Obstetric Anesthesiology Fellowship

The Section of Obstetric Anesthesiology in the Department of Anesthesiology has primary clinical responsibilities on the Labor & Delivery Unit at the Prentice Women’s Hospital of Northwestern Memorial Hospital, a designated Level 4, high-risk obstetrical unit in the heart of downtown Chicago. The physical facility contains state-of-the-art facilities for providing care to obstetric patients and their babies.

Prentice performs the largest number of deliveries in the state of Illinois — over 12,000 per year. The patient population is a mix of private and service patients, routine and high-risk. The cesarean delivery rate is 27 percent (3,500 cases/year), and the labor neuraxial analgesia rate is 90 percent (11,000 procedures).

The fellowship will enable the fellow to acquire an advanced body of knowledge and level of skill in the management of parturients, particularly of high-risk parturients. This should allow the fellow to assume a future leadership role in academic or private practice in the field of obstetric anesthesiology. The objectives include:

• Understanding the obstetric management of high-risk parturients
• Understanding fetal heart rate measurement and interpretation
• Understanding the anesthetic management and the interdisciplinary approach to the management of the high-risk parturient
• Understanding neonatal resuscitation (American Academy of Pediatrics Neonatal Resuscitation Certification)
• Understanding the moral and ethical issues in the care of the parturient, including maternal vs. fetal well-being
• Understanding the economic issues in obstetric anesthesiology
• Organizing a functioning obstetric anesthesiology service
• Critically evaluating the clinical literature in obstetric anesthesiology
• Teaching obstetric anesthesiology to others
• Carrying out a scholarly project, including study design, recruitment of patients, carrying out of a study, analyzing and publishing the results

Fellows will be expected to participate in at least one research project, with the goal of one abstract and publication (three-month research rotation). Additionally, fellows rotate to the MFM and Neonatology services for two-week rotations and participate in a formal simulation curriculum. Fellows meet for a weekly didactic session with one of the faculty members. One meeting per month is held jointly with the MFM fellows, usually a journal club. Fellows participate in regular patient care conferences and other multidisciplinary conferences. Our goal is for fellows to complete the program as well-rounded anesthesiologists whose primary interest and expertise is obstetric anesthesiology.

Rotations

• Labor & Delivery Rotation: Fellows will complete a total of seven months in a clinical rotation that includes the Labor & Delivery Unit and the obstetric operation rooms. Fellows will provide care for high-risk patients, organize and supervise residents and other healthcare providers and provide antepartum consultations for patients referred by Maternal-Fetal Medicine or their obstetrician.
• Research Rotation: Fellows will complete a total of three months in a research rotation, consisting of 13 weeks scheduled in one-week increments approximately every four weeks throughout the year. A faculty mentor will guide fellows through study design, data analysis, scientific writing and presentation. Fellows will be expected to participate in at least one research project with the goal of one abstract and publication.
• Neonatology Rotation: In this two-week rotation in Neonatology, fellows provide evaluation and resuscitation of neonates with the NICU team on the labor and delivery unit.  At the end of this rotation, fellows will receive their certification in neonatal resuscitation.
• Maternal-Fetal Medicine Rotation: This two-week rotation in Maternal-Fetal Medicine allows fellows to become familiar with the early stages of pregnancy and build relationships with the physicians and staff on the Maternal-Fetal Medicine service. Fellows rotate to the Maternal-Fetal Medicine clinics and physician offices and gain experience in antepartum fetal testing and high-risk antepartum care.
• Blood Bank Rotation: This one-week rotation in the blood bank allows fellows exposure to transfusion medicine. Fellows work with a transfusion medicine attending and gain experience in blood component therapy, perioperative blood management, antibody evaluations and transfusion reaction evaluations.
• Fetal Surgery Program: Fellows are actively involved with the care of patients with fetal complications through the Chicago Institute for Fetal Health, a multidisciplinary collaboration with Ann & Robert H. Lurie Children's Hospital of Chicago. Procedures that fellows will participate in include twin-to-twin transfusion syndrome laser treatments and myelomeningocele repairs in utero.

Quality Improvement

Fellows will participate in at least one quality improvement project. Examples include postpartum hemorrhage protocol, escalation of care protocol (for parturients requiring obstetric and critical care) and roll-out of the electronic medical labor analgesic record. Projects should aim to enhance the fellow’s engagement in multidisciplinary care of obstetric patients or improve patient safety as it applies to the fellow’s practice of obstetric anesthesiology.

Participate in a system improvement project based on the literature, quality improvement data and patient and family satisfaction data

Working with Residents

Anesthesiology residents are integral members of the anesthesiology team caring for obstetric patients. Fellows frequently directly supervise the residents in providing care to low-risk patients. They may also provide care to patients during times when residents are busy with didactic educational activities. Additionally, fellows will either assist the residents or provide direct care to high risk obstetric patients.

Residents, fellows and attendings participate in twice-daily sign-out rounds. These rounds often include discussions of evidenced-based care in the context of the patients on the unit. Fellows participate in the daily resident didactic lectures. The lectures are based on a 2-month obstetric anesthesiology rotation and the fellows are expected to prepared and present each lecture topic at least once during the fellowship year. These lectures are directly supervised by at least one attending anesthesiologist. Additionally, fellows, in conjunction with an attending anesthesiologist, are assigned approximately one journal club each month. The journal club is attended by obstetric anesthesiology faculty members, students and residents rotating on the service and fellows.

Both residents and fellows help care for patients enrolled in clinical studies; however, this is primarily the responsibility of the fellows. In particular, fellow are expected to have knowledge of the enrollment criteria for all of the current clinical studies and help alert the research nurses with patient enrollment, study procedures and data collection. The core program director and the fellowship program director meet regularly to assess the quality of interactions between the fellows and residents.

Conferences

• Weekly Obstetric Anesthesiology Fellow Lectures: Fellows will have weekly didactic sessions covering a range of in-depth topics in obstetric anesthesiology. The format may vary and may include lectures and problem-based learning. Some of these didactic sessions will be joint sessions with the maternal-fetal medicine fellows. All sessions will be supervised by at least one core obstetrical anesthesiology faculty member.
• Weekly Obstetric Anesthesiology Journal Club: Fellows will participate in a weekly journal club every Friday morning with the obstetric anesthesiology faculty members and anesthesiology residents. At least once a month, a fellow will primarily lead the journal club. Faculty will assist in selection, appraisal and assimilation of evidence from scientific studies relevant to obstetric patients. In addition, fellows will participate in interdisciplinary education with maternal fetal medicine fellows by participating in their journal clubs.
• Daily Obstetric Anesthesiology Morning Conferences: Fellows will participate in the daily morning obstetrical anesthesiology conference lecture series for the residents on their obstetrical anesthesiology rotation. The lectures cover a broad range of topics in obstetrical anesthesiology based on Chestnut's Obstetric Anesthesia: Principles and Practice. Fellows will develop their didactic skills by participating as the lead educators one or two times each month.
• Anesthesiology Grand Rounds: Fellows will attend the Department of Anesthesiology Grand Rounds every Friday morning. Fellows will also be required to present at the grand rounds once during the year. The presentation will be on a topic in obstetric anesthesiology of their choice such as controversies in obstetric anesthesiology or updates on the most current obstetric anesthesiology practices. Each fellow will be assigned a mentor from the obstetric anesthesiology faculty to assist in the preparation of the presentation. This will allow the opportunity to locate, appraise and assimilate evidence from scientific studies related to their patient population and obstetric anesthesia practice. Additionally, fellows will demonstrate their ability to be an educator in the field of obstetric anesthesiology.

Ultrasound Workshop

Fellows will participate in an ultrasound workshop at the beginning of the year that will review the basics of ultrasound techniques and equipment. Emphasis will be placed on use of ultrasound for focused transthoracic echocardiography, transversus abdominus plane blocks and neuraxial techniques in patients with back pathology or morbid obesity. By the end of the workshop, the fellows should be able to decide which patients would benefit from ultrasound-guided regional anesthetic techniques, obtain optimal images, interpret the images, perform the regional technique and assess the results. There will be additional follow-up lectures throughout the year to cover more in-depth topics with transthoracic echocardiography and ultrasound as well.

Simulation

The Anesthesiology RRC requires that trainees participate at least once yearly in a simulation experience, and the ABA requires that diplomates participate in a six-to-eight-hour simulation course in Part IV of its Maintenance of Certification (MOCA) program. The proposed simulation education curriculum for the obstetric anesthesiology fellowship provides a bridging experience from trainee to practicing anesthesiologist through a dual strategy: learning through participation in simulation and learning about using simulation as a lifelong teaching and learning platform. Learn more on our Northwestern Center for Clinical Simulation page.

Fellows are evaluated quarterly. The program director and Clinical Competency Committee chair will meet with the fellow for the evaluation.

Successful completion of the program will be contingent upon meeting curricular and skills requirements as judged by evaluations. In addition, the trainee must complete at least one scholarly project suitable for publication, make one local presentation and show evidence of teaching medical students and residents. 

In addition to McGaw Medical Center of Northwestern University benefits and wellness resources, Cardiothoracic Anesthesiology fellows receive:

• $700 educational expense account
• Funding for one national society meeting: ASA or SOAP
• Additional funding for a second academic/research meeting; fellows who present an abstract at a national meeting will receive funding for a second meeting, based on the program director's approval
• Dedicated office space with desktop computer

All Obstetric Anesthesiology fellowship positions are filled through the San Francisco Match. Please register and apply at the San Francisco Match website.

To be considered for a Obstetric Anesthesiology fellowship position, candidates must be eligible for certification or fully certified by the American Board of Anesthesiology before fellowship training begins.

Candidates must have taken USMLE Step 3 and obtain a temporary or permanent Illinois Medical License before starting their fellowship training. Licensing information and application can be found at the Illinois Department of Financial & Professional Regulations website. To apply for a permanent license, the applicant must already have taken the USMLE Step 3. Please be aware that it may take up to 60 days to process and grant an Illinois license.

For more information, contact Northwestern's Office of Graduate Medical Education:

McGaw Medical Center of Northwestern University
420 E. Superior St.
Suite 9-900
Chicago, IL 60611
312-503-7975

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