What We Teach:
A wide diversity of patients and obstetric disease coupled with superior clinical expertise provides the backbone for our clinical fellowship training in Obstetric Anesthesia. Our hospital and its sister site, the Johns Hopkins Bayview Medical Center combine to perform over 4000 deliveries annually. Our obstetric fellows have the opportunity to participate in the education of our residents as well as consult and collaborate with our obstetric team. In addition to research opportunities within the Department of Anesthesia, collaboration with Obstetrics, Neonatology, Neuropsychology and the Bloomberg School of Public Health are all possible.
Participating Hospitals: The Johns Hopkins Hospital (downtown campus), Johns Hopkins at Bayview Medical Center
Application Deadline: July 31, 2016
Match Rank Order List Deadline: September 21, 2016
Match Day: October 5, 2016
Number of Fellows: 1-2 per academic year
Annual Salary: PGY Level 5, no less than approximately $61,610
Special Requirements: MD state medical license, MD state permit to dispense drugs, DEA license;
Our institution does not sponsor J-1 visas beyond residency
In addition to your application we will need the following info. Items in bold are required.
- Updated CV
- Personal statement (optional)
- Three letters of recommendation (all on official letter head and signed, not to be more than 6 months old). Your recommendation letters should not state that you are applying for a “fellowship.” It should say “position”, since you will technically be credentialed as an Instructor.
- Medical school Dean’s letter of recommendation (optional)
- Medical school transcripts
- USMLE Complex scores (Parts 1 & 2 are required, Part 3 is optional)
- Copy of Visa and ECFMG certificate if applicable
- Contact info (phone, cell, pager, email)
- Picture ID (passport type)
- Letter in good standing from your current program.
Please do not staple any of your documents or put them in binders.
Applications are reviewed only when they are complete. You will be contacted via email if you selected for an interview. Interviews are usually held in July and/or August. Please feel free to contact us if you have any questions.
The Johns Hopkins Obstetric Anesthesia Fellowship participates in the NRMP Match. In addition to the application process described above, you must complete the registration process in NRMP’s Registration, Ranking, and Results (R3) system, electronically sign the Match Participation Agreement, and pay Match fees. After completing interviews, a rank order list (preference list of programs) must be created and certified in the R3 system.
The goal of the obstetric anesthesia rotation is to provide the resident with the necessary skills to safely and efficiently provide anesthesia to obstetric patients. The following goals have been established:
- Residents will develop an understanding of the basic principles of obstetric anesthesia care in the normal parturient as well as those with complex medical requirements.
- They will develop the necessary skills in pre-anesthetic assessment and preparation, as well as care of the laboring patient, intra operative management of the parturient, and post- operative care including assessment of complications, care and prevention strategies.
- Residents in the CA-2 and CA-3 years will be expected to attain further proficiency in these areas. In addition they are expected to act with more independence in the development and facilitation of patient care plans for both normal and high risk parturients.
The resident will be expected to:
- Act responsibly and with integrity with their patients, nurses, fellow residents and health care providers
- Fulfill clinical duties in a timely and appropriate manner
- Adhere to ethical principles including respect for privacy
- Demonstrate and active interest in learning and participating in the care of patients receiving anesthesia for obstetric management
Interpersonal and Communication Skills
The resident will be expected to interact well and demonstrate cultural sensitivity to patients, nurses, midwives, nurse anesthetists, obstetricians, and the attending anesthesiologist. The should develop skill in educating and preparing for regional blocks and other anesthetic techniques they may administer.
- Provide effective patient education regarding indications, risks and side effects of procedures
- Obtain appropriate informed consent from patients
- Communicate effectively with other members of the team
By the end of the 2 months rotating in Obstetric Anesthesia residents are expected to:
- Have a thorough knowledge of the physiologic changes in pregnancy.
- Understand the physiology and stages of labor, and the effects of anesthetics on labor and delivery.
- Understand and be able to describe the anatomic features and appropriate landmarks necessary to administer a regional anesthetic block including spinal dermatomes and pain pathways.
- Understand uteroplacental blood flow, its determinants, and how it is altered by regional and general anesthetics, as well as vasopressors and antihypertensives.
- Understand the available monitoring for fetal assessment as well as how to interpret electronic fetal heart monitoring patterns.
- Understand the pharmacokinetics / pharmacodynamics of local anesthetics as well as complications/toxicity in the parturient and neonate.
- Understand maternal uptake/distribution, placental transfer, and perinatal effects of local anesthetics, narcotics, sedatives, volatile anesthetics, barbiturates, ketamine, neuromuscular blocking agents, antihypertensive agents.
- Have a thorough understanding of the available anesthetic options and be able to discuss the advantages, disadvantages, and risks of:
sedation, inhalation, epidural, spinal, and pudendal anesthesia for labor and delivery local, regional and general anesthesia for cesarean section.
- Discuss the obstetrical considerations and management of labor complications including cord prolapse, breech/transverse lie, multiple gestation delivery, and premature rupture of membranes/preterm delivery.
- Understand and discuss elective and emergent indications for cesarean section (obstetric and fetal).
- Understand and manage induction, maintenance, and emergence from general anesthesia, and the effects of volatile anesthetics on the uterus and fetus. In addition residents should begin to be able to manage complications such as failed intubation, aspiration, hypotension, hypertension, etc.
- Be able to identify and assess the relative and absolute contraindications to regional anesthesia.
- Describe/manage complications of regional anesthesia in pregnancy including hemodynamic changes, neurologic sequelae, infection, and PDPH.
- Discuss and manage maternal hemorrhage. Including the risks associated with: placenta previa, placental abruption, accrete/percreta/increta, uterine rupture, uterine atony, retained placenta, uterine inversion, and DIC.
- Understand, recognize, and manage patients with medical conditions in pregnancy including:
- Hypertensive disorders: including Pregnancy induced hypertension, chronic hypertension
- Scoliosis and other spinal or neurologic anomalies
- Cardiac disease including congenital/ischemic/valvular/cardiomyopathy)
- Respiratory disease (restrictive/obstructive)
- Bleeding disorders in pregnancy
- Morbid obesity
- Difficult airway
- Endocrine Disorders
At the conclusion of the the CA-1 rotation residents should recognize the above and be familiar with the management options. It is expected that the CA-2/CA-3 resident expand their knowledge of the above topics while focusing on developing facilitating management plans for the patients and topics discussed above.
By the end of the 2 months of rotations, residents should be able to:
- Safely and proficiently place and manage regional anesthesia (both spinal and epidural anesthetics) for labor, cesarean delivery, D&C, postpartum tubal ligation, cerclage, etc.
- To be able to safely and thoroughly prepare an operating room to be ready to administer an anesthetic for vaginal/cesarean delivery.
- Safely administer general anesthesia to the parturient in both the non-emergent and emergent setting for both vaginal and cesarean delivery.
- To be able to pre-operatively evaluate and design a safe anesthetic plan for the anesthetic management for healthy and high risk obstetric patients for both labor and delivery as well as cesarean section (elective and emergent)
- Diagnosis and management fetal/neonatal distress.
Practice Based Learning and Improvement
During this rotation the resident will be expected to demonstrate life-long practice based learning and improvement by reviewing the literature, including use of electronic media, for management of obstetric anesthesia. Residents are expected to:
- Access relevant literature on issues in acute postoperative pain anesthesiology.
- Critique own performance in procedural and management skill.
- Seek and apply feedback to improve performance.
The resident should demonstrate an awareness of and responsiveness to the needs of the large health care system as it relates to the obstetric patient. They also will understand the rationale for and participate in hospital initiatives to improve quality and efficiency as it pertains to obstetric anesthesia.
- Work effectively as a member of the patient care team.
- Understand basic principles of safety in the treatment of obstetric patients.
- Identify areas for quality improvement in the treatment of obstetric pain.
- Understand the documentation of the treatment of obstetric anesthesia.
The resident will receive paper or electronic evaluation (E-value) by the Division of Obstetric & Regional Anesthesia and Acute Pain, as well as verbal feedback informally throughout the rotation. The case-logs of the resident will also be evaluated periodically by the clinical competency committee for the number and type of cases to ensure they are obtaining adequate experience.
Lecture and Conference Obligations
- All residents are required to read Chestnuts Obstetric Anesthesia (3rd edition).
- Lectures will be given daily as time permits. Preparation for lectures should including reading of the corresponding lecture from Chestnut as well as any supportive reading identified on the lecture. Copies of Chestnut are available from Gloria McCoy in 280 Carnegie and readings are available online. Lecture schedule and outline are available on the education website and should be accessed and reviewed the night before the lecture.
- Attendance at Obstetric Anesthesia/Regional/Acute Pain journal club the last Wednesday of every block at 12noon. Residents will be required to present and discuss an article assigned by the journal club coordinator.
- Attendance at Obstetric team sign out/morning report at 7am
- Attendance at Thursday morning 7 AM grand rounds.
Dave Berman, MD
Truc-Anh Nguyen, MD
Obstetric Anesthesia Fellowship
Department of Anesthesiology and Critical Care Medicine
The Johns Hopkins Medical Institutions
Sheik Zayed Tower 8120L
1800 Orleans Street
Baltimore, MD 21287