What is your pain rotation like?

Interns and CA-2 residents rotate on the chronic pain service. During this experience, they work largely with chronic pain patients in the outpatient pain clinic setting. Residents evaluate patients, make treatment recommendations, and participate in diagnostic and therapeutic procedures (depending on level of training). Interns and residents do not take call on the chronic pain rotation.

CA-1, CA-2, and CA-3 residents rotate on the Acute Pain Service (APS). During this experience, they work in the inpatient setting, evaluating patients and participating in performing perioperative peripheral nerve blocks and epidurals. They also round on inpatients on the APS for management of acute postoperative pain. Acute pain call is shared with the regional anesthesia fellows. This is home call. However, the resident taking in-house OB night call generally handles simple issues such as changing the epidural infusion rate or replacing a pump battery. 

What are the strongest subspecialties in your department?

Regional anesthesia (approximately 3,700 peripheral nerve blocks/year), surgical intensive care (3,000 admissions/year), orthopedics, otolaryngology, neurosurgery, general surgery (including transplant and trauma), and pediatrics (approximately 20% of our anesthetics involve patients under 18 years of age).

Your program seems to place a strong emphasis on critical care. Is this true–and why?

This is true. Our department has managed the Surgical and Neurosciences Intensive Care Unit (SNICU) and Cardiovascular ICU (CVICU) at the University of Iowa Hospitals & Clinics for decades. The goal of the department is to train outstanding physicians, not technicians.

One factor that defines the excellent anesthesiologist is his/her ability to care for the critically ill, both in and out of the OR. We feel strongly that critical care experience is crucial to meeting our goals. Our interns spend two months in the SNICU and CVICU; clinical anesthesia residents spend three months in the SNICU and CVICU.

Can you describe a typical OR day for your residents?

On Monday and Tuesday, patients are expected to be in the OR at 8:15 a.m. On Wednesday, Thursday, and Friday, the in-room time is 7:30 a.m. Residents typically arrive between 6 and 6:30 a.m. to set up their rooms and to perform regional blocks, etc. before moving their patients into the OR.

Residents typically get breaks in the morning and afternoon, and a break for lunch. Our ORs usually begin to wind down between 4 and 6 p.m.; the night-call team, late-day CRNAs, and evening shift resident work to get residents out of the OR by 6 p.m.

Although we follow ACGME duty hour rules, residents are expected to remain with critically ill patients or major cases as long as necessary (for patient safety or educational value). The ORs are particularly busy during the summer, but we do our best to relieve non-call providers.

If residents need to leave (for personal reasons) at some earlier time, they notify the OR Clinical Director and we do our best to get them relieved.

What kind of rotations do you have for the interns?

We take 15 interns each year. Their rotations include:

  • 2 blocks in the SNICU/CVICU
  • 1 block each in:
    • Emergency medicine
    • General medicine ward
    • Renal medicine consult service
    • Trauma surgery
    • Pediatric surgery
    • PICU (Pediatric ICU)
    • EKG course
    • Palliative care medicine
    • Safety and quality
    • Advanced clinical medicine
    • Anesthesia

Interns spend 2 weeks each on the inpatient cardiology service and an elective (chest radiology or chronic pain).

Interns are also invited and encouraged to attend Anesthesia Grand Rounds.

What are your 'weakest' rotations?

Our residents have no difficulties meeting their ACGME requirements in any area–so we really have no "weak" rotations.

We have a limited number of OB deliveries (about 2,100/year), but since these are frequently complicated pregnancies and because we have a very high rate of neuraxial labor analgesia, residents easily meet their case requirements without the need for an outside OB experience.

Like many other institutions, our cardiac surgical load (cases on bypass) is limited, but recent increases have eliminated the necessity for an outside rotation. However, we retain our very popular senior cardiothoracic elective rotation in Des Moines.

What electives do you have?

Away electives for seniors include:

  • Cardiothoracic anesthesia in Des Moines
  • International pediatric anesthesia in underserved foreign countries—on hold during the pandemic

UI Hospitals & Clinics anesthesia electives include:

  • All surgical subspecialties
  • Simulation
  • ECHO
  • Ambulatory surgery anesthesia
  • Regional anesthesia
  • Advanced clinical anesthesia
  • Chronic pain
  • Fluoroscopic pain anatomy
  • Research
  • Point-of-Care Ultrasound (POCUS)
    • We have 2 certified POCUS faculty who are passionate about teaching the skills to residents.

I've also heard that you have a very strong regional anesthesia program.

Absolutely true! We performed more than 3,700 peripheral nerve blocks last year. Many of our faculty have expertise in regional anesthesia–including ultrasound guidance for blocks. Given these numbers, it shouldn't be surprising that our surgeons enthusiastically accept regional anesthesia as a beneficial part of patient care.

CA1 and CA2 residents rotate through the regional anesthesia service. Senior residents can elect a regional anesthesia rotation. Residents also participate in a formal training course in regional anesthesia. Our graduates perform approximately 150 peripheral nerve blocks during their training.

Anesthesia residents on a mission trip in Colombia

Do you offer foreign mission trip experience?

Yes, our CA3 residents have opportunities to participate, with our faculty, in mission trips to Guatemala and Colombia.  We hope to expand our opportunities to include Zambia this year.

We offer this opportunity to four to six of our CA3 residents and continue to explore opportunities for more residents to participate in these valuable international mission trips. Unfortunately, the COVID-19 pandemic had halted our mission trips for two years, but we plan to start again in 2023.