Letter from the Chief Resident

Dear Anesthesia Applicant:

Anesthesia training in the Department of Anesthesiology and Peri-Operative Medicine (APOM) at OHSU offers cutting-edge opportunities in general and sub-specialty OR training, pain medicine, pediatrics, critical care medicine, and research for fellows, residents, and medical students.

Students who rotate through our department are surprised by how much they can learn in one month. Dawn Dillman, MD, Director of Medical Student Education, has developed a specific medical student curriculum that uses a textbook, didactic lectures, intra-operative teaching, and hands-on anesthesia experience to introduce third and fourth year students to the exciting challenges and opportunities of anesthesia. Every year, there are students who choose to extend this introductory month into a career in anesthesiology and return to our department for their resident training.

Residency in APOM provides not only a solid foundation in the standard requisites of general and sub-specialty anesthesia (obstetrics, pediatrics, cardio-thoracic, ambulatory, pain medicine, pre-operative assessment, and PACU), but it also provides mentors, resources, and support to tailor one’s education for specific long-term career goals. Our particular strengths include:

- Regional Anesthesia (including ultrasound-guided peripheral nerve blocks): APOM has invested in the latest technology for ultrasound-guided block and line placement. We have a strong orthopedic anesthesia program and are one of the few centers in the country to have an established outpatient block service including home infusion pumps. This rotation is fast-paced and highly rewarding. Our graduates report a high level of comfort performing regional anesthesia and analgesia.

- Neurosurgical Anesthesia: From the chairman to established NIH-funded researchers to the director of neurocritical care, APOM is a stronghold of research and clinical expertise in neuroscience and neuroanesthesia. We have a very busy neurosurgical service offering many opportunities to do anesthetics for both routine and complex procedures, including awake craniotomies.

- Critical Care: The medical director of Critical Care at OHSU is Dr. Per Thorborg, who has been involved in the development of the national SCCM curriculum “RICU” specifically designed for residents learning how to manage critically ill and injured patients. Students meet Dr. Thorborg during the trauma ICU rotation. The 8C ICU team, led by Dr. Lars Hegnell, cares for critically ill post operative cardiothoracic and surgical subspecialty patients. The 7C Neurosciences ICU is led by Dr. Anish Bhardwaj, who also runs a neurological injury laboratory. In summary, the anesthesia department has a dominant influence in critical care for surgical patients at OHSU. Commensurate with this breadth and depth, there are training programs for a traditional critical care fellowship (a year after CA-3) as well as a unique program integrating critical care training into the anesthesia residency, a 48-month combined track. There are two 48-month track positions in addition to the regular contingent of matched resident spaces.

- Research: Our department ranks third in the nation in NIH funding for anesthesia departments and second in NIH funding of departments at OHSU. All residents have an introductory, dedicated research rotation as CA-1s. Opportunities are available for clinical and basic science research projects, and the department encourages persons interested in an academic career to consider the clinician-scientist track during the CA-3 year when up to six months can be devoted to research. In addition to the categorical anesthesia and critical care combined program positions, there is a 48-month track for a person who will divide his or her time between clinical training and in-depth research. Furthermore, our program provides funding for residents to attend research conferences at the state and national level. Current residents who are interested in scholarship have also collaborated with faculty on book chapters and other published articles.

- Cardiac Anesthesiology: The core of the resident training in cardiac anesthesiology comes from two month- long rotations: one at the VA and one at OHSU. Our cardiac program continues to expand, with our graduates comfortably exceeding required numbers of open-heart cases. Intraoperative teaching includes instruction in trans-esophageal echocardiography and a formal lecture series on TEE has been added to the resident curriculum. There is a busy congenital heart defect program at Doernbecher Children’s Hospital, which residents are exposed to in the third year.

- Subspecialty Training: In addition to programs for special certification in critical care and the research tracks, there are competitive, well developed fellowships in pediatrics and pain medicine. Fellowship training at OHSU is exceptional, and care has been taken to ensure that fellowship training does not detract from resident training.

- Pediatric Anesthesia: Doernbecher Children’s Hospital is attached to the south hospital by a sky bridge. All pediatric faculty are dedicated pediatric anesthesiologists. We have a pediatric congenital heart surgery program and a neonatal intensive care unit, which is a tertiary referral center.

- Pain Management: The pain management services have moved into a new facility in the Center for Health and Healing at the South Waterfront and offer comprehensive resources for management of chronic pain. These include the dedicated Comprehensive Pain Center  - complete with fluoroscopically equipped procedure room, pain psychologists, physical therapists, and an acute pain service, which responds to inpatient consults. Travel between the new Center for Health and Healing and the main hospital is facilitated by a short ride on the new Portland Aerial Tram. The new hospital wing commands breathtaking views of Mt. Hood and the Willamette River and has state-of-the-art operating rooms and patient care wards.

Other Unique Opportunities
Residents each year are selected to participate in week-long medical missions to third world countries to provide anesthesia, thanks to the Wendell Stevens Memorial Fund. In the past, missions have gone to Peru and Ecuador.

Personal Perspective
I am honored to be a member of this department. I came to this department after beginning my post-graduate training in surgery and critical care. I feel fortunate to have found a wonderful career and to be trained in a forward-thinking department. Additionally, my husband, dog and I love living in Portland with the rich cultural, culinary, and active outdoor environment it offers. 

Learning, healing, and discovery is the motto for OHSU, and the Department of Anesthesiology and Peri-Operative Medicine is at the forefront. Resident education is a high priority, demonstrated through the orientation month lecture series, our weekly oral board review with APOM Chair Dr. Jeffrey Kirsch, our ever evolving weekly didactic curriculum, journal club, and grand rounds with nationally-renowned speakers.

Faculty make education a high priority. Residents are excused from the OR to attend conferences (both didactic weekly lectures for each resident class separately as well as grand rounds for the whole department). Faculty regularly participate in journal club and provide feedback on every seminar as well as intra-operative teaching, which has been enhanced with the keywords series started last year.

We have beautiful, state-of-the art facilities, incredible case volume and diversity, and a department that prioritizes resident education. Perhaps one of the best things about our department, though, is the people. The faculty care about me and my fellow residents with respect to how we score on exams; but they also care about our individual goals, our family lives, and our personal happiness. They ask what can be improved in the program, not only with respect to education, but also with respect to fostering a nurturing and humane environment. Each resident has an advisor, who helps her or him with individualized goals. The educational and administrative staff members are always friendly and helpful. I feel strongly supported by the entire department in my goal of becoming the best anesthesiologist and the best person I can.

I encourage you to visit and see for yourself the many opportunities and the unique training environment offered by the Department of Anesthesiology and Peri-operative Medicine at OHSU. Thank you for your interest and good luck!

Miko Enomoto, M.D.
Chief Resident 2007-08