1. Orientation Details

• All residents will obtain an identification badge, locker, parking pass, pager, and key for infusion pumps. The secretary for the anesthesia department, Mrs. Peggy Mikulski, will assist you in this process (she can be reached in the anesthesia office at 443-777-7179)
• Residents will wear the Franklin Square Identification Badge while on duty in the hospital.
• Residents are expected to be present M-F from 7:00 am- 5:00 pm daily. If there are cases pending, or in progress, the resident is expected to remain on duty until released by the OB Anesthesia attending.
• The OB anesthesiologist will carry pager #1526, and a phone #2077.  The resident will carry pager #1527. Both pagers should be activated simultaneously during the day.

2. How the Day Begins and Progresses

• Residents will be dressed in scrubs and ready to attend OB rounds at 7:00 am M-F.
• Each morning, the resident will check all three OB operating rooms to assure that each is clean, stocked, and ready for immediate use. Any drugs left out on the carts will be discarded.  All drugs should be stored in a drawer in a locked anesthesia cart.  All drug syringes in OR 1 and 3 should be replaced twice per week, usually Mondays and Thursdays.  Please date and time all syringes.
• On the first day of orientation, the OB anesthesia attending will give the resident the codes to open locked drawers and supply rooms, as well as the code to operate epidural infusion pumps.
• All documentation is done in the computer.  Each resident will have a user name and password distributed on the first day of the rotation to access all L & D charts.
• The resident is expected to fill out a pre-anesthesia evaluation on all patients admitted to Labor and Delivery throughout the day.
• The resident will be expected to make hourly visits to patients with running epidurals, and document these visits in the computer.
• The resident will make daily post-anesthesia visits on patients seen in the previous 24 hours, and document in the computer.
• The residents will not be given access to the Pyxis machines. However, the nurses and OB anesthesia attendings can sign out medications and waste according to protocol.
• A designated call room will be available during the day for use by the resident.  
• The resident will sign out to the call anesthesiologist after being released for the day by the attending OB anesthesiologist.

3. Procedures

• Residents will introduce themselves to patients as Dr. XYZ with an explanation that he/she is a Hopkins anesthesia resident doing a month-long clinical rotation at Franklin Square Hospital.
• The nurse in the labor and delivery room is available for assistance during epidural starts and will obtain the necessary drugs for the procedure.
• The resident will communicate with the nurse the type of epidural started (usually CSE) and the amounts and concentrations of medications administered.
• Narcotics will be wasted by the L & D nurse or the OB anesthesia attending.
• The resident is expected to dispose of all sharps and needles after the epidural is started.
• The attending anesthesiologist is expected to be present during the start of all procedures performed by the resident.
  

4. Conferences

• Residents will attend the Thursday morning anesthesia conference after rounds are completed, if the schedule permits.

5. Absences/Emergencies

• Any absence during the rotation will need to be cleared, in advance, with John Vincent, M.D.
• If you are ill or have a family emergency during the rotation, you should contact the Charge Anesthesiologist at 443-777-2760 as soon as possible in order that he/she may adjust the schedule for the day.

6. Evaluations

• At the start of the second week of the rotation an evaluation of the resident’s performance will be discussed to assist the resident in maximizing their clinical experience during the remainder of the rotation.
• At the conclusion of the rotation, the resident will have an opportunity to discuss the rotation with John Vincent, M.D.

7. Goals

1. Manual Skill Development
   • CSE/Epidural Catheter placement
     • Efficiency and proficiency in placement of CSE/Epidural block (target time for completion is < 10min)
     • Achieve a low epidural replacement rate
     • Low incidence of PDPH
     • High patient satisfaction rate
     • Achieve >80% success rate on epidural placement
   • Subarachnoid Block/Spinal Placement
     • Efficiency and proficiency in placement of subarachnoid/spinal blocks (target time for completion <5min)
     • Achieve >90% success rate on SAB placement
   • General Anesthesia
     • Achieve skills to administer rapid, safe medical care under general anesthesia in obstetrical patients
2. Develop skills to act as a medical consultant in Anesthesiology for OB services
   • Formulate anesthesia plans for high-risk patients
   • Pre-labor consult
   • Pre-procedure Evaluation
   • Peri-partum period and post-delivery complications
     • PDPH
     • Maternal hemorrhage
     • neonatal resuscitation
3. Presentation of lectures related to obstetric anesthesia at departmental conferences

Frequently Asked Questions

What are the hours like?
It can vary, but in general you are fairly busy. Morning always start at 0700.  Obviously hours vary depending on the seasons, but you will leave at 1700 at the earliest. Most days you leave at around 1800-1900 at the latest.

When can I leave?
They usually want you to finish whatever case is started at or before 1700, but beware because things typically get busy around leaving time. A c-section starting around 1700 could really ruin your evening.

Who do I give the pager to when it’s time to leave?
You keep it for the duration of the rotation.  On your last day, give it back to Peggy along with the key to the epidural pumps.

Where’s the free food/drinks?
Crackers and sodas are to be had in the nutrition rooms; no one seems to really care if you raid the nutrition rooms, but be discrete anyways. The OB conference has lunch on Thursdays, but usually you’re too busy to attend so don’t count on it. The anesthesia group may provide lunch, but this is rare. Lastly, there may be a drug lunch, but this too, is rare.

Is this a good rotation?
Good educational value, but you’ll likely work hard for it. Look on the bright side, all your weekends are free!

What is a typical day like?

• 1-4 c-sections
• 2-6 labor epidurals
• 4-15 post-ops
• 1 OB-anesthesia consult
• Multiple pages for deliveries, PCA refills, etc.