Department of Anesthesiology

Pediatric Anesthesiology Rotations and Call

Master
Content

The Baylor College of Medicine/Texas Children's Hospital Pediatric Anesthesiology Fellowship is a one-year program approved by the Accreditation Council for Graduate Medical Education.

The Anesthesiology Department at Texas Children's performs more than 50,000 anesthetics a year. These include nearly 1,000 cardiac surgery procedures, approximately 40 liver transplants, and the full range of neonatal and pediatric surgical procedures on healthy children and those with complex medical conditions. We are also actively involved in the delivery of anesthesia to gravid patients who present for fetal interventions.

Our practice is unique in that we work with both academic and community surgeons, which prepares our fellows for both academic and private practice careers. All faculty members are certified by the American Board of Anesthesiology and are fellowship-trained.

Clinical Rotations

Rotation

Length

Core General Pediatric Anesthesiology

Six months

Cardiac Anesthesiology

Two months

General - Education/Supervision

One month

General - Non-Operating Room Anesthesia

Two weeks

General - Airway Rotation

One month

Pain Service

Six weeks

Regional Anesthesia

Six weeks

Critical Care – Surgical ICU

One month

Elective

One month

Meeting/Conference

Five days

Vacation

Fifteen weekdays

During the six months fellows spend in the main operating room, the fellow is exposed to various cases, from healthy children undergoing routine procedures to the most challenging cases.  The fellows have "first dibs" at the most challenging cases on the schedule each day.

One month toward the end of the year is devoted to the fellow's development as a clinical educator, with mentored teaching of medical students, pediatric residents, and others. During this same month (on different days), the fellows are allowed to run the OR schedule with faculty back-up as a way of exposing them to the interpersonal and systems issues related to "making the schedule work."

The fellow also has the opportunity to spend two weeks in non-OR locations, including diagnostic imaging, interventional radiology, GI procedures, and neuroradiology. This opportunity allows the fellow to understand the special techniques needed and the pitfalls involved in working in an off-site location.

One month is designated as an Airway Rotation, during which time the fellow is assigned to the best airway cases daily. Specifically, cleft lip/palates, infant direct laryngoscopies and bronchoscopies, and dental cases. The airway faculty have agreed to supervise non-traditional techniques if specific airway cases not available on certain days.

The fellow works in the Cardiac ORs and the cardiac catheterization lab for two months. Most fellows do approximately fifteen cardiopulmonary bypass cases per month.

The Pain Service/Regional Anesthesia rotation has three priorities, in this order:

  • Management of acute perioperative pain
  • Performance of ultrasound-guided peripheral nerve blocks and neuraxial blocks
  • Exposure to chronic pain patients

The fellow has the responsibility for managing patient-controlled analgesia and epidural catheters and evaluating consults requested by medical services. The fellow sees chronic patients in the clinic with the attending physician.

During the one month rotation in the Pediatric Intensive Care Unit, the fellow is a member of the Surgical ICU team, with direct patient care responsibility, and writes notes/makes management decisions on the patients. Also, the PICU faculty expects anesthesia-related didactic/bedside teaching of the team by the anesthesiology fellow and assistance with airway issues and line placement (central and arterial) on PICU patients.

The fellow may choose to do a month at our community elective (West Campus TCH), CV OR, Pain, CVICU, or a unique elective - which must be approved by the program director.

Vacation – 15 weekdays

Meeting/Conference – 5 weekdays

Call Assignments

All call assignments meet compliance with the ACGME's 80-hour duty limits, the requirement for the rest periods between shifts, and the opportunity for days off during the month.

In the Main operating room rotations, fellows share the general call burden with anesthesiology residents, with the majority of fellow call being second call. First call, which is an in-house call, begins at noon and ends at 7 a.m. the following morning; the fellow has no clinical duties post-call. The second call trainee begins the shift with a "regular" OR day and stays into the evening until the OR comes down to one location. The fellow is usually relieved by 11 p.m. and allowed to go home and has the next day off. It is unusual for that person to be called back to the hospital once relieved, but he/she must be prepared to do so.

There is no call at night or on weekends on the Pain Service, as the service is covered during those times by the attending on service.

In the PICU, the anesthesiology fellows do not take in-house night call.  Shifts will be 6:30 a.m .- 6 p.m. with at least two weekends off per month.

On the cardiac anesthesiology rotation, hours can vary considerably depending on the caseload and the number of trainees rotating on the service. Fellows are given the next day off after a late call.

Index Call – a separate call for fellows (call from home) to equitably share the fellow level cases after hours.  These include emergent neonatal cases (life or limb) and solid organ transplants (renal transplants under 20 kg and all liver transplants).  Fellows can be second call and index call simultaneously.