Senior Month
This rotation was created to give seniors the opportunity to engage in out-of-OR, attending and pre-tending opportunities. Additionally, the Day and night jeopardy rotations are designed so residents are pulled from other educational activities less often. This rotation is an opportunity for self-guided, senior level learning, and gives residents the opportunity to drive their experience, so please be proactive in getting what you want out of this experience.
This month consists of the following breakdown:
- 1 week at of "Pretending"
- 1-week Senior nights (see senior nights section for details)
- 1 week Day Jeopardy, “Senior Days”
- 1 week Night Jeopardy, “Wildcard”
Day Jeopardy, “Senior Days”
When you are on your day jeopardy rotation, you are jeopardy Mon-Sun for any day shift for which someone calls out. If you are not called in, you arrive to UCH at 645-7am during the week.
Opportunities for the senior day resident:
Sign into the airway/trauma pager and responding to codes in the hospital during the day
It is expected you respond to trauma and airways (communicate with the lead APP and charge of the day)
Field inpatient consults
Assist urgent matters in the PACU and perioperative area (e.g., “Anesthesia STAT” calls).
Running the board with charge and learn the logistics of that process.
Pre-tending with an attending and a junior resident.
If you are not called to another location, you are relieved at ~3 pm once most of the afternoon board running has been completed (check with charge before you leave). You do not come in on weekends unless called in for a jeopardy shift.
Night Jeopardy, “Wildcard”
You are jeopardy Mon-Sun for any night shift for which someone calls out. If you are not called in the night prior, you arrive at 7am. If the DAY jeopardy was pulled, you will assume that role (above).
Opportunities for the night jeopardy, wildcard resident:
Sign into airway and trauma pagers to help the day jeapordy resident as above
Assist with starting cases/pre-tending for junior residents/helping out where necessary (AKA OB is getting crushed and need a hand or East needs someone to manage all the blocks for the day).
Help with difficult airway management if it is occurring in a non-resident room (e.g., attending solo room).
Help APS with first start epidurals/blocks.
If the chief residents find out you are going to be called in for a night shift, you will be sent home as soon as possible to rest for the shift and will not have to come in during the day the next day. You could still be called in for a night shift the next night. If you are not called in, you are relieved at ~3pm with the Day Jeopardy resident. You do not come in on weekends unless called in for a jeopardy shift.
If a 24-hour ICU shift needs to be covered, the day and night jeopardy residents will split the ICU shift in half (7-7).
Jr-Attending (Res-Pretend):
- You will function as the attending for the case, at the guidance of the faculty attending. With this in mind, you are responsible for the plan, induction, intraoperative management, emergence, resident teaching, and hand-off to the oncoming attending if the case is still going when you are relieved for the day.
- The junior residents staff with you, and you staff with the attending the night before.
- You are on the same call schedule as your faculty attending, and they are responsible for releasing you for the day.
- We ask that you take ownership of this role! Great leadership and attending practice.
Senior Nights
Senior Nights are a wonderful chance to gain experience in anesthesia supervision and board running. You will be expected to act as the charge attending. Be sure to take advantage of the opportunity to practice as an independent attending, while still having supervision and backup if you need it.
Hours 9PM- 7AM, Monday, Tuesday, Wednesday, Thursday, and Friday nights.
Typical Workflow
Upon arrival at 9pm- sign into both the trauma and airway emergency teams on epic., and call the C1 charge (85920) to get an update on any ongoing/pending cases and any concerning PACU patients that may need your attention. Let the C1 know that you will be forwarding the charge phone to your PCD/cellphone as well. Be sure to clarify which C1 faculty is responsible for what cases overnight (e.g. usually they switch over around 2:30am).
During your shift, you will be acting as the overnight attending for all cases. You are expected to check in with both the R1 resident and C1 APP. They should be calling you for the usual things they would call the C1 attending for such as changes in patient status, plans for new patients, induction, extubation, transport assistance, or breaks. Typically you will be responsible for seeing and consenting patients in preop. You should clarify with the attendings of the night what they want to be notified for (e.g. call when a case is booked, or text when getting ready to induce and emerge). Be sure to keep the balance of cases roughly even between the R1 resident and C1 APP (typically alternate every other case). If things are light, you can discuss what call rooms are available with the C1 attending. There is a Leprino call room specifically for senior nights.
Cardiac and transplant cases overnight should be covered by the assigned on-call or float resident. However, there may be emergent cases that will require your help to setup and start while the on-call resident is on their way to the hospital, or the float resident is occupied. If such a case develops, please discuss with the C1 attending and the appropriate specialty faculty (CT1/LT1).
At 7am call the daytime charge attending to let them know of any sick or post-calls from overnight (e.g. did anyone call the phone to call out sick? Or did you call in R2 and they are post-call), you will also handoff any ongoing/pending cases to the AIP Charge attending. Before leaving, please ensure that you have forwarded the charge phone to the AIP charge.
Communication
Even though you are “independently” practicing, you will continue to follow the Policy for Supervision of Anesthesiology Residents. Briefly, the responsible C1 attending anesthesiologist must be called when:
A trauma activation occurs. Be prepared to provide additional details such as patient location, mode of injury, extent of injuries, and whether operative management is needed.
Airway emergencies are received. Be prepared to provide additional details such as patient location, patient respiratory status, urgent or emergent nature of securing the airway, and whether any other airway tools may be needed.
Specific perioperative events.
When the patient is set to be transported from the preoperative environment to the operating room.
When the patient is ready for induction of anesthesia.
When the patient is ready for emergence from anesthesia.
When any perceived patient safety issue exists.
When any significant change in patient clinical status occurs.
When any regional or neuraxial procedure is underway.
When any central line placement is underway.
When any difficult arterial line placement occurs.
Calls to the charge phone often require guidance from the responsible C1 attending anesthesiologist. Call the attending when any surgeon/surgical issue arises (e.g., cases that need bumped because of an emergency, multiple concurrent emergent cases, discussion of complex cases, etc.). For stroke alerts, be prepared to provide details such as patient location, time of stroke onset, extent of injury, the IR suite for the procedure, and whether general anesthesia or sedation is requested. This list is not exhaustive, please use your best judgement and do not hesitate to contact the C1 attending about any questions/concerns.