Wake Forest

Study Guides for Each Rotation:

Our study guide system is unique to Wake Forest. We call them “Things to Remember” and we have introductory and advanced versions for each rotation. Each study guide has a dozen or so open-ended questions that residents answer during the first two weeks of each rotation. These serve as ice-breakers for one-on-one discussion with faculty and they cover all of the key concepts to be learned from each rotation. Everything that matters most is best remembered through repetitive drill: seeing, writing, speaking, even drawing. Our Things to Remember Guides are a thorough application of fundamental learning theory.

Chaperoned Reading Program:

Our faculty has created a system to help first year residents get the most out of the introductory texts in our field. It consists of web-based quizzes that can be done from home in five chapter intervals. It is optional, low key, and not graded. It covers more than 500 key words and provides instant answers with explanations for each question. It can be used and re-used a variety of ways. Two introductory texts are covered with 19 quizzes under this format to help prepare our junior residents for the Basic Examination.

Distinguished Graduate Program:

Residents at Wake Forest can choose to pursue Academic Distinction in three different ways: Research, Quality Improvement, or Exam Performance. A few exceptional residents each year earn the Academic Distinction notation on their diploma along with a monetary award. The time and commitment required is above and beyond the expectations to finish the program, but it is a tangible lofty goal for the motivated learner.

Obstetrics in Ghana, Africa:

We have two or three rotations per academic year in Ghana for those with interest in Global Health and working in austere environments. It is a longstanding relationship with our Obstetric Anesthesia Section and it includes both clinical work and instruction.

Carey Commendation Awards:

We incentivize performance on the national in-training exam by presenting awards to those who perform particularly well. We have named it after one of our graduates who got the highest score in the nation when he was a CA-3. The award includes a certificate and a monetary bonus that is added to their Books and Travel account.

Supervisory Ambulatory Anesthesia:

One of our most popular elective rotations, our Advanced Ambulatory rotation allows our CA-3 resident to help run our 8 operating room ambulatory suite as its Board Runner. Thus, there are numerous pre-operative nerve blocks and the determination of home readiness in the PACU. It is an opportunity to supervise younger residents, CRNAs and SRNAs during the normal workday, much like they might be doing ever after beginning the following year.

Safari:

We have more than a dozen exciting Out-of-OR sites that allow this rotator to feel like they are truly on safari. Day in, day out, for an entire month, the resident gets to explore distant locations far from the safety and comfort of the operating room: each day determining the most fundamental concerns required to anesthetize remote patients safely. Cases are tracked daily to make sure each resident gets ample opportunities in interventional radiology, gastroenterology, burns, cardiology, brachytherapy, and half a dozen other unique locations that would never have been considered anesthetizing locations a decade ago.

Internship Electives:

Our transitional internship is controlled and designed by us to maximize the resident’s preparation for anesthesiology. We have the required ward rotations on Cardiology, Internal Medicine, Neurology, Otolaryngology, Pediatrics, and Vascular Surgery. Two critical care months are done in the Coronary Care Unit and the Medical Intensive Care Unit. Electively, all residents get a rotation on the Arrhythmia Consult Service, Pulmonary Consults, Chronic Pain Clinic, Blood Bank, and a preparatory month in the final quarter with us in Anesthesiology. Our Blood Bank and Arrhythmia rotations are particularly unique, created solely to prepare our residents for Anesthesiology.

Obstetrics in Africa:

We have two or three rotations per academic year in Ghana for those with interest in Global Health and working in austere environments. It is a longstanding relationship with our Obstetric Anesthesia Section and it includes both clinical work and instruction.

Embedded Simulation:

Throughout the continuum of residency training, our simulation center is used repeatedly to enhance preparation for both the rare and routine. It provides initial orientation, a Boot Camp experience during the intern rotation, and numerous opportunities to practice Crisis Management scenarios. Simulation is completely embedded into the curriculum with advanced case complexity simulations for our senior residents every Tuesday, and Crisis Management scenarios for our CA-1s every Monday.

Emergence Planning:

We teach case planning from back to front, so the emergence can be optimized both objectively and subjectively: objectively to optimize timing, hemodynamics and pulmonary drive; subjectively with regard to endotracheal tube tolerance, delirium, nausea, and neurologic assessment as needed. Case plans are individualized for each patient based on their comorbidities, chronic medications, the procedure in question, and occasionally the surgeon involved. Our landscaping approach to case planning allows those with extreme needs to be identified up front, giving them the best opportunity for a smooth anesthetic.

Ancillary Airway Training:

Ours is an “Airway First” profession, so we make sure all of our graduates can comfortably follow each branch of the Difficult Airway Algorithm, awake and anesthetized. We have more than a dozen fiberoptic bronchoscopes in constant circulation and our residents average more than 50 fiberoptic intubations during their training. We particularly embrace the awake intubation because of its unique complexity and importance. All of our residents perform at least 20 awake intubations and learn to use both topical and nerve block approaches to anesthetizing the airway.

The Lightwand:

The lightwand is an old, simple, inexpensive, remarkably “low-tech” rescue device. Great in a helicopter or the woods, it is now rarely taught outside the military. Nonetheless, it is sublime in that it very rarely fails because it actually places the endotracheal tube in the trachea. We embrace this tool because it is at its best when circumstances are at their worst: blood in the mouth, fused neck, failed DL, remote locations, vomit in pharynx, patient on ground, no electricity, et cetera.

http://www.wakehealth.edu/School/Anesthesiology/Tutorials/Lightwand-Intubation-Tutorial.htm

Elective Rotations:

Most of our final training year is spent in preparation for supervision as a consultant. We have more than 20 electives from which to choose, with all of our residents getting at least Seven. Merit Badge is a senior elective rotation whereby we support the resident in the acquisition of as many training certificates as they can acquire. Certificates obtained include ACLS, BLS, PALS, NRP, ATLS, AWLS (wilderness), ABLS (burns), ALSO (obstetric), and ECMO to name a few. The first years of practice are a challenging time, obtaining these specialized certificates in the final months of residency helps our graduating residents hit the ground running wherever they might land.

Exam Preparation:

Certifying in Anesthesiology is a primary objective of residency training. We have a 99% Certification Rate over the past twenty years. We have Mock Oral Exams every semester that closely mimic the real thing. We have chaperoned reading programs and separate review sessions prior to the Basic Exam in June and the national In-Training Exam in February. We have two incentive programs that reward exceptional performance with a certificate and additional funds for books and travel. We also have extensive exposure to ultrasound guidance for nerve blocks, central line placement and transthoracic echocardiography. Transesophageal echocardiography has been a particular strength of our training program for some time and many residents have obtained the Basic Certification in TEE as well.