I have been actively involved in teaching residents at the Massachusetts General Hospital since 1996. My primary venue for teaching residents is in the perioperative setting. Most of my teaching occurs on the Thoracic Anesthesia Service as well as the General Surgical Anesthesia Service. his teaching involves full pre-operative discussion regarding the patients’ medical conditions and plans regarding the anesthetic for the patient. Contingencies are discussed, medical plans are evaluated and current literature is discussed as it pertains to the case. Various medical aspects of the patients and their ramifications regarding patient care are also discussed in detail. ovel aspects of the case are always reviewed in full prior to each case. In the intra-operative setting, germane aspects of the case are reviewed and I assess each resident for their ability to understand various aspects of the case and the implications thereof. The resident is required to critically evaluate their understanding of the medical decisions regarding the anesthetic care. When appropriate, the relevant literature is discussed. In addition, we hold a weekly on the Thoracic Anesthesia Service conference, and I lecture to the Anesthesia Residents at about 25-30% of these conferences. During these conferences we go over all aspects of thoracic anesthesia and cardiopulmonary function. I have also been involved in running the Core Curriculum for Cardiovascular Physiology, which is a series of six lectures given to all of our residents. I organize and deliver all six of the lectures, and I am in charge of the evaluation process thereof.
TEACHING - ADMINISTRATIVE
I am presently the Vice Chair for Education for the
Department of Anesthesia, Critical Care and Pain Medicine at the MGH.
I have no active research at this time.
My primary clinical contributions are made on the Thoracic Anesthesia Service. I am responsible for evaluating and anesthetizing patients for a wide variety of both minor and major thoracic surgical procedures. I am actively involved in taking care of patients for minor procedures that include bronchoscopy, mediastinoscopy, esophagoscopy, lung biopsy,rigid bronchoscopy with dilatation and flexible esophagoscopy with dilatation. Some of the patients are post-lung transplantations. In addition, I am responsible for taking care of patients having major thoracic procedures such as video-assisted wedge resection, open-thoracotomy with lobectomies, pneumonectomies as well as total esophagectomies. In addition, I care for patients having complex airway surgery including tracheal resection and anastomosis and carinal resections including carinal pneumonectomies. In addition, I am an active member of the Lung Transplant Team and take call on a regular basis. Our lung transplants are done for cystic fibrosis, pulmonary hypertension, emphysema, and pulmonary fibrosis. In addition, I have taken care of a number of patients for living-related lobar lung transplants. I also supervise thoracic epidural invasive placements. In addition, I am responsible for central line placement and pulmonary artery catheter placement for some patients. A regular part of my clinical work on the Thoracic Service involves endo-bronchial intubation with differential lung ventilation as well as fiberoptic bronchoscopy to ascertain tube position. I regularly participate in the initiation, maintenance and troubleshooting of one-lung ventilation. In addition, for lung transplants requiring circulatory support, I also am involved in managing patients who require circulatory support with cardiopulmonary bypass.
My other clinical duties involve contributions to the General Surgery Anesthesia Service as well as participating in the main operating room call schedule. In these venues, I am responsible for a wide range of medical conditions requiring surgery and anesthesia. I am responsible for primary care of the patient as well as supervising the residents in this capacity. Approximately 15% of my total clinical time is spent in a primary anesthesia provider role, the other 85% is in the supervisory role. On the General Surgical Service, I am responsible for taking care of patients having a wide range of co-morbid disease and undergoing a wide range of procedures. The extremes would include entirely healthy patients ranging up to patients who arrive in full arrest. The procedures again range from procedures as minor as a biopsy of a lymph node to patients whose surgeries are life-threatening. While on call, I’m also responsible for providing emergency backup for any emergency airway in the hospital where the Anesthesia resident, as the first responder, deems it necessary to have additional support at the time of airway management.