgery and critical care medicine. Opportunities to gain teaching experience are provided, and each fellow is expected to complete at least one clinical investigation during his fellowship year.

Information about fellowship opportunities and other questions should be directed to:

Dr. Jack S. Shanewise, Director of Cardiothoracic Anesthesiology
Emory University Hospital
1364 Clifton Road NE
Atlanta, Georgia 30322-1104
Phone: (404) 778-3917
Fax: (404) 778-3940

Emory Healthcare includes 3 teaching hospitals which performed 2,458 cardiac surgical operations in 1995. In 1994, (the latest year for which comparative data are available) Emory Healthcare was the fourth busiest heart surgery center in the USA. In addition to Emory University and Crawford Long Hospitals, cardiac surgery is performed at Grady Memorial Hospital and Veterans Administration Medical Center, which brought the total numbers of heart operations to 2,663 in the calendar year 1995.

• Emory University Hospital is a 600 bed tertiary referral hospital in which more than 1,100 cardiac and 400 thoracic surgical procedures are performed each year in adult patients. The cardiothoracic anesthesiology fellow functions in both learning and teaching capabilities during cardiac surgical procedures. Early in the fellowship year, a fellow administers anesthesia to patients in relatively good physical condition who are undergoing more or less routine cardiac operations. Subsequently the fellow is assigned more complex and challenging cases. Later in the year, a fellow is given increasing responsibility for supervising residents providing anesthesia for cardiac and thoracic operations. Our goal is to increase the fellow's knowledge and experience to the point where he/she can competently assume full responsibility for patient management and be both effective and comfortable in the role of an independent practitioner.

  Our program includes all facets of anesthesia care for surgical patients with coronary, valvular, and congenital heart disease, heart and lung transplantation, lung disease and thoracoabdominal aortic aneurysms. Experience is gained in medical and surgical treatment of dysrrhymias, management of acute and chronic heart failure, clinical pharmacology and physiology, uses of cardiac assist devices, fluid and electrolyte balance, hyperalimentation, and all aspects of immediate postoperative care. The most sophisticated invasive and noninvasive monitoring techniques (e.g. transesophageal and epicardial echocardiography) are used in most patients. Opportunities to learn the technical procedures and to operate the cardiopulmonary bypass machine are offered.

  Anesthesia care for thoracic surgical procedures emphasizes the use of one-lung ventilation and sophisticated monitoring techniques such as mass spectrometry. In addition to operations on the lung, a variety of diagnostic procedures including bronchoscopy, mediastinoscopy and mediastinotomy are performed.

  The post cardiac surgical intensive care units are included in the Division of Cardiothoracic Anesthesiology. Most fellows spend 6-8 weeks on the Critical Care Medicine Service. In addition to direct patient care, the fellow is given the responsibility of directing the critical care team of anesthesiology and surgery residents. Fellows demonstrating excellence are offered the opportunity to serve as assistant attending physician / junior faculty. It is possible to arrange extended periods in the surgical ICU's. The training program for a fellow in the intensive care units is at a higher level of expertise than that provided in the usual anesthesiology residency. At the conclusion of the rotation, a fellow should be able to diagnose and treat effectively all aspects of acute cardiac failure as well as multisystem organ failure. He will have become experienced in the use of cardiovascular drugs, ventilatory support, hyperalimentation, renal dialysis, intraaortic balloon counterpulsation, and other therapeutic modalities. Because many patients undergoing cardiac surgery have other systemic diseases, the fellow can often gain experience in the medical management of neurological, pulmonary, renal, endocrine, matabolic, infection and coagulation problems.

   

• Crawford Long Hospital is a 583 bed general community hospital in which more than 900 cardiac and 300 thoracic surgical operations occur annually. All of the attending cardiothoracic anesthesiology staff are regular members of the Emory University Medical School faculty and of the Cardiothoracic Anesthesiology Division of The Emory Clinic.

   

• Children's Health Care of Atlanta at Emory University (formerly ) Henrietta Egleston Hospital for Children is a 235 bed major pediatric referral and teaching hospital in which over 450 cardiac operations with cardiopulmonary bypass (CPB) and including the most complex congenital lesions and transplantation are performed each year. In addition, there are more than 200 cardiac operations which do not involve CPB. Fellows may elect three to six months on the cardiac anesthesiology service at this pediatric hospital.

   

• Veterans Administration Hospital is a 550 bed hospital in which 100-150 cardiac surgical operations are performed annually. The anesthesiology care of these patients is provided by members of the cardiothoracic anesthesiology division.

   

• Grady Memorial Hospital is a 1000+ bed county hospital in which approximately 100 cardiac surgical procedures are performed each year. The emphasis is on patients with thoracic and cardiac trauma as well as multisystem disease. The Anesthesiology program, under the direction of Peter S. Sebel, M.D., B.S. Ph.D, emphasizes both the intraoperative and postoperative management of patients with multisystem injuries. Special rotations to Grady Memorial Hospital can be arranged for those fellows who desire such experience.

Fellows are encouraged to participate in teaching students on the cardiothoracic anesthesiology service at Emory University. These students include: fourth year medical students taking a one-month elective in cardiothoracic anesthesiology or cardiac surgical intensive care, anesthesia residents (CA-2) during their four months on the cardiothoracic anesthesiology and intensive care services, and physician's assistants studying for the Master of Medical Science degree in Anesthesiology. Once competence in the anesthetic and life support management of cardiothoracic surgical patients has been demonstrated, the CT fellow is given the opportunity to supervise CA-2 residents beginning their rotations on the CT service.

The Division of Cardiothoracic Anesthesiology conducts weekly seminars, journal clubs and conferences related directly to cardiothoracic anesthesiology and intensive care. These meetings are under the direction of the cardiothoracic anesthesiology faculty, but the fellows participate in the organization and presentation of the programs. It is expected that each fellow will be responsible for at least one major seminar and one conference during the year. Twice monthly, there are combined conferences with the cardiothoracic surgical attending, fellow and resident staff. In addition, there are opportunities to make presentations at other departmental and institutional conferences and at local and national meetings. Our division participates routinely in weekly interdepartmental Emory Heart Center conferences with the adult and pediatric divisions of cardiology, cardiac surgery, cardiac radiology and cardiovascular pathology. Postgraduate programs are presented by the cardiothoracic anesthesiology faculty each year and the fellows attend and some make presentations to audiences of anesthesiologists, surgeons, cardiologists and perfusionists.

Extensive clinical research is performed in the operating rooms and intensive care units of Emory University Hospital in cooperation with the faculty and fellows of the cardiology and cardiac surgery divisions. Individual cardiothoracic anesthesiology faculty also conduct clinical investigations at the other hospitals affiliated with the Emory School of Medicine. Clinical problems related to cardiovascular pharmacology and physiology are of great interest. The cardiovascular effects of various anesthetic agents including opioids, tranquilizers, hypnotics, volatile anesthetics, and muscle relaxants have been studied. Cardiovascular drugs such as vasodilators, inotropes, antidysrhythmics, autonomic blocking drugs, calcium channel blockers, and a variety of experimental drugs are being evaluated. New monitoring techniques, both invasive (e.g. heart catheterization) and noninvasive (e.g. transesophageal echocardiography), are utilized in our busy operating suites. Studies dealing specifically with cardiopulmonary bypass involving brain protection, hemodilution, hypothermia, cardioplegia, anaphylaxis and coagulation problems have been performed. The development and execution of specific research protocols by the fellows is encouraged as is their participation in ongoing clinical and laboratory investigations.

Extensive research training is also available in the surgical intensive care units. Research in these units has included studies of cardiovascular drugs, the assessment of monitoring techniques such as the various modifications of central venous and pulmonary artery catheters, evaluation of the effects of hyperalimentation in the perioperative period, investigations into changes in the immune system after cardiac surgery, studies of different modes of ventilation, development of infusion schemes for continuous analgesia and sedation, and evaluation of various cardiac pacing modalities.

Extensive studies in the area of pharmacokinetics of anesthetic, analgesic, sedative, and cardiovascular drugs have been performed. Sophisticated assays for virtually all anesthetic, autonomic and cardiovascular drugs are available in our analytical laboratories.

Investigations of cardiovascular and pulmonary pharmacology and physiology are performed in the laboratories of the Departments of Anesthesiology, Surgery, and Medicine in the Woodruff Memorial Building adjacent to Emory University Hospital. Among the cardiothoracic anesthesia faculty, Drs. Hug and Michelsen study the pharmacokinetics and dynamics of opioid, anesthetic and cardiac drugs. Dr. Levy's work focuses on mechanisms of anaphylaxis, the actions of drugs on vascular smooth muscle, and modifiers of blood coagulation. In collaboration with cardiac surgeons, there are opportunities for studies of cardiopulmonary bypass in animals. The animal laboratory is equipped for invasive monitoring, echocardiographic and angiographic studies, and other techniques for evaluating cardiovascular function.

The above studies utilize a broad spectrum of research techniques including blood gas analysis, chromatography, spectrophotometry, radioisotopes, sophisticated animal models, and statistical data analysis. Research fellows are encouraged at the beginning to join an ongoing project as part of a team, and those who are interested in an academic career have the opportunity to pursue their own projects. The goal is to gain experience in experimental design, interpretation of data (including statistics), and presentation of results and conclusions in peer-viewed journals and at meetings of national scientific and medical organizations.

CRITICAL CARE FELLOWSHIP

Our ACGME certified fellowship program in Critical Care Medicine consists of one year of training in Critical Care units and complimentary specialty fields. The year is structured to meet the needs of individuals who have completed a core residency in anesthesiology and seek additional training and certification in Critical Care Medicine.

(A) The fellow will spend 8-9 months in a combination of 4 Critical Care Units. The proportion of time in each unit will depend on the previous experience and training goals of each individual. The objective of these rotations is to expose the fellow to a broad range of medical and surgical patients, as well as teaching from anesthesiologists, surgeons, and internists who are Critical Care practitioners.

1) Emory University Hospital Cardiothoracic/vascular ICU:

This 18 bed unit serves the surgical caseload at this tertiary referral hospital. The fellow will be supervised by Critical Care Anesthesiology faculty and will, in turn, supervise anesthesiology and surgery residents and students during their ICU rotations. We enjoy excellent day to day working relationships with the surgeons and internists who refer patients to the Critical Care Service.

2) Emory University Hospital Multidisciplinary ICU:

3) Grady Memorial Hospital Surgery/Trauma ICU:

This 20 bed unit serves the surgery and level 1 trauma services at this busy 750 bed county hospital. The fellow will be supervised by Critical Care Surgery faculty and will supervise residents and students in surgery and emergency medicine.

4) Grady Memorial Hospital Medical ICU:

This 20 bed unit serves the Medicine and Pulmonary Medicine services for the hospital. The fellow will be supervised by Critical Care Pulmonary Medicine faculty and will supervise residents and students in surgery, emergency medicine, and family medicine.

(B) The fellow will spend 1-2 months on one or both of a Neurology/Neurosurgery Critical Care Unit, and a Pediatric Critical Care Unit. The Pediatric rotation is at the Henrietta Egleston Childrens Hospital at Emory University; the Neurology/Neurosurgery rotation is at Emory University Hospital. Fellows with special interest in these fields may choose additional time either at Emory-affiliated units, or at comparable units at different institutions.

(C) The fellow will spend 2-4 months on electives related to the practice of Critical Care Medicine. The following electives have been designed, however additional customized electives are possible:

1) Renal medicine
2) Infectious Disease
3) Pulmonary Medicine/bronchoscopy
4) Blood bank/hematology
5) Medical engineering, equipment

The fellowship is designed to train candidates to become expert practitioners of Critical Care Medicine and as such does not have specific time set aside for research. Fellows will be encouraged to become involved in ongoing clinical research and will be supported in their efforts to complete projects in which they have been involved. The opportunity to spend additional time in research is available.

Fellows will be expected to participate in and present at regularly scheduled conferences both at the individual unit level and at the departmental level. Critical Care and additional subspecialty and interdisciplinary conferences are held at least weekly in each of the core units. In addition, as described above, a major function of the fellow is the direct supervision of less experienced individuals. The fellow will be expected to teach Critical Care principles and skills to house staff and students in all the core units.

James Bailey, M.D.
Director, Division of Critical Care Medicine
Department of Anesthesiology
Emory University Hosptial
1364 Clifton Road, NE
Atlanta, GA 30322
Phone: (404) 778-5874
FAX: (404) 778-5194
email: James_Bailey@emoryhealthcare.org

OBSTETRIC ANESTHESIOLOGY FELLOWSHIP

The fundamentals of any Obstetric Anesthesia fellowship should not depend on epidural/spinal administration, labor analgesia and surgical anesthesia management. Our fellows become comfortable with the daily management of an obstetric anesthesia service. While this may include personally providing labor analgesia in the difficult to manage parturient (morbid obesity, myocardial dysfunction, valvular stenosis or regurgitation, CNS tumor, sickle cell crisis, pneumonia, etc), our fellows more importantly oversee both, junior and senior residents. This includes didactic lecture series/morning rounds, epidural/spinal placement, and OB ICU management. Our hands on practice in the intensive care unit includes pre, intra and postpartum care, for parturients who often present with a host of complicated medical issues. The fellow is expected as well to participate in various ongoing research projects, and to initiate a project of his own. A day a week is provided for nonclinical time to achieve this goal, as well as to maximize the fellow's knowledge base. While the call schedule is not fellow dependent, some call duty is taken to allow the fellow to further work on his independent decision making process.

Specific Goals:

• To become comfortable with the daily clinical management of an obstetrical anesthesia service.

• To help lead the didactic lecture series/morning rounds with the junior and senior residents.
• To become comfortable with managing the OB ICU.
• To participate in the various ongoing research projects on the service.
• To initiate a clinical research project.

Raphael Y. Gershon, M.D.
Associate Professor
Emory University School of Medicine
Chief, Department of Anesthesiology
Grady Health System
80 Jesse Hill Drive
Atlanta, GA 30303

PEDIATRIC ANESTHESIOLOGY FELLOWSHIP

Introduction and Goals

The Pediatric Anesthesiology Fellowship at Emory is based at Childrens Healthcare of Atlanta at Egleston. Affiliated hospitals include Emory University Hospital and Childrens Healthcare of Atlanta at Scottish Rite. The goal of our program is to produce anesthesiology consultants with expertise in all areas of pediatric anesthesiology including:

• critical care
• Pain management
• advanced life support

The Fellowship program is designed to provide fellows the opportunity to develop skills in clinical care and judgement, teaching, administration and research. The fellowship is ACGME approved, one year in duration and all clinical rotations are at Egleston.

.

The one year pediatric fellowship includes the following clinical rotations- -- the program offers some flexibility in rotations for each fellows' specific interests.

1. Main operating rooms- 6-7 months- exposure to the full spectrum of cases including general surgery, orthopedics, neurosurgery, ent, craniofacial, ophthalmology, urology and also off site ct, mri, radiation therapy , and angiography. choa at egleston has an active transplant program including heart , liver, kidney and lung transplants.

2. Pain service- 1 month-fellows will gain experience in pediatric pain Management including epidural management, acute pain management in the recovery room and rounding on pain service patients.

3. Cardiac anesthesia-2-3 months- over 500 operations with cardiopulmonary bypass are performed at egleston each year. Fellows will gain experience with the most complex cardiac lesions ( tof, hypoplastic left heart ) as well as with the more common cardiac lesions. ( vsd, asd, pda)

4. Picu- 1 month-fellows will round with the picu team and participate in the care of critically ill infants and children, gaining experience in advanced life support in a wide variety of patients.

5. elective/ research- 1 month

Clinical Research and Didactics

Fellows are strongly encouraged to participate in ongoing research projects with the faculty or plan and execute their own project ideas. Several faculty members at Egleston have ongoing research projects and fellows can be matched with mentors to guide them in their research interests. Morning lectures ( 0645-0700) are presented by faculty, fellows and residents. Journal club and case conferences are also periodically presented and while on the cardiac service the fellows attend cardiac cath conference to discuss upcoming cardiac cases. monthly lectures are also given by faculty and special lecturers along with performance improvement reviews.

Application Process

Interested applicants should contact the Department of Anesthesiolgy at Egleston Childrens Hospital ( Childrens Hospital of Atlanta at Egleston) Applications can also be requested on the Emory Anesthesiology website. Applications should generally be received in the fall of the preceding year and interviews are extended as early as september.

Carolyn Bannister, M.D.
Director, Division of Pediatric Anesthesiology
Childrens Healthcare of Atlanta at Egleston Hospital
1450 Clifton Road, NE
Atlanta, GA 30322-1062
Phone: (404) 325-6671
FAX: (404) 325-6427
email: Carolyn_Bannister@emoryhealthcare.org