Desired qualities in a candidate 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 underserved and diverse trauma populations. An enthusiasm for teaching and mentoring junior trainees. Structure of the Fellowship The Trauma & Acute Care Surgery Anesthesia Fellowship is a 12-month clinical, non-ACGME accredited fellowship. Fellows will be employed by UCSF as a Clinical Instructor and work an average of three days per week as an Attending Anesthesiologist to provide salary support. 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. Goals 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 Call - All calls are compensated in line with the current ZSFG Anesthesia compensation plan. Trauma call - The Fellow will take the equivalent of two 12-hour in-house ‘weekend trauma fellow calls’ per month. This shift will be either Friday night or Saturday night. During this shift, the Fellow will be supervised by the D1/night attending for any trauma cases. The scheduling of these weekend call shifts is at the Fellow's discretion with approval by the Program Director. The goal is for the Fellow to be exposed to trauma and acute care specific cases during these calls. Back-up call - The Fellow 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 the Fellow’s opportunities to be exposed to relevant clinical incidents, the Fellow will be called early as part of the ZSFG disaster management tree: This backup is a non-mandatory call back, but if the Fellow is available and within 30-minutes of the hospital, it is highly encouraged that the Fellow respond. If activated in this capacity, the Fellow will be compensated in line with the current ZSFG compensation plan. When on-site, the Fellow 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 Fellow's participation in trauma OR cases when possible. Completion of at least one trauma anesthesia-related quality improvement, education, or research project The Fellow is expected to identify a project they are interested in pursuing within the first month of their fellowship, and throughout the course of their fellowship provide monthly reports of their progress to the program director. The Fellow 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 Fellow should plan to present their QI or research project to the department at the end of their fellowship, 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 fellow 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 Fellow 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. Fellows 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 Fellow 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, DEI, 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. Electives The Fellow can request additional electives based on their clinical interests. Currently available electives include those listed below. However, if the Fellow has any particular interests that are not included below, these can be discussed with the Fellowship Director prior to the commencement of the fellowship year: Pediatric trauma rotation at Children’s Hospital in Oakland (strongly recommended) The Fellow 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 Fellow 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 & Regional Anesthesia in Trauma The Fellow 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 Fellow 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 Fellow will participate in multidisciplinary rounds and decision-making in advancing the care of trauma patients. The Fellow will function in the capacity of a trainee in the SICU under the supervision of the ICU attending. It is recommended that the Fellow 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.
