Rotations & Clinical Experience

Ambulatory Surgery Rotation

The goal of this rotation is to provide residents with the foundation, skills and clinical experience in the care of ambulatory patients requiring surgical procedures and tests. This rotation is provided at our ambulatory surgery center in Voorhees, NJ which is a fully integrated site. Over 8000 procedures of all types are performed at this site. Additionally, residents in the CA-3 year will attain addition proficiency in Ambulatory Anesthesia allowing them to assist junior resident training, and act with more independence.

Anesthesia Preoperative Evaluation Clinic

The Anesthesia Preoperative Evaluation Clinic provides a unique service for both the resident and the pre-surgical patient. This comprehensive clinic evaluates and determines the optimal medical preparation of the outpatient and inpatient undergoing anesthesia, especially the medically complex patient. All anesthesia residents rotate through this service in a one (1) month rotation during the CA1 year. Faculty members in anesthesia and other disciplines provide an extensive educational experience in preoperative anesthesia assessment.

The resident will have the opportunity to evaluate a large number of patients for diverse operations from healthy patients for minor ambulatory surgery procedures, to severely ill patients with complex medical problems scheduled to undergo major surgery. The resident will be in charge of performing the preoperative history and physical examination, assessing anesthetic risk, determining appropriate laboratory work and consultation prior to surgery and documenting these findings.

Basic Exam Study Sessions

The BASIC Examination, the first in the series of exams, will be offered to residents in their CA-1 year. It focuses on the scientific basis of clinical anesthetic practice and will concentrate on content areas such as pharmacology, physiology, anatomy, anesthesia equipment and monitoring. To prepare for this exam residents are provided a 2-week study block to review and prepare. Resident lectures are provided on the basics of clinical practice, and self-study time is provided to review pharmacology and physiology by utilizing the Learnly Program. The program has a 100% basic exam pass rate.

Cardiovascular Anesthesia

The goal of this CA2 rotation is to provide residents with the foundation, skills and clinical experience in the care of patients requiring cardiac surgical procedures. Integral to this goal is for the resident to become competent in the preanesthetic evaluation, formulation of the anesthetic plan including preoperative, intraoperative and postoperative management of the patient. It is expected that the resident work with other health care professional as a member of a complex team to provide safe and effective care. Residents in the CA-3 year will attain addition proficiency in Cardiovascular and Thoracic Anesthesia allowing them to assist junior resident training, and act with more independence.

Critical Care Medicine/ICU Rotation

The Critical Care/ICU rotation for Anesthesiology residents occurs in their second and/or third dedicated year. The resident functions as a primary care provider for patients in the Cooper Medical/Surgical Intensive Care Unit, a closed unit. The ICU attendings are members of the Departments of Anesthesiology, Internal Medicine, and Emergency Medicine. They directly supervise the residents' day-to-day performance. On this rotation, residents have the opportunity to gain the experience and knowledge base to skillfully care for the critically ill patient in a collaborative, team-oriented setting.

The duties of the Anesthesia resident on the ICU rotation include:  patient admission "work-ups," case discussions, continuing patient management, routine procedures (e.g., airway management, invasive monitoring, etc.), and common administrative responsibilities (e.g., writing orders, dictating case summaries, family meetings, responding  to "code calls," etc.)  The resident is expected to build upon the knowledge and experience gained during the clinical base year and the subsequent years spent in the operating room.

The patients managed by the resident include those with primary medical disease, routine post-surgical cases, post-cardiac surgery, and post-cardiac arrest. Special emphasis is given to respiratory failure/ventilator management, prolonged sedation, sepsis/shock, cardiac failure, nutritional support, and renal failure. The resident reports directly to the ICU fellow assigned to that service or the on-call ICU fellow. The major didactics include the published ICU lecture series, daily rounds, and supplemental lectures/discussions. The critical care group also has an active basic and clinical research program. Interested residents are more than welcome to assist in these projects.

This rotation will provide the resident with the ability to integrate perioperative assessment and management skills into a broader continuum of patient care. The overall goal of the critical care rotation is to enable each resident to acquire the knowledge, skills, and experience to successfully assess and manage the complex interrelated physiologic principles unique to critically ill patients. After completion of this rotation, the resident will be able to provide basic intensive care medical management should the need arise after residency is completed.  

Difficult Airway Rotation

The Difficult Airway Rotation is designed as a one month block located at the Cooper Hospital and Regional Trauma Center. During the month, residents are directly supervised by faculty members. This care is inclusive of general anesthesia, regional anesthesia, intravenous sedation as well as appropriate regimes for analgesia in this population. The CA3 resident will be able to effectively assess patients with potentially difficult airways and be able to demonstrate proficiency in the use a number of techniques to successfully manage the difficult airway. Additionally, the residents work with members of the ENT department on an outpatient basis to evaluate patients of all ages with a wide range of preexisting airway pathology. 

General OR Rotation

The goals of this CA1 and CA2 rotation are to provide clinical experience and didactic instruction sufficient for the resident to acquire the necessary skills to master the basic principles and techniques of anesthesia. The clinical anesthesia case load experience will come from the following services: general surgery, orthopedics, gynecology/oncology, trauma, plastics, ophthalmology and otolaryngology. The first three months are orientation which includes a one-to-one preceptorship with an assigned faculty member. As a CA3 resident every effort will be made to assign the most difficult and challenging cases available on any particular day. The goals of this rotation are to provide clinical experience and didactic instruction sufficient for the resident to acquire the necessary skills to master the principles and techniques of anesthesia. The clinical anesthesia caseload experience will come from the following services: general surgery, vascular surgery, orthopedics, gynecology/oncology, trauma, plastics, ophthalmology and otolaryngology.

Neurosurgery Rotation

Residents are assigned to the neurosurgical operating room for four weeks during CA-2 and during the advanced clinical rotation in CA-3. During the CA2 year the goal of the rotation is to provide residents with the foundation, skills and clinical experience in the care of patients undergoing diverse neurosurgical procedures. Integral to this goal is for the resident to become competent in the preanesthetic evaluation, and formulation of the anesthetic plan, including intraoperative and postoperative management. Included will be the development of skills for brain protection and intraoperative monitoring of neural tissue integrity. The Neurosurgical Anesthesia CA3 rotation is designed as a one month or longer block located at the Cooper Hospital and Regional Trauma Center. Residents in the CA-3 year will attain addition proficiency in Neurosurgical Anesthesia allowing them to assist junior resident training, and act with more independence.

Obstetrical Rotation

Obstetrical anesthesia is a 1 month required rotation for late CA-1 anesthesia residents. The goal of the rotation is to provide residents with the foundation skills and clinical exposure in the care of obstetric patients requiring both elective and emergency services. Included in the rotation is the development of the necessary skills and expertise for the management of the obstetric population for routine and high-risk patients. Residents should become adept at regional anesthetic techniques.

Obstetrical anesthesia is a 1 month required rotation for CA-2 anesthesia residents. It may also be selected as a one month, or more, elective rotation at the CA-3 level. The goals of the rotation are identical to those of CA1 rotation with the addition of added responsibility in caring for higher risk obstetric patients. Included in the rotation is the development of the necessary skills and expertise for the management of the obstetric population for routine and high-risk deliveries. Residents should gain added confidence in performing regional anesthetic techniques and demonstrate mastery of all skill objectives of CA-1 residents. In addition, the teaching of medical students will be an added responsibility of this rotation.

Obstetrical anesthesia is an elective rotation for CA-3 anesthesia residents. Included in the rotation is the development of the necessary skills and expertise for the management of the obstetric population for routine and high-risk deliveries. Every effort will be made to assign the CA-3 residents to the most difficult and challenging cases available on any particular day.

Pain Management Rotation

In the Pain Medicine rotation the resident functions in an inter-disciplinary fashion, integrating the specialties of neurosurgery, psychiatry, physical medicine and rehabilitation, behavioral medicine, oncology, nursing, and social work in an organized and directed approach to managing patients with pain.

The goal of this CA1 rotation is to provide residents with the foundation, skills, and the clinical exposure in the care of patients requiring complex pain management and interventional pain control. In addition, training will be provided for the management of acute pain management, including postoperative and trauma related pain. Emphasis is on a multidisciplinary approach to pain management in both outpatient and inpatient settings. In addition, chronic malignant and non-malignant pain control techniques will be approached with interaction of other disciplines.

During the CA2 year residents are expected to develop a more in-depth knowledge of the principles of pain management, in addition to more difficult procedures. Training will be provided for the management of acute pain management, including postoperative and trauma related pain. Emphasis is on a multidisciplinary approach to pain management in both outpatient and inpatient settings. In addition, chronic malignant and non-malignant pain control techniques will be approached with interaction of other disciplines.

The goals of this CA-3 rotation are similar to that expected of a CA-2 resident but with increased responsibility to be a leader and a teacher for CA-2 residents The rotation will enhance their knowledge and skills in acute and chronic pain management. Emphasis is on a multidisciplinary approach to pain management in both outpatient and inpatient settings. In addition, chronic malignant and non-malignant pain control techniques will be approached with interaction of other disciplines.

Pediatric Rotation

Residents gain experience with routine and complex anesthetic issues, including extreme prematurity. Equipped with the latest innovations in airway evaluation and intervention for pediatric patients, residents will learn how to evaluate and manage both the routine and extraordinary airways that often present in pediatric cases. Regional anesthetic techniques are routinely utilized for both intraoperative anesthetic management and postoperative analgesia. Residents become familiar with caudal, spinal, and peripheral nerve blocks, and the management of continuous epidural analgesia in the pediatric population.

Residents are also involved in the care of children with both acute and chronic pain management issues. Residents also participate in providing care for specialized procedures where general anesthetic or intravenous sedation techniques are learned to manage pediatric patients undergoing a variety of procedures such as cardiac catheterization, radiologic procedures (such as MRI, CT, or angiography) endoscopic procedures and regional blocks. Additionally, a CA2 and CA3 rotation is designed as a three month block located at the Children’s Hospital of Philadelphia. During the three months residents are directly supervised by faculty members of the Children's Hospital Department of Anesthesia in the provision of anesthesia and post-anesthetic care for newborns, infants, children and adolescents to age 21 undergoing therapeutic, diagnostic and surgical procedures. This care is inclusive of general anesthesia, regional anesthesia, intravenous sedation as well as appropriate regimes for analgesia in this population.

Perioperative Medicine Rotation

The Perioperative Medicine rotation is a 1 month rotation in the CA-1 year that will teach the elements of anesthesiology that occur outside the operating room, excluding critical care and pain management. Location sites outside the OR include: 1) Gastroenterology Clinic-upper endoscopy, colonoscopy, lung biopsy, PEG insertion, endoscopic retrograde cholangio-pancreatography (ERCP), 2) Radiology Department-diagnostic imaging, angiography and cardiac catheterization, 3) Electroconvulsive Therapy, and 4) Fertility Clinic.

Postoperative Care Rotation

The goal of this rotation is to furnish residents with the foundation, skills and clinical experience to provide for the care of patients recovering from general, regional and monitored anesthesia care. Residents should be competent in recognizing and managing common PACU problems, including effectively communicating with the appropriate surgical and nursing services and primary anesthesia team. By the end of the residency, the resident will be capable of acting as a consultant in anesthesiology in all matters related to the PACU.

Regional Rotation

Regional anesthesia is a 1 month elective rotation for CA-3 anesthesia residents. This is an opportunity for the advanced resident to further hone skills in regional anesthesia and to gain exposure to other areas of interest. Specifically, these areas include but are not limited to teaching, research, and additional clinical experience. The CA-3 resident will be scheduled for cases in which there is a high probability of spinal and/or peripheral nerve blocks. Typical block procedures include: cervical, thoracic and lumbar epidural catheters; interscalene, supraclavicular, infraclavicular, and axillary blocks of the brachial plexus; lumbar plexus blocks; femoral, sciatic, lateral femoral cutaneous, obturator, popliteal, and ankle blocks. However, individual patient needs should take precedence in determining the anesthetic choice selected. Residents completing this rotation will have excellent skills in regional anesthesia as well as a good understanding of the management of postoperative pain and the impact of regional anesthesia on postoperative pain management. With completion of this rotation trainees should be able to demonstrate proficiency in caring for patients with complicated medical problems in a compassionate manner. This includes the preoperative evaluation, intraoperative management, and postoperative care utilizing the most current medical knowledge pertinent to each case; using on-line medical information; communicating with patients and working effectively with patient care team; demonstrating ethical principles; and practice cost-effective yet quality health care.

Simulation Education

Simulation is integrated throughout the Cooper Anesthesiology residency curriculum with an emphasis on the acquisition and refinement of both medical/technical skill and behavioral/leadership skills.

  • The simulation curriculum is adapted to the Cooper Anesthesiology residents’ level and experience. All objectives are tightly integrated with ACGME core competencies.
  • Crisis Resource Management (CRM) is laced throughout the curriculum.
  • Simulation methods primarily use mannequin-based simulation along with reflective and formative debriefing.
  • Quality and Patient Safety initiatives such as transitions of care and handoffs, transitions from novice to advanced resident to practicing anesthesiologist, and working with emergency manuals are also covered extensively in the SimLab.
  • Scenarios vary from preoperative to intraoperative and postoperative cases. They represent cases that residents are likely to encounter in their careers.
  • Senior Cooper Anesthesiology Residents may take a one-month simulation elective and may become involved in research projects in the SimLab
  • Unusual and rare events as well as Oral Board reviews are also covered during their training.

Thoracic Rotation

The goal of the rotation is to provide residents with the foundation, skills and clinical experience in the care of patients requiring thoracic (non-cardiac) surgical procedures. Integral to this goal is for the resident to become competent in the preanesthetic evaluation, formulation of the anesthetic plan including both intraoperative and postoperative pain management. Included with the rotation is the development of necessary skills and expertise in the management of one-lung anesthesia and lung isolation techniques, along with skills in fiberoptic bronchoscopy.