Which Fellowship is Right for Me? Part 1 of 2
September 11, 2023 | Emma Huebner, MD, Lindsay Brown, MD, Tina Yu, MD, Colby Tanner, MD
Anesthesiology residency is a whirlwind. While busy 24-hour calls and challenging rotations may sometimes feel arduously long, each year flies by faster than the one before. Just as CA-1 residents are finally getting to relax in their chairs behind the illustrious blue drape of a routine lap chole or ORIF ankle, they must begin to consider the prospect of pursuing fellowship.
Fellowship applications generally begin in the fall and winter of the CA-2 year, before residents have even had the time to rotate through every subspecialty. Given the crunched timeline, it is helpful for residents to have an idea of what they may be most interested in; they can request these rotations early in CA-2 year and have a better chance at making an informed decision when it is time to apply.
UCLA offers ACGME-accredited anesthesiology fellowships in adult cardiothoracic anesthesiology, critical care medicine, pain medicine, and pediatric anesthesiology. The obstetric anesthesiology fellowship is currently in the process of becoming ACGME-accredited at UCLA.
In addition to these, UCLA also provides an extra year of training in regional anesthesia and acute pain medicine, liver transplant, perioperative medicine, and other niche areas of anesthesiology if interest arises. These non-ACGME accredited fellowships tend to be more fluid and flexible in schedule, often functioning as a hybrid fellow/attending year during which trainees also work independently in the main OR, with higher financial compensation for this time.
For those interested in further sub-specialization, UCLA offers a combined two-year training program in critical care and cardiothoracic anesthesiology, as well as an additional year after pediatric anesthesiology fellowship in pediatric cardiothoracic anesthesiology.
On a brief personal note, I am the poster child for decision paralysis when it came to the fellowship application process. I started residency with the intention to pursue a fellowship in critical care medicine, changed my mind after loving my pediatric rotation at CHLA, fully applied and interviewed for pediatric fellowships, only to then start questioning my decision when I liked my cardiac and OB anesthesiology rotations even more. After these rotations finished, I started a month in the CTICU and immediately remembered why, despite my love for many niches within anesthesiology, the ICU is where I am most at home. This fortuitous month in the CTICU landed me in my final decision to pursue a critical care fellowship after residency.
Having come full circle, I think that I needed to take that circuitous route to be as confident and excited in my decision as I am. Aside from the necessary self-reflection that a fellowship decision requires, I found it incredibly helpful to hear the insights of others who had gone before me. With the knowledge that we are all unique and have different skill sets and talents, as well as different passions and motivators, I think it is helpful for residents who are early in their training to learn what piqued others’ interest in embarking on their respective career paths, and why a similar route might be a good fit (or not) for each individual trainee.
This issue and next, we will be featuring various subspecialists in anesthesiology at UCLA, and what prompted them to pursue the paths they took. To our new interns, CA-1s, and CA-2s, I hope you enjoy their stories and possibly glean some insight into what drives you, and where you want to take your own career after residency.
Lindsay Brown, MD
Pediatric Anesthesiology
Medical School: Georgetown University
Residency: University of Virginia
Fellowship: Boston Children’s Hospital
Did you start residency knowing that you wanted to do your fellowship of choice?
I did. I have always loved working with children and went into medicine thinking I would pursue a pediatric subspecialty. During medical school, I found that pediatric anesthesia combined the physiology and pharmacology that I enjoyed with my favorite patient population in an incredibly fulfilling way.
What personality traits or skill sets are beneficial for your sub-specialty in anesthesiology?
Pediatric anesthesiologists exhibit a strong emphasis on precision and attention to detail. Things can change very quickly in peds anesthesia and preparation is key; we love a well-organized and labeled OR set-up! We also have to be very adaptable and patient, as babies and children can’t always communicate or cooperate with us. Additionally, parents play a key role in the perioperative team, so versatile communication skills are important for interacting with all ages and personalities.
As for procedural skills, I think most procedures in pediatric anesthesia can be learned with practice and patience (and a good ultrasound also helps).
What is your favorite thing about your sub-specialty?
The patients! Working with kids is exciting and rewarding. I love getting to know each kid’s personality and connecting with them.
What are the biggest challenges that you face within your sub-specialty?
Seeing sick kids every day can certainly be challenging, but it helps knowing that you are working to make their lives better.
Are there any changes you foresee within the field of anesthesiology that will affect your sub-specialty?
Pediatric anesthesia is expanding with the advancement of fetal medicine. In the past few years, there has been a significant increase in the number of centers providing intrauterine procedures to the developing fetus with the goal of decreasing morbidity and mortality from conditions such as neural tube defects, congenital heart disease, and congenital diaphragmatic hernias. Anesthetic care for these procedures requires integration of both obstetric and pediatric anesthesia practice. Fetal anesthesia is not currently a routine part of pediatric anesthesia training, and it will be exciting to see how these new practices are integrated.
If you hadn’t done what you are currently doing, what would have been Plan B?
Tie between kindergarten teacher and dolphin trainer.
Tina Yu, MD
Obstetric Anesthesiology
Medical School: UCSF
Residency: UCSF
Fellowship: UCSF
Did you start residency knowing that you wanted to do your fellowship of choice?
I had no idea when I started residency that I would be doing an obstetric anesthesia fellowship. I thought I would go into critical care because so much of medical school and intern year was centered around medicine, and ICU physicians were the anesthesiologists I was most exposed to.
What was your favorite rotation during residency? Your least favorite?
I had two favorite rotations during residency: obstetric and regional anesthesiology. I didn’t have a least favorite rotation, but I had rotations that I learned quickly were not subspecialties I would be pursuing.
Which personality traits or skill sets are beneficial for your subspecialty in anesthesiology?
In addition to basic anesthesia skills, you need to have good procedural skills, ultrasound skills, and bedside manner, since our patients are awake and not sedated most of the time. You also need leadership skills, as you will be co-managing the labor and delivery deck with the obstetricians and charge nurse. Flexibility is also important, as things can change rapidly in labor and delivery.
What is your favorite thing about your sub-specialty?
My favorite thing is the opportunity to be a part of such a significant moment in a person’s life.
What does a typical day look like for you when you are practicing within your subspecialty?
The day starts off with getting handoff/sign-out from the preceding anesthesiologist. Tasks to follow include checking to ensure that the ORs are ready for any crash cesarean deliveries, reading up on the admitted patients and noting any high-risk issues that may need anesthesia intervention, performing any necessary procedures like labor epidurals, and providing support for cesarean deliveries or postpartum hemorrhage as they occur.
What are the biggest challenges that you face within your subspecialty?
There are some people who feel you do not need an obstetric anesthesia fellowship to do obstetric anesthesia. However, with the increasing number of high-risk patients like congenital cardiac patients getting pregnant, I would argue just the opposite. An additional year focusing on caring for high-risk obstetric patients is invaluable. The high rates of maternal mortality in this country also point to the need for additional education and training to address the effects of bias and racism in healthcare.
Are there any changes you foresee within the field of anesthesiology that will affect your sub-specialty?
I think AI will have a big impact on the way we practice. I can’t say how specifically, but the prospects are huge.
If you hadn’t done what you are currently doing, what would have been Plan B?
I would have done a regional anesthesia fellowship if I did not end up going with obstetrics.
Colby Tanner, MD
Liver Transplant Anesthesiology
Medical School: Loma Linda University School of Medicine
Residency: UCLA
Fellowship: UCLA
Did you start residency knowing that you wanted to do your fellowship of choice?
I started residency thinking that I would go into private practice without doing fellowship. I was fairly open-minded about the idea of fellowship but didn’t feel strongly about it. I figured I would just go through residency and see if anything seemed worth pursuing further as a fellowship. It wasn’t until a couple of weeks after I completed my liver rotation as a resident that I started to consider the value of doing the fellowship. I found that (resident call schedule aside) I really enjoyed the cases. I also felt that the liver faculty members had a lot to offer from a teaching standpoint. An extra year of working with them as mentors seemed like a valuable opportunity.
What was your favorite rotation during residency? Your least favorite?
I would say my favorite rotation was OB. I found it to be fun, exciting, and overall rewarding. I feel like the highs are very high and the lows very low when on OB. I enjoyed the change of pace and new skills I gained from that rotation. I especially enjoyed doing OB at Long Beach Memorial Hospital.
My least favorite rotation was probably chronic pain (no offense to anyone who trained me there). I loved our faculty and really appreciated the teaching they provided. I found that I just didn’t love being in clinic for such a large portion of the day. I found it tiring and kind of grueling.
What personality traits or skill sets are beneficial for your sub-specialty in anesthesiology?
Being calm and a good communicator. We have to coordinate very closely with the surgeons and nursing staff during liver transplants so that each team can adjust to any issues or concerns that are presenting during the surgery. If each team is working in isolation and not communicating what they are seeing, the cases tend to go very poorly. Additionally, being flexible and responsive to constant changes is a must. You have to stay on your toes and be ready for literally anything that comes up.
What is your favorite thing about your sub-specialty?
I love the fact that we can take patients that are about as sick as possible and help them get through an otherwise deadly procedure. The cases are oftentimes not super fun in the moment, but in retrospect are deeply rewarding. I also really appreciate the camaraderie we have with the transplant surgeons and nursing staff. We are a tight-knit team.
What does a typical day look like for you when you are practicing within your sub-specialty?
Generally I will take liver call 1-2 times a week. When I am assigned to liver, I will generally start the morning by reviewing any pending transplant cases that are already accepted for the day. Most often our cases happen in the afternoon and evenings, so during the day we will do other hepatobiliary cases such as liver resections, transplant take-backs, etc. In the evening, I will remain in close contact with the transplant coordinators to make sure that we are adequately prepared for any upcoming cases.
What are the biggest challenges that you face within your sub-specialty?
I think the biggest challenges we face are very patient care-related. In any given case we must be prepared to fight for our patients’ lives. Patient decompensation and even death is a real threat for us in each case. This can be very physically and emotionally draining.
Are there any changes you foresee within the field of anesthesiology that will affect your sub-specialty?
Our field is seeing significant changes as technology improves. One of the most significant recent developments is normothermic machine perfusion of organs. As this becomes more available, we are seeing increased patient stability during transplant surgery. Additionally, these machines have the potential to increase availability of organs as we can get more information about organs of more marginal quality before they are transplanted.
If you hadn’t done what you are currently doing, what would have been Plan B?
I most likely would have ended up doing general anesthesia in another setting without a fellowship. Although I originally thought I would go into private practice, I have really enjoyed working with medical students and residents. I think being in an academic setting would have ended up being a part of my plan with or without fellowship.