From the Chair, Dr. Todd

Thumbnail portrait of Michael Todd

Thank you for taking time to learn more about the Department of Anesthesia at The University of Iowa. This is one of the oldest and, in our clearly biased opinion, one of the best clinical training programs in the country. If you are interested, you can find out more about our Departments history, and if you don't believe me about quality, just ask our graduates.

We receive about 600 applications each fall, interview ≈100 candidates, and accept ≈13 PGY-1 residents through the match. 80% are US grads, the remainder are from around the world (and typically top students in their classes). The program is designed to prepare graduates for anything that medicine can throw at them, in any environment from the smallest rural practice to the largest tertiary multispecialty hospital. Our residents are good. Some go directly into practice after residency. Roughly half go into fellowship training. Our 10 year ABA Board pass rate is 99%.

  1. Faculty and Teaching: We have a large faculty (over 60 people), many of whom are young, incredibly bright and eager, and from our own program - in Pediatric Anesthesia, Regional Anesthesia, Critical Care, Pain Medicine, Cardiac Anesthesia and others. Most of these individuals are "clinician - educators" and the University of Iowa takes teaching very, very seriously (teaching is not optional). Faculty are evaluated by our residents (and by students) in both the OR and the classroom - and each faculty member knows where he/she stands relative to his/her peers. And since promotions are heavily dependent on teaching, it isn't surprising that teaching scores have risen progressively over the last 5 years. In addition, members of our faculty play prominent roles in the Medical School (including as the Chair of the College Admissions Committee), and in all years of the curriculum. Several faculty are working towards their Masters in Medical Education and there has been a steady stream of faculty members receiving teaching awards - not just from our residents but from the medical school.
  2. Regional anesthesia: At Iowa, regional anesthesia is a way of life. Over a dozen of our faculty are skilled "regionalists" and more than 5,000 patients per year (about 25% of our total surgical load) receive some kind of regional anesthetic - and this doesn't include obstetrics. All of our residents become facile in thoracic epidurals and cervical, thoracic, and lumbar paravertebral blocks, as well as both upper and lower extremity blocks (for example, interscalene, infraclavicular, axillary, femoral, sciatic, and popliteal blocks). Ultrasound machines are everywhere! We have a detailed program for training residents in anatomy related to regional anesthesia (including cadaver workshops). Our residents typically complete their training with regional caseloads several times greater than that required by the Residency Review Committee (RRC).
  3. Critical care medicine: In many departments, anesthesiologists are consultants in the ICU. Not at Iowa. The Department has directed the Surgical Intensive Care Unit for 40 years. The Medical Director of the SNICU is Dr. Kent Pearson. Ten of our faculty members are critical care trained and certified. We manage over 3,000 patients per year, and our residents spend a full six months in the ICU during their training, obtaining some of the best critical care training in the country. Even if you have no interest in a career in Critical Care Medicine, the experience gained in the management of such complex patients will go a long way toward helping you to be the best clinical anesthesiologist possible.
  4. Pain management: Under the direction of Dr. Tim Brennan, Iowa has developed one of the most active and sophisticated pain medicine programs in the Midwest. Our Acute Pain Service typically cares for 15-20 patients per day (most of whom have continuous catheter regional anesthetics) and our Pain Clinic deals with all aspects of chronic pain, including fluoroscopically-guided interventional procedures. Residents participate fully in both the acute and chronic pain services.
  5. Pediatrics: Over 20% of our cases involve children and the University of Iowa Children's Hospital performs almost 75% of the complex pediatric surgery in the state of Iowa. These range from preemies to teenagers, and involve every kind of major and minor surgical procedure. And construction on the new UI Children's Hospital is underway.
  6. Patient Simulator Center: The Department of Anesthesia opened the first simulator center at the University and one of the earliest simulator centers among anesthesia departments in the Midwest. In January 2008, we replaced our old adult simulator with a new, state-of-the-art, high-fidelity unit. Simulator-based activities are now an integral part of our clinical rotations (including critical care) and all of our residents participate in simulator-based training on a regular basis. In addition, more and more effort is being devoted to "in situ" multidisciplinary team training in the OR and elsewhere.
  7. Service vs. Education: Residents are no longer students but licensed medical professionals hired by hospitals to help care for patients - and in the course of that effort learn how to practice medicine. Extensive, focused, rotation-based clinical work is required for good training, and anyone who tells you that residency isn't hard work is being dishonest. This is not a "7 to 3" job - and if you are looking for a program that guarantees that you'll be out of the hospital by 3 p.m. every day, don't look at Iowa. But a good residency must involve more than just doing a lot of cases; residents are here to learn. A big part of our job is to carefully manage the activities of our residents to insure a balance between service and educational needs. For example, we use our CRNAs to help insure that cases assignments are of maximal benefit - and to help get trainees out for key conferences and for simulator time. We have an elaborate case-tracking system so that we know who has done what and who needs to do what - to guide assignments. Our Chiefs work closely (often on a daily basis) with our Program Director and with our scheduling team to make sure that the education/service balance is maintained.

Our goal is to provide the best, well-balanced residency experience possible, in terms of both clinical training and the extensive medical knowledge you will need to succeed, and to do so in an intense yet pleasant working environment. You will not find a department with a better focus on clinical training and education or on team spirit, quality of life, family values, and community.

Michael M. Todd, MD
Professor and Head

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