Penn offers both Categorical and Advanced track residency spots through ERAS. Each residency class generally consists of 24 residents, 16 of which are categorical positions. Beginning with the CA1 year, both the categorical and advanced track residents train primarily at the Hospital of the University of Pennsylvania, with speciality rotations at the Children's Hospital of Philadelphia, Penn Presbyterian Hospital and the Tuttleman Pain Center. Below is an overview of clinical training by year. If you have specific questions, please contact us.
Rotation Descriptions and Call Schedules
There are over 40 main operating rooms at HUP. While working in the Main ORs, residents rotate through specific blocks designed for specific surgical sub-specialties. These include: General Surgery (Lamont), Gynecological Surgery, Otorhinolaryngology/Urology, Orthopedic Surgery (PPMC), Ambulatory Surgery, Transplant Surgery, Out of Operating Room Anesthesia, Vascular/Thoracic Surgery, and Neurosurgery. Residents typically take approx 3 calls per month and approx one weekend call per month.
Call teams are made up of an Attending Anesthesiologist and 4 Residents. In addition to emergent cases, the anesthesiology call team is responsible for all airway emergencies throughout the hospital. a for emergent/late cases as well as respond to airway emergencies throughout the hospital. The four residents on call consist of two senior residents (CA2 or CA3) and two junior (CA1) residents. Most junior residents truly enjoy the call experience as it gives them an opportunity to work with senior residents and learn from them in an informal environment.
- 1st Call – Typically a CA3 or senior CA2, they are in charge of "running the board," responding to airways, and act as the Attending. The goal of 1st call is to prepare the senior resident to become a true consultant. They are in charge of the call team, management of the operating room, including coordination between surgery and OR nursing. The On-Call Attending is always present to supervise and support the 1st call resident.
- 2nd Call – Typically a CA2, the 2nd call resident tends to staff complex cases like liver transplants, craniotomies, major vascular and thoracic surgeries.
- 3rd and 4th Call – Usually CA1's, these residents cover all types of cases of varying complexity.
All residents are relieved at 7 am and have their post-call day off.
Ambulatory Anesthesia (CAM)
There are 7 operating rooms at the Perelman Center for Advanced Medicine. Non-orthopedic outpatient surgery procedures are performed for a variety of cases including: general, colorectal, plastics, ENT, OB/Gyn and oncology. This rotation provides the resident with the ability to learn about managing anesthetics with an emphasis on ability for quick post-operative discharge home.
During this rotation, the resident is still part of the main OR call pool. There is also an outpatient GI endoscopy center on the 4th floor of the Perelman Center for Advanced medicine, but this is mainly staffed by nurse anesthetists.
HUP is one of the largest cardiac surgery centers on the east coast. Cases include CABG's, valvular surgery, aortic surgery, ECMO, heart and lung transplant. HUP is also one of the study centers for trans-femoral aortic valve replacement. The volume and complexity of cases provides an incredible education in cardiac anesthesia.
Residents on cardiac typically take call every 4 -5 nights. The on call resident stays as late as necessary to finish any ongoing cases. When all the cardiac cases are finished, the on-call resident may go home, but must be within 30 minutes of the hospital in case they are called back in for an emergency case.
In addition to the on call resident there is a late/backup resident. The late/backup resident stays as late as 8 pm helping to finish up any cases that run late. They may also be called in if there are multiple emergent cases.
The on call resident has their post-call day off even if they didn't get called in.
Residents spend 1-2 months per year in the HUP surgical ICU. During this rotation residents learn to take care of the "sickest of the sick" including trauma patients and transplant patients.
The ICU team is is a multidisciplinary team made up of both anesthesia and surgical colleagues.
Call in the ICU is every 4th night (q4). Overnight, the on call resident is responsible for attending to the needs of patients in the ICU, admit new ICU patients, and for preparing for the next morning's rounds. In the morning, the on call resident leads round and then goes home (or they leave at a time when they would be breaking work hour rules if they stayed). Residents have the rest of their post call day off and additionally, they get their post-post call day off.
Residents spend several months at CHOP with the option of spending more time if they're interested. While at CHOP, residents perform anesthesia on a wide variety of cases. One day may be spent providing anesthesia for common procedures like ear tubes, while another may be providing anesthesia care for patients with extremely rare conditions that are only experienced at a place like CHOP.
There is one resident on call per night at chop. Typically the resident comes in at 11 am. They then help give lunches, do preops, and then take over late running cases. They then stay in house to provide anesthesia for any emergency cases. In the morning they sign out to an attending and usually leave the hospital around 7:30 AM.
Obstetric Anesthesia (OB)
Residents spend at least two months rotating on the HUP labor and delivery floor. There are four residents on the OB service every month so residents are on call every 4th day.
Each morning begins with a lecture on obstetric anesthesia by the attending covering the OB service that day. The post-call resident goes home after this lecture. The two non-call residents then begin to cover the daily OB duties which consist mainly of placing epidurals and providing anesthesia for c-sections. The on-call resident arrives at 4 pm when they relieve the pre-call resident and start taking call.
The pain management rotation provides residents the opportunity to care for acute and chronic pain patients in both the outpatient and inpatient setting. The month is broken up into three core rotations which include the acute pain service, procedures, and clinic. During the acute pain service week, resident responsibilities include managing all post surgical patients with epidurals in place from the operating room along with seeing consults for patients with acute pain issues on the floor at HUP.
Both the outpatient pain clinic rotation along with the week of pain procedures are performed at the Tuttleman Center on South Street in Center City Philadelphia which is a few miles from HUP. Resident responsibilities in the pain clinic include seeing both new patient referrals and existing patients that are seen in the clinic monthly. After the examination process the resident in conjunction with the attending pain physician and/or pain fellow formulate a management plan for the patient. The procedure week involves performing a multitude of interventional pain procedures under the direct supervision of the pain attending, most procedures utilize fluoroscopy for identifying pertinent landmarks.
Regional Anesthesia (Blocks / PMUC)
The regional anesthesia rotation is performed at Presbyterian Hospital and Penn Medicine University City. During this rotation the resident becomes familiar with a variety of common peripheral nerve blocks including but not limited to interscalene, supraclavicular,infraclavicular, axillary, femoral, sciatic, popliteal and ankle. Presbyterian Hospital is where most outpatient and complex orthopedic procedures are performed in the Penn Healthcare System. There is a dedicated holding room where patients are blocked before they move on the operating room to have their procedure.
Penn Medicine University City is a free-standing ambulatory surgery center. Residents become familiar with fast-turnover cases that span orthopedics, otorhinolaryngology, and general surgery. Many of these cases are performed under monitored anesthesia care and regional blocks where appropriate. The ambulatory regional catheter program is mainly based from this location. The resident also gains experience in supervising nurse anesthetists.
The resident works with a diverse group of anesthesia faculty who are each skilled in performing nerve blocks via ultrasound, nerve stimulator, or anatomical techniques. The resident on this rotation is only responsible for performing the nerve blocks with the block attending before transferring care of the patient to another anesthesia provider to monitor the patient in the operating room. Besides having a dedicated month at Presbyterian Hospital to perform nerve blocks, many opportunities exist while at HUP to perform regional techniques on patients whose surgery and or comorbidities may benefit from the use of regional anesthesia.