ANESTH-440c Anesthesia. Fourth year students can participate in the perioperative anesthetic management of patients while assigned to an individual resident or attending anesthesiologist. The close interaction with faculty and residents is based around rotations of approximately two weeks in the general operating rooms – one in the cardiothoracic operating rooms, and a fourth week in subspecialty areas, including Duke’s hyperbaric facility, the Acute Pain Management Service, and others. Learning opportunities will include preoperative patient evaluation, anesthetic technique selection, airway management, pharmacology, physiology, and anatomy, as well as procedures such as ultrasound guided vascular access, including central venous and arterial line placement, and patient monitoring. These areas will be reinforced by lectures, Grand Rounds, and an innovative problem-based learning series that builds through the rotation. The course director is Dr. Elizabeth Malinzak.
ANESTH-401c Cardiothoracic Critical Care Elective and ANESTH-402c Cardiothoracic Critical Sub-I. The cardiothoracic intensive care sub-internship or elective will allow fourth year medical students to be exposed to and participate in the care of the postoperative and critically ill cardiac and thoracic surgery patient. This patient population has the highest rate of invasive monitoring, echocardiographic and hemodynamic assessment, and advanced circulatory support, including utilization of inotropes, vasopressors and mechanical circulatory support devices (LVAD, RVAD, IABP). A working knowledge of these concepts will be critical to a future career in anesthesiology, critical care medicine, or surgery.
Critical care medicine has evolved from a discipline where one or two organ systems are supported during critical illness to one where technological advances allow us to support virtually all organ systems. The CTICU (7W) utilizes the highest variety circulatory support and a wide variety of support of other organ systems. Physicians practicing in the 21st century will need a working knowledge of these devices, the opportunities they offer, and their shortcomings. The course director is Dr. Sharon McCartney.
ANESTH-441c. Critical Care Sub-I. The sub-internship in the Surgical Intensive Care Unit (SICU) is designed to broaden the student’s knowledge and experience in managing critically ill surgical patients. Under supervision, students function as sub-interns in the SICU. Students are assigned their own patients and actively participate in daily rounds as part of the SICU team. There is a daily lecture on aspects of critical care. Students take call one night in four and work on a one-on-one basis with SICU house staff in the supervised management of critically ill patients. Time may be spent in the SICU at Duke University Medical Center (trauma, vascular surgery, liver-kidney-pancreas transplantation, general surgery) and/or the SICU at the Durham VA Medical Center (cardiothoracic and vascular surgery, general surgery). There is emphasis on teaching of procedures and techniques necessary for the management of all critically ill patients, including hemodynamic assessment and monitoring, cardiovascular resuscitation and use of vasoactive drugs, ventilator management such as ARDS, prevention and management of nosocomial infections, and ethical decision making in the ICU. Students are formally evaluated by the SICU house staff and the attending physician. The course director is Dr. Chris Young.
ANESTH-446C Acute and Chronic Pain Management. This course is offered to fourth year medical students within Duke Anesthesiology. During this four-week elective, students will participate in both inpatient and outpatient pain management. Each student is assigned daily to an individual fellow or attending physician who supervises the student’s active involvement. This involvement emphasizes a multidisciplinary approach appropriate for the individual patient. Topics reviewed include opioid and non-opioid management, interventional procedures such as epidural and peripheral nerve catheter placement, nerve blocks, neurolytic procedures, as well as implantable devices. The benefits of physical and psychological therapy are stressed. Students will observe and/or participate in various interventional procedures. In addition to this clinical work, students attend a pain conference and weekly grand rounds. The course is offered during each elective period throughout the year. The course director is Dr. Lance Roy.