Academic Program
One of the strengths of our residency program is the strong didactic lectures. The department conducts a variety of didactic sessions to achieve the essential education upon which clinical experiences are built. The academic calendar is divided into Modules with specifics subspecialty teaching. Lecture topics are designed to teach important information for the coinciding module.
- CA-1 Six-week orientation course- conducted three times weekly for the first six weeks of residency, this orientation course provides new residents with lectures covering the basic fundamentals of Anesthesia.
- Grand Rounds- Weekly instruction on important Anesthesia related topics given by visiting professors or members of the Drexel Anesthesia facility
- Morbidity and Mortality- Examines cases and discusses management issues with an emphasis quality improvement and patient safety. Held monthly
- Case Conference- Monthly meeting where unusual cases with complex management are discussed. Topics chosen are rare diagnoses or cases with difficult judgment decisions.
- Journal Club- Monthly meeting where journal articles are discussed in an open forum format. Emphasis on important anesthesia related topics in the literature and statistical review.
- Text Review- Bi-weekly meeting covering pages from anesthesia text books. Multiple text books are given by the program to each resident and the topic discussed is chosen based on the current module.
- Keyword Review- Weekly topic focused discussion based on our program’s results from the yearly ABA in-training exam
- Q & A- Monthly meeting focused on board style question and answer. Emphasis on commonly tested topics, board preparation, and test taking strategy.
Anesthesia Simulator
 Working with the simulator allows mastery of basic techniques for junior residents as well as exposure to rarely experienced clinical scenarios for the advanced resident. CA-1 residents are first exposed to the simulator during the six-week orientation to begin working on basic airway skills. Periodically, throughout the next three years residents work on many scenarios including difficult airway management, obstetric emergency, ACLS protocol, Malignant Hyperthermia, and numerous others. Each resident is evaluated and provided with a printout based on performance.
Rotation Specifics
Pediatric Anesthesiology
 Anesthesia residents rotate for one, 2-month block at St. Christopher’s Hospital for Children during their 2nd year of anesthesia residency. Residents learn pediatric anesthesia through didactic lectures, case conferences, bedside teaching, morning report, and patient care. In addition the staff anesthesiologists and fellows provide basic lectures in pediatric anesthesia. Conferences are held Wednesday and Friday from 7-8:00 AM. The residents perform preoperative evaluations, which they review with a staff anesthesiologist. They administer the anesthetic under the supervision of a fellow and a staff anesthesiologist. Post-operative checks are also part of the education.
At the completion of the rotation, residents should understand basic anatomic, physiologic, pharmacologic and emotional differences between adults and children. They should be familiar with many of the common disease states unique to pediatrics. They should learn the skills necessary for preoperative evaluation and preparation, induction and maintenance of anesthesia, vascular access, endotracheal intubation, IV fluid therapy, and vasoactive support of the circulation of the pediatric patient. They should understand the indications for, and be able to interpret the data from non-invasive and invasive monitors. They should know when and how to use regional anesthetics in children and be familiar with various modes of postoperative analgesia.
Anesthesia residents in the CA-3 year may use elective time to rotate and receive additional subspecialty training in pediatric anesthesiology. CA-3s are assigned the more challenging cases. Some CA-3s spend time on the critical care service (CCS) in the pediatric ICU. CA-3s are also assigned to the Post Anesthesia Care Unit (PACU) to handle early postoperative problems and to the Pediatric Pain Service to gain familiarity with the diagnosis and treatment of acute and chronic pain.
Anesthesia fellows in their 4th year of anesthesia training rotate for 12 to 24 months within the pediatric OR, Pain and Critical Care services. In the OR, they have a supervisory role and learn to be capable of independent practice in a tertiary care children’s hospital setting. They lead a 30 minute Board Review on each Tuesday morning. Each is involved in clinical research project leading to publication.
Cardiothoracic Anesthesiology
 The Drexel University Cardiothoracic Anesthesiology Core Rotation is based primarily at Hahnemann University Hospital (HU). This site offers a wide variety of cardiac surgical cases ranging in surgical technique (on and off pump coronary revascularization) and level of acuity. Examples range from minimally invasive valvular repair (Heartport technology) to insertion of right and left ventricular assist devices. HU was one of five centers in the US to implant a self-contained total artificial heart for a patient in chronic heart failure.
The core CT rotation consists of two dedicated months during the CA-2 year caring for these patients with ischemic, valvular, and congenital heart disease. The application of cardiovascular physiology and pharmacology to hemodynamics, and the sequelae of cardiopulmonary bypass are the major didactic goals. Clinical goals include proficiency in insertion of central venous and arterial catheters, regional anesthesia for cardiac surgery, and an introduction to transesophageal echo (TEE).
Up to six months of additional elective training is available in the CA-3 year with one month dedicated to image acquisition and interpretation of TEE. The advanced training allows for opportunities for greater autonomy and advanced techniques applicable to the CT patient. The overall emphasis then becomes the integration and interpretation of various sources of physiologic monitoring into well articulated and executed therapeutic interventions.
Critical Care Medicine
The SICU is a multidisciplinary unit caring primarily for critically ill surgical patients. These patients include trauma, general surgery, neurosurgery, orthopedic surgery, vascular surgery, GYN and ENT patients. The mission of the SICU is excellence in patient care, education and research.
Daily rounds are made with an Anesthesiology or Surgical Critical Care attending where patient care and educational issues are discussed. Patient care responsibilities include all aspects of the critical care patient. Residents are expected to perform all invasive monitoring procedures (except intracranial line placement) including placement of central lines (IJ, subclavian, femoral), flow-directed PA catheter placement, A-lines (radial, DP, PT, femoral), tube thoracostomies, NG, foley,
etc. Residents assist attending surgeons in bedside operative procedures, which include tracheostomy, gastrostomy, laparotomies, fasciotomies, etc.
BI-weekly educational conferences are part of the didactic curriculum of the SICU. One of these conferences each month will be multidisciplinary and include the Medical Intensive Care Unit. The MICU Fellows and residents attend. Faculty for these educational sessions will be Intensivists from the MICU, SICU, NICU and Anesthesiology as well as leaders from traditional ICU support services (respiratory, pharmacy, nutrition etc.)
Neurosurgical Anesthesiology
Residents spend two months in Neurosurgical anesthesia in the CA-2 year and may elect additional months during the CA-3 year. The neurosurgical anesthesia rotation takes place at two sites. One month is spent at Hahnemann University Hospital and the second month spent at Abington Memorial Hospital. Special attention is on management of increased intracranial pressure, posture, air embolism, cerebral protection, cerebral vasospasm, ventilation, fluid management. A wide range of cases are seen and include craniotomy, intracranial vascular, spine surgery, intracranial tumor, and many more.
Obstetric Anesthesiology
Anesthesiology residents at Drexel University begin participating in the anesthetic care of obstetric patients during their first year of anesthesia residency. They spend a month long rotation caring for patients undergoing vaginal deliveries, Cesarean sections, and various other obstetric related procedures. More importantly, this first month rotation introduces the resident to maternal/fetal physiology and to its impact on anesthetic management. In addition, labor analgesia techniques and anesthetic techniques for Cesarean section are stressed. Preanesthetic evaluations and analgesic/anesthetic plans are developed for each patient. This rotation often provides residents with their first major hands-on experience in neuraxial conduction blocks such as spinal, epidural, and combined spinal-epidural techniques.
During the second year, residents have the opportunity to hone their skills introduced during their first OB rotation. They are also expected to explore the implications of various pregnancy-related and non-pregnancy related disease processes on the parturient, fetus and the management of delivery, especially as related to anesthetic management. Third year elective rotations are available for up to six months in order to continue the learning process as well as introduce the resident to opportunities in obstetric anesthesia research.
Faculty members with expertise in obstetric anesthesia closely supervise residents, discuss anesthetic plans and provide didactic instruction to all residents and medical students rotating on the labor floor.
Ambulatory Anesthesiology
 The Ambulatory Surgery Center at Hahnemann University Hospital is a busy multidisciplinary unit where residents rotate during their CA-1 and CA-3 years. Typically residents encounter a variety of general surgical, orthopedic, gynecologic, ophthalmologic, and urologic cases. In addition, residents are exposed to a large population of otolaryngology cases where alternative airway and ventilation techniques are often utilized. Finally, residents are exposed to the endoscopy suite to prepare them for the unique aspects of office based anesthesia practice. The cases encountered during this rotation require a broad range of anesthetic plans ranging from local with sedation and regional techniques, to general anesthesia. A comprehensive reading list, including recent articles in the literature, is also provided to facilitate discussion during the rotation.
During the CA-1 year, residents will be assigned more simple cases and serves as an introduction to the unique challenges that separates the ambulatory procedures to others seen in the general inpatient setting. The wide variety of cases and techniques performed in the Ambulatory Surgery Center offer ample opportunity for residents to master airway and regional anesthesia skills. Later, the more intensive rotation offered to CA-3 residents focuses on the more complex patients and airway procedures. Here residents develop clinical judgment as it pertains to candidates for ambulatory surgery and criteria for discharge. Residents can expect to be prepared for any situation they may encounter in the outpatient population after completing this rotation.
Pain Management
 The pain service is a two-month rotation during the CA-2 year with additional elective time available during the CA-3 year. Residents spend time primarily in the Pain Center at Hahnemann University Hospital. The center specializes in the assessment and development of long-term treatment plans for patients suffering from chronic pain associated with common disorders of the spine, cancer pain and neuropathic pain. Under the supervision of a pain faculty member, residents will be responsible for the medical management as well as determining the course of interventional therapy. Procedures done in the pain center include epidural injections, facet blocks, sacroiliac joint injections, trigger point injections, radio frequency ablative procedures, provocative discography, percutaneous spinal cord stimulator trials, intrathecal pump trials, and neurolytic injections in patients with cancer pain. Other responsibilities involved are inpatient consults and follow-up on post-operative pain patients. The residents’ experience at the Pain Center includes evaluation of new patients and evaluation of follow-up patients. Residents are expected to attend multidisciplinary chronic pain meetings. This experience is supplemented with weekly rounds by a neurology attending on the Complex Regional Pain Service.
Post Anesthesia Care Unit
Goals for this rotation include developing a level of competency for the evaluation and management of postoperative pain, ensuring that patients meet the requirements for discharge before being released, and facilitating patient discharge from the PACU when appropriate criteria have been met. Residents will also develop the capability to diagnose and manage anesthetic complications that are unique to the post-operative period.
Regional Rotation
 The practice of regional anesthesia has seen resurgence in recent years and is firmly established as an integral and important part in the practice of modern anesthesiology. Residents spend time on the regional service during the CA-2 and CA-3 clinical training years. During this time the focus is on identifying the appropriate patients, discussing the benefits/risks of regional techniques, and performance of effective blocks. By the end of the rotation, the resident should be proficient in techniques, indications, contraindications, clinical complications, and medications used in regional techniques.
Research
An elective, the research rotation engages residents in research activities at Drexel University, with a minimum 2 block continuous commitment and maximum of 6 blocks. Opportunities for basic and clinical research experience exist in the Department of Anesthesiology, and in other clinical and basic science departments in the College of Medicine and other Schools and Colleges of Drexel University. There are many opportunities for residents to either participate in an ongoing research project or develop their own project.
Example Rotation Schedule
CA-1- Typical schedule consists of general rotations in the following disciplines:
- Orientation period
- General OR
- Obstetric
- Ambulatory Anesthesia
- PACU
CA-2- During this year, most rotations are in sub-specialty areas of Anesthesiology including:
- Pediatric Anesthesiology
- Cardiothoracic Anesthesia
- Critical Care
- Pain Management
- Neurosurgical Anesthesia
- Regional Rotation
- Obstetric Anesthesia
CA-3- Each resident determines how the last year of training will be formulated. Any combination of rotations may be chosen given that the ABA/ACGME requirements have been met. Many choose to focus on Peds, Pain, CT, or OB in preperation for fellowship.
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