One of the most frequently asked questions is: “What rotations do you do?” To help answer this question, our Chiefs have created this summary of the typical rotations you will do as an anesthesia resident at UT Southwestern. Certainly, the schedules change occasionally, and you can tailor your residency (specifically your CA3 year) to accommodate your needs and practice preferences. But just to give you an idea….
Intern Year Rotations
Methodist Internal Medicine
Our interns complete 4 months of medicine wards at Methodist Hospital. A foundation in managing common medical pathology is crucial in becoming a strong perioperative physician. As an intern on medicine wards, residents learn the work up and management of acute coronary syndrome, congestive heart failure, COPD, cirrhosis, acute CVA, renal failure, pneumonia and much more. They admit patients from the ER and coordinate their care for the duration of their hospital stay. They round with a medicine attending, an upper level resident, and will also have the opportunity to teach medical students.
Methodist Medicine Intensive Care Unit
Managing critically ill patients is a fundamental part of our specialty. Our interns spend one month rotating through the medicine ICU at Methodist Hospital. While rotating here, residents see common critical disease processes such as sepsis, cardiogenic shock, hemorrhagic stroke, diabetic ketoacidosis, liver and renal failure. They also gain experience doing procedures such as intubations, central and arterial lines, bronchoscopies, lumbar punctures, thoracentesis, and paracentesis. They learn to make decisions about mechanical ventilation and inotropic/vasopressor support. They round with excellent critical care faculty who provide guidance by using current evidence-based practice data. Each team consists of an anesthesia intern, two senior level residents and one internal medicine intern. This is one of the most high yield rotations we do as interns.
Baylor Coronary Care Unit
On this rotation, residents work closely with a team of cardiologists and internal medicine residents to care for patients with complicated cardiac physiology. Residents see patients both on the floor and in the CCU, as well as having the opportunity to spend time in the angio suite observing percutaneous interventions. They become proficient in the management of patients after acute MI and with chronic congestive heart failure due to any number of disease processes. This rotation is a change to become well-versed in cardiac physiology, understanding electrocardiography and choosing vasoactive agents. This rotation has in house call.
Children’s Medical Center Pulmonary Service
Our interns spend one month rotating on the pulmonary service at Children’s Medical Center (CMC). The pulmonary service takes care of some of the sickest patients at Children’s Medical Center in Dallas: cystic fibrosis, severe asthmatics, chromosomal and syndromic disorders, and children dependent on mechanical ventilation with tracheostomies. This unique group of patients often requires very specialized management. The pediatric pulmonologists working closely with our residents are some of the most respected in the country. Anesthesia interns work on a team with a senior pediatric resident and two other pediatric interns. They learn to manage the patient's hospital and home ventilators. They become familiar with all the different pharmacology available to treat pulmonary pathology. This rotation is especially helpful for those with an interest in pediatric anesthesiology, as early exposure is crucial.
Parkland Hospital Emergency Medicine
Rotating one month through Parkland Hospital’s Emergency Room is an exciting and fast paced rotation. Residents learn to rapidly assess, triage, and stabilize patients as they walk through the door of one of the busiest ER’s in the country. As a Level One Trauma Center, Parkland is a high-volume trauma and burn center. A normal shift has the potential for patients with injuries related to gunshot wounds, motor vehicle accidents, knife wounds, and drug overdoses. Our residents are often the first physician to diagnose a STEMI or an acute CVA. They may also be called upon to intubate an unstable patient, or perform an I&D of an abscess. This rotation trains residents to promptly make a decision on a critical patient, which is a skill that will serve well in the operating room.
Parkland Hospital Obstetrics and Gynecology
Not only is Parkland Hospital’s Obstetrics Department (OB) one of the busiest in the country, they also see some of the highest risk pregnancies and deliveries in Texas. As an intern, our residents rotate on the OB service for one month with another OB intern and two or three OB senior level residents. They have the opportunity to be present for deliveries and manage the post-partum course of these patients. Learning about the decision process and concerns of the OB/Gyn faculty offers unique insight into this distinct patient group that is tremendously helpful later on when rotating through OB Anesthesia. The comparatively light schedule of this rotation makes it a perfect chance to take Step 3 exam.
Parkland Hospital or Baylor Pulmonary Service
One month is spent rotating on the pulmonary consult service at Parkland Hospital or Baylor Hospital. Residents see and assess patients with a wide range of pulmonary pathology such as tuberculosis, pulmonary fibrosis, pulmonary malignancies, etc. They observe and participate in bronchoscopies in the pulmonary lab. Understanding pulmonary mechanics is an imperative part of our specialty, and our residents certainly master the basics on this rotation. They cover consults on the floor, the ICU and see patients in clinic once a week. The team usually consists of an anesthesia intern, a medicine resident, a pulmonary fellow and a pulmonary critical care attending. The schedule of this rotation is generally amenable to studying for and taking Step 3 exam.
Baylor Transplant Intensive Care Unit
Rotating at Baylor Hospital is a favorite rotation among our residents. The Liver and Kidney Transplant program at Baylor is one of the busiest in the country. Residents have the opportunity to accompany the surgeons on “harvest runs” which could be a drive across town or a plane flight to a neighboring state. They assess potential transplant recipients preoperatively, scrub and assist on the transplant operation, and directly manage the transplants in the post-op period. They work as part of a team that includes a surgical intern, a transplant surgery fellow and the transplant attending. As the anesthesia intern, our residents are responsible for covering the pre and post op patients in the Intensive Care Unit.
All of our interns will attend Vapor Camp in June of their intern year. This rotation is an invaluable “intro to Anesthesia” month. Interns are paired with upper level anesthesia residents. Residents learn how to perform thorough pre-ops, set up the operating room for cases and practice induction and emergence techniques and skills such as intubation, arterial and central line placement. This rotation was created five years ago to improve our interns’ anesthesia experience, and the difference in the abilities and knowledge base of our new CA-1s in July has been noticed by the faculty. This rotation gives residents the confidence they need to start CA-1 year in the OR.
Junior Level Rotations
Parkland Hospital General Anesthesia
As a CA-1, residents will spend 2-3 months rotating on general anesthesia at Parkland Hospital. This is where our CA-1s learn the bread and butter of anesthesia. They are involved in a wide variety of cases: general surgery, urology, ENT, gynecology, surgical oncology, ophthalmology, ortho, and plastics. Residents will take call with a senior level resident and an attending. Because Parkland is a busy trauma center, call nights are full of ex-laps for gunshot wounds, motor vehicle accidents, neck explorations for stab wounds, open orthopedic fractures, ruptured globes, and the endless supply of lap appys and I&Ds. Overnight call at Parkland is a great opportunity to learn from upper level anesthesia residents and develop some autonomy of your own.
Parkland Hospital Burn Anesthesia
Parkland Hospital is a national burn center (ever heard of the "Parkland Burn Formula"?) and, as a CA-1, residents spend one month providing anesthesia in the Burn OR. Burn patients are a unique patient subset and often present many anesthetic challenges: difficult airways requiring awake fiberoptic intubations, challenging IV access, difficulty with temperature and fluid regulation, and surgical procedures with great potential for blood loss. This rotation also allows for experience with pediatric burn patients, as they are often transferred to Parkland for burn care. This rotation has in house call, with an experience similar to that described above under Parkland General.
Parkland Hospital Obstetric Anesthesia
As a CA-1, residents spend two months on Labor and Delivery, learning to place spinals, epidurals, and combined spinal/epidurals for both scheduled and emergent C-sections. They also assist with epidurals for laboring patients. Many of the patients at Parkland are considered high-risk OB, meaning their pregnancy has been complicated by pathology such as pre-eclampsia, HELLP syndrome, placenta previa, diabetes, HIV/AIDS, etc. Residents see the full complement of OB emergencies, including STAT C-sections for fetal distress, placental abruption, amniotic fluid embolism, post-partum hemorrhage and shoulder dystocia. Because of our proximity to Children's Medical Center of Dallas, it is also common to be part of the delivery of infants with congenital anomalies (e.g. EXIT procedures). This rotation has in house call.
Dallas VA Medical Center General Anesthesia
As as CA-1, residents spend 1-2 months rotating on general anesthesia at the VA Hospital. Many of the patients at the VA have complex pathophysiology- coronary artery disease, COPD, chronic pain, PTSD, cirrhosis, etc. At the VA, residents get experience in orthopedic surgery cases (including regional blocks), ENT, general, urology, and plastics. Because the VA has their own full time faculty, residents are exposed to many different methods of delivering anesthesia. This rotation has home call.
University Hospital General Anesthesia
The University Hospital System (William P. Clements, Jr. Hospital and Zale Lipshy Hospital). These are busy ORs that handle cases ranging from general surgery, ENT, ortho, vascular, surgical oncology, gynecology/gyn-onc, plastics and liver and kidney transplants. Many of our CA-1s find themselves in cases such as pheochromocytomas, large abdominal tumor debulkings, radical neck dissections for laryngeal cancer, cosmetic procedures and kidney transplants. Call on this rotation is home call.
CMC Pediatric Intensive Care Unit
Our CA-1's spend one month rotating in the Children's Medical Center Pediatric ICU. Managing critically ill pediatric patients certainly presents a unique set of challenges that are distinct from the management of adults. Common presentations include septic shock, traumatic accidents, toxic ingestions, status asthmaticus, etc. CMC is also an ECMO center, and thus residents learn the intricate nuances of taking care of a child on ECMO. Gaining experience with pediatric intubations, arterial lines and central lines is especially valuable for residents with an interest in doing pediatric anesthesia. There is no call on this rotation.
Dallas VA Medical Center Intensive Care Unit
We have a unique opportunity to take care of some of our nation’s veterans as they recover in the peri- and postoperative period. Our interns spend a month in the VA ICU managing both SICU and CVICU patients after major abdominal, thoracic and cardiac surgeries. Our ICU is a closed anesthesia-run unit with surgical services following their patients on a daily basis in a consultant capacity. Call for this rotation is in house.
Parkland Hospital Pre-Operative Anesthesia Clinic
Parkland Hospital has a pre-operative anesthesia clinic where patients come prior to surgery to be assessed and optimized by an anesthesiologist. Two CA-1s each month rotate through this clinic. This is an excellent opportunity for residents to refine their pre-op assessment skills, learning to decide who is medically optimized for surgery and when surgery needs to be delayed for further work-up. The clinic-type schedule of this rotation makes for a comparatively light load. There is no call on this rotation.
Senior Level Rotations
Similar to the CA-1 rotation, residents may spend a month in the VA ICU managing both SICU and CVICU patients after major abdominal, thoracic and cardiac surgeries. Our ICU is a closed anesthesia-run unit with surgical services following their patients on a daily basis in a consultant capacity. This rotation has in-house call.
Clements University Hospital Cardiovascular Intensive Care Unit
Residents may spend a month in the Clements Hospital cardiovascular intensive care unit taking care of critically ill patients. These patients include post cardiac and thoracic surgery patients including, but not limited to: CABG, valve replacements, heart transplants, liver transplants, ECMO, and heart failure patients. Residents will gain experience in the post operative care including weaning of inotropic agents, weaning from the ventilator, and placement of lines and catheters. There is no call on this rotation.
Children’s Pediatric Anesthesia
Each resident will spend two consecutive months at Children’s Medical Center where he or she will gain exposure to pediatric anesthesia. Children of all ages with an array of different congenital and acquired illnesses travel to CMC for their care. In addition to their own large NICU, CMC also serves the surgical needs of the Parkland NICU next door. Residents spend time in both the main hospital operating rooms and the pediatric ambulatory surgical center. They gain experience with high case volume and rapid turn overs, complex physiology and the specialized skills required for airway management, peripheral IV access and regional anesthetic techniques in small children and infants. This rotation has in-house call.
Clements University Hospital Hybrid Pain
At Clements, two residents each month work closely with our pain and regional faculty learning to perform blocks both pre- and post-operatively. They also manage any in-hospital pain consults. Call on this service is from home.
Dallas VA Medical Center Chronic Pain
One resident each month rotates in the VA Chronic Pain Clinic. In addition to seeing patients and performing office-based interventions, residents spend one full day per week in the operating room learning a variety of chronic pain procedures such as intrathecal pain pump, ablations and injections. Call on this service is from home.
Dallas VA Medical Center Cardiac
Each month, one resident is assigned to the cardiac OR at the VA and will have the opportunity to provide anesthesia for many complex cardiac and thoracic cases. For each cardiac case, the resident will place all of the lines, intubate, and perform the majority of the medical management throughout the case using the knowledge that he or she has acquired on their prior cardiac rotations. In addition, the resident will work directly with the cardiac faculty to hone his or her basic TEE skills. This rotation has home call.
Texas Scottish Rite Hospital for Children Pediatric Anesthesia
Each month, one CA3 will have the opportunity to rotate at Texas Scottish Rite Hospital for Children (TSRH). TSRH is a children’s hospital that provides a multitude of services to children from all over the region. Most of the operations performed are by orthopedic and plastic surgeons to correct congenital musculoskeletal abnormalities, and this creates a rather unique patient population. The resident will perfect his or her pediatric anesthesia skills with special focus on fluid therapy, difficult airways, and pain management. This resident does not take call or work any weekends/holidays.
Baylor University Medical Center Transplant Medicine
Two CA3 residents rotate at Baylor University Medical Center (BUMC) each month. The main purpose of this rotation is to gain experience in liver transplant anesthesia, but our residents may partake in any of the anesthetics that occur at BUMC. This allows the resident to experience anesthesia in a more private setting in addition to learning how to manage the complex physiological challenges presented during a liver transplant. One resident will take call for liver transplants each day.
Dallas VA Medical Center Intensive Care Unit Chief
One CA3 per month will be assigned as the VA ICU chief. This presents an opportunity to showcase the strong training that our residents have received throughout their years. The chief has the responsibility of overseeing the care of the service, coordinating care with the team’s surgical colleagues, and teaching lower level residents as well as medical students. This rotation has in house call.
Clements University Hospital Advanced General
This rotation allows senior residents to spend time focusing on the anesthetic management of complicated surgeries. They spend time dedicated to the busy hepatobiliary, surgical oncology and colorectal services, taking care of patients undergoing exploratory laparotomies for tumor resections, liver resections, pheochromocytomas and Whipple's. No change in Whipple procedures. This rotation does not currently have call.
Zale Lipshy University Hospital Neuroanesthesia
At Zale, four residents each month work closely with our neuroanesthesia faculty learning to perform anesthesia for a variety of neurosurgical procedures including: craniotomy for neurovascular disease and tumors, complex spine surgery, endovascular neurosurgery, and functional neurosurgery. They also get exposure to anesthesia for ECT. Call on this service is from home.
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