1. Operating Room Experience
During the 8 to 10 months spent in the operating
room, the pediatric anesthesia fellow performs
preoperative evaluations, intraoperative care and
postoperative follow-up on a daily basis. The
pediatric anesthesia fellow assesses inpatients
on the day prior to surgery and sees outpatients
in our pediatric preoperative evaluation clinic.
Each case is discussed with a member of the
pediatric anesthesia faculty on the evening prior
to or day of surgery. An anesthetic plan is formu-
lated, as are plans for postoperative analgesia
and care. Anesthetic care is always provided
under the direct supervision of a member of the
division of Pediatric Anesthesiology. As the fellow gains experience, he/she will be given the opportunity to assist the faculty in teaching clinical
skills to residents, medical students and CRNAs. Pediatric anesthesia fellows make postoperative rounds on their inpatients.  Perioperative problems and complications are discussed at monthly Morbidity and Mortality (M&M) conferences.

2. Pediatric ICU Rotation
Pediatric anesthesia fellows spend 2 months in the Pediatric Intensive Care Unit. While on the rotation they will function at the same level as a Pediatric Critical Care Fellow. They will have direct patient care responsibilities for all medical and cardiothoracic patients. Consultative services are provided to all other patients. An attending pediatric intensivist supervises all patient care duties. Both the Department of Pediatrics and the Department of Anesthesiology provide pediatric critical care faculty.

3.  Research Elective (optional)
The fellow is strongly encouraged to participate in ongoing and/or original research projects. Depending on the demands of the project, work in this area can be incorporated into non-clinical time provided during regular operating room rotations or may be provided as a block of time, up to 2 months.
 
Support for research projects is available through the departments research division. Laboratory space is available, along with technical support for animal studies. The department has ample computer and technical support for data base entry, management and statistical analysis. Two research nurses are on staff to assist with research protocol development, subject recruitment and data collection for clinical studies. A modest departmental research fund is available to support projects deemed to be of sufficient merit.

4. Other Electives
The fellow may make special arrangements to spend up to two months (instead of a research elective) on other rotations outside the operating room. Examples of such rotations would be Pediatric Pulmonary Medicine, Neonatology or Pediatric Cardiology.
 
5. Cardiac Anesthesia
The fellow can usually be assigned to the pediatric cardiac room as frequently as one time each week depending on their level of interest. For these cases they will work one-on-one with a pediatric cardiac anesthesia attending. Additional experience in managing these complex patients will be provided during the fellows PICU rotations.

6. Pediatric Acute Pain Service 
A separate pediatric pain rotation is not provided. Instead, the pediatric anesthesia fellow has daily exposure to pediatric pain issues during the time spent in the operating room and the intensive care unit. Under faculty supervision, the fellow learns to perform and utilize caudal, epidural and spinal anesthesia/analgesia for pediatric patients. Peripheral nerve blocks, including penile, femoral, sciatic, lumbar plexus and brachial plexus blocks are also taught. Pediatric anesthesia fellows participate in planning and trouble shooting epidural catheters placed for postoperative pain management. An Adult/Pediatric Acute Pain Service makes daily rounds on all patients with epidural catheters. The pediatric anesthesia fellow and the pediatric anesthesia faculty serve as consultants to the pain service in managing the pediatric pain service patients.

In addition to the rotations described above, the fellow will be expected to participate in consultative services provided by the division of Pediatric Anesthesia. The Department of Anesthesia provides consultative services for pediatric patients within the hospital for sedation, acute and chronic pain management, airway management and other perioperative services. Consultative services for physicians in the community are provided through the Carolina Consultation Center. Pediatric anesthesia fellows are expected to participate in each of these areas except for the Carolina Consultation Service.