Anesthesiology

Adapted from “DRAFT Program Requirements for Fellowship Education in Obstetric Anesthesiology” (http://soap.org/acgme.php) 

The subspecialty fellow, upon completion of the program, will have achieved & demonstrated a consistent level of expertise & proficiency in:

• Providing & managing anesthetic care of women,
  • at various degrees of risk, during labor & vaginal delivery;
  • undergoing cesarean section, postpartum tubal ligation, dilation & curettage, removal of placenta, and similar procedures;
  • undergoing interventions for conditions threatening maternal or fetal life (ante-/post-partum hemorrhage, placental abruption, cord prolapse, uterine rupture, etc.);
  • with obstetric conditions of early pregnancy;
  • undergoing non-obstetric surgery during pregnancy, non-operative diagnostic and interventional procedures requiring anesthesia, and assisted reproductive technology interventions;
  • undergoing in utero fetal surgery, or ex-utero intrapartum treatment (EXIT) procedures with & without neonatal transfer to extracorporeal membrane oxygenation (ECMO).
• Antenatal evaluation & preparation of both high & low risk parturients, and their fetuses, prior to & after anesthesia.  The fellow will demonstrate mastery of a wide variety of clinical problems that can occur in obstetric patients through appropriate & relevant clinical application, and through communication verbally (with obstetricians, anesthesiology faculty & residents, nurses, other consultants, and with patients) and in writing (consultation notes).
•  Performing, supervising, and teaching the full spectrum of obstetric anesthetic & analgesic interventions, including the relevant underlying context-specific rationale & decision-making, assessment of effectiveness, troubleshooting, and detection & management of complications.  These interventions include, but are not limited to
  • neuraxial labor analgesia (epidural, spinal, combined techniques, intrathecal catheter, patient controlled infusion modalities)
  • non-neuraxial labor analgesia (intravenous and inahaltion [nitrous oxide]modalities),
  • provision of analgesia & anesthesia for spontaneous & operative (e.g. forceps, vacuum) vaginal delivery,
  • elective & emergent cesarean delivery,
  • general anesthesia for cesarean delivery and other procedures,
  • invasive monitors,
  • ultrasound guidance (e.g. transversus abdominus plane block, neuraxial block)
  • antenatal procedures (e.g. external cephalic version, cervical cerclage),
  • epidural blood patch.
• Assessing & managing pregnant women with co-existing illness, including, but not limited to:
  • hereditary or acquired hemostatic disorders: thrombophilias, coagulopathies, drug therapy;
  • morbid obesity;
  • moderate to severe cardiac, pulmonary, renal, endocrine and neurologic disease;
  • infectious diseases (e.g. chorioamnionits, herpes, HIV, etc.).
• Assessing & managing common obstetric conditions (such as preeclampsia, multiple gestation, abnormal fetal presentation, obstetric hemorrhage, pre-term labor and/or delivery), and more broadly, pregnant women who are referred to maternal-fetal medicine specialists for any reason;
• Teamwork, Communicating, & Collaborating
  •  effectively & collegially with all members of the inter-professional care team (anesthesiology, obstetrics, midwifery, nursing, students, residents, faculty, ancillary staff, neonatologists, other relevant consultants, and most importantly, the patient),
  • in a manner that promotes care that is as good as it can be (safe, effective, timely, efficient, equitable, and patient-centered), and
  • in ways that unequivocally demonstrate the value added by the fellow’s contributions as a member of the inter-professional care team.
• Cognitive, affective, and verbal skills essential to learning & teaching, including
  • continuing to develop advanced adult his/her own self-directed learning skills & behaviors,
  • developing, practicing, &improving teaching skills (informal on-the-fly, small group facilitated, formal presentation, assessment, curriculum development, etc.), and
  • demonstrating behaviors consistent with a commitment to inquiry, improvement, and discovery (active participation in teaching, clinical discussions, inter-professional rounds, journal clubs, quality improvement activities, etc.).
• Scholarship of discovery, dissemination, and/or application, in the form of
  • participation in research;
  • publication of review articles, chapters, or commentaries; and/or
  • publication or presentation of case reports/series or medically challenging cases.