trauma anesthesia

[2win]

Just a simple question - I was browsing the UW fellowship programs (to see if Cahana or Prescott is the chief in pain medicine...) and I saw the trauma anesthesia fellowship there.
http://depts.washington.edu/anesth/training/fellows/trauma.shtml

Doesn't look very appealing ( I can be wrong) if they pay the fellow as a pg5...
What's the reason for a fellowship in trauma anesthesia?
IMO most of the programs should prepare you more than enough for that...
Could be something to put in your CV for an academic career?
And IF - why not CCM, pain or CT?
I feel that they are looking for cheap labor there..
Any insights?
Thank you,
2win

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[nap$ter]

Just a simple question - I was browsing the UW fellowship programs (to see if Cahana or Prescott is the chief in pain medicine...) and I saw the trauma anesthesia fellowship there.
http://depts.washington.edu/anesth/training/fellows/trauma.shtml

Doesn't look very appealing ( I can be wrong) if they pay the fellow as a pg5...
What's the reason for a fellowship in trauma anesthesia?
IMO most of the programs should prepare you more than enough for that...
Could be something to put in your CV for an academic career?
And IF - why not CCM, pain or CT?
I feel that they are looking for cheap labor there..
Any insights?
Thank you,
2win

i think this may be true. the new chair is pounding for all sorts of new custom "fellowships"; and isn't very transparent about the financial advantages obviously posed for the department...

couple other things - there is NO cardiac at HMC - only one attg out of all of 'em is TEE certified - they have a pump but it gathers dust and gets used maybe once every two months. also, not sure how much trauma rotating on the pain service at HMC would garner - that service is full of LE block catheters for ELECTIVE knee, ankle, and foot surgeries..

personally, i don't know who would go for that fellowship.. you could get the same experience for way more pay working as an attending at HMC... and if you wanted to fellowship, as 2win says, you should just do CCM, pain, or CT. i don't really think trauma anesthesia is complicated enough to justify a fellowship...

 

[2win]

i think this may be true. the new chair is pounding for all sorts of new custom "fellowships"; and isn't very transparent about the financial advantages obviously posed for the department...

couple other things - there is NO cardiac at HMC - only one attg out of all of 'em is TEE certified - they have a pump but it gathers dust and gets used maybe once every two months. also, not sure how much trauma rotating on the pain service at HMC would garner - that service is full of LE block catheters for ELECTIVE knee, ankle, and foot surgeries..

personally, i don't know who would go for that fellowship.. you could get the same experience for way more pay working as an attending at HMC... and if you wanted to fellowship, as 2win says, you should just do CCM, pain, or CT. i don't really think trauma anesthesia is complicated enough to justify a fellowship...

Obviously you know much more than me...
Really - why a trauma fellowship???
Soon a GI one? For colonoscopy sedation?
I am aware of all the buzz - society of trauma anesthesia and conferences and so on..
Just to keep some program directors happy???
Indulging themselves with an additional degree in "trauma anesthesia"?
So let's start one for 'bariatric surgery"!
Send please the applications pm. LOL

 

[hoyden]

Just a simple question - I was browsing the UW fellowship programs (to see if Cahana or Prescott is the chief in pain medicine...) and I saw the trauma anesthesia fellowship there.

2win

You meant Trescot, right?

 

[sevoflurane]

I also feel that any decent residency should incorporate a good amount of trauma. It was very annoying hearing that beeper go off all night long... run down to the trauma bay for the 6th time of the night to handle all the crazy crap that came in- crazy peds included. Open chest cardiac massage, GSW to the trachea, heart and lungs, crush injuries, etc, etc... Those have been some of my most memorable cases.

The trauma bay is a good place to learn- a lot. Won't forget the 4 month, 8 month and 11 month stat calls to the trauma bay- all three in cardiac arrest due to carbon monoxide poisoning... at midnight. OB resident busy. So it was two senior residents a junior and an attending.... You learn how to divide and conquer. You won't get that type of experience if your residency can't provide it.

If you are going to be at a hospital that handles this kind of stuff on a regular basis, and have not had this experience, you may consider something like a trauma fellowship. However, it is a good way to get cheap labor... no matter how you dice it up. Best bet... pick a good residency with a good amount of trauma. It makes your calls a lot more demanding, but it makes you much more experienced once you get out. If B&B is what you wan't in PP, then not necessarily a must.

Plank.. you are from Jackson Memorial right? Good place to do trauma if you are to do a trauma fellowship of some sort.

 

[urge]

I feel that they are looking for cheap labor there..

I concur. People with tainted CVs tend to apply for those.

 

[Noyac]

Back when I was in residency these types of fellowships (peds included) were for residents that were graduating but could not land a job. They typically were the poorer residents. It was not uncommon to see people with 1-3 fellowships that were awful and spoke poor english.

 

[dhb]

Back when I was in residency these types of fellowships (peds included) were for residents that were graduating but could not land a job. They typically were the poorer residents. It was not uncommon to see people with 1-3 fellowships that were awful and spoke poor english.

Are you baiting Mil to post back here 😉

 

[Noyac]

Are you baiting Mil to post back here 😉

No, but if I were this would undoubtedly do it.

 

[2win]

You meant Trescot, right?

Sorry for misspelling - yes.

 

[IlDestriero]

If someone wants trauma experience, they can just get a job at a real major trauma center (USC, Maryland, etc.). You'll make 5x the money and have full benefits, retirement, perks, vacation, etc.
Upon arrival, seek out the faculty with the greyest hair and ask lots of questions. Everyone wants the junior faculty members to succeed.
When you can't take it anymore, quit and move on to a better job. You'll leave an expert in trauma with a new Benz and a down payment on your new house.
I can't imagine why ANYONE would be interested in a trauma fellowship. I have an interest in pediatric trauma. It's not rocket science. Airway, access, blood products, work the labs. Arrive in PICU with a perfect bloodgas and coags. NEXT!
Regards,

 

[Noyac]

If someone wants trauma experience, they can just get a job at a real major trauma center (USC, Maryland, etc.). You'll make 5x the money and have full benefits, retirement, perks, vacation, etc.
Upon arrival, seek out the faculty with the greyest hair and ask lots of questions. Everyone wants the junior faculty members to succeed.
When you can't take it anymore, quit and move on to a better job. You'll leave an expert in trauma with a new Benz and a down payment on your new house.
I can't imagine why ANYONE would be interested in a trauma fellowship. I have an interest in pediatric trauma. It's not rocket science. Airway, access, blood products, work the labs. Arrive in PICU with a perfect bloodgas and coags. NEXT!
Regards,

Is that you Zip?

 

[IlDestriero]

Is that you Zip?

Nope. Is that a good thing?

 

[2win]

Great post !!!

 

[Frank Rizzo]

If someone wants trauma experience, they can just get a job at a real major trauma center (USC, Maryland, etc.). You'll make 5x the money and have full benefits, retirement, perks, vacation, etc.
Upon arrival, seek out the faculty with the greyest hair and ask lots of questions. Everyone wants the junior faculty members to succeed.
When you can't take it anymore, quit and move on to a better job. You'll leave an expert in trauma with a new Benz and a down payment on your new house.
I can't imagine why ANYONE would be interested in a trauma fellowship. I have an interest in pediatric trauma. It's not rocket science. Airway, access, blood products, work the labs. Arrive in PICU with a perfect bloodgas and coags. NEXT!
Regards,

It is a zippy-esque post.... right down to the 'regards' signoff

 

[periopdoc]

A little insight into the trauma fellowship. It predates the current chair and her drive for "mini fellowships" by several years. Neither was it developed for cheap labor, there is too little time spent billing in the OR for that to be the case. It is designed for people who want to study and develop trauma systems with a special focus on provision of pre-hospital care and integration with pre-hospital systems.

We have a unique geographical trauma system here. Harborview is the only Level 1 trauma hospital providing care for the five state area of Washington, Wyoming, Alaska, Montana, and Idaho. Additionally, we have transfers of US citizens from the Western Canadian Provinces. This huge geographic area presents special challenges that you are unlikely to experience at any other institution.

It is not uncommon to coordinate multiple transfers of patients of >500 miles during an ER shift while at the same time providing initial triage and resuscitation of a wide variety of blunt and penetrating trauma.

The fellowship director has been in place for longer than our chair, and he is all about improving and increasing the anesthesiologist role in comprehensive trauma care from the field to the floor.

IMHO if you are looking for is training in providing initial resuscitation and stabilization, you would be better off at a place like U-Maryland. If you want to learn how to remotely manage trauma patients and care for them through to discharge to floor, this would be a great place to spend a year.

BTW as a resident here, you are predominately involved in the initial triage and resuscitation and ICU care of trauma patients. Our residents do not have significant involvement with the prehospital systems unless they specifically seek it out.

-pod

 

[nap$ter]

A little insight into the trauma fellowship. It predates the current chair and her drive for "mini fellowships" by several years. Neither was it developed for cheap labor, there is too little time spent billing in the OR for that to be the case. It is designed for people who want to study and develop trauma systems with a special focus on provision of pre-hospital care and integration with pre-hospital systems.

i don't agree with this. i concede that the departmental goals for the fellowship may be multi-faceted ie containing what you propose, but i guarantee that a large driver for the development of any non-ACGME "mini" fellowship is financial gain for the department.



The fellowship director has been in place for longer than our chair, and he is all about improving and increasing the anesthesiologist role in comprehensive trauma care from the field to the floor.

what changes has he accomplished within the last five years to justify this statement?

IMHO if you are looking for is training in providing initial resuscitation and stabilization, you would be better off at a place like U-Maryland. If you want to learn how to remotely manage trauma patients and care for them through to discharge to floor, this would be a great place to spend a year.

BTW as a resident here, you are predominately involved in the initial triage and resuscitation and ICU care of trauma patients. Our residents do not have significant involvement with the prehospital systems unless they specifically seek it out.

-pod

I agree with pod about the unique opportunities afforded via the WWAMI catchment system. that being said, i'm not sure how much of what can be learned here is transferrable to any other place.

so... why not just work here as an attending (get paid far more), and seek out the experiences you want...

 

[Licoricestick]

We have a unique geographical trauma system here. Harborview is the only Level 1 trauma hospital providing care for the five state area of Washington, Wyoming, Alaska, Montana, and Idaho. Additionally, we have transfers of US citizens from the Western Canadian Provinces. This huge geographic area presents special challenges that you are unlikely to experience at any other institution.

If you want time spent dealing with geographical realities you could also come down under and do some aeromedical retrieval work. There are no level 1 trauma units outside of Brisbane, Sydney, Canberra, Melbourne, Hobart, Adelaide, Perth, and possibly Cairns (but I've never worked in Queensland so I'm not sure on that one).

This means that if you are involved in a high speed MVA near Ayres Rock (aka Uluru - the massive monolith that all tourists seem to want to see that is nearly in the middle of the country) you are likely to first be aeromedically retrieved to Alice Springs (440km away, a town of about 30,000 people, single hospital covers a catchment area of 1.6million square kilometres with a population of 55,000 within that area), then, if further care is required, flown 1500km (~930mi) to either Darwin (which has ICU, gen surg, plastics and midrange ortho) or Adelaide (which is the nearest burns centre, has more ortho - only city in two states that does surgical management of #pelvis, neurosurg, cardiothoracic, paediatric ICU, neonatal ICU).

Distance and retrievals are a daily part of medical life here, even if you work in the capital cities.

If you want to read about one of Australia's more extensive retrieval operations - a series of articles was published regarding the experiences of Darwin hospital (also from a medical student's perspective), the civilian aeromedical retrieval exercise, the military aeromedical retrieval and the role of holidaying Australian doctors in Bali following the Bali nightclub bombing in 2002.

 

[periopdoc]

Probably why we have a ton of Aussies that come over to learn about our system and share how to improve ours.

The problem with being an attending is that you are tied to the OR too much if you want to concentrate on any of the out of hospital stuff.

Still, I wouldn't do the fellowship myself, I just don't think it is exactly what people were blaming it to be.

- pod

 

[Noyac]

Nope. Is that a good thing?

Don't F with me.😍

 

[canjosh]

We have a unique geographical trauma system here. Harborview is the only Level 1 trauma hospital providing care for the five state area of Washington, Wyoming, Alaska, Montana, and Idaho. Additionally, we have transfers of US citizens from the Western Canadian Provinces. This huge geographic area presents special challenges that you are unlikely to experience at any other institution.

-pod

pod--

What about Salt Lake City? Two adult Level I facilities and a pedi Level I. I've always thought their catchment included Wyoming, Idaho, and Montana.