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The BWH Obstetric Service is an active tertiary care unit performing about 9,000 deliveries annually. Twenty to thirty percent of the patient population is high risk. Besides taking care of the OB patients, anesthesiologists are also involved in taking care of patients for in vitro fertilization (IVF) and GIFT procedures; in 1994 anesthesiologists were involved with 400 cases. Twenty-four hour in-house staff coverage is always available in this unit. All staff anesthesiologists are extensively experienced in OB anesthesia. During the preliminary stage, the new senior residents and fellows are closely supervised and advised about clinical techniques and management of high risk and normal patients. After the first weeks, the residents perform the techniques without direct supervision, but a staff anesthesiologist is always in close proximity for any advice or assistance. Board rounds are performed every morning and afternoon, a compulsory part of the clinical management. During this time, residents absorb considerable information about the patients currently in the labor and delivery area. A special session is held Tuesday afternoons, dedicated to the anesthetic management of high-risk obstetric patients. All residents and fellows will also have experience in our general operating rooms, to maintain their fundamental anesthesia skills. Staff anesthesiologists are active in teaching and preparing the residents for their written and oral boards. Several OB anesthesia textbooks are available in the OB anesthesia office for reference along with a collection of important journal articles. Residents are also given copies of Obstetric Anesthesia Digest as soon as issues are available. Senior residents and fellows soon become involved in teaching the junior residents both technical skills and theoretical aspects of OB anesthesia. On weekday mornings except Wednesday, residents are designated to give a lecture for 30-45 minutes. The BWH Obstetric Anesthesia Section is very active in clinical and basic science research. Senior residents and fellows can expect to be involved in ongoing research projects, or can start an original project with a staff member after receiving permission from the hospital Human Studies Committee, when indicated. One senior resident or fellow is designated Chief, in charge of day-to-day administrative activities for the junior residents. The Chief makes the on-call and lecture schedules and acts as liaison between the staff and residents. Weekdays 7 am to 3 pm, one CA-3 or fellow is designated floor leader and one OR leader, running the OB floor and operating room with a staff member. At night, one CA-3 resident or fellow acts as team leader, responsible for running the service, backed up by the in-house OB anesthesia staff. Another senior resident or fellow is in charge of the high risk unit, keeping track of all the high risk patients on the in-patient OB floor and planning the anesthetic management with a staff anesthesiologist and other residents. Sanjay Datta, MD Director of Obstetric Anesthesia