Montifore Medical Center

OR Management

Effective OR management requires knowledge, skills and, most importantly, a team. To this end, a three-stage educational approach was created to expose residents to principles of business management and interpersonal communication. First, interdepartmental cross training designed to improve knowledge, communication, and teamwork skills sufficient to cross discipline lines during critical situations was implemented at a junior surgical and anesthesia resident level. Secondly, an OR management rotation designed to develop the confidence and practical skills needed to actively manage ongoing perioperative situations was implemented for senior anesthesia residents. Finally, with the university’s business school as a partner, an OR and Practice Management Fellowship is being offered which will combine business training with acquisition of advanced theoretical knowledge as well as the development of leadership and practical skills in both OR and practice management. The fellow will earn an MBA through this interdisciplinary program and will be able to efficiently manage a busy anesthesiology practice.

Basic Transesophageal Echocardiography Certification

Within the Cardiac Anesthesia Division, residents have an opportunity to obtain the training and experience necessary to become certified in basic transesophageal echocardiography (TEE). This goal is accomplished with an echocardiography elective in addition to the basic training obtained while on required cardiac rotations. In the next phase of this program, set to begin in the upcoming academic year, the echocardiography elective will be expanded to include both "advanced" and "basic” options. The “basic” will be a two-week elective that will serve as an introduction to technique for interested residents who do not meet the qualifications for the advanced course or who do not plan to obtain certification in basic TEE. Interested residents will qualify for the advanced elective based upon their academic standing. The expectation for all residents taking the advanced elective is certification in basic TEE.

QIPS CA2 Project

The Department of Anesthesiology Quality Improvement and Patient Safety educational program provides an opportunity for CA2 residents to create substantive change while in training. Working in a team-based model under faculty mentorship, the residents undertake a year-long quality improvement project which includes identification of a quality and/or patient safety issue, research of its parameters, and a proposal for resolution of the issue including an implementation plan with assessment of barriers to implementation. With the support of their mentors, the four resident groups present their projects to the entire Department at a Grand Rounds. Guest judges from the hospital’s quality team evaluate the presentations on multiple criteria to award first honors to the winning group and honorable mention to the runner-up. This program has received an enthusiastic response from participants within and beyond the Department.

Airway Curriculum

The Department offers an innovative continuum of airway management training resources that addresses the medical student, resident, and fellow. We offer a resident-based curriculum designed to provide exposure to complex airway management cases in multiple surgical subspecialties, foster critical thinking in difficult airway scenarios, and initiate exposure to fiberoptic bronchoscopy and other airway adjuncts. In addition to the rotation through Otorhinolaryngology (ORL), Bariatrics, and Oromaxillofacial surgical subspecialties, the four-week rotation consists of bi-weekly simulation sessions that expose the resident to automated mannequin simulation, partial task-trainers, and computer-based simulation. An online airway education logbook, www.airwayeducationlog.net, tracks each resident’s procedures, deficiencies, and competency. The logbook allows comparison of our residents with those from other residencies across the country and internationally. An elective CA3 rotation was designed in which the anesthesiology resident trains with the ORL surgeons performing elective tracheostomies, managing difficult airways outside the operating suite, participating in ENT clinics and all pertinent airway didactic sessions. This rotation provides an opportunity to see airway management from the ORL perspective, thereby fostering communication in the operating room. The combined Otorhinolaryngology/Advanced Airway Fellowship is now in its third year. The goal of the fellowship is to produce competent comprehensive anesthesia consultants for perioperative management of routine and complex airway management patients. Though the fellowship is combined with ORL, the fellows rotate through Bariatrics, Oromaxillofacial, Thoracic, Pediatric Bronchoscopy, and Sleep Medicine.