Residency Program

Clinical Base Year Rotation Descriptions

The Anesthesiology Clinical Base resident (PGY-1) is an equal participant with other PGY-1 residents on each service with respect to opportunities for learning (clinical and didactic), access to procedures, and assigned responsibilities. Work hours rules outlined by the Accreditation Council for Graduate Medical Education (ACGME) are strictly adhered to. The following is a brief overview of the available rotations for the clinical base year:

Required Rotations

Department of Medicine

General Internal Medicine (Durham Regional Hospital): This rotation provides exposure to the inpatient care of patients with simple and complex general medical conditions, including diabetes, peripheral vascular disease, coronary artery disease, pulmonary disease and many others. The service has 3-4 interns with 2-3 upper level residents plus junior and senior medical students. The Duke Department of Internal Medicine provides attending faculty coverage. Daily didactic sessions and patient care rounds with the team are highlights of the rotation.

Cardiology Inpatient Service (DUMC): The team is composed of interns and cardiology fellows, as well as fourth year medical students on an elective rotation. An attending cardiologist provides teaching and supervision each month. The patient population typically consists of hospitalized patients with coronary artery disease and congestive heart failure, who require stabilization or diagnostic procedures, and does not include patients in the coronary care unit. The call is covered by a day and night float system, and each intern typically is on a night-shift call for approximately one week during the rotation.

Pulmonary Medicine Inpatient Service (DUMC): The service is covered by several teams each consisting of interns, a pulmonary/critical care fellow and a pulmonary medicine attending. The predominant patient population on the service is patients with pulmonary disease (especially cystic fibrosis, COPD, interstitial pulmonary fibrosis) who require hospital admission, but not intensive care. Patients undergoing evaluation for lung transplantation and those admitted after lung transplantation are covered by the service as well.

Department of Surgery

General Surgery Inpatient Service (DRH): Two or three interns plus senior surgical residents generally staff this service. Attending surgeons admit their patients to the service and provide supervision for the housestaff. These general surgery patients encompass a variety of surgical disease processes, including vascular disease, hepatobiliary conditions, intestinal disorders and many others. Interns are responsible for the preoperative and postoperative care of these patients.

Surgical Intensive Care Unit (Durham VA Medical Center):A team of 3-4 interns or junior residents, a critical care fellow, and a dedicated anesthesiology/critical care attending provide care for a twelve-bed multispecialty surgical intensive care unit at the Durham Veteran’s Affairs Medical Center. Medical students also have an elective experience in this setting. Patients undergoing all types of surgical procedures, including neurosurgery and cardiothoracic procedures are admitted to this unit.

Emergency Medicine

Emergency Department (DUMC):Interns on this rotation function on the front lines of the care of patients in the Duke Hospital Emergency Room. Interns generally work on alternating day or evening shifts, working closely with dedicated emergency medicine physicians in the care of simple and complex conditions. Interns also interact with residents and faculty from many different departments, including Surgery, Internal Medicine, Pediatrics, and Obstetrics & Gynecology.

Department of Pediatrics

General Pediatric Wards (DUMC): Working alongside pediatric interns and residents, anesthesiology interns are responsible for the care of children on the inpatient pediatric wards at Duke Children’s Hospital. Children with a variety of simple and complex medical conditions are cared for on this rotation. Anesthesia interns are supervised by dedicated pediatric faculty from Duke University Medical Center.

Pediatric Intensive Care Unit (DUMC): This sixteen bed unit admits patients ages newborn to 18 with a variety of medical and surgical conditions. Approximately 60% of its admissions are surgical (predominantly cardiac, transplant and trauma). The medical patients typically consist of ARDS, hematology-oncology, and those with sepsis. The team consists of two pediatric critical care fellows and 2-3 pediatric residents (PGY-2/3). Attending level supervision is provided by one of five pediatric intensive care faculty, most of whom are also anesthesiologists. The clinical base intern is supervised by a pediatric fellow and attending.

Electives

Department of Anesthesiology

Clinical Anesthesiology (DUMC): Clinical base interns have the opportunity to spend a month at DUMC on the anesthesiology service, providing anesthetic care to a variety of patients under the direct supervision of an anesthesiology faculty member. Night and weekend call is optional.

Independent Study

Human Patient Simulation Laboratory: Interns work closely with faculty in the Duke Human Patient Simulation Lab to become familiar with the basics of patient simulation using an advanced METI® human simulator. Opportunities are available for interns to develop scenarios based on common physiologic derangements. These scenarios are then used to teach medical students and residents.

Department of Pediatrics

Pediatric Subspecialties (DUMC):Rotations are available on the hematology-oncology, pulmonary and neurology services. Interns typically take no call but rather participate in care of children in the clinic setting and as part of consult teams for inpatients at Duke Hospital. Teams generally consist of one attending specialist, one or two fellows, a pediatric resident, and occasional medical students.

Hyperbaric Medicine

Environmental Medicine (Duke Hyperbaric/Hypobaric Unit): Interns serve at the Duke Center for Environmental Physiology and Hyperbaric Medicine and participate in a variety of clinical and research activities. Treatment of scuba diving accidents, carbon monoxide poisoning and therapies for wound healing are among these activities. The chamber is also involved in high altitude experiments for NASA and the Air Force and diving research for the U.S. Navy. Interns can also participate in activities of the Divers Alert Network (DAN) which is based at Duke.

Department of Medicine

Medical Intensive Care Unit (DUMC) : Two junior medical residents and several critical care fellows staff this service. Specialists in pulmonary and critical care medicine provide attending coverage. The patient population is composed of critically ill, non-surgical patients with sepsis and respiratory failure constituting the major diseases. The clinical base intern typically accompanies a junior medical resident on his or her schedule.

Department of Surgery

Surgical Intensive Care Unit (DUMC):The Duke SICU is a sixteen bed surgical unit for trauma and surgical patients with the exception of cardiothoracic and neurosurgical patients. Most of the patients are recovering from liver or kidney transplantation, trauma, or major vascular or general surgery. The house staff are from the Departments of Surgery and Anesthesiology, with three PGY-1 or 2 level residents providing first-line care. Weekly faculty coverage is provided from a pool of dedicated surgical ICU attendings, with representation from both the surgery and anesthesia departments. Call is once a week.

Cardiothoracic Surgery ICU (DUMC): The 20 bed Cardiothoracic ICU is staffed by anesthesiologists and fellows from the Division of Cardiothoracic Anesthesia. Patients are admitted to this ICU after cardiac or other intrathoracic surgeries, including lung transplants. Interns assist in the care of these patients under the direction of Anesthesia and Surgical Faculty. There is no call.

Rotation Information