Clinical Anesthesiology – Operating Room

Under the coordination of Dr. Grace McCarthy, Duke medical students in their 2ndyear have the opportunity to spend time in the VA operating rooms during their two week Clinical Anesthesiology Selective. Students have the opportunity to shadow a senior anesthesia resident and work with different anesthesia attendings to get an introduction to clinical anesthesiology. Students are encouraged to get hands-on practice placing IVs, and also practicing bag mask ventilation and other airway skills. They learn about different anesthetic techniques as well as the physiology and pharmacology relevant to each case. In addition, Dr. Becky Schroeder and Dr. Srinivas Pyati serve as interviewers for medical student applicants to the Duke University School of Medicine.

Dr. McCarthy also coordinates the Duke Anesthesiology Durham VA OR and VA Cardiac residency rotations. Residents spend one month per year in the main operating rooms at the Durham VA during their CA-1, CA-2, and CA-3 years where they take part in the clinical evaluation and anesthetic care of patients having a wide-range of procedures ranging from general surgery to subspecialty surgical cases including orthopedics, neurosurgery, and thoracic surgery. The VA OR rotations include a daily didactic lecture series, monthly multidisciplinary ICU or perioperative conferences, and monthly defibrillator review sessions and OR mock codes. During their CA-3 VA OR rotation, residents are given more administrative leadership experience and have the opportunity to act as an attending to junior residents. CA-3 residents also spend one month on a VA Cardiac rotation where they have the opportunity to learn basic transesophageal echocardiography (TEE) skills with one-on-one intraoperative teaching by their attending. The VA cardiac rotation includes a weekly TEE conference led by Dr. Jonathan Mark as well as a weekly multidisciplinary cardiac listing conference to discuss potential candidates for cardiac surgery. The VA cardiac resident has the opportunity to get exposure to procedures in the Electrophysiology lab and is also given the opportunity to supervise junior residents when the schedule permits.

Durham Pain Program

Pain Clinic

Founded by Dr. Joel Goldberg in 1988, the Durham VA Pain Clinic is one of the oldest VA-based pain clinics in the country, and has been providing clinical education to Duke pain fellows for almost 20 years. Duke Anesthesiology pain fellows spend three months at the Durham VAHCS, where they practice both inpatient and outpatient pain medicine and learn multiple interventional procedures while working with a very unique patient population. Fellows learn in a truly multidisciplinary environment, with a group that includes physical medicine and rehabilitation physicians, advanced practice providers, nurses and anesthesiology pain specialists.

Surgical Intensive Care Unit

Under the direction of Dr. John Lemm, the VA Surgical ICU is a true multidisciplinary unit, staffed by a mix of intensivists from Anesthesiology or Surgery and three permanent physician assistants.  We have an excellent case mix, caring for patients from all surgical subspecialties including cardiac, thoracic, major vascular and neurosurgery. We host resident trainees from Anesthesiology, Surgery, and Emergency Medicine, where they are exposed to caring for a broad mix of surgical disease, with a special focus on the postoperative cardiac patient. During their time on service, trainees participate in multidisciplinary rounds and perform basic ICU procedures such as the placement of intravascular lines, and endotracheal intubation, to name a few. Another highlight of this rotation is one-on-one, hands-on point-of-care-ultrasound (POCUS) training with Dr. Yuriy Bronshteyn, a national expert in this field, as well as other ICU attendings. Didactics include a daily Anesthesiology morning conference, a monthly ICU multidisciplinary conference, and multiple ICU-focused didactics each week by the ICU attending. An elective ICU month for CA-3s is offered, where the resident takes on a leadership role, mentoring the junior residents, as well as providing more clinical decision-making and participating in higher level ICU procedures.

Critical care fellows from Anesthesiology and Surgery provide year-round coverage in the VA SICU, where they perform a critical role as they progress towards independent practice. Responsibilities for the fellow include the development of attending-level decision-making skills, advanced procedural skills and mentorship and teaching for the junior residents. While on service, the Anesthesiology fellows participate with the intraoperative TEE for all cardiac cases, as well as assist on many of the non-OR TEE consultations. A weekly TEE conference led by Dr. Jonathan Mark is highly attended and typically the highlight of the week for learners. Additionally, anesthesiology fellows aid with out of operating room airway management throughout the hospital. Critical care fellows also take on a didactics leadership role, providing teaching for the trainees in the ICU, as well spearheading our multidisciplinary ICU conferences.