Residency in Anesthesiology at Northwell Health
Curriculum & schedule
The Anesthesiology Residency Training Program at Northwell Health consists of a clinical base year and three years (36 months) of clinical anesthesia. The majority of the program is provided at North Shore University Hospital and Long Island Jewish Medical Center (including Cohen Children’s), with required one-month assignments at Long Island Jewish Valley Stream and Syosset Hospital. All institutions are member hospitals of the health system.
The Clinical Base Year (CBY) is designed specifically to give residents a strong foundation in clinical medicine and prepare them for the advanced three year continuum in anesthesiology. Nine of the 12 months are spent on the internal medicine service as fully integrated members of the internal medicine team. An additional two months will be spent rotating in the surgical intensive care unit and one month will be dedicated to emergency medicine.
The CA-1 year emphasizes basic and fundamental aspects of the management of anesthesia. During July and August, CA-1 residents attend a daily lecture series designed to introduce basic concepts, techniques, monitoring, record keeping, and formulation of the anesthetic plan. The simulation lab is used frequently to enhance the clinical and didactic learning experience. Most of the CA-1 year is spent in basic anesthesia training, and residents will become proficient at managing routine cases as well as more complex cases in patients with significant co-morbidities. The remaining time will be devoted to the following four week subspecialty rotations:
Preadmission testing — The goal of this rotation is to gain experience in the important areas of preoperative assessment. The resident, with faculty consultation and supervision, will determine which preoperative tests and/or consultations are indicated and discuss the anesthetic options, risks and benefits with the patients and their families. Over 30,000 patients are assessed in the PAT units annually, giving residents the opportunity to evaluate a culturally and medically diverse patient population scheduled for a wide variety of surgical procedures.
Acute pain management — The acute pain experience encompasses adult and pediatric inpatient care using oral analgesics, intravenous, neuraxial and perineural drug infusions. The daily census approaches 100 patients, and includes management of postoperative pain as well as acute pain secondary to trauma and sickle cell crisis.
Obstetric anesthesia — Residents are part of a multidisciplinary team that cares for both routine and high risk parturients in the busiest obstetrical centers in New York State. Over 4,000 cesarean sections are performed and 6,600 labor epidurals are placed each year in the North Shore University Hospital and Long Island Jewish Medical Center’s labor and delivery suites. Residents will complete their first four week rotation at Long Island Jewish Medical Center. The requirement is completed at North Shore University Hospital in the CA-2 year.
Pediatric anesthesia — Cohen Children’s Medical Center performs over 10,000 surgical cases each year. Residents will have the opportunity to manage cases in all subspecialty areas of pediatric surgery, including neurosurgical and cardiac procedures. Additional pediatric experience is available in two on-site freestanding ambulatory surgery centers, where residents master a variety of regional anesthetic techniques in this patient population. The first four week rotation is offered in the CA-1 year, and residents complete this requirement in the CA-2 year.
Post anesthesia care unit — The PACU resident, under the supervision of the PACU Director, will be responsible for the initial postoperative evaluation and care of the patient from admission until discharge. Cases throughout the day widely range in complexity from a straightforward monitored anesthesia care case that will stay in the PACU for an hour to a critically ill patient who may require mechanical ventilation and hemodynamic support. The PACU resident also carries the code beeper and responds to airway emergencies throughout the hospital.
Residents in the CA-2 year gain experience in the subspecialty areas of anesthesia, which emphasize the theoretical background, subject material and practice of subdisciplines of anesthesiology. Many of the required subspecialty rotations are continued or completed during the CA-2 year, and include:
Cardiac Anesthesia — Residents will participate in both routine and complex adult and pediatric cardiac procedures, including coronary artery bypass (both on and off-pump), valve replacement procedures, minimally invasive cardiac surgery (including valve repair), robotic heart surgery, and thoracic aneurysm surgery. Training experience also includes clinical and didactic instruction in transesophageal echocardiography.
Neurosurgical Anesthesia — This rotation encompasses both interventional radiologic and surgical based treatment of brain and nervous system disorders. These include intracranial aneurysm and arteriovenous malformations, brain tumors, stereotactic neurosurgery, functional and restorative neurosurgery (including surgical treatment of movement disorders and placement of deep brain stimulators), extensive skull based surgery with utilization of intra-operative MRI, minimally invasive endoscopic pituitary surgery, surgery for the treatment of seizure disorders, cortical mapping of awake patients with complex lesions, the surgical treatment of Chiari Malformation, and an extensive array of advanced spinal surgical procedures.
Critical Care Medicine — Residents will spend one month caring for patients in the Pediatric Intensive Care Unit after they have completed both four week required rotations in pediatric anesthesia.
Thoracic Anesthesia — Through a variety of non-cardiac thoracic procedures on the lungs and mediastinal structures, residents acquire expertise in various lung isolation techniques using double lumen endotracheal tubes, bronchial blockers, Univent tubes, and fiberoptic bronchoscopy as well as placement of thoracic epidural catheters for postoperative pain management.
Regional Anesthesia — Residents perform a large number and variety of peripheral nerve blocks and neuraxial techniques for both operative anesthesia and postoperative pain management utilizing ultrasound guidance and nerve stimulation. Hands-on experience at the Bioskills Cadaveric Lab at the Northwell Health Center for Learning and Innovation supplement this rotation.
Resident assignments in the CA-3 year will include the most difficult or complex anesthetic procedures and care of the most seriously ill patients. CA-3 residents work with the Program Director to create a rotation schedule based on individual interests and needs. Additional rotations offered include:
Major Vascular — These cases cover the entire range of open and endovascular reconstruction including treatment of aneurysms of the aorta (both open and minimally invasive endovascular techniques), thoracic endovascular aortic repair (requiring cerebrospinal fluid drain placement), carotid endarterectomy (with use of intraoperative electroencephalogram monitoring), and carotid stenting. Residents acquire the psychomotor and cognitive skills necessary to manage complex patients with multiple co-morbidities requiring invasive hemodynamic monitoring and stabilization.
Advanced Airway Management — Our department provides anesthesia for over 5,800 ear, nose, and throat procedures annually including thyroid and parathyroid surgery, skull base surgery, treatment of airway papillomas, facial plastic and reconstructive surgery, head and neck oncology, uvulopalatopharyngoplasty, and sinus and nasal surgery. In addition, the Department of Oral and Maxillofacial Surgery performs a variety of complex surgical procedures on the airway including orthognatic, reconstructive, temporomandibular joint and surgery for maxillofacial trauma and infection. Residents manage a wide variety of complex airway abnormalities and emergencies and utilize advanced airway management techniques including awake oral and nasal fiberoptic intubation, intubating LMA, multi-modal video laryngoscopy, and jet ventilation to manage these cases.
Critical Care Medicine — Residents will spend one month caring for patients in the Neurosurgical Intensive Care Unit after they have completed both four week requirements in neurosurgical anesthesia.
Ambulatory Anesthesia — Residents will master the delivery of efficient, cost effective patient care that minimizes risk and maximizes patient safety in two free standing ambulatory surgery centers where over 15,000 cases, encompassing general surgery, plastic surgery, otolaryngology and pediatric surgery, are performed annually.
Chronic Pain Management — This one month rotation at Syosset Hospital provides residents with the opportunity to treat patients with chronic and cancer related pain using the most advanced treatment options including peripheral nerve blocks, epidural steroid injections, intravenous infusion therapy, and placement of spinal cord stimulators, intrathecal infusion devices, nucleoplasty, radiofrequency ablative techniques and intra-discal electrothermal therapies. In total, over 7,000 interventional pain management procedures per year are performed at this facility.
Residents will also have the option of applying for an advanced research track, allowing them to perform six uninterrupted months of full time research during their elective time in the CA-3 year of training. Other electives offered include Pediatric Cardiac Anesthesia, TEE, and advanced rotations in any of the core subspecialty rotations listed above.
Medical student clerkship
The Department of Anesthesiology offers a four-week elective designed to provide an in-depth introduction to Anesthesiology for fourth-year students. Each student will work one-on-one with an attending Anesthesiologist. Special emphasis will be placed on clinical skills with progressive responsibility assigned to each student. Exposure to many sub-specialty areas including Obstetric, Pediatric, Neurosurgical and Cardiovascular Anesthesia are available to meet individual interests. Students will be involved in preoperative evaluation, preparation of patients for anesthesia and surgery, choice of anesthetic agents and techniques, airway management, physiologic alterations relating to surgery and the patient's medical condition, pharmacology of the drugs used by anesthesiologists, and common techniques in regional anesthesia. In addition to clinical activities, the student is required to attend and participate in weekly departmental Grand Rounds, Morbidity and Mortality, and Quality Improvement conferences.
Zucker School of Medicine is using the Visiting Student Application Service (VSAS) to receive visiting student applications for the 2018-2019 academic year. This service is available to MD students enrolled in a U.S. LCME accredited school.
To apply, please complete and send us a VSAS application with your preferred dates.
For specific questions about this clerkship, please contact the Student Coordinator in the Department of Anesthesiology.
Bioskills Education Center
Northwell Health is home to one of the largest fresh frozen cadaveric laboratories in the country. The 6,200 square-foot facility is a laboratory that resembles an operating room and includes a contemporary classroom with advanced audio-visual conferencing capabilities. This invaluable resource provides residents with many experiential learning opportunities including placement of ultrasound guided peripheral nerve blocks, invasive airway management techniques, and procedures for the treatment of acute and chronic pain syndromes.
The Northwell Health Center for Learning and Innovation (CLI) is now the second largest facility in the country devoted exclusively to medical simulation and patient safety. The simulation lab includes PC-based interactive, high fidelity, digitally enhanced mannequins, and partial and full body task trainers, including TEE simulation. Full-scale patient simulators, including SimMan, SimBaby, TraumaSim, Noelle for managing obstetric emergencies, and Hal 3000 Mobile Team Trainer will help residents diagnose and manage clinical problems. Training scenarios replicate situations in the environments anesthesia residents are taught such as the critical care unit, emergency department, operating room, and labor and delivery suite. Simulation is scheduled at frequent intervals throughout the academic year to supplement both clinical and nonclinical instruction.
The Feinstein Institute for Medical Research is the research branch of Northwell Health and is headquartered in Manhasset, NY. The Institute is composed of more than 1,500 clinicians, scientists and staff who work in laboratories and clinical research programs in collaboration with clinicians and patients throughout the many facilities of Northwell Health. Every year, more than 15,000 patients and volunteers participate in over 2,000 research studies. Residents interested in research may participate in any of the ongoing research projects in the department, or develop one of their own under the guidance of a research mentor. Qualified residents may also submit an application for the advanced research track during the CA-2 year to perform up to six uninterrupted months of full time research during their elective time in the CA-3 year.