Obstetric Anesthesiology Fellowship

 A plethora of clinical, academic, and mentoring resources is essential to supporting & enhancing the obstetric anesthesiology fellow's professional development at Vanderbilt. 

• Ample Clinical Experience: The annual delivery rate at VUMC has risen steadily, with a high percentage (>85%) of anesthesia/analgesia involvement. This program's abundant, high quality case exposure is a centerpiece of fellow learning. There is a vast diversity of clinical cases including:
  • Uncomplicated, low-risk care;
  • High-risk tertiary referrals with full spectrum of obstetrical & medical complications;
  • Several perinatal care models (traditional-individual obstetrician, Maternal Fetal Medicine referral, CenteringPregnancy, provate midwifery practices, family-centered cesarean birth).
• Consultations: Fellows conduct 70-90 formal consultations annually for complicated obstetric cases, which represents a great source of high-yield, faculty mentored learning. Many problems for which management has become famliar or routinized (e.g. super-morbid obesity, buprenorphine/methadone maintenance, etc.), or which may be handled via phone call, do not demand in-person advanced consultation. The fellow coordinates this decision process through communication with referring obstetrician, patients, and core faculty.
• Inter-professional Collaborative Care: The Division of Obstetric Anesthesiology enjoys an excellent collaborative relationship with the Department of Obstetrics & Gynecology faculty & residents, Maternal-Fetal Medicine faculty, obstetrics nursing staff, midwives, neonatologists, and a host of consultants.
• Focus on Quality: The disciplines participating in womens health are highly oriented to quality care and improvement. Fellows participate in and lead the multi-faceted program which includes:
  • daily collaborative team practice,
  • twice daily inter-professional briefing sessions,
  • monthly Perinatal Quality Improvement Committee meetings,
  • Dept. of Obstetrics & Gynecology MM&I conferences,
  • and the Obstetric Anesthesiology quality improvement program.
• Fetal Surgery: Vanderbilt was one of 3 trial sites in the original NICHD Management of Myelomeningocele Study (MOMS trial). Vanderbilt's inter-disciplinary fetal surgery program continues to be very active, with approximately 50 fetal surgery cases performed annually.
• Cultural Diversity: There are ample opportunities for developing cultural & linguistic competence, owing to Nashvilles large and diverse immigrant population, with over 40 languages represented. The increasingly important skills needed to recognize & address unique culture, language, and health literacy of diverse patients and communities are emphasized & promoted by faculty and interpreter services staff with extensive expertise and interest in this area.
• Emphasis on Education: The divisions education program is well-developed & comprehensive, including a protected daily 1-hour morning didactic conference, unique & innovative assessment tools, and a purposeful supervision & feedback structure. A host of high-yield supplementary formal didactic sessions deliver outstanding educational breadth & depth. are Fellows participate actively, including daily teaching, supervision, and assessment of the many learners rotating in the division (anesthesiology residents, student nurse anesthetists, medical students). By year's end, fellows have acquired vast experience and a large repertoire of education/assessment tools, which they may readily apply in their subsequent leadership roles. Of note, fellows spend most of their time learning & mastering through actively practicing & assuming the roles of subspecialty consultant, teacher, team leader, and supervisor, under the close guidance & mentorship of the core faculty. The wealth of clinical learning opportunities during weekday hours far exceeds that which is needed for an outstanding training, limiting weekend & night.
• Simulation: The division participates actively in inter-professional team training, crisis management training, and individual & procedural simulated practice (Center for Experiential Learning & Assessment; Noelle, Laerdal Patient Simulator Mannequins).
• Procedural Expertise: The full complement of analgesia & anesthesia procedures are performed: labor analgesia (neuraxial, inhalation nitrous oxide), cesarean anesthesia (neuraxial, general), post-partum anesthesia (e.g., hemorrhage, retained placenta), antenatal anesthesia (e.g., cerclage), ultrasound guided techniques (e.g., neuraxial block, transversus abdominus plane block), etc.
• Research & Scholarly Opportunities are abundant in a variety of areas, including chapters/reviews (all faculty), placental perfusion lab (JD, CB, RP), inhalation nitrous oxide analgesia (SS), fetal surgery (RP), simulation (JB), inter-professional practice & education (MR, JB), qualitative research approaches to parturient perspectives, quality assessment & education (MR), database research (excellent clinical & research informatics resources & support), and numerous collaborations with faculty in the Department of Obstetrics & Gynecology. The Department of Anesthesiology and Vanderbilt University offer a wide variety of resources that support & promote effective, high quality research & scholarly productivity.
• Fellow's are provided with protected time to actively participate in several additional learning activities:
  • Monthly Virtual Grand Rounds in Obstetric Anesthesia [fellows' webinar series]
  • Department of OB/Gyn's Annual High Risk Obstetrics Conference
  • AAP's Neonatal Resuscitation Program [certification], linked tightly with the 2-week neonatology rotation, prviding ample opportunity for valuable hands-on newborn assessment & resuscitation.
  • Electronic Fetal Monitoring course [certification]
• Professional Societies: The faculty are active participants & leaders in state, national, & international professional associations (SOAP; ASA; OAA; AMEE, Tennessee Society of Anesthesiologists), and eagerly support fellows membership & participation in these organizations, as well as their contributions & attendance to annual meetings.

Standard Compensation & Benefits (health, life, & disability insurance; retirement plans; etc.) are in accordance with the Vanderbilt University Office of Graduate Medical Education.  The salary stipend provided is established annually, and is provided to fellows at the Vanderbilt University School of Medicine PGY5 level.

Application Process
Please use the SOAP Common Application. All materials can be mailed or emailed to LaurieAnn Hembree.

Personal Interviews
Selected applicants will be invited for a personal interview at Vanderbilt. We begin considering applicants in January each year (18 months before program start date).

Selection Process
Beginning in 2019, OB Anesthesiology fellowship programs in the US will be participating in the San Francisco Match for fellow applications and selection.  You can find more information at https://www.sfmatch.org.

Further Questions
We welcome further inquiries about the application process.
For more information:
LaurieAnn Hembree
Associate Program Manager
615-936-7616
laurieann.hembree@vumc.org

Definition & Scope
Obstetric anesthesiology is the subspecialty of anesthesiology devoted to the comprehensive anesthetic management, perioperative care, and pain management of women during pregnancy & the puerperium.

Core Goals
The subspecialist in obstetric anesthesiology, upon completion of training, shall have the knowledge & expertise to:

• Provide anesthesia care for the full spectrum of pregnant women requiring anesthesia care, particularly those with complicated medical & obstetric conditions, for all types of obstetric, surgical, therapeutic and diagnostic interventions;
• Perform resuscitation, pain management, and critical care specific to pregnant women;
• Serve as a consultant to other generalist anesthesiologists, obstetricians, pediatricians, and nurses and critical care medicine physicians;
• Develop new knowledge & techniques for the anesthetic care of the pregnant woman;
• Train future generations of generalists and sub-specialists in obstetric anesthesiology;
• To develop, implement, and manage obstetric anesthesiology clinical & educational programs.

Adapted from “DRAFT Program Requirements for Fellowship Education in Obstetric Anesthesiology” (http://soap.org/acgme.php)

The subspecialty fellow, upon completion of the program, will have achieved & demonstrated a consistent level of expertise & proficiency in:
Providing & managing anesthetic care of women, at various degrees of risk, during labor & vaginal delivery;

• undergoing cesarean section, postpartum tubal ligation, dilation & curettage, removal of placenta, and similar procedures;
• undergoing interventions for conditions threatening maternal or fetal life (ante-/post-partum hemorrhage, placental abruption, cord prolapse, uterine rupture, etc.);
• with obstetric conditions of early pregnancy;
• undergoing non-obstetric surgery during pregnancy, non-operative diagnostic and interventional procedures requiring anesthesia, and assisted reproductive technology interventions;
• undergoing in utero fetal surgery, or ex-utero intrapartum treatment (EXIT) procedures with & without neonatal transfer to extracorporeal membrane oxygenation (ECMO).

Antenatal evaluation & preparation of both high & low risk parturients, and their fetuses, prior to & after anesthesia.  The fellow will demonstrate mastery of a wide variety of clinical problems that can occur in obstetric patients through appropriate & relevant clinical application, and through communication verbally (with obstetricians, anesthesiology faculty & residents, nurses, other consultants, and with patients) and in writing (consultation notes).

Performing, supervising, and teaching the full spectrum of obstetric anesthetic & analgesic interventions, including the relevant underlying context-specific rationale & decision-making, assessment of effectiveness, troubleshooting, and detection & management of complications.  These interventions include, but are not limited to

• neuraxial labor analgesia (epidural, spinal, combined techniques, intrathecal catheter, patient controlled infusion modalities)
• non-neuraxial labor analgesia (intravenous and inahaltion [nitrous oxide]modalities),
• provision of analgesia & anesthesia for spontaneous & operative (e.g. forceps, vacuum) vaginal delivery,
• elective & emergent cesarean delivery,
• general anesthesia for cesarean delivery and other procedures,
• invasive monitors,
• ultrasound guidance (e.g. transversus abdominus plane block, neuraxial block)
• antenatal procedures (e.g. external cephalic version, cervical cerclage)
• epidural blood patch.

Assessing & managing pregnant women with co-existing illness, including, but not limited to:

• hereditary or acquired hemostatic disorders: thrombophilias, coagulopathies, drug therapy;
• morbid obesity;
• moderate to severe cardiac, pulmonary, renal, endocrine and neurologic disease;
• infectious diseases (e.g. chorioamnionits, herpes, HIV, etc.).

Assessing & managing common obstetric conditions (such as preeclampsia, multiple gestation, abnormal fetal presentation, obstetric hemorrhage, pre-term labor and/or delivery), and more broadly, pregnant women who are referred to maternal-fetal medicine specialists for any reason;

Teamwork, Communicating, & Collaborating

• effectively & collegially with all members of the inter-professional care team (anesthesiology, obstetrics, midwifery, nursing, students, residents, faculty, ancillary staff, neonatologists, other relevant consultants, and most importantly, the patient),
• in a manner that promotes care that is as good as it can be (safe, effective, timely, efficient, equitable, and patient-centered), and
• in ways that unequivocally demonstrate the value added by the fellow’s contributions as a member of the inter-professional care team.

Cognitive, affective, and verbal skills essential to learning & teaching, including

• continuing to develop advanced adult his/her own self-directed learning skills & behaviors,
• developing, practicing, &improving teaching skills (informal on-the-fly, small group facilitated, formal presentation, assessment, curriculum development, etc.), and
• demonstrating behaviors consistent with a commitment to inquiry, improvement, and discovery (active participation in teaching, clinical discussions, inter-professional rounds, journal clubs, quality improvement activities, etc.).

Scholarship of discovery, dissemination, and/or application, in the form of

• participation in research;
• publication of review articles, chapters, or commentaries; and/or
• publication or presentation of case reports/series or medically challenging cases.