Brigham and Women's Hospital

Elective Rotations at Brigham and Women’s Hospital Boston

Humanitarian Overseas Elective

The Anesthesia Department at Brigham and Women’s Hospital has a long tradition of commitment to humanitarian overseas work. Residents can choose to spend time abroad as an integral part of their residency training with the financial support of the department. Preparation and collegial exchange of the experience is facilitated through the Harvard Global Anesthesia Initiative (http://www.globalanesthesia.org). Every year more than ten senior residents from Brigham and Women’s Hospital provide care in underserved areas and assume teaching responsibilities around the world (South America, Africa, Asia). Established locations include Rwanda, Dominican Republic, Guatemala and Peru. The residency program maintains a database with information about the different opportunities for the residents to access at any point during their training.

Operating Room Management Elective

The Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital offers a one month elective in Operating Room Management, open to internal residents, that serves as an introduction to the basic principles of managing the Perioperative Suite on both a day-to-day and long-term basis. The resident rotator works daily with the Anesthesiologist assigned to manage the hospital’s 44 operating rooms and additional non-operating room locations. In addition to helping coordinate patient flow through the perioperative areas, the resident will actively participate in operating room schedule adjustments, departmental assignments, add-on case placement, and delegation and completions of daily operating room and departmental tasks. During the rotation, the rotator will accompany perioperative and departmental leadership, including the Operating Room Medical Director, to daily, weekly and monthly operational meetings pertaining to the operating room and the hospital. Residents are also encouraged to participate in a process improvement project that may serve to address a deficiency in the operating room, and potentially may establish the foundation for a larger academic project.

Regional Anesthesia Elective

Our combined Division’s of Regional and Orthopedic Anesthesia provide resident and fellow training in perioperative regional anesthesia. Our team’s commitment to promoting, providing, teaching and innovating regional anesthesia follows a proud tradition and has kept us in the forefront of the “ultrasound revolution” in the field. The program engages our residents early on during their CA1 year, both didactically and clinically. It strives to build a solid fundament in neuroanatomy, sonoanatomy, pharmacology and neurophysiology, upon which technical skills evolve through mentored practice and unique learning experiences that cultivate inquisitive minds, self-sufficient practitioners and competent consultants. Our educational activities include scheduled and elective workshops for different levels of training and active participation in the Regional Anesthesia Toolbox project. Our regional anesthesia training transcends the orthopedic ORs into all perioperative domains, including cardiac surgery, where we are pioneering continuous proximal intercostal nerve blocks for patients undergoing transcatheter valve replacement surgery. Not surprisingly, many of our residency graduates are inspired to pursue further regional anesthesia fellowship training and careers in regional anesthesia and perioperative pain medicine.

Anesthesia Technology Elective

The Brigham and Women’s Hospital Department of Anesthesiology Technology Education Program integrates components of Theory and Clinical Practice with optional opportunities for Discovery, Research, and Innovation. The learning experiences include panopto-recorded lectures followed by flipped classroom adventures, hands-on equipment workshops, screen-based simulation workshops, and OR clinical applications. During Orientation, theory and use of drug delivery and monitoring equipment is presented and explored by all incoming residents. During CA-1 year, a set of didactic experiences covers all of the ACGME requirements in the form of Panopto variable-playback-speed lectures followed by classroom experiences including lecture discussions, structured PBLD’s, and Board question and review sessions. The CA-2/3 Didactics are structured similarly on more advanced topics. A Technology Elective is offered to CA-3 residents focusing on topics designated by the instructor and supplemented with topic(s) requested by the resident. Residents interested in developing medically related inventions are encouraged to confidentially share ideas with the BWH Anesthesia Innovation & Entrepreneurship Group, which meets to discuss items of interest and listen to presentations, by Hospital IP and Licensing experts.

Advanced Airway Elective

The Airway Elective (A²E) is an innovative program that offers a comprehensive airway curriculum that is essential to our multidisciplinary practice. The advanced training includes a special focus on challenging airway management, independent decision-making, clinical assessment; clinical aptitude and patient care efficiency. While participating in the A²E elective, residents spend one day each week in the laryngeal surgery clinic mastering fiberoptic and video-assisted bronchoscopies.

The CA-2 and CA-3 residents participating in this elective will have unique opportunities to expand their airway assessment and management of patients with a challenging airway in a supported context. While traditional “required” curricula offerings are effective at delivering the required core curriculum to residents, this elective will go beyond this by offering residents a unique opportunity to focus on mastering advanced airway skills.

Interdisciplinary Team Based Simulation

BWH anesthesia residents have access to the STRATUS Center for Medical Simulation, an on-campus high-fidelity simulation experience. A full-time clinical anesthesiologist is the assistant medical director of the facility and the department has an eight-member team of anesthesiologists formally trained in simulation. The department believes in practicing high-acuity, low frequency events in the safe and non-judgmental environment of simulation. Throughout their residency residents are taught the tenets of CRM and mirrors their experience with similar material in the operating rooms. In this protected environment residents have the opportunity to practice the basics of surgical cricothyroidotomy, ultrasound-guided nerve blocks, advanced airway management, team training, leadership skills and a host of other topics. At the end of each session residents have the ability to self-define practice gaps and approach the team members for more time in the simulation center to close their identified gaps.