Medical Students

One month with the pain team working in the outpatient clinic on chronic pain issues and the inpatient acute setting. The month includes observing and participating in block procedures as well as rounds and conferences. The rotating medical student meets with the division/program director to establish goals and expectations of the rotation. During the rotation the student is encouraged to be an integral part of the team with the residents and fellows and to obtain exposure to all aspects of clinical pain medicine. The student will also have directed meetings with core faculty to discuss their learning and address any concerns. At the end of the clerkship, the student will present a brief lecture on a pain-management-related clinical or research topic of their choosing.

4-week Operating Room Elective: The Department of Anesthesiology offers a one-month 4th-year elective in the operating rooms to all students throughout the United States. The primary objective is to acquaint students with the broad scope of operating-room anesthesia as it is practiced here at Columbia. Because of our large service, students can see a wide variety of clinical cases. Generally students spend two weeks in the general operating rooms honing IV placement and airway management skills. The rest of the month is spent in the subspecialty areas, such as cardiac, neuro, pediatrics, etc. This can be tailored to the particular student's interest or be very generalized. Neither weekend nor night call is required. There are didactic sessions once per week, where students are expected to present short topics in anesthesia that they have researched through the literature. At the end of the rotation, students are asked to do a longer presentation on a topic in anesthesia of particular interest to them. The rotation is offered August through June of the following year.

The department offers one-month subinternships in Cardiothoracic and Surgical Intensive Care. This sub-I elective has been consistently the most popular elective in the curriculum, as students get the chance to follow critically ill patients throughout the month and have critical input into their care. The rotation is offered throughout the year (July through June) for up to six students per month. Students spend half of the month in the cardiothoracic intensive care unit (CTICU) and the other half in the surgical intensive care unit (SICU). In the CTICU, students care for patients recovering from major cardiothoracic surgery, including heart and lung transplantation, coronary revascularization, ventricular assist device (VAD) placement, and extracorporeal membrane oxyenation (ECMO). In the SICU, the patient mix consists of thoracic, liver transplant, vascular, abdominal, orthopedic, ENT, urologic, and gynecologic patients requiring postoperative critical care. Under the supervision of the ICU attendings and fellows from the Department of Anesthesiology, students participate in day-to-day patient care.

Rounds are held twice daily with ICU attendings, during which patients and their laboratory and x-ray findings are carefully analyzed and plans are made to clarify and resolve management problems. Each Thursday, students attend Critical Care Grand Rounds, a conference attended by all staff involved in critical care at Columbia University Medical Center. Consultants in infectious disease, cardiology, renal disease, neurology, and pulmonary medicine make daily rounds within the unit and review problems relevant to their special fields with the house staff and subinterns. Students are required to take twenty-four hour call and late call during the week, and there is no call on weekends or holidays.

Students will develop a working understanding of: resuscitation and endotracheal intubation; mechanical ventilation; hemodynamic monitoring using arterial, central venous pressure, and pulmonary artery catheters; nutritional support, including total parenteral nutrition; interpretation of blood gas and other monitoring data; management of major postoperative problems, such as bleeding and sepsis; and an understanding of organ-system failure and shock. Students will have an opportunity to develop the skills of analysis and judgment important in the optimal management of complex critically ill patients.

The department conducts research across the broad spectra of basic and clinical research. We maintain modern research laboratories that support NIH- funded research from molecular to whole animal models addressing topics in physiology and pharmacology across many organ systems. Clinical research includes direct interventional research/clinical trials as well as large data outcome studies using sophisticated statistical approaches. Examples of basic research topics include organ ischemia reperfusion injury, purinergic receptor signaling in sepsis, anesthetic effects on the electroencephalogram and post-anesthesia outcomes, inflammatory and fibrotic lung diseases, elucidation of protein structure/function via cryo electron microscopy techniques, mitochondrial bioenergetics, mechanisms of anesthetic neurotoxicity and mechanisms of acute and chronic pain. Clinical studies include investigations into biomarkers of kidney and liver injury in the perioperative/lCU environment, delirium and cognition changes in the perioperative period, protective strategies against ventilator induced lung injury, perioperative pain and opioid management, complications in the pediatric patient after surgery/anesthesia, and the impact of palliative care in cancer patients. Large data studies address research topics related to pediatric anesthetic neurotoxicity, intraoperative predictors and interventions for kidney injury, anesthetic complications in obstetrical anesthesia, and risks for cognitive decline and delirium after anesthesia and ICU care. Students are paired with mentor(s) experienced in clinical, basic and epidemiological research and identify appropriate contributions to ongoing research projects during this elective.