Trauma and Acute Care Surgery Anesthesia Clinical Instructor Program

We are committed to advancing and sustaining opportunity for all applicants.

• Strong clinical foundation with a commitment to ongoing personal learning, including staying up to date with advancements in trauma anesthesia.
• Ability to work collaboratively with a multidisciplinary team.
• Dedication to improving clinical practices and patient outcomes through QI initiatives and/or research.
• A strong desire to work with medically, economically, or educationally disadvantaged populations.
• An enthusiasm for teaching and mentoring junior trainees.

The Trauma and Acute Care Surgery Anesthesia Clinical Instructor Program is 12-months long. Clinical instructors will be employed by UCSF and work an average of three days per week as an attending anesthesiologist. The remainder of the week will be devoted to research and educational activities. Many of these educational activities will involve clinical work in a supervised capacity.

Clinical and procedural proficiency

• Master the perioperative anesthetic management of trauma and acute care patients, including advanced airway management and vascular access, massive transfusion, pain management, and regional anesthesia techniques.
• Understand the pathophysiology of specific traumatic injuries and the physiologic responses to trauma.
• Attain competency in interpreting coagulation tests including thromboelastographic testing as it pertains to the management of transfusions, coagulopathies, and resuscitation of trauma patients.
• Achieve proficiency in essential trauma procedures, such as central line placement, arterial line insertion, emergent and complex airways, and point-of-care ultrasound (POCUS).
• Learn to prioritize interventions and manage multiple critical tasks simultaneously in the resuscitation of trauma patients.
   

Interdisciplinary Collaboration

• Develop leadership skills to effectively coordinate multidisciplinary patient care in emergent situations and contribute effectively to patient stabilization and resuscitation efforts.
• Represent the UCSF Department of Anesthesia at local, regional, and national anesthesia committees and conferences.
   

Research and Academic Development

• Contribute to the advancement of trauma anesthesia by participating in quality improvement or research projects.
• Contribute to the education of students and residents via hands-on clinical training, trauma simulations, and didactic sessions.
• Develop skills in evidence-based practice and critical appraisal of the available trauma anesthesia literature.
   

Program requirements

• Trauma call - The clinical instructor will take the equivalent of two 12-hour in-house weekend trauma calls per month. This shift will be either Friday night or Saturday night.
  • During this shift, the clinical instructor will be supervised by the D1/night attending for any trauma cases.
  • The scheduling of these weekend call shifts is at the clinical instructor's discretion with approval by the Program Director.
  • The goal is for the clinical instructor to be exposed to trauma and acute care specific cases during these calls.
• Back-up call -
  • The clinical instructor will take two weekday back-up calls (1900-0700) each month and an additional 24-hr weekend back-up call every other month.
  • To maximize opportunities to be exposed to relevant clinical incidents, the clinical instructor will be called early as part of the ZSFG disaster management tree:
    • This backup is a non-mandatory call back, but if the clinical instructor is available and within 30-minutes of the hospital, it is highly encouraged that they respond.
    • If activated in this capacity, the clinical instructor will be compensated in line with the current ZSFG compensation plan.

When on-site, the clinical instructor is encouraged to carry their trauma pager regardless of their shift and to participate in trauma activations when available. The D1 will do their best to facilitate the clinical instructor's participation in trauma OR cases when possible.

Completion of at least one trauma anesthesia-related quality improvement, education, or research project

• The clinical instructor is expected to identify a project they are interested in pursuing within the first month of their program, and throughout the course of the program provide monthly reports of their progress to the program director.
  • The clinical instructor can either:
    • Engage in a yearlong project focusing on an area of improvement for the Department of Anesthesia with a focus on emergency surgery and trauma. Examples of past projects include: Fasting Times for Emergency Surgery, Post-Operative Analgesia in the Complex Pain Patient, and Blood Transfusion Management in the OR.
    • Join an existing clinical or translational science research project, with the opportunity to write or contribute to an IRB, data collection, analysis, or write-up. The specific exposure will depend on the project status.
    • Assist in the development of a trauma anesthesia curriculum for trainees.
  • The clinical instructor should plan to present their QI or research project to the department at the end of the program, as well as at a regional or national conference (ASA, IRS, TAS). Departmental funding will be provided for conference attendance.

Completion of a trauma anesthesia case log, including at a minimum, participation in:

• 10 penetrating trauma cases
• 10 blunt trauma cases
• 15 orthopedic trauma cases
• 5 multi-system trauma cases
• 10 neuro trauma cases (TBI or SCI)
• 5 vascular trauma cases
• 5 trauma takeback cases
• In addition to these more commonly seen trauma anesthesia cases. The clinical instructor will be encouraged to participate in the care of patients with more unique injuries. Potential Index Cases:
  • Penetrating cardiac injury
  • Massive pulmonary hemorrhage (potentially requiring OLV)
  • Major aortic injury
  • Simultaneous craniotomy and laparotomy or thoracotomy
  • Pediatric trauma (<12 yo)
  • Crush injury of 2+ limbs
  • Major unstable penetrating neck injury (aerodigestive tract injury)
  • Emergency obstetric cases requiring MTP (uterine rupture, unrecognized accreta)

Completion of a perioperative cardiac ultrasound course

Completion of the ECO 1 Course in Clinical Echocardiography and Ultrasound offered by www.iteachu.com in conjunction with the Society of Cardiovascular Anesthesiologists. This course is department-funded. The clinical instructor should be eligible to sit for the National Board of Echocardiography Basic PTE Certification exam by the end of the year.

Completion of Advanced Trauma Life Support training

This is a two-day course that prepares healthcare providers to identify and respond to life-threatening traumatic injuries. This is a department-funded certification opportunity. Clinical instructors will receive CME credit upon the completion of this course.

Participation in the Trauma Anesthesiology Society

Membership is department-funded.

Participation in departmental meetings

• UCSF Anesthesia Grand Rounds – 1st Wednesday of the month
• ZSFG M&M meetings – 3rd Wednesday of the month
• ZSFG Faculty Education series – 4th Wednesday of the month
• Anesthesia LEAN Huddle – EVERY Wednesday 0800 – 0830 in the hallway of the main OR
• ZSFG faculty meetings 1500-1630 every 2nd Thursday of the month

Participation in trauma-specific meetings

• Multidisciplinary Trauma Peer Review – usually the 3rd Wednesday of the month from 1500-1700 via Zoom
• Multidisciplinary Trauma Video Conference – usually 2nd Wednesday of the month 1700-1600 via Zoom
• TAS Multidisciplinary Trauma Lecture – timing TBD.
  • This is run by the University of Washington in St. Louis and occurs monthly. The clinical instructor is highly recommended to attend if clinically available.

Participation in departmental teaching activities

• Present at the annual UCSF Trauma Grand Rounds – this may either be an interesting trauma case presentation or a presentation on any other trauma anesthesia-related topic.
• Present a literature review or update on trauma anesthesia best practices at one ZSFG anesthesia faculty education session.
• Give monthly trauma-anesthesia-related lectures to the anesthesia residents as part of the SFGH Trauma Anesthesia Resident Seminar (STARS) didactic series.
• Participate in simulation-based teaching sessions for anesthesia residents.
• Participate in the ICU fellow lecture series.
• Participate in the quarterly UCSF All-Fellow Education Days
  • These are half-day sessions that cover a variety of topics including: board preparation, practice management, interviewing and job searches, risk management, building resilience, career launch, healthcare finance, and time management. There may be slight variations in the topics from year to year. These sessions are followed by a department-sponsored social gathering.

The clinical instructor will be able to participate in additional opportunities based on their clinical interests. Currently available opportunities include those listed below. However, if the clinical instructor has any particular interests that are not included below, these can be discussed with the Program Director prior to the commencement of the program:

Pediatric trauma rotation at Children’s Hospital in Oakland (strongly recommended) 

• The clinical instructor will participate in elective and emergent pediatric anesthesia cases in order to gain additional exposure to pediatric vascular access, transfusion management and trauma cases.
• PALS certification is optional but will be sponsored by the department if the clinical instructor chooses to pursue it.

Advanced Trauma Diagnostics and Procedures 

This may include dedicated hands-on experience in the Emergency Department performing diagnostic ultrasounds and FAST scans under the supervision of Emergency Medicine providers. There may also be opportunities to learn more about the role of interventional radiology in the management of trauma patients.

Pain Management and Regional Anesthesia in Trauma 

The clinical instructor may be scheduled with the regional anesthesia team to participate in self-performed or supervised peripheral nerve blocks. They will learn about the role of regional anesthesia in acute traumatic pain management. In addition, they can gain exposure to the Inpatient Acute Pain Service, which manages all catheter-related pain issues in post-surgical and trauma patients.

Surgical Critical Care 

• This is a four-week rotation during which the clinical instructor will be scheduled to be a part of the Surgical Intensive Care Unit team to learn more about the pre/post-operative or non-operative care of trauma patients in the ICU. During this rotation, the clinical instructor will participate in multidisciplinary rounds and decision-making in advancing the care of trauma patients.
• The clinical instructor will function in the capacity of a trainee in the SICU under the supervision of the ICU attending.
• It is recommended that the clinical instructor take two overnight in-house calls during the course of this rotation. They will cover both the MICU and SICU overnight under the supervision of an in-house ICU attending.

Sherry Liou, MD, MBA
Assistant Clinical Professor
Program Director of Trauma Anesthesia
Zuckerberg San Francisco General Hospital
University of California, San Francisco
Email: [email protected]