Registrar Office

Department of Anesthesiology (2016)

E201 Cardiothoracic Anesthesiology (Montefiore Medical Center)
**NOT OFFERED TO OSTEOPATHIC VISITING STUDENTS**
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
Modules: All
Maximum: 4


E501 Sub-Residency in Clinical Anesthesiology (Montefiore Medical Center)
**NOT OFFERED TO OSTEOPATHIC VISITING STUDENTS**
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 of 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
Modules: All
Maximum: 10



E502 Basic Transesophageal Echocardiography (Montefiore Medical Center-Moses)
**NOT OFFERED TO OSTEOPATHIC VISITING STUDENTS**
Echocardiography is a diagnostic modality that is being increasingly utilized by non-cardiologists such as emergency room and critical care physicians. In this rotation, students will be exposed to echocardiography in the perioperative period, primarily transesophageal echocardiography (TEE) in cardiac surgery. Working with our TEE board certified cardiac anesthesiologists, students will see first hand how echo is routinely used to guide cardiac operations and anesthetic management. Students will have the opportunity to practice image acquisition on our TEE simulator, and after demonstrating competency, perform exams on patients. The rotation will emphasize the interpretation of TEE images in a wide variety of cardiac surgery patients, and how it correlates to anatomy and physiology. Students will also be exposed to transthoracic echocardiography (TTE) and its utility in the perioperative period. 

Measurable learning objectives of elective: By the end of the rotation, students will be expected to:
Understand appropriate use of echocardiography, including indications and contraindications.
Be familiar with basic ultrasound and Doppler physics as it pertains to echocardiography.
Know the views in the basic perioperative TEE exam and the associated anatomy.
Be familiar with quantitative and qualitative methods to assess ventricular and valvular function.
Demonstrate safe probe manipulation and proper image acquisition.

Learning experience: Students will primarily be in the cardiac surgery operating rooms, working intimately with cardiac anesthesiology attendings, as well as fellows and residents on rotation. Students will be expected to arrive daily (Monday to Friday) at 6:30am to help set-up for cases. For each day, the chief fellow will direct the student which operating room to report to ahead of time. Students will also be expected to visit other cardiac operating rooms during the day to review TEE exams. Students are also required to attend any didactic sessions for the fellows and residents relating to cardiac anesthesiology. When time is available, students will practice TEE skills on the simulator with faculty and fellows. Students interested in TTE will also have an opportunity to learn TTE on the simulator or with the Department of Cardiology.

Method of student feedback and evaluation: Students will be required to maintain a log of all exams interpreted and performed under supervision. Students will also be assigned reading material from the course text and may be tested on the material on an ongoing basis. The TEE simulator will be used to assess knowledge of anatomy and if students will be allowed to perform exams on patients. At the end of the rotation, students will present an interesting case to the faculty and fellows. During the presentation, students will be evaluated on knowledge and interpretation, and will serve as an end-of-rotation exam.

Textbook(s) information:  ISBN ISBN-13: 978-0702034275
Cost $74.73 (On amazon.com)
Title Practical Perioperative Transesophageal Echocardiography: Text with DVD-ROM
Edition:  2nd edition
Author: David Sidebotham
Is this required or suggested? Required. Department will provide copies for students to borrow.

Christopher Tanaka, MD
ctanaka@montefiore.org
718-920-4316
Administrative support: Ms.  Beverly Mcgonagle, bmcgonag@montefiore.org, 718-920-4383 or 4308
Maximum: 1
Modules: All
On the first day students report to:  Moses Campus Silver Zone 4th Floor- Department of Anesthesiology Graduate Education Office at 8:30AM 

 

E600 Regional Anesthesia and Inpatient Pain Medicine (Montefiore Medical Center-North/Wakefield/Weiler)
**Einstein students must contact the course directors for approval prior to registration** 
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: 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. They will have an opportunity to learn use of ultrasound and identification of relevant anatomy as well as performing entry-level blocks. The rotation will be Monday to Friday from 7am to 2 pm. The rotating student will also be included in resident didactics in the rotation. Interested students can also present a journal club. 

Recommended texts: 
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 given ongoing feedback during the rotation. They will be evaluated on their understanding of ultrasonography as well as sonographic anatomy and skill in performing entry level blocks.  Students will be evaluated by the course directors at the end of rotation also.

Course Director: Amaresh Vydyanathan, MD
avydyana@montefiore.org, 917-577-1811
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Maximum: 1
On the first day student(s) report to:  Wakefield PACU/Block Area on the 2nd Floor of 600 East 233rd Street, Bronx, NY 10466 or Hutch PACU/Block Area on the 3rd Floor, Tower Two, 1250 Waters Place, Bronx, NY 10461,  at 6:30am (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.  Dr. Naum Shaparin, the Co-Course Director is also available for questions. 

 

E601 Research in Regional Anesthesia & Pain Medicine (Montefiore Medical Center-Moses)
**Einstein Students must contact the course directors for approval prior to registration** 
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: At the conclusion of the elective the student will have the following skills: 

  • 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. 
  • Preparation and presentation of completed projects as abstracts in regional and national conferences. 
  • Preparation of completed projects as manuscripts for publication 
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. They will also have the opportunity to submit and present abstracts at regional and national conferences. The typical workday will be Monday to Friday from 9 am until 3 pm, 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.

Course Director: Amaresh Vydyanathan, MD
avydyana@montefiore.org, 917-577-1811
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Maximum: 2
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 or the chronic pain clinic. Dr. Naum Shaparin, the Co-Course Director is also available for questions. 



E602 Outpatient Chronic Pain Medicine (Montefiore Medical Center-Moses)
**Einstein students must contact the course directors for approval prior to registration** 
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 schedule will be from 8:30am to about 4pm.  They will also have the opportunity to learn the basics of performing image guided interventions.

Recommend texts: 
"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 upon request. 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.

Course Director: Amaresh Vydyanathan, MD
avydyana@montefiore.org, 917-577-1811
Co-Director: Naum Shaparin, MD
nshapari@montefiore.org, 718-920-8946
Modules: All
Maximum: 1
On the first day student(s) report to:  The Hutch metro center, 1250 Waters Place, Bronx, NY 10461 at 8:30am 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 pain clinic on the 8th floor of the building. Dr. Naum Shaparin, the Co-Course Director is also available for questions. 

 

 

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