Anesthesiology

What is an anesthesiologist?

Anesthesiologists are consultants in perioperative patient care.  We manage acute/chronic pain, trauma, critical care, transfusion medicine, airways, and basic/advanced resuscitation in addition to providing sedation.  An anesthesiologist can care for patients in a broad variety of settings.  Our core training is focused on perioperative management however we have one year fellowships such as critical care or pain medicine which extend our responsibilities outside of the OR.  Other fellowships include pediatric anesthesia, regional, OB, and cardiac.  Combined fellowship programs include cardiac and critical care or pediatric cardiac anesthesia both of which are two years. 

Preoperatively we can assist surgeons with medical management and develop anesthetic plans tailored to the patient’s comorbidities and their likelihood of discharge vs admission.  In the operating room we provide safe and efficient operative conditions for the surgeons combined with amnesia, anesthesia, and analgesia (lack of memory, sensation, and pain) for our patients.  This portion of the case requires rapid data interpretation, physical exam, and diagnosis in addition to appropriate direct administration of a wide variety of treatments.  Technical skills including airway management and line placement are crucial as are communication, teamwork, and leadership qualities.

Postoperatively we may treat many conditions including acute pain, emergence delirium, and post-operative nausea and vomiting most commonly.  However, life/limb threatening issues such as acute respiratory failure, myocardial infarction, compartment syndrome, and hemorrhagic shock (just to name a few) can occur at varying points of our care which is why constant vigilance is key for the anesthesiologist.

Why did I choose anesthesiology?

I initially became interested in medical school through pharmacology and physiology courses.  My professors frequently referred to anesthesiology when explaining many applicable concepts.  During 3rd and 4th year rotations I appreciated the anesthesiologists role in safely getting patients through what may be one of the biggest events of their lives.  I also wanted to become an expert in airway management and ultrasound techniques for line or block placement and even perioperative diagnosis.  It’s a challenging and dynamic field yet I couldn’t see myself doing anything else.

A day in the life of an anesthesiology resident

It’s called residency for a reason!  It is meant to grow you into a physician who will be a consultant and expert in a field of medicine.  There are some programs more rigorous than others, but really it depends on what you want out of it.  I knew I wanted to keep doors open and be well trained so I went for programs known to have a strong variety of cases and experiences.  Don’t burn your future self by taking an easy route here.  Residency can be what you make of it and if you often choose the back seat you will struggle clinically after graduation.  Hard work will pay off massively.

Days for the typical anesthesiology resident start at about 5-6 am depending on the rotation and type of case.   Residents look up their patients, read about their cases, and present a tentative anesthetic plan to their attendings the evening before.  They perform pre op exams and obtain consent if the patients are in house.  There is generally some type of call format each month.  Sometimes it will mean just staying late (~7p-10p) or other times in house for 24 hours.  The shifts can be long, but being in a county hospital for those kinds of hours brings many cases which you may not experience otherwise (trauma and emergency cases).  During residency you will usually have a post call day to recover (this usually does not exist in private practice).  Performing with fatigue is expected and can be tough, but it will make you a strong clinician.  You will however need to learn your limitations and be honest with yourself.  There is no need to be a hero and compromise yourself or patient safety.  Anesthesiology is always a team effort even when practicing solo.

The anesthesiology resident will be the first one to the OR the morning of surgery.  They test the anesthesia machine and prepare/find equipment (suction, monitors, airway, IV supplies).  Supplies are prepared in a manner that is cost-effective yet efficient and most importantly safe.  They know who the anesthesia techs are and develop plans in regards to fiberoptic scopes, etc and their likely availability in the event they are needed.  The resident communicates with the OR nurse for updates on surgical plan, patient readiness for OR, and possible expected surgical equipment delays.  They will also communicate with a surgical resident or attending to determine if there are any specific needs or surgical nuances which might alter the anesthetic plan.

Next the resident will adjust the setup, speak with the patient and perform an interview/exam if not done previously, and obtain consent along with providing a tentative plan with possible or likely deviations.  During the CA-1 year or clinical anesthesia year 1 (which is PGY-2 or your 2nd year of anesthesia residency) the attending anesthesiologist will be significantly more involved in the direction of the anesthetic.  As you learn and gain enough experience to be a step ahead and especially through CA-2 to 3 year, the attendings will allow further autonomy as appropriate.  Induction and emergence will generally be directly overseen by the attending with particular exceptions based on case complexity, resident experience, and concern for patient safety.

The combination of working hours that range from 50-80 hours a week and simultaneously preparing for board exams may be one of the toughest things about residency.  Learn about each program including their strengths/weaknesses, typical work hours, types of cases they see, and especially learn how the current residents feel about their day to day.  Finding a program that is a good fit is key.  Location is big because many will end up working where they complete training due to personal connections developed during residency. 

How to become an anesthesiology resident

Anesthesiology is comparable to EM in terms of competitiveness for residency spots.  You will want to find a good program and thus good grades in medical school and strong USMLE scores will get you the interviews you need.  Research is always helpful especially for those interested in a more academically focused career, however when I applied the ACGME average was 1-2 publications.  Letters of recommendation need to be there and not be a negative.  Try to ask for them only from those who know you well enough.  Many programs require only 1 or 2 anesthesiology specific letters.  Letters from surgeons and internal medicine docs are also great if they are strong.  Rotating at a program is helpful IF you’ve had some prior clinical experience and can show that you at least have a basic understanding of what we do.  No one expects you to be excellent clinically or never miss an intubation, but it is important to be teachable, friendly, and appreciative.  The clinical scenarios in anesthesia especially for beginners can become tenuous very quickly and taking a step back when you are uncertain is always better than making assumptions or being too aggressive.  Good connections made on these away rotations can be very helpful when interview invites go out.

How long does it take to become a fully licensed anesthesiologist?

A bachelor’s degree, medical school, and a 4-year general anesthesiology residency are needed to practice.  Many do a 1-year fellowship making the clinical training 5 years.  After graduation a written board exam is required.  Once passed an OSCE and oral board exam are required to become board certified in anesthesiology followed by recertification every 10 years.

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