The Pediatric Anesthesia fellowship at Monroe Carell Jr. Children’s Hospital at Vanderbilt attracts physicians who have a passion for learning in an environment that encourages independence, a commitment to patient care, compassion for their patients in the spirit of the anesthesia team model. You will have the opportunity to work with other fellows, anesthesia residents, CRNAs and SRNAs and the perioperative team all whose goal is to deliver the best medical and supportive care to their patients.
Our program provides 12 months of subspecialty education and training in all aspects of pediatric anesthesiology. This program is accredited by the Accreditation Council for Graduate Medical Education. Subspecialty training is at the CA-IV level and begins after satisfactory completion of an ACGME-accredited residency in anesthesiology.
Education and training concentrate on all phases of the patient’s inpatient and outpatient perioperative anesthesia care. All clinical training programs are conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt which serves as both a primary care facility for local residents and a regional referral center. Clinical training in pediatric anesthesia ranges from brief outpatient procedures to complex neonatal, cardiovascular, orthopedic, transplant, and neurosurgical procedures.
The clinical anesthesia program provides a broad experience, beginning with routine case assignments, progressing to increasingly complex surgical procedures and coexisting diseases. Fellows can expect to easily exceed the minimum requirements for clinical case experience recommended by the ACGME. Fellows gain experience in the management of sedation and anesthesia outside the operating room by participating in the care of patients undergoing radiation therapy, PET scanning, cardiac catheterization, MRI and other diagnostic and therapeutic procedures. The Society of Pediatric Anesthesiology Fellowship Directors committee has developed a content study guide for pediatric anesthesia fellows.
Rotations are offered in the following areas:
- General and Advanced Pediatric Anesthesia (up to six months)
- Pediatric Cardiac Anesthesia (two months)
- Pediatric Critical Care Unit (one month)
- Neonatal Intensive Care Unit (two weeks)
- Pediatric Acute and Chronic Pain Management (one month)
- Preoperative Clinic (PATCH Clinic) and PACU (one month)
- Heart, Kidney, Liver, and Lung Transplants
- Supervision (one month)
- Global Pediatric Anesthesia Elective (one month)
Research Opportunities - Up to 20 Non-clinical days/year
The ACGME has formulated the following policy concerning research during the pediatric anesthesia fellowship: "The subspecialty training program in pediatric anesthesiology should provide the opportunity for active fellow participation in research projects pertinent to pediatric anesthesia”. It is difficult to become a research fellow in one year. If research will be an integral part of your career a two year fellowship is suggested that includes MPH or Masters of Clinical Research training.
Trainees are encouraged to participate in clinical projects that can be presented in abstract form at the SPA or ASA and later published in a peer reviewed journal.
The Department of Anesthesiology at Vanderbilt is committed to providing our trainees experience in an international environment through our Vanderbilt International Anesthesia (VIA) program. The VIA experience allows our fellows the opportunity to spend one month in a cross-cultural environment at Kijabe Hospital in Kenya. This experience enables our fellows to develop knowledge, skills, attitudes, and behaviors essential for effective anesthesia practice in less developed, limited resource, international healthcare settings. Teaching and transfer of knowledge and clinical skills to local anesthesia practitioners and perioperative nurses is a key element of the VIA program. Fellows will also have extensive opportunities to develop regional anesthesia skills that may be underutilized in contemporary western practice. Working and teaching in international settings broadens fellows' awareness of cultural diversity and international healthcare delivery systems, and allows them to develop invaluable skills as educators in our field.
Monroe Carell Jr. Children’s Hospital at Vanderbilt is also committed to providing medical services in underserved nations. This is evidenced by the number of our physicians and surgeons who travel to developing countries to offer their health care services. The Shalom Foundation is an organization dedicated to providing care to those children who live in poverty. The department of pediatric anesthesia actively participates in medical mission trips to Guatemala sponsored by Monroe Carell Jr. Children's Hospital and The Shalom Foundation. Fellows are also encouraged and welcome to participate in these mission trips which take place at least two times per academic year.
Participation in Conferences
Fellows will be instructed in the conduct of scholarly activities and the evaluation of investigative methods and interpretation of data, including statistics. They should have the opportunity to develop competence in critical assessment of new therapies and the medical literature. Journal club allows the fellow to learn to use available tools and resources to evaluate scholarly works by critically evaluating investigative methods, data interpretation and statistical analysis. Fellows will choose a medical article, and will lead journal club with a designated faculty mentor. Each fellow will receive the book entitled Studying a Study and Testing a Test by Richard K Riegelman MD, MPH, PhD, which should be used as a guide when participating in journal club.
Weekly Education Conference
Fellows attend a weekly didactic conference led by division faculty. Although all anesthesia providers may attend, this conference is aimed at topics appropriate for fellowship education. Included in these conferences are the discussion of competencies (ACGME Core Competencies: medical knowledge, professionalism, communication & interpersonal skills, systems/teams practice, practice-based learning & improvement, clinical care) as they affect clinical care outcomes. Discussion is supported by evidence from the medical literature that is presented, and analyzed. Continually improving our ability (knowledge, skills, and behaviors) to deliver quality healthcare (as individuals, teams, and systems of healthcare) is the goal. Suggested reading material covers key features from the ABA Pediatric Anesthesiology Content Outline. The primary text used is Cote’s A Practice of Anesthesia for Infants & Children. The supplemental text used is Holzman’s Pediatric Anesthesiology Review: Clinical Cases for Self-Assessment. Both of these texts are provided by the program. Monthly board review will focus on oral exam preparation July to May and written sub-specialty examination review for the remainder of the year.
Weekly Art of Anesthesia Conference
The goal of this conference is to create a round table discussion of management issues in pediatric anesthesiology. During training, fellows are exposed to many ways of approaching unique issues in anesthesia. Fellows decide on a topic of the week to promote discussion among the attendings during this conference.
The Division of Pediatric Anesthesia holds a Quarterly Pediatric MMI conference. This conference represents a forum in which unanticipated perioperative events are discussed in an open, yet, confidential forum and the work of the Pediatric Anesthesiology and Perioperative Quality Improvement Group is presented. Attendance and participation by fellows is mandatory. Fellows are excused when their rotations make them unavailable to attend.
Society for Pediatric Anesthesia Annual Meeting
All fellows are encouraged to attend Annual SPA meeting. Fellows presenting an abstract, PBLD, or participating in a workshop, will have travel costs covered when funding is available.
Vacation and Educational Leave
Fellows are granted 15 days of vacation and 5 days of educational leave. Good-faith attempts are made to adjust clinical schedules in order to provide the time requested as needed.
Jenna Helmer Sobey, MD
Program Director, Pediatric Anesthesiology Fellowship
Assistant Professor of Anesthesiology
All applications for our Pediatric Anesthesiology fellowship are now accepted through each year until May 31st in ERAS (ACGME Program ID # 0424721021), the online application service of the AAMC. Letters of recommendation should be addressed to the program director, Dr. Thomas Romanelli. We also request that you send your most recent ITE scores by email or US post to our coordinator, Mary Ruth Brewer.
If you are interested in applying after May 31st, we will accept applications June 1st through June 30th using the common application. Please submit the common application and the following documents to Mary Ruth Brewer:
Our program participates in the National Resident Matching Program (NRMP), so we do ask that all applicants register with the NRMP to be included in the match process. Find more information about the National Resident Matching Program.
Also, if you have any questions regarding your application, please contact:
Mary Ruth Brewer
Fellowship Program Coordinator
2200 Children's Way
Nashville, TN 37232
General and advanced Pediatric Anesthesia - up to 6 months
Fellows will be assigned to surgical cases that span the spectrum from private practice-like fast turnover cases to kidney transplants. The complexity of the cases assigned to the fellow will be tailored to the fellow’s needs. After the first 2 months in the pediatric OR, the fellow is encouraged to sit down with the fellowship director or the fellow’s mentor to insure that the assignment mix meets the fellow’s needs. During the last 4 weeks of the fellow’s rotation the emphasis will change from hands on anesthesia to medical supervision of anesthesia providers.
Pediatric Cardiac Anesthesia – 2 month rotation
The pediatric cardiac anesthesia rotation involves intense training for a wide spectrum of congenital heart defects. The workload is both challenging and rewarding. Fellows are expected to become adept at advanced airway skills, cardiopulmonary bypass, vascular access, and emergency preparedness. Essential knowledge base includes pediatric physiology, and how this physiology is altered in congenital heart disease, advanced pharmacology, transfusion medicine, and cardiac lesions associated with known congenital syndromes.
Pediatric Critical Care Unit - 1 month rotation
Each fellow will spend a minimum of 2 weeks on the Cardiac Critical Care service to participate in pre-surgical, immediate post-surgical, and sub-acute post-surgical management of children with congenital heart disease. During this rotation, the fellows will be able to participate in the immediate post-operative admission and care of surgical cases (both cardiac and non-cardiac). In addition, the Anesthesia fellows will also concentrate on procedural skills and sedation/pain management during this time.
Neonatal Intensive Care Unit - 2 week rotation
During the NICU rotation, responsibilities include making daily NICU rounds with the NICU staff. The fellows are not expected to follow specific patients or write notes or orders. The rotation provides an opportunity to observe and study the medical issues inherent in the care of these neonates. Specifically, this rotation provides an opportunity for our rotating fellows to familiarize themselves with ventilator strategies and fluid management that are sometimes different from those used by anesthesiologists in the operating room. It is imperative the fellow understand high frequency jet and oscillator ventilation. This rotation provides an opportunity to gain a better understanding of the medical care of these patients outside the OR. The rotation affords the fellow an opportunity to share knowledge with the NICU staff as well as the pediatric anesthesia perspective dealing with sedation in the NICU, post-operative epidural analgesia, and intraoperative fluid management.
Pain Service - 1 month rotation
Under the leadership of Dr. Andrew Franklin, and collaborating with divisional nursing and physician staff, pediatric anesthesia fellows gain experience in managing perioperative pain, acute pain associated with various medical and surgical conditions, and chronic pain in infants, children, adolescents, and young adults. In conjunction with the Pediatric Pain Service nurse and attending on service, fellows also provide first-call coverage of the Pediatric Pain Service. In this capacity, fellows are the initial contact in providing ongoing analgesia for patients receiving continuous regional anesthesia, most commonly via epidural catheters placed by other anesthesia staff in the operating room. Fellows assist in developing the complete analgesic regimen for such patients, and follow these patients daily until continuous regional anesthesia is discontinued. While providing first-call coverage of the Pediatric Pain Service, fellows are also the initial contact at Children’s Hospital for consultative assistance in the management of children with acute pain secondary to a wide range of medical and surgical conditions. In this context, fellows gain experience in assessment of the role for various non-pharmacologic analgesic modalities, management of potentially complex pharmacologic regimens including non-opioid, opioid, and adjuvant agents. In addition, the fellow will engage in provision of numerous interventional procedures including peripheral nerve block and epidural blood patch.
Experience with management of chronic pain in pediatric patients is gained from working with Pediatric Pain Service nurse and physician staff in the Pediatric Pain Clinic. This clinic is the only setting for provision of dedicated out-patient pediatric chronic pain management in all of Middle Tennessee, and one of the few such settings in the entire Southeast. The clinic provides consultative assistance in the management of chronic pain in infants, children, adolescents, and young adults with a wide range of medical and surgical conditions including headache, functional pain, oncologic disease, various neuropathic pain states, and complex regional pain syndromes.
Preoperative clinic (PATCH CLINIC) and PACU – 1 month rotation
Our preoperative clinic is staffed by nurse practitioners to assess complex patients in advance of their upcoming surgery. Early evaluation allows us to identify problems and optimize the patient’s readiness for a procedure prior to their surgery. These patients will also be evaluated by child life. This is an opportunity to learn about and assess patients with rare disorders who require surgical procedures. You will not only be responsible for personally evaluating patients but act as a consultant to the nurse practioners who evaluate patients in the PATCH clinic.
During this rotation, the fellow is also exposed to patient care in the PACU. Our 25 plus bed PACU provides ample opportunity to manage post operative airway problems, pain, nausea, emergence agitation, apnea, airway obstruction and discharge related problems. In both the PATCH clinic and the PACU the Anesthesiologist in Charge will always be available for immediate consultation.
Heart, Kidney and Lung Transplants
Fellows will acquire a basic understanding of the pathology and pathophysiology of various end-stage organ system failures. The fellow will be actively involved in delivering anesthesia to patients receiving these organ transplants. These patients frequently require procedures both prior to and after their organ transplant allowing the fellow to see the full spectrum of organ failure and the patient’s responses to anesthesia after transplantation.
Supervision – 4 weeks
The majority of the fellowship will be spent providing hands-on anesthesia. During the last month of the fellowship, the fellow will have an opportunity to begin supervising CRNA’s, SRNA’s and residents. Attending faculty remain responsible for approving the anesthesia plan and personally supervising all critical aspects of anesthesia care, consistent with departmental and HCFA policies.