Medical Students

This clinical elective is designed to familiarize the student with basic aspects of anesthesiology practice. The primary teaching method is patient care in a clinical setting. The student will learn the basics of preoperative evaluation of surgical patients, the use of intraoperative monitoring inpatient management and postoperative care. In addition to perioperative care, the student will be exposed to other clinical areas which include our pain management clinic, regional anesthesia / acute pain management, cardiothoracic intensive care unit, labor and delivery, pediatric anesthesia, and the Center for Preoperative Assessment and Planning.

During the four-week rotation, the student will learn airway management skills, basic IV skills, practical perioperative fluid and electrolyte therapy, along with general and regional anesthetic techniques. As an integral part of the anesthesia care team, the student will participate actively in the anesthetic management of surgical patients.

This clinical elective offers practical experience in the perioperative assessment and management of surgical patients undergoing cardiothoracic procedures. The student, as an integral part of the cardiothoracic anesthesia team that is composed of faculty members, fellows and residents, will learn basic principles of airway management and lung ventilation, essential aspects of pharmacologic treatment of hemodynamic abnormalities and cardiac dysrhythmias, and management of intraoperative coagulation disturbances. Emphasis will be placed on the interpretation of intraoperative hemodynamic data, echocardiographic finding (TEE), and laboratory results. During this rotation, the student will also gain practical experience in endotracheal intubation as well as the placement of intravenous lines and invasive monitoring lines, including radial artery and pulmonary artery catheters. The students are expected to attend the didactic sessions of CTA and the Department of Anesthesiology. A presentation will be assigned.

This clinical elective is designed to teach the theory and practice of pediatric anesthesiology and pain management. It features individualized instruction with faculty who specialize in the perioperative care of pediatric patients. The elective consists of active participation with pediatric anesthesiologists at St. Louis Children’s Hospital where the student will have the opportunity to learn about pre-anesthetic assessment, the performance of routine anesthetics (which includes instruction and practice in pediatric airway skills), other technical skills such as intravenous line placement, and the management of patients in the post-anesthesia care unit (PACU).

This clinical elective offers practical experience in the postoperative management of cardiothoracic patients. The student will be fully integrated into one of the intensive care teams and have the opportunity to contribute to the management of critically ill patients. Students will have the opportunity to follow specific patients over the course of their stay in the ICU, during which time they will gain insight into holistic management of patients with multi-organ dysfunction. Students will have opportunities to learn and sometimes assist with procedures, such as central lines, chest tubes, bronchoscopy and pulmonary artery catheter insertion as well as bedside ultrasound including TTE and TEE. Principles of management and resuscitation of hemodynamically unstable patients following surgery will be emphasized as well as ventilator management. Students will also see and help manage patients with unique physiology such as those patients on ventricular assist devices, and on ECMO.

Acute pain is the most common symptom of medical illness and is ubiquitous after major surgery. Chronic pain is the leading cause of worker disability. Severe pain afflicts most people with advanced cancer. Learning the fundamentals of pharmacologic, interventional, and multidisciplinary pain management is important for all areas of clinical medicine.

Students will help care for patients having challenging neurosurgical procedures. Students will become familiar with complex procedures, brain monitoring, cardiovascular support and airway management and will be exposed to all kinds of neurosurgical pathology. Student must be prepared to participate in the intricate anesthetic management of patients undergoing surgery in our novel intraoperative MRI rooms. For those interested, clinical research projects are ongoing and student participation is encouraged.

The medical students will learn the different analgesia/anesthetic options for the labor patient. They will also learn how the physiological adaptations of pregnancy influence anesthetic management. They will be actively involved in the parturient management, i.e., starting an IV, placement of spinal, epidural or CSE (combined spinal epidural) anesthetics. They will also attend the OB anesthesia conferences and interview patients in labor (with an OB anesthesia attending).

Directors: Anita Zimmerman, MD; and Catherine Foster, MD
Student time distribution: Inpatient 90%; Conferences/Lectures 10%; Subspecialty Care 100%
Patients seen weekly: 15
On-call/weekend responsibility: There are no required weekend or call shifts.

This Advanced Clinical Rotation is like the General Anesthesiology elective in exposure to anesthesiology, but the level of participation and assessment is enhanced. The expectation is that the students act at the level of a Clinical Anesthesia Year 1 resident. Though a prior elective in anesthesia is not required, it is encouraged, if possible. Students will learn the basics of preoperative evaluation of surgical patients, the use of intraoperative monitoring in patient management, and postoperative care. In addition to perioperative care, they will be exposed to other clinical areas which include labor and delivery, pediatric anesthesia, and the Center for Preoperative Assessment and Planning. The students will interact with patients across all age ranges and demographics.

During the four-week rotation, the student will learn airway management skills, practical perioperative fluid and electrolyte therapy, along with general and regional anesthetic techniques. As an integral part of the anesthesia care team, the student will participate actively in the anesthetic management of surgical patients. Grading will be based on competency of anesthesia skills such as preoperative evaluation, bag mask ventilation, intubation, vascular access, handoffs, postoperative pain orders, etc.

The student’s specific requests to be assigned to certain types of cases will be honored as time and availability dictate. The rotation will include clinical simulator sessions using a simulator mannequin for practical management of airway problems, resuscitation, and trauma emergencies as well as supplemental educational sessions covering relevant topics in anesthesiology.

NOTE: Presence and participation in presentation on the last day of the rotation are required to receive a grade.

Directors: Justin Knittel, MD; and Jessica Nelson, MD
Student time distribution: Inpatient 95%; Conferences/Lectures 5%; Subspecialty Care 100%
Patients seen weekly: 25
On-call/weekend responsibility: Students will work primarily daytime shifts but will also have some night shifts built into the schedule.

The 4400 Surgical ICU provides an exciting and challenging opportunity to care for some of the sickest patients in the hospital. From acute trauma to complex organ transplants, the SICU offers incredible teaching and education about a variety of medical topics and conditions. The ACR SICU rotation integrates medical students into one of the two SICU teams, and each medical student, in conjunction with a resident, will care for 3-5 patients on the service. This entails, at minimum, examining the patient, gathering pertinent information (lab results, significant events, etc.), and presenting the patient on rounds. Working with the resident, medical students will develop a problem list, as well as an organized plan for their patients. They will then need to follow up on the execution of all determined labs/interventions/consults, closely communicating with the residents, fellow, and attending throughout the shift, as well as presence for sign-outs each morning/evening at shift change.

In addition, medical students will be expected to attend and participate in multiple educational conferences throughout the week/rotation, as well as sessions for skills such as line placement and ultrasound.

This rotation takes place at the Barnes-Jewish Hospital 4400 ICU Surgical and Burn/Trauma Intensive Care Unit. This ICU takes care of patients from a variety of backgrounds, including general surgery, trauma/acute care surgery, transplant surgery, vascular surgery, urology, as well as medical ICU overflow patients. The Surgical ICU is divided into 2 teams, red and blue, with each covering up to 18 patients. Medical students will be assigned to either the blue or red critical care teams while on the SICU rotation.

Directors: Justin Knittel, MD; and Jessica Nelson, MD

This KISC aims to provide learners with the skills needed to excel in the unique and challenging environment of the Surgical Intensive Care Unit. This course is a combination of education and instruction on critical care concepts, hands-on skills sessions, and case-based discussions, revolving around longitudinal, clinical care of critically ill patients. Students will integrate into one of the ICU teams, participating in rounds each morning by formulating a care plan for each of their patients. Afternoon education sessions will revolve around core concepts in critical care medicine, such as mechanical ventilation, shock, and transfusions, while also exploring more holistic topics, such as leading a medical team, family meetings, and post-ICU placement. Students will examine the question of how health equity, race, and ethnicity play significant roles in outcomes for critically ill patients through interactions with the ICU social workers, who are an integral part of the ICU team and help address some of the profound barriers to health that critically ill patients can experience. In addition, time will be spent exploring some of the cutting-edge areas in critical care, including telemedicine, the digitization of healthcare, and the role of artificial intelligence. Multiple hands-on skill sessions led by faculty and fellows that cover the basics of line placement, airway management, ICU monitoring, and ultrasound assessment will also be established using simulation and 3D models. Upon completion of this rotation, students will have a greater grasp of the complex, multi-faceted approach needed to treat these complicated and critically ill patients.

Directors: Jordan Mcall, PhD, MPH; and Jooyoung Maeng, MD

According to a recent systemic literature review, the average United States medical school graduate receives only 11 hours of pain education. This brief exposure is discordant with the impact of pain on clinical medicine and is not enough to adequately respond to societal needs for pain treatment. The prevalence of pain, the negative consequences of untreated pain, disparities in access to pain treatment, and the potential for misuse and abuse of commonly prescribed analgesics makes pain management a critical public health challenge. The Science, Medicine, and Societal Effects of Pain KISC will use the Learn-Apply-Consolidate-Explore (LACE) pedagogy to introduce students to the neuroscience, sociology, and psychology of pain. Students will learn about the neurocircuitry of pain perception, modulation, and related psychological phenomena. They will understand fundamental basic science behind preclinical pain research and begin to be able to interpret these types of studies. They will investigate how social determinants of health affect pain. Students will apply these neuroscience principles and their understanding of social determinants of health into the practice of pain medicine, and learn how to assess, measure, examine, and treat patients with various pain conditions including acute pain, chronic and cancer pain. At the end of the course, the students will consolidate these aspects of pain medicine into a multidimensional biopsychosocial model.

Concurrently throughout the course, students are immersed into the cutting-edge science of basic and clinical pain research. They will explore basic preclinical pain modeling to help understand the neurobiology underlying this disease and how this translates into clinical pain research including what the critical limitations to each branch of research. This course uses a variety of instructional methods including didactics, case-based discussions, clinical care of patients in and out of the hospital settings, self-learning through research, reflective project completion, laboratory discovery, and scientific journal club presentation. Together we expect this course to more properly prepare future physicians to tackle the important public health challenge that improper pain management presents.