MSD

A Regular Day in the OR

Day Before:

• Usually by the early afternoon, you will receive your OR assignment from the Anesthesia Scheduler on Epic. 

  • There are 3 main locations: 500P, 300P, and the ASC (among a few others - Endo, MRI, Cath lab). 

• You can look up each case on Epic and then discuss with your assigned attending (find their phone number on the Ether app) what the plan will be for the following day!

Day of:

• 6:00-6:30 AM: Arrive to setup for your first case start

• 6:45 AM: After your OR is ready, meet patient in pre-op area, discuss the anesthetic plan, connect with your attending, and confirm with your OR circulator nurse before rolling back to the OR.

  • If placing an epidural for a first case start, please review the protocol HERE.

• First case start: 

  • Monday 8:15 AM (due to Grand Rounds which is held every Monday at 6:30 AM)

  • Tuesday-Friday 7:15 AM

• Your day will continue until you have finished all your cases (be aware that you may get add-ons if your OR schedule is light!). A regular day is expected to go until 6PM, but don't forget that you can accrue Academic Hours for your overtime work if you are kept longer than this (see below)!

Haven't been in the MSD in a while? Refresh with these resources:

***Please click HERE to review the expectations and etiquette of working in the Stanford operating rooms***

If it's your first time in the Stanford ORs or haven't been back in a while, you may also find the following resource to be helpful in orienting you to where many essential equipment and drugs can be found in the OR: Stanford Anesthesia Cart and Machine Drawers

OR Resources

• Pharmacy: Both 300P and 500P have OR pharmacies with commonly required drugs/drips, etc. 

  • ASC does not, so grab some drugs from 300P before heading there!

• Anesthesia Techs: All 3 locations are staffed by anesthesia techs (see phone numbers button above). They are your friends!

Regular Day

• First case start - 6pm (may be relieved sooner - always check in with scheduler when your cases are finished to make sure they don't need you elsewhere!)

MSD Call Order

As of July 1, 2024:

• 1 Call

  • • Weekday  1 call/night float: 6pm-7am (Sun - Fri)

      • This is a week-long call shift, which starts with the Sunday MSD 1 Sunday PM 6pm-8am shift (13-hr because of Grand Rounds on Mondays)

    • Saturday 1  call: 

      • AM resident from 7am-6pm

      • PM resident from 6pm-7am

    • Sunday 1 call: 

      • AM resident from 7am-6pm

• 2 Call

  • • Weekday 2 call: 7am - until only 1 OR running (and home-call for remainder of night until 7am). DAC next day.

    • Saturday 2 call: 24-hr home call: 7am-7am

    • Sunday 2 call: 25-hr home call: 7am-8am (for Grand Rounds). Monday DAC.

• Relief shift: 3:45pm - latest 1am (you're relieved after the 3 call resident); this is a week-long call shift

  • Relief shift relieves the E-day resident (AMION (p/w resident@su) →  "Who's on?"→ call →  "E-day").

• 3 call: First case start - latest 12am 

  • • 1pm start the next day - you'll relieve the "Half-Day" person listed on the AMION call schedule: AMION (p/w resident@su) →  "Who's on?"→ call →  "Half-day"

• 4 call: First case start - latest 8pm

• 5 call: First case start - latest 8pm

• Half-Day: First case start - 1pm (relieved by 3 call resident from previous night - nice perk!)

  • • Shift applicable Tuesday-Friday only

• E-Day: First case start - 3:45 pm (relieved by the Relief shift person)- a great shift to consider requesting for an afternoon appointment or early day out!

**IMPORTANT NOTE: Residents on "MSD-adjacent" subspecialty rotations [ie SAU, regional, PACU, MSD Periop, etc.] largely take either 4 or 5 call (extenuating circumstances such as the first couple months of the year when CA1s are not call-eligible may necessitate a higher call number). When taking call, please report to the anesthesia scheduler at 3:45pm for your call assignment. 

Liver

Check out the Liver page for more details on set-up, papers, and callback policy!

• Liver 1: 2 week rotation where the resident is first-call for any liver transplants on weekdays and weekends. They will rotate through the MSD on days where no liver transplants occur, but are not eligible for MSD call on the weekdays/weekends. The Liver 1 call resident will have a DAC on the Monday following their last Sunday of the two-week rotation. Residents are expected to notify the rotation directors of the rotations (e.g. ICU) that follow their Liver rotation of their  post-Liver Monday DAC to ensure that they aren't scheduled for a shift on that Monday.

• Liver 2: Backup resident on the weekends (7a-7a) to be available via home-call for simultaneous liver transplants, or when two back-to-back livers will cause the Liver 1 resident to break duty hours.

Jeopardy

Jeopardy Policy

• Senior Call: CA-3s

• 2 week block of "Jeopardy" shifts

• Monday 8 AM - Monday 8 AM during Jeopardy week

• NOTE: All jeopardy activations must come through the Chiefs! Confirm with the chiefs prior to activating.

A Few Pretending Tips - an editable Google document from senior residents who have done the rotation before!

Academic Hours Submission Form 

Academic Hours Policy

These are extra days off that residents can earn when they work in the Stanford OR ("MSD") beyond certain times. They can only be earned in the MSD, and can only be used on MSD rotations (e.g. MSD, ortho, trauma, urology, neuro, etc) or electives (e.g. Ob elective, cardiac elective, regional elective, etc). You must request your "academic day" at the time of the block schedule requests. Their utilization is approved by the chief residents. No academic days may be used during the last week of the year.

8 academic hours = 1 "academic day" = day off

Academic hours are accrued in 10 minute increments starting at the following times:

• MSD non-call: 6 PM

• MSD 4 & 5 call: 8 PM 

• MSD 3 call: 12 AM 

• MSD relief: 1 AM

• MSD 1 and 2 call are not eligible for academic hours. 

Dining

• Anesthesia Department (300P): free assortment of coffee, pastries, fruits, hardboiled eggs, etc for breakfast made available every weekday thanks to our lovely anesthesia department!

• 300P Cafeteria: rotating selection of options from local restaurants on a daily basis

• 500P Cafeteria: Hospital cafeteria food with a selection of pre-packaged sandwiches/sushi/fruit cups/etc, daily fresh soups/salads/sandwiches, grill options, coffee and other drinks, and desserts. Be sure to pick up a "Loyalty card" found at the cashier in either 300p or 500p cafeteria and an enrollment form to active it; this gives you a 10% discount on purchases made at the Market Square Cafe, The Perk, Courtyard Cafe, Java Junction, and the 730 Welch Coffee Kiosk.

• ASC Zoom Cafe: Free lunch available when working at the ASC/OSC locations using THIS link. Instructions to sign-up here.

• After-hours food: 500P 3rd floor in the "Stanford Dining Room" - the GME stocks the lounge with healthy snacks for after hours (9pm - 2am) when the cafeteria and other food options are not available. This food is for Residents and Fellows only.

Intro

This is a short and sweet one- to two-liner for each rotation. These rotations are eligible for MSD call and follow the rules of a regular MSD OR day (6a-6p), unless noted otherwise. Enjoy!

Abdomen

Senior-level. 2-week rotation doing large abdominal cases with the hepatobiliary surgical team including liver resections, Whipples, etc. Cases include judicious fluid management, specialized vascular access, and potentially epidurals.

ASC

Junior-level. 2-week rotation doing cases at Lane Surgery Center (potentially other sites TBD) including a focus on outpatient surgeries, early recovery in PACU, and a variety of ENT, Breast, Plastics, and Gen Surg cases.

ASC Scheduler

Senior-level. 2-week rotation operating as the Anesthesia Scheduler at Lane Surgery Center. You will help coordinate the flow of the ORs, including case scheduling, relief plans, and breaks for solo providers.

Please click here for a comprehensive guide to the rotation. The guide, compiled by Rupa Patel (thanks Rupa!) and with Dr. Saffary's knowledge, contains helpful information that has been passed down from resident to resident.

Bariatrics

Junior-level. 2-week rotation with a focus on bariatric surgeries including minimally invasive techniques. Learn to manage morbid obesity, procedures for weight loss/control, and the safe conduct of anesthesia with ERAS protocols.

ENT

Senior-level. 2-week rotation, mostly in the Lane Surgery Center performing high-level, complex airway management. Gain skills managing TIVA anesthetics and operating many different airway devices.

MSD Green

Junior-level. 2-week rotation. Focus on learning the practice of green, eco-friendly anesthesia and how to reduce the environmental impact of your anesthesia practice.

Liver

Senior-level. 2-week rotation. Learn to perform liver transplant anesthesia including specialized vascular access, intra-operative TEE, and massive transfusion, among many others. 

• Liver Transplant Guide

MSD High Risk

Senior-level. 2-week rotation. Perform anesthetically-challenging general OR cases in patients with severe cardiac abnormalities who may benefit from intra-operative TEE.

Neuro 1 (Cranis)

Junior-level. 4-week ACGME rotation. Perform anesthesia for intracranial/extracranial procedures. Learn the intricacies of neuromonitoring, specialized vascular access, and management of hemodynamics and intracranial pressure.

Neuro 2 (Spine)

Junior-level. 4-week ACGME rotation. Perform anesthesia for spinal surgeries, varying from simple outpatient microdiscectomies to multiple level anterior-posterior spinal fusions with transfusion management, specialized vascular access, and neuromonitoring.

• KZ's Spine Sheet

Ortho

Junior-level. 2-week rotation. Perform anesthetics for joint replacement, learning about neuraxial and regional techniques, along with transfusion management, bone cementing, etc.

Out of OR

Junior-level. 2-week ACGME rotation. Focus on managing anesthetics in potentially challenging environments.

"As residents, you mostly will spend time in Cath/IR (300P and 500P, and sometimes Lane Cath IR), and Endoscopy. At this time, residents are rarely assigned to MRI and CT areas. 

On the Ether website, under Specialty Resources, you will find articles and information relating to this rotation, including articles and general guide on Cardiac Electrophysiology/ablations, MRI, CT. There is also a textbook- Out of OR Anesthesia- available in Lane Library.  

Dr Tim Angelotti is your resource for Endoscopy- there is a brief guide written by Dr Angelotti, about Endoscopy.  Please contact me for any questions and issues relating to this 2 week Out-of-OR rotation."

PACU

Senior-level. 2-week ACGME rotation. 8a-6p. Evaluate, assess, and directly manage patients in the PACU recovering from anesthesia. Manage surgical and anesthetic complications including complex airway management and ongoing post-surgical resuscitation.

Periop

Junior-level. 2-week ACGME rotation. 7a-5p. Evaluate patients pre-operatively for anesthetic risk and engage in high-level discussions with the surgical team, patients, and their families. Assist with ICU sedation for bedside procedures and ECTs.

Please click here for a comprehensive guide to the rotation. The guide, compiled by Rupa Patel (thanks Rupa!) and with Dr. Kloosterboer's knowledge, contains helpful information that has been passed down from resident to resident.

Reproductive and Gynecologic Surgical Care (RGSC)

Junior-level. 2-week rotation. Prepare and execute anesthetic plans for benign and malignant gynecologic procedures varying from simple hysteroscopies to complex abdominal tumor debulking, utilizing regional/neuraxial techniques and specialized vascular access.

SAU/Preop

Junior-level. 2-week ACGME rotation. Hours vary: check clinic schedule on EPIC. Evaluate patients in the pre-operative anesthesia clinic to allow for appropriate work-up and optimization prior to surgery. You may also assist with ECTs (will be notified and placed on your schedule).

Thoracic

Senior-level. 4-week ACGME rotation. Learn to manage single-lung ventilation, double-lumen tubes, bronchial blockers, specialized vascular access, and thoracic epidural placement and management.

Trauma

Junior-level. 2-week rotation. Learn to manage trauma patients, including massive transfusion/resuscitation. Predominantly orthopedic surgical patients, but can see variety of cases.

Urology

Junior-level. 2-week rotation. Learn to manage anesthesia for urologic procedures, varying from simple cystoscopies to robotic cystectomies with specialized vascular access, potential for transfusion, and specialized positioning management (Trendelenburg with abdominal insufflation).

Vascular

Junior-level. 2-week rotation. Prepare and execute anesthetic plans for a variety of vascular procedures, including AV fistula formation, amputations, and large vascular endarterectomies/bypasses. Can vary from simple regional/MAC cases to complex GETA. Understand intra-operative IV heparin dosing and monitoring.