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Preoperative Clinic

Second-year students spend one month in the preoperative clinic at Memorial Hermann- Texas Medical Center in Houston, Texas. Memorial Hermann is one of only two Level I trauma centers in Houston and is also associated with Memorial Hermann Heart and Vascular Institute. This hospital provides exceptional care in heart, neuroscience, orthopedics, women's health, general surgery, and organ transplantation, allowing our students to be directly involved in patient care at the preoperative clinic.

A typical day begins at 8:00 AM.. Students arrive at the preoperative clinic and meet with the resident and intern scheduled to work in the clinic for the month as well as the anesthesiologist running the clinic for the day. About 20 to 25 patients are listed on the schedule. The nursing staff in the clinic gathers all of the proper paperwork (EKGs, ECHOs, stress tests, laboratory values, past anesthesia records, etc.) prior to the anesthesia team assessing the patient. Students learn how to evaluate a variety of patients ranging from pediatrics, cardiac, bariatric, and much more. By allowing students to interview these patients, students are able to learn about various surgeries, numerous disease processes, and common medications. In addition, students learn how to direct their questions for certain patients and surgeries. For instance, students learn how to access exercise tolerance for cardiac patients. By understanding how to mold preoperative evaluations for particular patients, students are able to help determine if these patients should proceed with their scheduled surgery. Once students complete an evaluation, they discuss the patient with the anesthesiologist. The anesthesiologist then reviews the evaluation, looking for any additional information that may be needed, orders additional tests, and answers any questions from the student. By rotating through the preoperative clinic, students have the opportunity to work with a variety of medical staff, while learning about numerous subspecialties.

Simulation Lab

Simulation lab is a required course every semester. During the first year of the program, students are scheduled to have simulation lab once weekly. A schedule is given to students at the beginning of the semester listing the topics that will be covered each week. The initial topics are very basic and general, allowing first year students to grasp these important concepts prior to beginning clinicals. Such topics include IV placement, anesthesia machine checkout, bag mask ventilation, LMA placement, intubation, induction, and emergence. The labs eventually become more involved and difficult. During the second year, students will be expected to run a full case independently, frequently encountering clinical emergencies ranging anywhere from a pneumothorax to cardiac tamponade. By rotating through the preoperative clinic, students have the opportunity to work with a variety of medical staff, while learning about numerous subspecialties.

During simulations labs, two instructors are present—one will run the lab in a separate control room and another will act as both the attending and surgeon. The labs are fully equipped with a mannequin, which has numerous capabilities such as crying, coughing, having a bronchospasm, mimicking a difficult intubation, and fasciculating. There is also a complete anesthesia machine, airway equipment, and a video camera to record students. All students are given a brief synopsis of the patient prior to the case. They are told the patient’s age, weight, major health issues, medications, allergies, and why the patient is having surgery. Students are expected to manage induction, verbally stating how much of each drug to give and communicating with the mannequin as if a real patient. Simultaneously, with a microphone located in the mannequin, the instructor in the control room repeats the student’s drug dosages as confirmation. The instructor also alters vitals and breathing patterns accordingly. Once induction is complete and the “attending” is no longer needed, the student will continue to manage the case, while this instructor changes roles and acts as a surgeon, taking notes on the student’s performance.

Simulation labs range from 30 to 45 minutes. Once each student finishes the lab, a debriefing takes place where students explain their rationale for making their decisions and the instructors provide feedback and advice for bettering their future performance. Simulation lab has become a vital aspect of the CAA curriculum because it places students in real-life, difficult situations that they will potentially face in the OR. These labs greatly prepare students for beginning clinicals in the first year as well as for major specialty rotations in the second year.

Ambulatory: Lubbock

The opportunity for second-year students to complete their ambulatory rotation at Grace Medical Center (GMC) in Lubbock, Texas has provided students with a vast array of experiences. A typical day begins around 6:30 AM.. Students are expected to set up the room they were assigned to the night before the case begins. Patients arrive to the holding area at 7:00 AM,and the students perform preoperative evaluations. Almost all cases involve general anesthesia. Typical surgeries include spinal decompressions and fusions, hysterectomies, knee replacements, and hip replacements. For the majority of gynecological procedures, an epidural or spinal is placed. In addition, most knee replacements involve placement of a femoral nerve block. Students are given the opportunity to place all of the above blocks, a tremendous highlight of this rotation.

Students work directly alongside anesthesiologists who also work at Lubbock’s cardiac hospital. These knowledgeable doctors give students immense responsibilities, allowing students to essentially run full cases while under their supervision. Although GMC is a relatively small hospital with four operation rooms, the opportunities provided to students and the welcoming manner of the entire staff from this small town hospital make this rotation extremely rewarding and enjoyable.

Children’s Medical Center – Dallas, TX

U.S. News & World Report consistently ranks Children’s Medical Center of Dallas as one of the nation’s top pediatric hospitals. Not only is Children’s the only full-service pediatric level I trauma center in North Texas, but it is also a major kidney, liver, intestine, heart and bone marrow transplant center. Throughout the two month rotation at Children’s, students aid in the care of neonates, infants, toddlers, and children with congenital diseases and defects that are rarely seen or treated at other pediatric facilities throughout the nation.

A normal day begins the evening before, when students review the electronic record of the patients for their assigned cases the next day. Students then contact the attending and construct an anesthetic plan for each case. At the hospital the next morning, students setup the room with appropriate sized endotracheal tubes/LMAs, drugs, and other equipment. Afterwards, the students meet their patient and their legal guardian in the holding area and perform an exam and history. This is often the best time to establish a relationship with the patient, in hopes to gain their trust (and also their parents’) and put them at ease. Once in the operating room, gas-induction is typically performed by mask followed by IV access and intubation.

During this rotation, students care for patients weighing only a couple of kilograms to adult-sized teenagers. Cases range from mask-only ENT cases to pyloromyotomies to complex Tetralogy of Fallot and TEF surgical repairs. Students learn to manage laryngospasm and bronchospasm, asthma and croup, and the art of deep extubation. Students will be presented with new challenges each day during this rotation. With the help and guidance of the extraordinary attendants, the pediatric rotation proves to be a rewarding experience for our students.

Texas Children’s Hospital

As is the case with many other rotations, students receive information about their cases at Texas Children’s Hospital the night before surgery. After thoroughly researching each surgery and determining the anesthesia needed for each case, the student contacts the attending who will evaluate their assessment and request specific equipment, drugs, and resources needed in the operating room.

The day begins at 5:30 AM with the operating room set-up, machine checks, and other forms of preparation.. At 6:15 AM, students attend the morning lecture series put on by attendings and fellows. The lecture series schedules are emailed a week in advance so student’s have the opportunity to participate in the lecture.

At seven o’clock, the lecture ends and students visit their first patient. The student generally encounters their young patient in the main OR’s pre-op holding or the outpatient OR’s holding. These brightly colored areas are outfitted with toys, wagons, books, a fish tank, and comfortable seating. The fun atmosphere creates a reassuring environment for the child, making pre-op medicines often unnecessary.

After recording initial pre-op data of the patient, students discuss the child’s health with the parents and assess the patient. Each patient meets with a Child Life Specialist prior to the OR, which puts many of the children at ease and offers the child an important opportunity to choose one of the million flavors they have for the mask.
All of the TCH employees strive to offer students a rewarding clinical experience, often patiently guiding the student to perform tasks in the OR. It is an incredibly efficient hospital that sees a large volume of patients with varying levels of acuity. The bright atmosphere at TCH is so positive that it is non-threatening for the children and refreshing for those providing care.

Memorial Hermann Hospital – Texas Medical Center (Neuroanesthesia Rotation)

During the month-long neuro rotation , students typically work with a resident and an attending anesthesiologist. There are two shifts available—a morning shift that begins at approximately 6:00 AM and ends around 2:00 PM and an evening shift that begins at 2:00 PM and ends at 9:00 PM. The set-up for these cases is often time-consuming, yet this is a necessary preparation that will ensure the success and ease of the pending surgery.

Students will experience different cases during this rotation including craniotomies for tumor resection, craniotomies for aneurysm clipping, VP shunt placements, aneurysm coiling, and spine cases like fusions, decompressions, discectomies. The type of case determines the set up. A spine case may need nerve monitoring that requires a change in anesthetic management because certain anesthetics and drugs affect the results. An aneurysm clipping necessitates maintaining a certain cerebral perfusion pressure to prevent neurologic damage and facilitate better outcomes for the patient. This requires very close monitoring of blood pressures using an arterial line and several different medications.

After set up is complete, students visit the patient in the pre-op holding area to conduct an initial interview with the child and the parents. Once in the operating room, monitors are placed on the patient, like a non-invasive blood pressure cuff, EKG leads, and pulse oximeter. Preoxygenation, induction, and intubation follows. Next, lines such as larger IVs and/or central line are placed on the patient for better access and infusions, and arterial lines to monitor blood pressures in real time. The patient is then positioned to optimize access for the surgeons. After double-checking that everything is set, it is time to start the case.

The Neuro rotation provides students with an intense experience. By the end of the month, students will have improved their clinical skills, understanding of anesthesia practices, and confidence in managing difficult cases.

Washington Hospital Center (Obstetric Anesthesia Rotation)

A typical day starts at 7:00 AM , but students are encourage to arrive 15 to 30 minutes early to get updated on the previous evening’s events from the overnight anesthetist. After this briefing, students prepare the ORs, ensuring that the machines, equipment, monitors, and emergency drugs are ready in the event of an OB emergency. The epidural carts used for laboring patients are also checked to make certain that they are fully stocked and equipped with emergency drugs as well. These responsibilities are usually shared with the SRNA (Student Registered Nurse Anesthetist) and senior residents (CA-3) who are also rotating for the month.

At 8:00 AM, students meet with other members of the OB staff to discuss the scheduled cases. Cases for the day may include scheduled Cesarean sections, cerclage placements, tubal ligations, and the occasional emergent C-section. The caseload is divided, giving each individual a turn to manage his or her own case. In between cases, members of the OB staff will place labor epidurals , evaluate new patients, follow-up with post-operative patients and attend to laboring patients with active epidurals that need to be checked. The day ends around 7:00 PM after the night anesthetists is briefed on the day’s activities, pending epidurals, and upcoming cases.

The AA-S will always work either one-on-one with the attending, senior resident, or CAA for all procedures. As the month progresses a great deal of autonomy is entrusted, allowing for considerable growth as an anesthetist. The OB rotation provides students with an excellent experience, allowing them to interact with and take care of an entirely different patient population and work in a unique clinical situation. During this rotation, the days can be busy and long, but students are rewarded with the satisfaction that they are helping mothers-to-be feel more comfortable and participating with families in welcoming a brand new person into the world.

Houston is the fourth-largest city in the United States of America, and the largest city in the State of Texas, with an estimated population of 2.1 million people. Houston is the seat of Harris County and the economic center of the fifth-largest metropolitan area in the U.S. with over 6 million people.

Houston was founded in 1836 by brothers Augustus and John Allen on land near the banks of Buffalo Bayou, now known as Allen’s Landing and incorporated into the Republic of Texas and served as its capital from 1837 to 1840.The city is named after General Sam Houston, who led the Texas Army to its victory over General Santa Anna's Mexican forces at the 1836 Battle of San Jacinto.

The burgeoning port and railroad industry, combined with oil discovery in 1901, has induced continual surges in the city's population. In the mid-twentieth century, Houston became the home of the Texas Medical Center - the world's largest concentration of healthcare and research institutions—and NASA's Johnson Space Center, where the Mission Control Center is located.

Rated as a global city, Houston's economy has a broad industrial base in energy, manufacturing, aeronautics, and transportation. It is also leading in health care sectors and building oilfield equipment; only New York City is home to more Fortune 500 headquarters.

The city has a population from various ethnic and religious backgrounds and a large and growing international community. It is home to many cultural institutions and exhibits, which attract more than 7 million visitors a year to the Museum District. Houston is one the few cities with permanent ballet, opera, symphony and theater companies. There are more than 30 museums, 500 parks, 100+ golf courses, 60 movie theaters and over 8,000 restaurants.