Registrar Office

Department of Anesthesiology (2014)

E201 Cardiothoracic Anesthesiology (Montefiore Medical Center)
The department of Anesthesiology is proud to offer an elective rotation available to senior medical students in cardiac anesthesia. The rotation will consist of a 4-week block and should be undertaken by those students who have a previous exposure to general anesthesiology. During this rotation the medical student will assist in patient care while obtaining a fundamental understanding of how a cardiac surgical case is managed by the anesthesiology team. They will be involved in the didactics during this month, which will be provided, by the attending anesthesiologist, the three cardiac anesthesia fellows, and the cardiac resident.

Goals:
1.Preoperative assessment: The medical student will be responsible for reviewing patient medical records and laboratory studies. They will form an anesthetic plan and discuss it with the team. The assessment will include physical examination with an understanding of angiographic and echocardiographic findings.

2. Intraoperative: Medical students will be expected to assist with patient monitoring. They will learn the necessary access for patients undergoing cardiac surgery. The medical student will understand the need for placement of central lines, arterial lines, and peripheral IV lines. In most cases, central venous access will be performed by the resident, but in certain cases; the medical student may perform part of this procedure as well. Medical students will obtain an understanding of all monitors used during cardiac surgery (EKG, arterial tracing, CVP tracing, PAP tracing). A brief introduction to transesophageal echocardiography will take place in the operating room.

3. Postoperative: Medical students on this rotation will follow their patients during the hospitalization. This will provide them with an understanding of the complex follow-up that cardiac surgical patients endure. The postoperative checks will be discussed with another member of the cardiac team.

Didactic Goals:
1. Cardiopulmonary bypass
2. Ischemic heart disease
3. Valvular heart disease
4. Congestive heart failure (Ventricular assist devices, cardiac transplant)
5. Pacemakers
6. Management of coagulopathy
7. Monitors
8. Anticoagulation

Reading:
A copy of the chapter on cardiac anesthesia by Barash will be provided to each medical student during the rotation. This will be supplemented with other sources as deemed necessary.

Michael Rufino, MD
mrufino@montefiore.org
Contact: Ms. Silvia Santiago, ssantiago@montefiore.org or Ms. Debbie Lopez, deblopez@montefiore.org,
718-920-4383
All Modules
Maximum 4



E501 Sub-Residency in Clinical Anesthesiology (Montefiore Medical Center)
This 4 week rotation in anesthesiology will expose students to the anesthetic management and care of patients in the peri-operative period.  Students will experience anesthetic care for a large variety of cases, encompassing all surgical sub-specialties.  The overall goal of this elective is for students to acquire a basic understanding of the physiology, pharmacology, and clinical management involved in anesthesia care and peri-operative medicine.

At the end of this rotation, Students will be expected to:
-Demonstrate the ability to perform the fundamental components of the preoperative evaluation
-Demonstrate the core principles and techniques of airway management
-Demonstrate a basic understanding of the pharmacology agents used for anesthesia
-Demonstrate an understanding of  standard monitoring employed for patients undergoing general and regional anesthesia
-Be familiar with the basics of invasive monitoring
-Be acquainted with the modalities available to treat acute pain
-Have an appreciation of the anesthesiologist as a care provider/problem solver in the hospital and outpatient settings

Students will be expected to arrive daily (Monday-Friday) at 6:30 to help set up the operating room for anesthetic care.  Students will then participate in the preoperative evaluation, the intra-operative management, and the postoperative care of their patients.   The day will end in the mid afternoon when students will pick up their room assignments for the following day. Further detailed instructions will be sent to students prior to starting the elective.  Evaluation will be from attending anesthesiologists the students have worked with.

Required Text Book:
Understanding Anesthesiology A Learner’s Guide by Dr. Karen Raymer, MD, MSc, FRCP(C), Clinical Professor, Department of Anesthesia, Faculty of Health Sciences, McMaster University  (This is an electronic book that will be provided to students as well as an iPad mini preloaded with other educational materials.)

Michael Rufino, MD
mrufino@montefiore.org
Contact: Ms. Silvia Santiago, ssantiago@montefiore.org or Ms. Debbie Lopez, deblopez@montefiore.org,
718-920-4383
All Modules
Maximum 10
Location: First day: Meet at 8:30 AM at the anesthesiology office on the 4th floor in the Silver Zone at the Moses campus.  Students will rotate at the Moses campus with the possibility of going to the Weiler or Wakefield campus depending on subspecialty interests and number of students.



E502 Basic Transesophageal Echocardiography (Montefiore Medical Center-Moses)
Echocardiography is rapidly evolving and important diagnostic and monitoring modality for physicians in multiple specialties including Internal Medicine, Cardiology, Anesthesiology and Cardiac surgery. We plan on implementing a curriculum to teach basic echo interpretation and its application to different patient population.  Along with learning this new technique, student will learn relevant cardiac anatomy and physiology. Common pharmacologic treatment based on the intra op TEE findings will also be discussed. The student learns image interpretation in the OR and practices acquiring images on the TEE simulator. In addition, the student will rotate in the Cardiology echo lab to learn interpretation of transthoracic echo (ITE).  This will help the student identify and understand the differences in transthoracic and transesophageal echo applications.  The goals of this elective rotation are to train medical students in interpreting a variety of cardiac exams ranging from normal cardiac exam to the very sick patient requiring cardiac transplant.  The knowledge can be valuable in any area of practice the student chooses to enter.

Learning objectives: At the end of this rotation, the student will have:  Understood the indications and contraindications of TEE.  Understood the advantages and disadvantages of TEE and ITE.  Understood basic physics that apply to TEE.  Learned to identify normal cardiac structures on TEE and ITE.  Learned to interpret pathological conditions including but not limited to-valve abnormalities, cardiac failure and cardiac structural abnormalities. Practiced image acquisition and interpretation on the TEE simulator.  The ability to identify patients who need further cardiac workup based on TEE and ITE.

Learning experience: The student will be paired with the resident/fellow on cardiac anesthesiology rotation.  During the month, the student will work in the cardiac rooms. The student will be taught cardiac anatomy and physiology to begin with. All patients routinely undergo intra operative TEE. The student will be taught TEE during the case by the attending and fellow. The rationale behind using different cardiac inotropes and pressers based on intra operative imaging will also be discussed.  He/she can then go to the other ongoing cardiac cases and view the Tee images in those cases.  Depending on the schedule of the day, the student may be exposed to one to about 4 cardiac exams per day. Every Friday, the student will be exposed to the TEE simulator which is a valuable tool for understanding image orientation and anatomic relation of cardiac structures.  During the third week of the rotation, the student will be paired with the cardiology fellow and will learn the differences between ITE and TEE.  Cardiac anatomy, physiology and clinical presentation of cardiac pathology will be discussed.  There will be no call obligation.

Method of student feedback and evaluation: Feedback is provided on a daily ongoing basis. At the end of the rotation, the student will be evaluated using the simulator.  He/She will be asked to identify normal cardiac structures on the simulator.  This will include: Identification of cardiac chambers. Identification of mitral, tricuspid, aortic and pulmonic valves. Identification of major vessels-SVC, IVC, aorta and pulmonary artery.  In addition to this, there will be a clinical scenario along with the relevant image which the student is required to diagnose.  This will require the application of the student’s knowledge in cardiac physiology and pharmacology.  This serves as the end of rotation examination.

On the first day student(s) report to:
Moses cardiac OR at 7:30am

Sujatha Ramachandran, MD
Jonathan Leff, MD
sramacha@montefiore.org
917-560-3468
All Modules
Maximum: 1



E600 Regional Anesthesia and Inpatient Pain Medicine (Montefiore Medical Center-North/Wakefield/Weiler)
The goal of the Regional Anesthesia and Inpatient Pain Medicine Rotation is to enhance the medical student’s overall knowledge, understanding and application of regional anesthesia and inpatient pain medicine principles.  Clinical experience in the ASU, OR, PACU, ICU and Floor will provide exposure to all aspects of regional anesthetic and inpatient pain medicine practice in a tertiary care medical center.  Students should expect significant hands on experience and anesthesia team/pain service member responsibility.

Learning objectives of elective:  At the conclusion of the elective, the student is expected to have the following skills:
-Understand pre-operative assessment principles to determine if a particular patient is a candidate for a regional anesthetic technique.
-Identify the best regional anesthetic technique for a particular surgery.
-Understand the components of patient informed consent discussing all of the risks, benefits, and alternatives of the procedures.
-Basics of performing peripheral nerve blocks/catheters and epidural catheters in regards to anatomy and landmarks.
-Gain an understanding of both nerve stimulator and ultrasound techniques for a variety of blocks along with an ability to read and identify relevant sonoanatomy.
-Understand principles of patient assessment and plan for inpatient pain management consults utilizing the multidisciplinary approach to inpatient pain medicine.
-Able to discuss basic options for treatment of pain and for the use opioids, NSAIDs, and other agents.

Learning experience:
Students who have completed this elective will have an understanding of how a Regional Anesthesia and Inpatient Pain Service functions at an academic medical center.  The rotation will be Monday to Friday from 7am to 4pm. The rotating student will also be included in resident didactics in the rotation. Interested student can also present a journal club.

Recommended texts are Textbook of Regional Anesthesia and Acute Pain management by Admir Hadzic. Students are also advised to use websites usra.ca and nysora.com to understand basics of ultrasound guided regional anesthesia.

Method of student feedback and evaluation:  Students will be evaluated on their level of participation in meeting the stated objectives.

On the first day student(s) report to: Please contact the Course Director, Dr. Vydyanathan prior to the start of the elective for where and when to report on the first day.  The rotation usually starts in the PACU of Montefiore North/Wakefield campus. Dr. Naum Shaparin, the Co-Course Director is also available for questions.

Amaresh Vydyanathan, MD
 avydyana@montefiore.org, 917-577-1811
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Max: 2



E601 Research in Regional Anesthesia & Pain Medicine (Montefiore Medical Center-Moses).
Projects in both basic science and clinical research are available for the motivated medical student interested in a career in Regional Anesthesia and Pain Medicine. Areas of research include (but are not limited to): usage of peripheral nerve blockade/catheters and epidural catheters in acute and chronic pain, opioid and non-opioid therapies for acute and chronic pain syndromes, neuraxial acute and chronic pain, joint acute and chronic pain, peripheral nerve pain, vulvodynia/perineal pain, and coccygodynia; radiofrequency ablation; and neuromodulation.  Interested students should make arrangements to meet with Dr. Shaparin and Dr. Vydyanathan to identify a research project.

Learning objectives of elective: At the conclusion of the elective, the student will have:
-Identified a project at the discretion of Dr. Shaparin and Dr. Vydyanathan
-Performed relevant literature search
-Developed a project plan under the direction of mentoring faculty
-Implemented the plan, which may or may not be completed by the conclusion of the elective. Projects that run beyond the elective may be continued with knowledge of the faculty mentor.

Learning experience:  Students who have completed this elective will have an understanding of how to conduct a research project in regional anesthesia and pain medicine through application. Interested students are expected to work towards submission of abstracts and manuscripts for publication under the direction of faculty mentor.  The typical workday will be Monday to Friday from 8 am until 4pm, however hours will vary based on the specific project the student is working on.

Method of student feedback and evaluation:  Students will be evaluated on their level of participation in conducting the research project and meeting the stated objectives. Emphasis will be placed upon the student’s ability to be instrumental in advancing an ongoing research project or developing an original research idea.

On the first day student(s) report to:  Please contact the Course Director, Dr. Vydyanathan prior to the start of the elective for where and when to report on the first day.  The rotation usually starts in the PACU of Montefiore North/Wakefield campus. Dr. Naum Shaparin, the Co-Course Director is also available for questions

Amaresh Vydyanathan, MD
 917-577-1811, avydyana@montefiore.org
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Max: 2



E602 Outpatient Chronic Pain Medicine (Montefiore Medical Center-Moses)
The goal of the Outpatient Pain Medicine Rotation is to enhance the medical student’s overall knowledge, understanding and application of outpatient chronic pain medicine principles.  Clinical experience in the Montefiore Pain Center involves participation in both office visits as well as interventional pain procedures and will provide exposure to all aspects of outpatient chronic pain medicine practice in a tertiary care medical center.  Students should expect significant hands on experience and chronic outpatient pain medicine service member responsibility.

Learning objectives:  At the conclusion of the elective, the student is expected to have the following skills:
-Understand the components of comprehensive consultative patient assessments to determine type of pain and pain differential diagnosis.
-Learn to form a treatment plan involving different modalities, from medications to physical therapy to interventions.
-Learn to identify the best interventional pain technique suited for pain type.
-Understand the components of patient informed consent discussing all of the risks, benefits, and alternatives of the procedures.
-Understand basics of the technical aspects of simple interventional pain procedures under ultrasound and fluoroscopic guidance.
-Understand a multidisciplinary approach to outpatient chronic pain medicine while working with fellowship training pain medicine physicians that all completed multidisciplinary fellowships. This involves knowledge as to how pain medicine physicians work with the other specialties, as pain physicians work extensively with all specialties of medicine and refer patients to each other.
-Understand the rationale for the different approaches for treatment of pain and discuss basic pharmacology of opioids, NSAIDs, and other agents (such as anti-convulsants, anti-depressants, and anti-spasmodics) in the treatment of chronic pain in outpatients.

Learning experience:  Students who have completed this elective will have an understanding of how a Chronic Outpatient Pain Medicine Service functions at an academic medical center.  The rotation will be Tuesday to Friday from about 7:30 am to about 4pm and Monday from 8:30am to about 4pm.  The recommend texts are "Essentials of Pain Medicine and Regional Anesthesia, 3rd ed. by Benzon" and "Atlas of Image Guide Interventions, 2nd ed. by Rathmell", both are available for the students to read in our library during the rotation.  Most teaching will be "at the bedside" however the medical student will participate in teaching alongside the resident’s didactic schedule which includes lectures as well as articles from the literature.  Students will be provided with the articles prior to the activity.  In addition, once a month there is an institution wide multidisciplinary spine/pain meeting that the student will attend with the pain service.

Method of student feedback and evaluation:  The feedback will be given by the course director with input from the rotating attendings.  Evaluation will be primarily on level of participation in meeting the stated objectives including quality of patient interactions, evaluations and H&Ps.

On the first day student(s) report to:  The MAP Building, 3400 Bainbridge Ave LL400, Bronx, NY 10467 at 7:30am (or 8:30am, if on a Monday).  Please contact the Course Director, Dr. Vydyanathan prior to the start of the elective for where and when to report on the first day.  The rotation usually starts in the PACU of Montefiore North/Wakefield campus. Dr. Naum Shaparin, the Co-Course Director is also available for questions

Amaresh Vydyanathan, MD
917-577-1811, avydyana@montefiore.org
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Max: 1




 

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