2023-24 Obstetric Anesthesia Fellowship Application cycle: Duke will be participating in the SF Match for Obstetric Anesthesia Fellowship positions. All interviews will be conducted virtually due to COVID-19 pandemic.

We remain an ACGME-accredited program and will accept applications for the 2023-24 fellowship year starting November 1, 2021.

To be considered for an obstetric anesthesiology fellowship position:

• Complete the Obstetric Anesthesiology Common Application.
• Include a personal statement in the Common Application.  We do not require the supplemental questions.
• Submit a Curriculum Vitae.
• Three letters of reference should be either emailed as PDFs or sent via USPS directly by the letter writer.
• Request an official USMLE transcript be sent directly to us. To receive a North Carolina medical license, each step of the USMLE or COMLEX must be passed within three attempts.
• Submit all available In-Training Examination reports.
• Register as an applicant with SF Match starting January 10, 2022.
• Eligibility, Recruitment and Selection 

Additional fellowship training through Duke Anesthesiology includes:

• Adult Cardiothoracic Anesthesiology
• Anesthesia Global Health
• Critical Care Medicine
• Neurosurgical Anesthesiology
• Pain Medicine
• Pediatric Anesthesiology
• Perioperative Medicine
• Regional Anesthesiology & Acute Pain Medicine
• Research
• Undersea & Hyperbaric Medicine

Applicants interested in a 2-year combined fellowship at Duke should e-mail Dr. Dominguez directly to inquire: jennifer.dominguez@duke.edu.

Important dates for 2023-24 Fellowship Application & Match process:

• November 1, 2021 – May 1, 2022: Applications accepted/Register with SF Match
• January 1 – June 1, 2022: Virtual Interviews scheduled and conducted
• June 14, 2022, 3 PM EST: Rank List Deadline
• June 21, 2022, 12 PM EST: Match List Released
• August 1, 2023: Duke Obstetric Anesthesiology Fellowship Start Date

Application materials may be submitted by mail or email to:

*1-2 dedicated research days/week during each rotation

Labor & Delivery Rotation

Clinical:

For seven months, an OB anesthesia fellow actively leads the OB anesthesia team, which includes residents and a nurse anesthetist. The fellow leads the twice daily handover rounds with MFM, in addition to consulting with obstetric colleagues throughout the workday. During the second half of the training year, the fellow takes a limited amount of overnight calls with a resident; the OB anesthesia attending is available in-house for consultation. OB anesthesiology fellows lead the pre-operative planning and multi-disciplinary collaboration for the care of high-risk parturients, and are involved in the majority of these cases with the support of a faculty member.

Didactics and Conferences:

• Obstetric Anesthesia Lecture series: Regular, planned lectures on a range of topics pertinent to an advanced consultant in obstetric anesthesia that are recommended by ACGME and taught by obstetric anesthesiology faculty members, as well as MFM and neonatology faculty
• Monthly SOAP-sponsored Virtual Obstetric Anesthesiology Grand Rounds will be watched with a faculty member in order to facilitate discussion
• Journal clubs: fellows will prepare and present articles for journal clubs during the fellowship year, including a joint-MFM journal club
• Morbidity and mortality conferences in anesthesiology & obstetrics
• Weekly multidisciplinary conferences — high-risk antepartum patients
• Monthly, multidisciplinary conferences — high-risk fetal patients
• Fetal Heart Rate monitoring interpretation course – MFM faculty
• Weekly Departmental Fellowship Seminar series: Aimed at issues of general interest to the anesthesiologist including professionalism, leadership, business management, education, career development, ethics, oral board preparation, and numerous other topics. These sessions are led by departmental faculty.
• Quality & Safety Course: Taught by anesthesiology faculty experts in quality improvement and patient safety. Course is taken in conjunction with other departmental fellows. Fellows develop their own QI project.
• Transthoracic Echocardiography Workshops: Taught by board-certified, echocardiography experts from the Division of Cardiothoracic Anesthesiology. This is an excellent opportunity to learn basic TTE examination skills and how they can be used to optimize the care of critically ill parturient.
• Advanced Crisis Resource Management training and leadership development in our state of the art Duke Human Simulation & Patient Safety Center. Opportunity to participate in multi-disciplinary obstetric emergency simulations with obstetricians, anesthesiologists and nurses.
• Point of Care Ultrasound Certification (Optional): Fellows that choose to pursue the POCUS elective will participate in a structured curriculum that adheres to training guidelines endorsed by all three U.S. critical care societies (SCCM, ACCP, ATS). POCUS training will cover the following organ systems: focused cardiac; focused pleural/pulmonary; focused renal/GU; focused DVT; and FAST exam.

Maternal-Fetal Medicine Rotation

The OB anesthesia fellow will join their MFM colleagues for a two-week, in-depth look into their practice and antenatal considerations of patient care. The OB anesthesia fellow will attend morning rounds with the antepartum inpatient team, as well as outpatient clinics including the Duke Fetal Diagnostic Clinic and high-risk obstetrics clinics.  The MFM faculty actively engage our fellow in educational topics best explained by them, in addition to seeking the anesthesia perspective on care considerations for high-risk patients.

Neonatology Rotation

The OB anesthesia fellow will rotate for two weeks in the Duke Intensive Care Nursery (ICN). This ACGME-required rotation is organized and led by Dr. Susan Izatt. The OB anesthesia fellow will attend morning rounds with the ICN team, as well as all cesarean deliveries as an active member of the neonatal resuscitation team. This two-week experience provides additional insight into the neonatal impact of antenatal and perinatal decisions, and has proved to be exceptionally valuable for our fellows. After completing this rotation, fellows will receive Neonatal Resuscitation Program™ certification.

International Maternal & Child Health (Optional Rotation)

Several of our Duke OB Anesthesia faculty are actively involved with Kybele, an international, non-profit organization devoted to the reduction of maternal morbidity and mortality worldwide. Their participation with this organization allows them to contribute to the improvement of maternal health through clinical, educational and research activities in other countries.  This relationship also provides an opportunity for our fellows and residents to extend research projects to other practice sites, such as Ridge Regional Obstetric Hospital in Accra, Ghana. Read more about past OB Anesthesia fellows’ experiences in Ghana.

The Division of Women’s Anesthesia currently has eleven faculty members who subspecialize in obstetric anesthesia and provide 24 hour/day, on-site coverage for the Duke Birthing Center.  In addition to dedicated teaching from Division of Women’s Anesthesia faculty, fellows rotate with, and receive ongoing teaching from, faculty in Maternal-Fetal Medicine (MFM) and Neonatology. MFM attendings also provide 24 hour/day, on-site coverage at the Duke Birthing Center. Fellows are provided a supportive environment in which develop clinical, consultant and in-depth research expertise.

With no more than two fellows per year, our fellowship program has all the advantages of a small program with the resources and patient acuity of a larger program. The small number of OB anesthesia fellows ensures access to all interesting cases and clinical subjects for research projects. However, OB anesthesia fellows enjoy opportunities for collaboration, as well as social support, with the more than 30 fellows per year across the nine sub-specialties in the Duke Department of Anesthesiology. The department holds weekly fellows seminars designed to be of broad interest to trainees of all sub-specialties, as well as provide an opportunity for engagement among fellows. This series includes formal education and guidance on the development and completion of a quality improvement project.  The Fellows’ Office provides all fellows in the Department of Anesthesiology personal workspace that is conveniently located to clinical worksites. OB anesthesia fellows also engage regularly with fellows in maternal-fetal medicine through clinical work, joint conferences and journal clubs.

Additional features of our clinical practice include:

• Social, economically and ethnically diverse patient population
• 40 percent cesarean section rate
• 90 percent neuraxial labor analgesia
• Multi-disciplinary Maternal Hemorrhage Protocol in place for over 10 years

High risk conditions commonly managed:

• Severe preeclampsia & HELLP syndrome
• Referral center for abnormal placentation: multi-disciplinary team approach
• Maternal cardiac disease
• Maternal congenital heart disease
• Pulmonary hypertension
• Respiratory diseases
• Endocrine disorders
• Post-transplant parturients
• Super-morbid obesity
• Oncologic conditions
• HIV
• Polysubstance abuse
• Neurologic conditions.

Fellowship goals include maximizing proficiency in:

• Providing compassionate, culturally-sensitive anesthetic care to both high and low-risk parturients from a diverse range of socio-economic, ethnic and religious backgrounds
• Leading an anesthesia team of anesthesia residents and nurse anesthetists to provide comprehensive peripartum anesthetic care on a high acuity labor and delivery unit in concert with nurses and other physician specialists from maternal-fetal medicine, neonatology, pulmonary, cardiology, surgery, hematology, neurology, transfusion medicine, or interventional radiology
• Demonstrating technical expertise and clinical judgment to perform all neuraxial anesthetics and any medically-indicated invasive monitors, including expertise in the use of ultrasonography for neuraxial placement and cardiac assessment
• Demonstrating competence in the comprehensive analgesic/anesthetic management of both maternal and fetal comorbidities for:
  • Vaginal deliveries with high-risk maternal or fetal conditions
  • Planned/emergent cesarean deliveries with high-risk maternal or fetal conditions
  • Non-obstetric, antepartum surgery
  • Antepartum fetal surgery
• Antepartum consultations with high-risk parturients
• Care of the critically-ill parturient and advanced crisis resource management

Other clinical education opportunities include:

Given the resources and collaborative nature of the practice at Duke, arrangements can be made based on specific interest of a fellow to work with physicians in different specialties who are also involved in the care of our pregnant patients. These opportunities include, but are not limited to cardiology, pulmonary and transfusion medicine.

Involvement in an anesthesia research project is REQUIRED and assures skill development in:

• The ability to formulate clinically relevant hypotheses in obstetric anesthesiology and perinatology
• Research design to create achievable studies that will answer questions according to scientific methods
• Execution of research project
• Introduction to statistical analysis techniques
• Interpretation of results and preparation of a manuscript
• Presentation of research at national or international meetings, which forms the basis of a peer-reviewed manuscript submission for publication
• Introduction to research funding and grants
• Ability to critically evaluate the research of other investigators

Research opportunities include clinical and basic science research with mentors from anesthesiology and obstetrics. The research interests and publications of Duke faculty can be explored at Scholars@Duke. In addition, Duke has maintained the use of electronic anesthetic records for obstetric patients since 2003, which greatly facilitates retrospective database studies. Duke University Hospital and the Duke Department of Anesthesiology have a vast research infrastructure that supports the research activities of OB anesthesia fellows during the year of training, including scientific writing courses and access to statistical support. Fellows also participate in an institutional patient safety committee and lead a quality improvement project. Fellows are provided with a laptop computer and a $1,500 educational stipend for education or travel to national meetings such as the Society for Obstetric Anesthesia and Perinatology (SOAP). Fellows are strongly encouraged to present abstracts and give lectures at local and national meetings.

Dr. Cameron Taylor, 2018-19 Obstetric Anesthesia fellow, presents a case report at the SOAP 2019 meeting in Phoenix, Arizona.

OB anesthesia fellows will work closely with Duke Anesthesiology residents and medical students during their rotations on OB anesthesia, and in the management of patients for non-obstetric, antepartum surgery. Fellowship teaching opportunities also include didactic lectures, dedicated obstetric simulation sessions at the Duke Human Simulation and Patient Safety Center, journal clubs, and division M&M. Fellows can also participate in the Duke AHEAD program that provides opportunities to learn and develop teaching skills.

OB anesthesia fellows are taught and mentored by faculty from the Divisions of Women’s Anesthesia, Maternal-Fetal Medicine and Neonatology. Meet our faculty and find out what our OB anesthesia fellowship alumni have been up to!

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