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Children's Medical Center Dallas (CMC) is a tertiary care center with 322 beds. It is immediately adjacent to Parkland Health and Hospital System (Parkland), which has a 50 bed neonatal intensive care unit. All neonatal surgical cases from the Parkland neonatal intensive care unit are referred to CMC. In addition, all pediatric surgical subspecialties are represented. There are 18 main operating rooms, 2 active cardiac catheterization sites, and several radiologic sites which may require anesthesia. In a separate physical site, there are 6 ambulatory operating rooms.
Cook Children's Medical Center (CMCC), located in Fort Worth, is a tertiary care center with 254 beds. It adjoins Harris Methodist Hospital and is a very active tertiary referral center for both pediatric and neonatal intensive care from Harris Methodist as well as the surrounding communities. The operating arena includes ten operating rooms and several off-site operating areas including MRI, the cardiac catheterization lab, and other sites within the hospital.
Fellows will complete portions of their training at both Children's Medical Center Dallas and Cook Children's Medical Center. During the first month of training, the fellow will spend two weeks at each of the two institutions. Subsequently, clinical experiences will be completed in 1 to 2 month blocks at one of the two institutions
OVERVIEW
The fellowship program meets all the requirements of the ACGME accreditation process for training in all aspects of pediatric anesthesiology, including cardiac, thoracic, neurosurgery, orthopedics, ENT, plastics, general surgery, and ophthalmology.
CURRICULUM
- One month bi-institutional orientation and cases
- Four months in general operating rooms
- One month neurosurgery
- Two months pediatric cardiac
- One month ICU rotation
- One month of anesthesia for major orthopedic procedures including spine
- One month of "off-site" anesthetic procedures including radiology and cath lab
- One month elective
RESEARCH OPPORTUNITIES
Fellows are encouraged to participate in research activities. Fellows will learn to submit an IRB, organize data collected for clinical studies, and participate in the presentation of a research project in some forum (paper, poster, lecture, or other forum).
DIDACTIC TRAINING
The Pediatric Anesthesiology Fellowship Program is designed to be a one-year program and will consist of a basic didactic curriculum with the goal of training consultant-level pediatric anesthesiologists. The didactic series is an integral part of the clinical and overall program. Afternoon lectures on Tuesdays cover all aspects of pediatric anesthesia. Also, pediatric fellows participate in morbidity and mortality, QI, and business administration conferences.
STAFF
The staff at both facilities consist of pediatric anesthesiology fellowship-trained specialists with experience in cardiac, critical care, and pain management.
Dr. Desmond Henry of CMC oversees the Pediatric Anesthesiology Fellowship Program.
Welcome to your rotation at Children’s Medical Center Dallas. Your experience during this rotation will be directed toward achieving certain goals and objectives. These are intended to assist you in gaining an understanding of this subspecialty, achieving general competencies appropriate for all physicians, and building upon those attributes necessary to become diplomates of the American Board of Anesthesiology.
The following outlined goals and objectives can be met through customary methods, including personal study, fulfilling supervised clinical assignments, and attendance and participation in lectures and case discussions. Formal evaluation at the completion of the rotation will be based on your ability to meet these goals and objectives; therefore, if at any time you think you may be having difficulty, please contact the course director or the director of residency training to discuss possible options for additional assistance.
- MEDICAL KNOWLEDGE
- Attends and participates in lectures, case conferences, journal club meetings, and other scheduled academic activities
- Demonstrates evidence of outside study
- Demonstrates an investigatory approach to and analysis of clinical situations
- Applies basic and clinically supportive sciences to anesthetic management
- Develop a comprehensive understanding of the developmental pharmacological, anatomic, physiologic, and psychological changes that occur with age and disease.
- PATIENT CARE
- Preoperative Evaluation: A comprehensive and concise preoperative evaluation provides the critical information necessary to develop an appropriate plan of anesthetic management as well as to anticipate potential problems and prepare contingency plans. It also provides the opportunity to discuss anesthetic options and plans with the patient and patient’s family, and answer any questions.
- Completes a thorough and concise preoperative evaluation in a timely manner
- Uses available information technology, such as computerized laboratory reporting, to obtain pertinent information
- Identifies and prioritizes medical and anesthetic concerns
- Identifies need for further medical work up or medical optimization prior to providing anesthesia
- Explains anesthetic options and plan to patient and family members and answers questions in a clear and respectful manner
- Verbally presents a clear and concise preoperative evaluation to supervising faculty
- Identifies need for and orders appropriate preoperative medication
- Development of Anesthetic Plan
- Develops and is able to justify an anesthetic plan based on preoperative evaluation, accurate and current scientific information, standards of care, clinical judgement, and patient preference if applicable
- Anticipates potential problems and develops contingency plans
- Verbally presents a clear and concise anesthetic plan to supervising faculty
- Intraoperative Anesthetic Management
- Adequately prepares the anesthetic setting, including machine and equipment checks and availability of emergency/resuscitative drugs
- Performs procedures on awake patients in a manner that addresses patient comfort without compromising patient safety
- Effectively implements the anesthetic plan, while demonstrating the ability to adapt to changing clinical conditions
- Demonstrates technical skills in pediatric airway management
- Demonstrates proficiency in clinical/technical skills, including intravenous catheterization, direct laryngoscopy, fiberoptic intubation, placement of laryngeal mask airway, regional and neuraxial anesthetic techniques, and placement of invasive monitoring such as an arterial catheter, central venous catheter and pulmonary artery catheter.
- Demonstrates an understanding of the risks, benefits, and indications for regional anesthesia and for invasive monitoring
- Develops the knowledge and skills necessary to interpret data from invasive monitors, along with how to use this data in clinical decision-making
- Interacts with members of other medical specialties or other health care teams effectively as an anesthesiology consultant for the purpose of providing patient-focused care
- Postoperative Care
- Demonstrates an understanding of common problems occurring in the Post-Anesthetic Care Unit (PACU), including pain, hemodynamic and respiratory derangements, and postoperative nausea and vomiting, and demonstrates knowledge of appropriate treatment options
- Demonstrates proficiency in providing cardiopulmonary resuscitation
- Demonstrates an understanding of clinical criteria for discharge from PACU
- PRACTICE-BASED LEARNING AND IMPROVEMENT
- Critically reviews and discusses current publications on topics pertaining to the practice of anesthesiology and medicine in general
- Assimilates into clinical practice new advances upheld by current peer-reviewed literature
- Demonstrates an understanding of how to use various technological resources, such as computerized medical databases, to obtain current information
- INTERPERSONAL AND COMMUNICATION SKILLS
- Speaks in a clear and concise manner
- Maintains appropriate eye contact
- Conveys respect for others and displays an appropriate degree of confidence
- Engages in therapeutic and ethically sound relationships with patients
- Uses effective listening skills
- Interacts effectively with members of other medical specialties or health care teams
- PROFESSIONALISM
- Demonstrates integrity, compassion and respect for others
- Demonstrates responsiveness and accountability to patients, society and the medical profession
- Demonstrates a commitment to ethical principles pertaining to patient care as well as business practices
- Demonstrates sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
- Demonstrates a commitment to excellence and continuing professional development
- SYSTEMS-BASED PRACTICE
- Demonstrates an understanding of the different types of medical practice and health care delivery systems
- Practices cost-effective health care and resource allocation that does not compromise quality of care
- Advocates quality health care and assists patients in dealing with complex health care delivery systems
- Works with other members of the health care delivery team to improve health care and health care system performance
CLINICAL ROTATIONS
- Pediatric ICU (one month)
- Ventilator management
- Medical management of complex preoperative problems
- Medical management of complex postoperative problems
- Cardiac anesthesia (2 months)
- Invasive monitor placement
- Inotropic support
- Cardiovascular physiology and pathophysiology
- Pain (optional 1 month)
- Diagnosing chronic pain issues in pediatrics
- Acute postoperative pain management in pediatrics
- Neurosurgery (1 month)
- Intracranial physiology
- Neuropharmacology
- Case specific management
- Neonatal ICU (1 month)
- Newborn physiology
- Neonatal pharmacodynamics and pharmacokinetics
- Neonatal procedures (UAC, UVC)
- ECMO-indications, complications, management
- HFJV and HFOV ventilator management
- General Surgery (4 months)
- Neonatal surgical lesion management
- Pediatric emergency surgical lesion management
- Airway management
- Venous Access
- Arterial Access
- Regional pain management techniques
- Outpatient surgery center (2 months)
- Outpatient surgery candidacy
- Outpatient surgery discharge criteria
- Perioperative efficiency
- Outpatient surgery center administrative issues
- Cardiac cath lab and other out or OR experience (1 month)
- Cardiac anatomy (fluoroscopic, angiographic)
- Anesthetic management issues in cath lab
- MRI
- CT Scan
- Conscious sedation
- Off-site anesthetic management issues
- Spine surgery (1 month)
- Neurophysiologic monitoring
- Anesthetic implications of neurophysiologic monitoring
- Controlled hypotension-objectives, management, pitfalls
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Pediatric Anesthesia Fellowship 
