Trauma Anesthesiology

• Academic Objectives
  • Basic Knowledge Acquisition:
    • Understanding of shock in trauma
    • Understanding of trauma hemorrhage, coagulopathy, blood resuscitation and damage control surgery
    • Learning how trauma systems integrate for best patient outcomes
  • Research Experience:
    • Understanding of basics of hypothesis formulation, literature review, experimental design, methodology, data acquisition, statistical analysis, interpretation of data, penmanship, peer-review process, and publication of results.
    • Participation in clinical research in trauma.
• Practical Objectives
  • Patient Management Skills:
    • Understanding of anesthetic management of trauma hemorrhage
    • Understanding of anesthetic management of TBI and SCI
    • Understanding of ICU management of polytrauma, TBI and SCI
    • Understanding of anesthetic management of pediatric and geriatric trauma.
  • Technical Skills:
    • Improved capability in TEE, POCUS and large bore venous access
    • Proficiency in managing a multi-disciplinary team in the OR resuscitation

NOTE: Actual experience and knowledge acquired during the fellowship is variable and dependent on the fellow’s own learning objectives, area of interest, level of motivation, enthusiasm and effort. 

In this non-ACGME-accredited faculty fellowship, fellows will split their time between 60% fellowship time and 40% faculty time. Fellows may begin their training at any point in the academic year, though most fellows typically start between July and September.

Our program provides ample opportunities for fellows to engage in a variety of ongoing clinical research projects and academic activities. At the beginning of the 12-month fellowship, each fellow meets with the program director to review responsibilities and departmental expectations and ensure all program requirements are met within a reasonable period. For fellows who have never worked in the U.S. healthcare system, we recommend adding an additional two months at the start of the fellowship to help familiarize you with University of Washington systems.

Faculty clinical experience (40% time) 

Faculty fellows spend their clinical time supervising anesthesia residents and CRNAs, and/or independently providing anesthesia care in a junior attending capacity. Faculty fellows are also expected to provide some evening and weekend on-call operating room coverage. 

Fellowship opportunities (60% time) 

Overall, the fellowship time is very flexible. The fellowship director and the UW are here to support your learning needs and build on your interests and prior experiences.

Prehospital trauma care and transport  

Harborview Medical Center works with a highly organized and utilized prehospital trauma care/transport system. The Seattle Fire Department’s “Medic One” division is a nationally recognized field paramedic and transport service providing primary trauma assessment in the field and aggressive field trauma care, including endotracheal intubation, peripheral and central venous line placement, and spine and extremity fracture stabilization prior to and during transport. 

Airlift Northwest is the primary medical air-transport service for patients in Alaska, Montana, Idaho, and Washington, delivering them to Harborview and four other Puget Sound hospitals.  

We strongly encourage our fellows to ride with the Medic One paramedic service and fly with Airlift Northwest flight nurses.

Emergency room assessment and management 

During emergency service, our fellows function in the role of surgical house staff, together with trauma surgery fellows and under the direction of the Emergency Medicine Department or trauma surgery attending. Fellows will evaluate and treat minor trauma and participate in all major trauma resuscitation cases. Depending on the fellow’s performance and evaluations, they may be given the opportunity to be an “acting trauma doctor.”

Advanced Trauma and Life Support (ATLS) 

To learn the trauma team’s approach to the acute management of major trauma, we strongly encourage our fellows to complete the American College of Surgeons’ ATLS course taught at Harborview and pass the certification examination early in the fellowship year. This two-day course provides didactic, demonstration, and interactive teaching of the ATLS skills/principles, and is taught by ACS-certified instructors in surgery, anesthesiology, and other subspecialties. The cost of the course is covered by the Department.

Trauma / Burns / Neuro ICU 

Harborview has separate trauma, burns and neuro intensive care units with over 100 beds. We encourage our fellows to spend time in these units learning how to manage ongoing care for patients with multi-system trauma.

Radiology 

Our fellows spend time in the radiology department learning how to read trauma CT scans. 

Point of Care Ultrasound (POCUS) 

The Department of Anesthesiology & Pain Medicine boasts a mature POCUS program led by Dr. Sara Nikravan. The POCUS program features a clear curriculum and mentorship opportunities for faculty and trainees to earn the American Society of Anesthesiology POCUS accreditation certificate.

Trans Esophageal Echo (TEE) 

TEE is increasingly being utilized in trauma resuscitation. We encourage our fellows to undertake focused TEE studies under the mentorship of Dr. Koichiro Nandate. Fellows will use the advanced TEE simulator at Harborview and will take scans with the Cardiothoracic Anesthesiology Division at UW Medical Center – Montlake.

Blood Bank 

Harborview boasts an active blood bank under the leadership of Dr. John Hess. All pre-hospital services in the area carry whole blood, and the department is heavily supported by blood bank services. Fellows are encouraged to spend time in the blood bank. Previous fellows have undertaken research projects in conjunction with the blood bank.

Regional anesthesia 

Harborview has a busy regional anesthesia service with two block teams working under the leadership of Dr. Paul Bhalla. Our fellows have the opportunity to work on the block team to gain skills and manage pain in our trauma population. 

Interdisciplinary conferences and didactics  

The Anesthesiology & Pain Medicine Department and other trauma-related services at Harborview offer a variety of clinical rounds and clinical conferences on a regular basis. Attendance at these conferences is not mandatory, but we recommend that our fellows attend each conference at least once, and then return to those that are most relevant to their specific interests.

Research opportunities and other scholarly activities 

The limited amount of non-clinical time defined for the year dictates somewhat specific opportunities for research and other scholarly activities. Our fellows can choose one (or two) opportunities for which they are highly motivated. 

These opportunities include: 

• Participation in an ongoing clinical research project under the direction of senior anesthesiology faculty at Harborview. Specific opportunities can be discussed with the fellowship director and currently include potential projects in neuroanesthesia, regional anesthesia/analgesia for trauma, cost analysis of tertiary trauma care procedures, analgesia for pediatric burn wound care procedures outside the operating room, and clinical practice guidelines for epidural analgesia after trauma. 
• Co-authorship of an invited review manuscript related to trauma and/or anesthesia practice.
  This opportunity is dependent on: 
  • Senior faculty being invited to write such a document, and 
  • making your intentions of wanting to participate in such an endeavor known. The fellowship director will help facilitate this opportunity. 
• Assisting senior faculty in their review of manuscripts for peer-reviewed journals. This is probably one of the least glamorous, yet most educational efforts that fellows can participate in, as they will learn to critically read and evaluate the literature from hypothesis to experimental design to data interpretation. 

Fellows are encouraged to undertake lectures at a regional and national level; participate in medical student, resident, CRNA and nurse education; and facilitate trauma journal club.

Requirements for non-U.S. graduates and foreign nationals 

Foreign medical graduates interested in the fellowship must provide documentation that they graduated from a medical school accepted by the World Health Organization (WHO), successfully completed a residency in anesthesiology and hold an unrestricted license to practice medicine in their country of residence. 

In limited and exceptional cases, the Department of Anesthesiology & Pain Medicine will sponsor H1B-visas for highly qualified candidates.

Competitive Salary: Faculty Fellow salaries begin at $140,000 per year.  

Academic Allowance: Faculty Fellows in the Department of Anesthesiology & Pain Medicine receive an annual academic allowance of $3,500. Additionally, the department will pay for the ATLS student course. 

Moonlighting Opportunities: Extra internal clinical shifts above and beyond fellowship commitment may be approved at the discretion of the program director for eligible fellows. 

Program Director: Rajen Nathwani, MD 

Program Administrator: Gabrielle Lachtrup 

Interested applicants must submit the following documents to the program administrator, Gabrielle Lachtrup lachtrup@uw.edu:

• Current Curriculum Vitae 
• Application for Faculty Fellowship
• Letter of intent/personal statement 
• Three current reference letters, including one from the residency program director or current director 
• Copy of medical school diploma 

• Copy of anesthesiology degree (if applicable) 
• Current medical license 
• USMLE (all three steps) 
• ECFMG documentation (if applicable) 
• Documentation supporting citizenship status (if applicable) 
• H1B Visa holder or eligible (if applicable)