Evolution of Anesthesiology
Health care is changing. Perioperative medicine and anesthesiology are also evolving rapidly as a specialty. Whereas a typical patient today is evaluated only a day or two prior to the scheduled procedure with little opportunity to improve their baseline state, the preoperative encounter at Duke is already being transformed into an opportunity to improve chronic disease management, with an eye to the short-term gain of safer surgery and the long-term gain of better health.
Duke Anesthesiology and its POET (Perioperative Enhancement Team) program at Duke University Medical Center, are leading efforts to advance the field of perioperative Risk Evaluation and Care Optimization (RECO) for issues including anemia management, diabetes management, nutrition management, complex chronic pain management, perioperative management of pacemakers and implanted defibrillators, anticoagulant management, and the special circumstance of extreme advanced age. In addition, Duke has pioneered Enhanced Recovery After Surgery (ERAS) implementation in the United States having a long-standing relationship with the leaders in the National Health Service and U.K. system from the University College London. Postoperative management and tracking, application of handheld ultrasound to enhance diagnostic skills, as well as business administrative skills are also included in the perioperative medicine curriculum.
Each fellow will have a faculty mentor and will be able to prioritize components of the fellowship to their individual clinical and research interest.
The fellowship curriculum will consist of several different components:
- Business Development and Operations
- MSc in Perioperative Medicine – fellows will be enrolled in UCL’s master’s program in perioperative medicine.
- Clinical Training – fellows will work one to two days per week in the operating room as faculty fellows. Clinical practice will include supervising residents and CRNAs, and will predominately involve anesthesia for high-risk noncardiac surgery.
- Perioperative Research and Academics – fellows will assume a supervised personal research project, which will also form the basis of their MSc dissertation.
- Clinical and Managerial Rotations – fellows will complete monthly core and elective rotations in different aspects of perioperative medicine.
- Morpheus Consortium Engagement
- Enhanced Recovery After Surgery (ERAS) Program Development and Management
- UCL Visit and Evidence Based Perioperative Medicine (EBPOM) Meeting Attendance in London, UK
- Electives: pre-admission testing, pre-anesthesia and surgical screening (PASS), post-anesthesia care unit, Point-of-Care Ultrasound (POCUS), regional, pacemaker preoperative optimization clinics: pain, smoking cessation, sleep, perioperative optimization for senior health (POSH), anemia, diabetes, nutrition, coagulation, cardiac implantable electronic devices and blood management.
A Typical Week Consists of…
- Two days of staffing the operating room
- One academic day to focus on research, quality improvement projects, and the MSc
- One day on clinical rotations
- One day of Perioperative Medicine Business Development & Operations
Fellows will also attend weekly fellowship lectures, Grand Rounds lectures, and Duke Perioperative Enhancement Team (POET) weekly meetings.