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Fellowship, Pediatric Fellow Program
Dear Applicant,
Thank you for your interest in the Pediatric
Anesthesiology Fellowship program at the
Department of Anesthesiology and Perioperative
Medicine at Oregon Health and Science University
(OHSU) in Portland. We are the only academic
medical center and pediatric anesthesiology
fellowship program in the state of Oregon.
OHSU is a tertiary referral center for Oregon,
Southwest Washington, Idaho, Alaska, and
Northern California. Doernbecher Children’s
Hospital is the recently built pediatric
facility designed for family-centered care
on the main OHSU campus overlooking the
city. Also situated on the ‘hill’
we have University Hospital with the new
Peter Kohler Pavilion Patient Care building,
Casey Eye Institute, the Portland V.A. Hospital,
the Shriner’s Hospital, medical, nursing,
and dental schools, as well as numerous
research facilities.
An exciting new extension of OHSU is the
waterfront campus known as the ‘Center
for Health and Healing’ that has opened
in the chic new urban neighborhood known
as the South Waterfront district. In December
2006, a new aerial tram will connect the
Peter Kohler Pavilion with the Center for
Health and Healing, allowing patients, staff,
and visitors to commute between the hill
and the waterfront via a three minute ‘flight’.
The Department has a highly regarded residency
program and offers fellowships in critical
care and pain management in addition to
pediatric anesthesiology. Many graduates
of our training programs have gone on to
be recruited as members of our faculty,
while others are successfully providing
care in other academic or community practices.
The educational mission of our Department
is a priority, with protected time for educational
activities, and curricula that incorporate
training sessions at the OHSU Simulation
Center as well as innovative web-based daily
evaluation tools, portfolios, and 360 surveys
that are used to assess the ACGME competencies.
All our programs were awarded the coveted
five-year review cycle by ACGME at the last
site visit, which is a testament to our
emphasis on education.
The Department has an active research group
with extensive basic science laboratory
facilities where investigators are studying
the molecular and cellular pathophysiology
of ischemic cell injury in the brain, heart,
and kidney, as well as the field of gender
pathobiology as it relates to cellular recovery
after ischemic injury. Clinical research
is conducted in the areas of adult and pediatric
pain, and pediatric procedural sedation.
In addition, the Department is involved
in a number of industry-sponsored trials.
The success of the research group has catapulted
it to the No. 3 spot in the nation for N.I.H.
funds for academic departments of anesthesiology
in 2006.
The pediatric anesthesiology fellowship
program has two training posts a year. Our
fellows enjoy personal attention and instruction
from the fifteen attending pediatric anesthesiologists
both in clinical settings as well as during
the didactic teaching sessions. Protected
time is earmarked for weekly teaching sessions,
departmental grand rounds, multidisciplinary
conferences, PALS training, and ACGME Competency
Workshops run by Graduate Medical Education.
We encourage fellows to attend the SPA/ASA
conference in October, and a generous CME
allowance with five days of meeting time
is provided for this purpose.
The total number of cases each fellow provides
anesthesia care for during their year of
training at OHSU (>600) regularly exceeds
the 90% percentile (595) for all pediatric
anesthesiology fellowship programs in the
country, based on the case logs submitted
to the program directors association every
year. Similarly, the number of neonates
as well as other index cases tracked by
ACGME falls between the 70%-90% percentile
for all programs. We are able to achieve
this in our physician-only pediatric practice
by having a maximum of one fellow and two
residents in the general ORs at any given
time, allowing the second fellow to rotate
through Pain, Pediatric Sedation, Pediatric
and Neonatal Intensive Care, and Pediatric
Cardiothoracic Anesthesia. We also allow
trainees flexibility to tailor the fellowship
to their individual needs or interests by
choosing an elective month in a subspecialty
of interest. Towards the end of the year,
graduated teaching opportunities are provided,
where the fellow will take on the role of
attending to guide residents through appropriate
cases with faculty supervision.
Our program offers a comprehensive clinical
experience with a strong emphasis on education
in a collegial atmosphere. Faculty members
are committed to maximizing the educational
opportunities available for trainees, and
encourage fellows to balance the demands
of their training with their personal life
by experiencing the outstanding recreational
pursuits available in the beautiful Pacific
Northwest. We are confident that we offer
an excellent experience that previous graduates
from our program (some of whom are on our
faculty) can attest to. We welcome your
interest in our program, and hope you will
consider submitting your application.
Please do not hesitate to contact me directly
should you wish to discuss the program in
more detail.
Sincerely,
Kirk Lalwani, MD, FRCA
Program Director
Associate Professor of Anesthesiology and
Pediatrics
e-mail: lalwanik@ohsu.edu
Useful links
http://www.ohsu.edu/
http://www.ohsu.edu/anesth/
http://www.pedsanesthesia.org/
http://portland-oregon.com/
http://www.portland-monthly.com/
http://portland.citysearch.com/
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Program Information:
Accreditation:
ACGME-accredited fellowship program (No:0424022052)
approved to train two fellows a year.
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Length:
One year, starting in July or on a mutually
agreeable date.
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Caseload:
The pediatric division provided 5027
general anesthetics in the operating room
in addition to 3353 clinic-based sedations,
of which 2500 were ‘deep’
sedation or general anesthesia. Faculty
members provide approximately 40% of general
anesthetics with no resident or fellow
in attendance; as a result, there is no
competition for index cases amongst trainees. |
Goals:
1. Equip the fellow with the knowledge,
skills, and abilities to function independently
and competently as a Consultant Pediatric
Anesthesiologist.
2. Provide a broad clinical experience
that allows fellows to develop proficiency
in the care of neonates, infants, children,
and adolescents in all surgical subspecialties.
3. Foster a thorough understanding of
the anatomical, physiological, developmental
and behavioral characteristics of patients
in different age groups.
4. Teach fellows the technical skills
related to airway management and invasive
monitoring.
5. Expose fellows to intravenous sedation
techniques for a variety of office-based
settings and diagnostic radiology.
6. Provide experience in acute and chronic
pediatric pain management, including cognitive
behavioral therapy.
7. Provide experience in the management
of critically ill neonates, infants, children,
and adolescents.
8. Fellows should acquire certification
in Pediatric and Neonatal advanced life
support.
9. Encourage the fellow to develop as
an educator by providing opportunities
to teach principles of airway management
and pediatric anesthesia to residents
and students.
10. Teach the basic principles of clinical
research, the protection of human subjects,
and evidence-based medicine. |
Competencies:
The program has incorporated teaching and assessment of the ACGME Competencies,
now mandatory for all ACGME-accredited programs. |
Duty hours:
The program adheres strictly to all ACGME
requirements for duty hours. Duty hours
are tracked using the web-based Verinform
system, and average approximately 50-60
hours a week over a 4-week cycle. |
Rotations:
The program consists of thirteen four-week
blocks designed to expose the fellow to
all pediatric surgical subspecialties.
The fellow will spend two blocks on pediatric
cardiothoracic anesthesia that include
cardiac catheterization laboratory and
echocardiography.
The pain block includes acute pain rounds,
consultations, acupuncture clinic, outpatient
pain clinic, and coping clinic for cognitive
behavioral therapy and biofeedback with
Dr. Tonya Palermo, who is our pediatric
pain psychologist. We also have two experienced
pain nurses dedicated to pediatric pain
management.
Two blocks are dedicated to intensive
care, and the fellow can choose to spend
both blocks in the pediatric intensive
care unit that is also the post-cardiac
surgery unit, or split the time between
pediatric and neonatal intensive care
units.
One block on the Pediatric Sedation Service
enables fellows to gain confidence in
providing sedation or anesthesia for diagnostic
radiology or in a variety of office-based
settings using intravenous techniques
without the use of a traditional anesthesia
machine.
The remaining blocks cover clinical anesthesia
rotations that encompass neurosurgery,
general surgery, plastic surgery, maxillofacial
surgery, dental surgery, otorhinolaryngology,
ophthalmology, dermatology, and orthopedic
surgery. |
Curriculum:
| Monday: |
0620-0700 Chairman’s
Oral Board Teaching Session |
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0700-0800 Anesthesiology and Perioperative
Medicine Grand Rounds |
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1500-1700 Pediatric Cardiac Multidisciplinary
Grand Rounds |
| Wednesday: |
0630-0730 Pediatric Anesthesiology
Seminar |
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0730-0815 Pediatric Anesthesiology
Journal Review |
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0900-1000 Departmental Research
Seminar |
| Thursday: |
0800-0900 Department of Pediatrics
Grand Rounds |
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(*During Cardiac
Rotations Only) |
Journal Club:
Pediatric Anesthesiology: Semi-annually,
hosted by fellow
Anesthesiology: Monthly dinner meeting
hosted by residents |
Duties:
The average workday typically lasts until
5pm. The fellow will be expected to participate
in teaching anesthesiology residents and
medical students the basics of airway
management and anesthesia in the operating
room.
In addition to clinical duties and teaching,
the fellow will be offered the opportunity
to initiate and complete a scholarly project
with the assistance of a faculty mentor.
This could take the form of a chapter,
case-report, review article, or a research
project. Additional academic time will
be provided as deemed necessary.
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Call:
All call is from home except for one
Friday / Sunday and one Saturday a month,
which are overnight in-house (average
total call frequency 1:4).
The fellow can expect to be free of all
duties for two weekends per 4-week rotation,
and work partial weekends for the other
two. During the Friday/Sunday weekend,
the fellow will be free of duties on Saturday
and Monday. When on-call from home, the
fellow is called back infrequently, and
only for designated fellowship level cases
that are deemed educationally appropriate.
A dedicated call room and computer are
provided for the fellows.
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Evaluation:
The fellow will be evaluated on a
daily basis using a web-based evaluation
tool. In addition, the fellow will have
formal evaluations every quarter, and
the third quarter evaluation will review
the trainee’s electronic portfolio
of educational material. The fellow will
participate in evaluation of the faculty,
rotations and program semi-annually.
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CME:
The fellow will be expected to gain certification
in Advanced Cardiac Life Support, Pediatric
Advanced Life Support and the Neonatal
Resuscitation Program during the year
of training. The fellow is allocated five
CME days and a CME allowance to attend
the annual ASA/SPA meeting (or other meeting
of choice), and to purchase books. |
Vacation/Sick:
A maximum of 20 days off (excluding 5
days of CME) is allowed; this translates
to 15 days of vacation, plus 5 days of
sick leave that may be taken as vacation
if not used as sick leave. Additional
absences have to be made up at the end
of the training period. |
Application:
Download an application form and details of
other documentation necessary to complete your application
(e.g.. 3 reference letters (including one from the program director), USMLE or NBE transcript, Dean's letter, etc.)
Application (Adobe PDF)
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Contact:
Pediatric Anesthesiology Fellowship
Coordinator
Anesthesiology and Perioperative Medicine,
UHS-2
Oregon Health and Science University
3181 SW Sam Jackson Park Road
Portland, OR 97239
Tel: 503-494-3361
Fax: 503-494-5945
Education Manager
Amy Juve: juvea@ohsu.edu
503-494-4205
Program Director
Kirk Lalwani, MD, FRCA
Associate Professor of Anesthesiology
and Perioperative Medicine, and Pediatrics
e-mail: (preferred) lalwanik@ohsu.edu
Tel: 503-494-5681
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