Anesthesiology Residency

Carilion Roanoke Memorial Hospital (CRMH) in Roanoke, Virginia, is a rapidly expanding, high-acuity academic institution. As an 835-bed tertiary care center and Level I Trauma Center, it serves as the primary teaching hospital offering exposure to complex cases. Residents in our program will spend the majority of their training at this site where they will develop core and advanced anesthesia skills. 

What Residents Learn at CRMH

• Managing high-acuity, complex, and emergent cases
• Team leadership in the OR and ICU
• Advanced airway skills (fiberoptic & lung isolation)
• Hemodynamic monitoring, including central lines & PA catheters
• Transesophageal echocardiography (TEE) fundamentals and interpretation
• Management of trauma and massive transfusion
• Pediatric airway and physiology
• Obstetric physiology and emergency delivery anesthesia
• Systems-based practice in a large academic medical center

Key Clinical Experiences:

• High-acuity inpatient anesthesia care including general surgery, trauma surgery, cardiothoracic and vascular cases, neurosurgery, orthopaedic surgery, pediatric surgery, and obstetrics (labor epidurals and c-sections). 
• ICU / Critical Care including ventilator management, vasopressor administration, resuscitation and shock management, and multidisciplinary ICU care
• Preoperative and postoperative anesthesia care including a PACU rotation ( focusing on assessment, complications, hemodynamic crises)
• Subspecialty anesthesia training including neuroanesthesia, cardiac anesthesia (including TEE/TTE training, ECMO exposure), pediatric anesthesia, obstetric anesthesia, regional anesthesia (blocks, neuraxial), and acute and chronic pain services
• NORA (Non-Operating Room Anesthesia): although more prominent at CRCH/ION, CRMH also includes off-site anesthesia such as cath lab, endoscopy, and radiology procedures
• Simulation, crisis training, and emergency response including difficult airway, malignant hyperthermia, surgical fire, codes and trauma activations
   

Carilion Roanoke Community Hospital (CRCH) is a specialized facility featuring a 34-bed inpatient rehabilitation unit for past-accident or illness recovery. It provides urgent care, wound care, outpatient surgery, pediatric dentistry, and high-risk pregnancy services. Residents in our program will have training at this site that is focused on high-volume ambulatory and short-stay surgeries, allowing them to master efficiency, regional techniques, and safe, fast-paced anesthesia care. 

What Residents Learn at CRCH

• How to optimize anesthesia for short-duration, high-efficiency outpatient surgery
• Regional anesthesia for same-day orthopedics
• NORA-style adaptability
• Workflow management & OR efficiency
• Pre-op optimization for ambulatory cases
• Post-op nausea/pain strategies designed for discharge

Key Clinical Experiences

• Ambulatory anesthesia including orthopedic outpatient procedures, ENT, general surgery, endoscopy and screening colonoscopy, and pain management procedures
• Newly expanded surgical capabilities at CRCH now includes 4 ORs capable of total joint and spine surgery with overnight-stay capability. Residents will learn same-day arthroplasty anesthesia, regional block planning for rapid recovery, outpatient spine anesthesia
• High-turnover case management including fast-paced OR flow, efficient pre-op assessment, and rapid emergence and PACU transitions

The Carilion Institute for Orthopaedics and Neurosciences is the hub for Carilion's comprehensive musculoskeletal and neurological treatment, including physical therapy, orthopaedic surgery, and brain/spine care. Residents at this site will focus training in preoperative medicine and pain management experiences that complement OR-based anesthesia learning. 

What Residents Learn at ION

• How to conduct detailed pre-op assessments for orthopedic and spine patients
• Identification and optimization of comorbidities before surgery
• Communication & coordination across surgical, anesthesia, and medical teams
• Chronic pain pathophysiology and long-term management
• Interventional pain considerations
• Systems-based practice in outpatient optimization clinics

Key Clinical Experiences

• Pre-operative evaluation rotations for patients who are scheduled for total joint replacement or spine surgery 
• Perform comprehensive preoperative assessments, risk stratification and optimization, coordination with surgeons and specialists, and development of anesthesia plans
• Residents work directly with pain faculty in the Chronic Pain Clinic to learn long-term pain management strategies, opioid and non-opioid therapies, interventional pain procedures (as permitted), and patient counseling
• Pain medicine training with exposure to regional/pain faculty, procedural observation/participation depending on level, and learning multimodal pain strategies