The University of North Carolina at Chapel Hill

Overview

Located in the heart of Chapel Hill, North Carolina, the UNC Department of Anesthesiology holds a long-standing tradition of exceptional training in the optimal work environment. Our program is proud to foster such positivity within a department of over 200 providers, including residents, fellows, faculty, CRNAs, research faculty, and nurses. Our residents and staff care for patients of all degrees of severity in the full spectrum of practice settings including a level I designation trauma and burn center, ambulatory care center, pain clinic, procedure center, and community hospital. Our culture of learning is exemplified by faculty who collaborate alongside trainees daily rather than relying solely on lecturing to them. We engage through interactive didactics, simulation, diverse clinical practice, and a formalized oral board review course with results demonstrated by our performance above the national average for ABA board certification examinations. With a dedicated simulation division, we offer the latest in simulation technology including adult and pediatrics, interdisciplinary crisis management, regional anesthesia, and virtual transesophageal echocardiography. Residents uniquely acquire perioperative leadership skills by directing anesthesia care team personnel and resources during the richly dynamic environment of overnight call. Clinical innovation occurs during all years of training through formal quality improvement projects under a dedicated division. Our work has been showcased at all major anesthesia conferences, with trainees presenting their work at both national and international venues. With all of our unique offerings, it is no surprise our graduates secure fellowships in all major anesthetic subspecialties as well as ultimately obtain competitive positions within both private practice and academic anesthesiology.

Educational Research

UNC places a large emphasis on educational research. We have recently hired an education research specialist, Fei Chen, who has a doctoral degree in Education Psychology and Methodology. Dr. Chen is working on numerous projects with our faculty to assess resident recruitment methods, milestone assessment through OSCE, medication errors, flipped classroom teaching method, and feedback methods. In addition, Dr. Chen teaches our PGY-1s in the Academic Medicine Rotation and assists residents in research projects and poster presentations.

Susie Martinelli also has a strong interest in resident education and education research and recently earned an Education Research Methodology Certificate from the University of Illinois. She was the recipient of a Research in Education FAER grant (2014-2016) for her work on the flipped classroom in resident education. UNC has collaborated with seven additional academic anesthesiology programs for this study comparing traditional lectures to the flipped classroom to determine resident and faculty attitudes, knowledge acquisition, and knowledge retention. Drs. Martinelli and Chen are also collaborating with two additional anesthesia programs to conduct a survey on faculty attitudes toward active learning in graduate medical education with the hopes of determining how best to teach faculty active learning models of education such as the flipped classroom.

Pain Research

Why is acute pain severity among individuals exposed to a traumatic or stressful event (surgery, traumatic injury, natural disasters, etc.) so variable? Why do some individuals who experience such events go on to develop chronic pain or other neuropsychiatric sequelae (e.g., posttraumatic stress disorder, depression) while others recover. How can vulnerable individuals be identified in the early post-traumatic period, and what secondary preventive interventions can be administered that improve recovery and reduce the development of chronic disorders? These are the questions studied in the UNC Department of Anesthesiology TRYUMPH Research Program. Dr. Sarah Linnstaedt’s work focuses on the use of microRNA specifically, and molecular mechanisms more broadly, to elucidate the biology of chronic pain development and to identify those at high risk. Her recent studies include a recent study demonstrating that miRNA in the early aftermath of injury predict chronic pain outcomes (Mol Pain 2015), a study identifying sex differences in opioid-mediated stress-induced hyperalgesia after motor vehicle trauma (J Pain 2015), and co-authorship with Dr. Bortsov of a study identifying genetic polymorphisms influencing chronic pain development after motor vehicle trauma (Pain 2016). Dr. Matthew Mauck, who recently joined the program, focuses on mechanisms mediating chronic pain and itch development among individuals experiencing major thermal burn injury. His recent analyses include an analysis demonstrating that pain and itch are common after major thermal burn injury, and evidence, consistent with preclinical animal studies, that pain and itch pathogenesis share overlapping mechanisms. Dr. Andrey Bortsov is a molecular epidemiologist and statistician who applies sophisticated, state-of-the art analytic methods to collaborative analyses that gain new insights into the pathogenesis of chronic pain and related disorders. He collaborates on many of the analyses of the investigative team, his recent work includes several of the above studies and investigations evaluating the pathogenesis of widespread pain (Pain, 2016) and postconcussion symptoms (Psychosomatic Medicine, 2016). Dr. Tim Platts-Mills is a collaborator with the research group and an active investigator who evaluates chronic pain mechanisms in elderly individuals. The group is led by Dr. Samuel McLean, who with the team performs longitudinal studies evaluating outcomes after motor vehicle collision, major thermal burn injury, and sexual assault. April Soward is the program manager, and manages the program and directs a large team of outstanding coordinators and research personnel. Further information can be found at http://www.med.unc.edu/anesthesiology/research/tryumph-research-group-1

ERAS at UNC

At the University of North Carolina, all residents are participate in quality improvement projects as part of their training. Our residents are given an exemplary opportunity to learn first-hand about multidisciplinary collaboration, quality improvement research and design, and how to apply evidence-based practices. One such opportunity is our institution's "Enhanced Recovery After Surgery (ERAS)" program. ERAS is a multi-disciplinary perioperative program to improve patient outcomes and decrease hospital expenditure using evidence-based, best practice recommendations. Our residents are actively involved with the design, implementation, and data analysis for a variety of ERAS programs at UNC including surgical oncology, thoracic surgery, urology, and gyn surgery. The residents work closely with anesthesiology and surgery faculty leaders, as well as with the perioperative nursing staff. Our residents' involvement in ERAS has lead to numerous presentations at national meetings, publications, and featured articles in newsletters.

Simulation Research at UNC

The Consortium of Anesthesiology Patient Safety and Experiential Learning (CAPSEL) at UNC offers a myriad of educational programs for residents related to the practice of anesthesiology. Prior to the start of clinical anesthesia training, all incoming residents go through an anesthesiology “Bootcamp” teaching the steps necessary to prepare for an anesthetic, management of common intraoperative problems, and basic procedural skills. Throughout the clinical anesthesiology training years, residents participate in several simulation sessions per year emphasizing crisis resource management skills for treating common intraoperative emergencies and rare intraoperative events (such as malignant hyperthermia). Residents also participate in a bi-annual Objective Structured Clinical Exam (OSCE) to prepare for the ABA primary certification exam. Lastly, residents have access to several opportunities for participation in multi-disciplinary and inter-professional simulation in a variety of clinical settings, such as the Children’s’ hospital operating rooms, Labor and Delivery floor, and the hospital “code-blue” team. For more information please visit: http://www.med.unc.edu/anesthesiology/simulation