The Department of Anesthesiology provides a three-year residency program with 30 residents and is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Anesthesiology (ABA). Maimonides Medical Center (MMC) is a major affiliate of SUNY Health Science Center at Brooklyn. Over 16,000 operative procedures are performed annually at MMC giving each resident ample hands-on opportunity to develop the clinical skills needed to become a successful anesthesiologist. The working environment at Maimonides is highly supportive and is based upon the respect and concern for patients and colleagues alike.
Our Anesthesiology staff consists of 50 faculty physicians, providing a faculty-to-resident ratio that allows for adequate one-on-one teaching experience in the operating rooms assuring an exceptional educational experience. Residents are assigned a mentor to guide them throughout their residency training. The mentor’s role is to provide supervision, evaluation, timely feedback and support his or her assigned resident as the need arises. By the end of the CA-3 year of training, our residents are clinically at the level of a consultant anesthesiologist and are proficient in providing care in all of the RRC required sub-specialties of anesthesia.
A goal of the program is to help prepare the residents to successfully pass the ABA examination. With this in mind the program administers written and oral examination reviews throughout the academic year similar to those given by the ABA. Residents are given ample time to attend didactic conferences and other scheduled educational programs.
Residents also have ample opportunity to hone their communication skills, critical thinking and to build confidence as well as gain experience in public speaking. We seek to accomplish our goal through the Didactic Activities that are provided daily throughout the academic year. To create an environment of inquiry residents are involved in critically evaluating research articles, writing chapters and are encouraged to participate in entry-level research projects under supervision. Additionally, residents who are interested in becoming involved in clinical research can present their ideas during on-going Research Projects / Updates meetings, which are conducted every other month. The CA2 and CA3 residents present several (on an average 20 per year) Abstracts and Clinical Case Reports at major national meetings like ASA, PGA, IARS, ASRA and SOAP. The time and expenses involved with these presentations are the courtesy of the department.
The Anesthesiology Residency Program at MMC offers an excellent training experience and our program strives to provide the best educational experience in an environment that assures a balance between academic and clinical activities. We take great pride in our success in preparing residents to become the next generation of expert practitioners.
Clinical Anesthesia Year One (CA-1)
During the months of July and August, the morning conference is geared towards orienting the CA-1 residents to the fundamentals of anesthesiology. CA-1 Residents are expected to attend the daily orientation lectures that are held Tuesdays through Fridays from 6:30 am to 7:15 am. Lectures are prepared by the Anesthesiology Attending faculty and faculty from other specialties. The topics for these lectures consist of the basics of anesthesia and introductory lectures for the various subspecialties of Anesthesiology:
Topics Related to Basic Anesthesia:
• Legal aspects of anesthesia
• Airway management
• The Anesthesiologist’s role as a perioperative physician
• Pre-anesthetic evaluation
• Principles of blood transfusion
• Introduction to Intravenous anesthetic agents
• Introduction to Inhalation anesthetic agents
• Introduction to narcotics
• Introduction to muscle relaxants
• Introduction to local anesthetic agents
• Introduction to basic and invasive monitoring
• Anesthesia Machine
• Blood transfusion
• Fluid and electrolyte management
Topics related to Anesthesiology Subspecialties:
• Introduction to Obstetric anesthesia
• Introduction to Pediatric anesthesia
• Introduction to Neuroanesthesia
• Introduction to Acute and Chronic Pain Management
• Introduction to Orthopedic anesthesia
• Introduction to Vascular anesthesia
• Introduction to Regional anesthesia
• Introduction to Cardio-thoracic anesthesia
Topics related to ACGME / Departmental Policies:
• Substance abuse detection and management
• Duty hours regulation
• Fatigued resident
• Maintenance of anesthetic record
The program's overall curriculum places emphasis on preparing the residents to successfully complete the ABA board examination. During our new residents' orientation we provide a brief overview of the board examination process and familiarize the residents with the tools that are used to prepare them for the boards. As part of the curriculum the educational tools listed below are used:
GRAND ROUNDS CONFERENCE:
This conference is conducted in a Problem-Based Learning and Discussion (PBLD) and Systems-Based Practice (SBP) format and provides an interactive educational experience with emphasis on oral communication skills along with medical knowledge, judgment and practice improvement issues. Active participation is encouraged from the residents and faculty. The weekly Grand Rounds include morbidity & mortality cases, cases with unusual or uncommon pathology/outcomes and cases discussed during the Performance Improvement (PI) meetings. The Chairman, Subspecialty Directors and other faculty members of the department moderate these sessions. The following aspects of the cases are discussed:
- Preoperative assessment and management
- Special anesthetic considerations
- Expeditious diagnosis and management of intraoperative complications &
- Postoperative care including pain management
- Significant Systems related issues and propose plans for improvement
On an average, once a month, the Grand Rounds is moderated by a Guest Speaker from another institution, or faculty from other departments or replaced by interdepartmental educational activities like Quarterly Combined Perioperative Services Meeting, TeamSTEPPS Training, Combined OB/Anesthesia Conference, etc.
When a case is selected for presentation at the Grand Rounds the anesthesia care givers (attending and the resident) who were involved in the perioperative management of the patient prepare a brief write-up of the case using the standard electronic M&M form. The form is submitted electronically to the PI nurse for review by the Chairman of the department. The form is available on the home page of the New Innovations System.
SHORT TOPICS PRESENTATIONS:
Presented at the Monday morning Grand Rounds, prior to the case discussion. This session gives our residents valuable opportunity to teach, improve communication skills and builds confidence in public speaking. The topics selected are either from the American Board of Anesthesiology’s (ABA) Key Words list (see explanation under Key Words) or topics pertaining to recent advances in anesthesiology. The resident is allotted 5-10 minutes to present their topic and the presentation should consist of no more than 5-8 slides. Residents are encouraged to review their presentations beforehand with an attending or subspecialty Director. Each resident is evaluated on Oral presentation, audiovisuals, research material and knowledge of subject matter as evidenced by the presentation and the ability to answer questions. Written feedback is provided to the resident.
Once a month residents are assigned to present a scientific journal article. The resident, together with the help of their attending moderator, selects an article from a recent issue of a well-known journal for oral presentation. Residents present the material in a methodical and critical fashion with supportive data from other reference articles. Each presenter is given 15 minutes for his/her presentation. Questions and comments are invited from the resident and attending audience. Each resident is evaluated on Oral presentation, audiovisual, research material and knowledge of subject matter as evidenced by their ability to answer questions. The moderator gives verbal feedback to the resident at the end of his/her presentation. Written feedback is also provided. Journal Club sessions are attended by residents, medical students and rotating residents.
Scheduled weekly from September through June for the CA1 residents to facilitate the preparation for the ABA Basic examination. Afternoon sessions of Key Words discussions are held once a month for the CA2s and CA3s residents. An attending moderator is assigned to supervise the Key Words discussions. Keywords from the ABA-ITE are reviewed and topics chosen are those which the program’s residents had difficulty answering. The residents are required to research the topic, write up a focused summary and present the information to the group for discussion among the residents. At the end of each key word presentation the moderator provides a set of questions and answers are discussed. Each resident is evaluated on Oral presentation, audiovisual, research material and knowledge of subject matter as evidenced by their ability to answer questions. The moderator gives verbal feedback to the resident at the end of his/her presentation. Written feedback is provided to the resident.
During the months of July and August orientation lectures are scheduled for the CA1 residents. These lectures are moderated by an Anesthesiology faculty and faculty members from other specialties. Topics consist of Basics of Anesthesia and introductory lectures on various subspecialties of Anesthesiology, such as Introduction to Cardiac Anesthesia, OB Anesthesia, and Pain Management and other relevant topics related to the practice of Anesthesiology like:
a. Legal Aspects of anesthesia
b. Substance abuse detection and management
c. The Anesthesiologist’ role as a Perioperative Physician
d. Principles of blood transfusion, etc.
e. Review of ACGME policies
f. Practical tips on how to be a successful anesthesiology resident/ anesthesiologist.
These topics are relevant and particularly suited for knowledge growth and discussion early in the training. A return to the original sequencing is once again established after two months. Continuity and sequencing are ensured by discussing topics of one subspecialty per week (i.e. the Respiratory system, liver, cardiac, etc.). We actively involve the residents to seek their opinion as to which other topics need to be discussed and cover these accordingly.
An Attending is assigned a clinical case to present in the oral board exam format and he/she involves all the participants in the discussion of perioperative care of the patient. Whenever possible, the clinical cases selected for the PBLD discussions are related to the Core Lecture topic of the week.
Once a month a PBLD session is assigned to a resident for presentation of a case in whose care he/she was involved. This session targets the PBLD/SBP competencies and provides an opportunity for residents to self-reflect and learn from their own experiences, which is in compliance with the ACGME Requirements. The assigned resident will select a case to present and discusses the salient points during the PBLD session. Active participation by all present is encouraged during the session. Following the presentation the resident is required to submit a brief summary of the case presented by completing a journal assignment on New Innovations under the Portfolio section.
WRITTEN BOARD REVIEW SESSIONS:
The board review sessions are interactive and held as a round table discussion. During these discussions residents are assigned a multiple choice question to answer and explain their rationale for the answer they selected. The discussion also involves how to derive related questions from the questions which were assigned to them.
CA1 and CA2 residents have afternoon board review sessions every other week, alternating with each other. Additionally, 2-3 (per month) board review sessions are conducted for the CA1 residents on Friday mornings to facilitate their preparation for the ABA Basic exam.
Weekly board review sessions are held for CA3 residents on Tuesday afternoons.
ORAL BOARD REVIEWS:
Held on a monthly basis for all the residents. A CA3 resident is assigned a clinical stem case and a review is conducted in the oral board exam format. At the conclusion of the exam the resident receives feedback on his/her performance from one or two residents who are present for the review and from the moderator. On an individual basis graduates who have completed part 1 of the written board exam are encouraged to meet with the Program Director and other faculty members for Oral Board Review prep sessions.
ITE TARGET REVIEWS:
During the month preceding the annual In-Training Exam (ITE) reviews are conducted in preparation for the exam. The content of these target reviews are high yield recurring topics which are collected from the most recent ABA ITE exams’ lists of keywords. Faculty with sub-specialty expertise will conduct the related ITE Target review sessions.
STATISTICS LECTURE / ONGOING RESEARCH PROJECT UPDATES:
Beginning in September the Departmental Research meeting will be held every other month to discuss the progress of the on-going projects and new initiatives. Residents who are interested in becoming involved in clinical research opportunities can present their novel ideas during this meeting.
The Department hosts a guest lecture series on a variety of subspecialty topics. Guest lecturers are selected for their expertise in their field and include faculty from within and outside the institution from a variety of specialties other than Anesthesiology. Topics selected include, but are not limited to, recent developments and current concepts in various subspecialty areas of anesthesia, issues related to practice management, billing, substance abuse – detection and management, and understanding ACGME implemented core competencies. Approximately twelve guest lectures are presented per year. Residents participate in deciding the topics to be covered. This series affords us the ability to offer lectures on topics which may not be covered extensively by our own faculty.
KEYWORD OF THE DAY:
Implemented in April 2015 as an initiative to enhance OR teaching and learning with the goal of covering all of the Key Words from the most recent ABA ITE list. Residents and faculty are emailed daily a “Key Word of the Day” with the objective of facilitating OR discussions during the course of the day. To maximize the educational benefits, residents are required to review the Key Word of the Day the night before in order to be fully prepared for the discussion.
THE PASS MACHINE COURSE:
In an effort to adequately prepare the residents for the ABA Part 1 Basic Exam (“ABA Exam”), effective August 2015 the program initiated the use of The Pass Machine Anesthesiology Board Preparation Course to enhance the CA1 residents’ education curriculum. The course content strictly follows the ABA exam outline and contains board-style practice exams and multiple-choice questions. CA1 board review sessions will resume in September and during these sessions there will be a review of the commonly incorrect answers with explanations. The Program Director and Education Director will monitor the residents’ usage and progress. We feel confident that, if fully utilized, The Pass Machine can increase the residents’ potential for passing the ABA Exam on the 1st attempt.
SIMULATOR TRAINING SESSIONS:
Placing residents in simulated intraoperative clinical experience scenarios is an ACGME requirement that assesses and improves all of the core competencies, providing a valuable learning opportunity. Effective August 2013, our program developed and implemented a simulation curriculum at the Maimonides Medical Center’s Simulator Center.
Residents are assigned according to their CA-level and participate in four simulated scenarios on a yearly basis. Each session will consist of three residents. These training sessions will take place on Wednesdays from 4pm to 5pm. Each session begins with a short pre-briefing, followed by a simulation case and concludes with a detailed debriefing. To complete the educational experience, at the end of every case, the residents will be provided with additional handouts on the subjects addressed. Additionally, over the course of the year, skills development sessions will be held in the simulation center.
Training sessions will include central line and A-line placement, fiber optic workshops and regional anesthesia workshops. The Simulator Program is organized and overseen by Dr. Kalpana Tyagaraj, Program Director, and Dr. Agnes Miller, Director of Resident Education.
PERFORMANCE IMPROVEMENT (PI) MEETING:
Held every Thursday morning at 10:00 AM in the OR Staff Lounge. The meeting is overseen by the Chairman of the Department and the PI Nurse Administrator and is attended by the Anesthesia faculty, chief residents and residents from the various CA levels, Risk Management staff and Institution Medical Director.
Each resident and attending involved in the perioperative care of a patient who had an unanticipated outcome, unusual, rare or complicated cases write up summaries of these cases and electronically submit it to the PI Nurse Administrator. The PI Nurse Administrator obtains the copies of these cases and other related documentation pertaining to the cases for review at the departmental PI meeting.
Clinical cases are reviewed to identify appropriateness of anesthesia care, problems related to co-morbid conditions of the patients and systems related issues. Discussions include determination of standards of care, corrective plans of action and areas of non-compliance. An attestation form is completed for each clinical case reviewed. If documentation compliance issues are identified, the nurse administrator meets with the Individual resident and discusses the appropriate methods of documentation.
Once the PI process is completed the clinical cases are presented and discussed at the department Grand Rounds by the Department Chairman in an oral board practice format. The objective is to review and educate regarding the principles of perioperative care of these clinical cases.
Additionally, to maximize the opportunities for the residents to get exposure to the PI process, once a month a morning conference is conducted for the residents to discuss the PI cases. The selected cases for the residents’ PI session would have undergone the PI process.
BOOK CHAPTER REVIEWS:
Beginning September/ October part of a book chapter is assigned to CA3 residents for presentation. The resident prepares for the presentation by reviewing relevant, latest articles, text books and discussion with the assigned moderator. The audience consists of all residents, rotators and medical students. At the end of the presentation feedback is provided to the resident on audiovisuals, style, content and relevance of the topic.
While didactic lectures are being conducted on a formal basis, significant teaching takes place in the operating rooms. Operating-room teaching includes the practical aspects of anesthesia such as intubation of the trachea, mask ventilation, insertion of intravenous catheters, use of anesthetic agents, principles of monitoring for neuromuscular blocking drugs, and similar techniques. The residents learn how to prepare an operating room for the anesthetics, and the safety features and trouble shooting of the anesthetic machine. Proper positioning of the patient and protection of all pressure points is emphasized. Residents also learn the principles governing treatment of commonly seen anesthetic problems such as hypotension, light anesthesia, cardiac arrhythmias, hypoxemia, hypercarbia, and electrolyte imbalance.
Additionally, individual in-OR didactic teaching occurs in the operating rooms. This is facilitated by maximizing one-to-one coverage (attending-resident). All CA-1 residents are required to call the attending the night before to discuss the OR cases for the next day. Any resident assigned to a ASA 3 or greater case must call their attending the night before the case to discuss and prepare for further in-OR didactic discussions for theses complicated cases. In order to facilitate OR-didactic teaching, residents assigned to a room which have in-patients requiring a preoperative evaluation are required to see at least the first two preops in that room.
All residents are encouraged to call their attending the night before to set the framework for the didactic teaching that we encourage in the operating rooms. The teaching that occurs in the operating rooms is monitored and supported by the department. Residents fill out attending evaluations regarding OR teaching. In fact, the department has implemented an incentive program in which those faculty that excel at operating room teaching are rewarded.
Guidelines issued to each resident at the beginning of the program indicate expected levels of knowledge and skill as a function of time. These guidelines aid the residents in self-evaluating their own progress. They are encouraged to consult the Program Director and/or the Chairman if they feel that their progress is not in accordance with the guidelines.
In the late fall residents are given an written examination that mimics the ABA exam and this is useful in assessing the decisions and judgements made by the resident. Additionally, the exam helps the residents gain an understanding of the ABA examination process through answering practice questions.
During the first six months CA-1 residents are scheduled to do anesthesia for general surgery. After six months, they are scheduled for rotations through the subspecialties: pediatric anesthesia, obstetrical anesthesia, neuroanesthesia, cardiac anesthesia, and the ICU rotations.
Responsibilities/Duties OF a CA-1, PGY-2 Resident:
1. Attend all morning conferences regularly and make presentations when required.
2. Arrive in Operating Room by 6:00am to set up.
3. Set up anesthesia equipment in preparation for vast majority of general anesthesia cases.
4. Describe the basic features of different ventilators and anesthesia machines.
5. Perform preoperative evaluations of ASA I & II patients and order correct premedication assisted by an anesthesiology attending.
6. Discuss preoperative evaluations with the attending physician.
7. Insert intravenous catheters (initially assisted by an attending and, after you have been credentialed, insert them on your own.)
8. Prepare for interactive teaching by attendings that takes place in the Operating Rooms with respect to your assigned cases.
9. Make minor decisions relating to patient management.
10. Discuss independent management decisions with your attending and then implement them.
11. Access adequate fluid intake with respect to fluid output, blood loss and case.
12. List dosages and describe the pharmacology of commonly used drugs.
13. Interpret EKG abnormalities.
14. Discuss and perform standard ASA patient monitoring, know the normal numbers.
15. Interpret viatls sign, recognizes devaition from the norm (or expected) and treat as needed.
16. Interpret ventilatory parameters and asses adequacy of all patients at all times.
17. Evaluate blood gases and correct ventilatory parameters as needed.
18. Perform special procedures such as arterial cannulations, central venous catheters, pulmonary artery catheters, local blocks, spinal and epidural blocks.
19. Keep detailed anesthesia records.
20. Describe criteria used to extubate a patient.
21. Call PACU ahead of time if special equipment or medication is needed.
22. Report to PACU nurses, patient’s surgical procedure, IV fluids given, estimated blood loss. Give vital signs in OR and tell nurses in PACU if anything special occurred during surgery.
23. In PACU, put EKG monitor and pulse oximeter on patients.
24. Write anesthesia postop notes.
25. Check computer terminals in PACU for newest laboratory data.
26. Complete any delinquent charts in the Medical Record Room.
27. Record every case on a case log sheet.
28. Be ACLS certified
29. Finish reading one of the suggested introductory books on anesthesia in preparation to start reading one of the major texts. Recommended list of major texts:
a. Anesthesia by Miller
b. Clinical Anesthesia by Barash
c. The Basics of Anesthesia by Stoelting
d. Pharmacology & Physiology in Anesthetic Practice by Stoelting
e. Text book of Anesthesiology by Morgan and Mikhail
30. Residents are required to conduct computer search on evidence based topics by referring to the following websites:
• www.update-software.com (USA portal for Cochrane database)
• www.jr2.0x.ac.uk/Bandolier (Monthly ezine of EBM - a must site!)
• www.ncbi.nlm.gov/PubMed (Free access to Medline - take the tutorial)
• www.bestbets.org (Large collection of CATS)
• www.omni.ac.uk (Organizing medical networked information)
• www.brisbio.ac.uk (Free downloads of medical images)
• www.med.yale.edu/library/heartbk (EBM for the heart)
• www.cancer.gov (Good source for cancer information)
• www.google.com (The best search engine on the net)
• www.shef.ac.uk (An excellent array of EBM resources)
• www.medscape.com (Good review articles - free)
• www.guidelines.gov (Good source of EBM materials on every subject)
• www.library.utoronto.ca/mrdicine/ebm (Free PDA downloads. A very good site)
• www.bmj.com (Free access to full text articles - an excellent journal)
31. Residents take a written Anesthesia Knowledge Test (AKT) at the beginning and end of July, at the end of 6 months and at the end of 24 months.
Clinical Anesthesia Year Two (CA-2)
Residents participate in all in-training exams described for CA-1. At this level, residents are given more responsibility. They are expected to manage more complex cases, and to show qualities of leadership and decision-making. They are expected to plan anesthetic management, and to discuss cases with the attending at a more sophisticated level. They also assume limited responsibility for teaching the CA-1 residents. By the end of this year, residents are expected to manage most routine cases with minimal help from their attending physicians. On the academic front, residents are expected to perform well in the in-training exam given by the Department. By the end of CA-2 they should start to approach the academic standard of a consultant in anesthesiology, and should begin to act as consultants to difficult preoperative problems when approached by members of other medical fields such as surgeons and internists. At this level, residents should also feel comfortable rendering anesthetic care to subspecialty cases, pediatric, cardiac, obstetrical and so forth.
In addition to the CA-1 Responsibilities, a CA-2 Resident’s Responsibilities/Duties consists of:
1. Be proficient in preoperative evaluations of all patients (ASA I-V).
2. Manage most routine cases with minimal help from their attendings.
3. Discuss the management of complex cases.
4. Manage more complex cases.
5. Recognize EKG abnormalities and develop a plan for their treatment.
6. Performed advance procedures:
a. perform Epidural anesthesia
b. Spinal anesthesia
c. Intravenous (central) catheter insertion internal jugular
d. Intravenous (central) catheter insertion subclavian
e. Pulmonary artery catheterization
f. Fiberoptic intubation.
7. Be thoroughly familiar with criteria used to extubate a patient.
8. Call the PACU ahead of time if special equipment or medication is needed.
9. Describe the principles of patient resuscitation and become familiar with intubating patients under adverse conditions outside the OR.
10. Complete PACU rotation.
11. Complete ICU rotations.
12. Finish all first month required subspecialty rotations.
13. By the end of their 3rd month, describe their planned scholarly acitvity or research project.
14. Maintain ACLS certification.
Clinical Anesthesia Year Three (CA-3)
Clinical assignments in the CA-3 year include anesthesia management of complex procedures and the care of seriously ill patients:
In addition to the CA-1 & CA-2 Responsibilities, a CA-3 Resident’s Responsibilities/Duties consists of:
1. CA-3 residents must be able to competently perform all duties of a CA-1 and CA-2 resident.
2. Manage vast majority of cases on their own.
3. Perform acute and chronic pain consults.
4. Manage more advanced and complex cases in the subspecialty areas.
5. Active part in teaching the junior residents.
6. Team leaders when on call: act as junior attending, triage cases and coordinate OR.
7. The Chief Resident (and occasionally CA-3) must do all OR scheduling (and assure that resident are assigned to the subspecialty rotation) for the residents and on call schedules.
8. At the end of their CA-3 year, residents are expected to perform anesthesia at the level of a consultant. They should be able to manage all of the cases on their own.
9. CA-3 residents must finish their scholarly activity.
10. CA-3 residents act as role models for the junior residents and participate in teaching of junior residents when on-call.
11. Maintain ACLS certification.
Required Subspecialty Rotations are:
- Cardiac Anesthesia
- Intensive Care Unit (SICU and CTICU) Rotations
- OB Anesthesia
- Post Anesthesia Care Unit (PACU) Rotation
- Pain Management
- Blocks (Regional)
- Pediatric Anesthesia
Education is provided on the following areas:
- General Surgery
- Vascular Surgery
For detailed information please see the Anesthesia Curriculum and Goals & Objectives for the following subspecialties:
Failed angioplasty emergency cases, intra-aortic balloon pumps, double-valve procedures, combination of valve & CABG and aneurysm repair involving total circulatory arrest, etc.
Patients with HELLP Syndrome, placenta accreta and possible cesarean hysterectomy, multiple gestation, multiple previous c-sections, morbid obesity and so forth. Residents would be involved in active decision making regarding choice of anesthesia, placement of invasive hemodynamic monitoring (as and when necessary), management of massive transfusion, selection of appropriate post-operative management modality, etc.
Management of complex pediatric & neonatal cases like foreign body aspiration in the airway, pediatric thoracic & neurosurgical cases. Surgeries involving preemie neonates. Neonatal surgical emergencies, e.g. congenital diaphragmatic hernia and tracheoesophageal fistula. The resident would make primary decisions involving airway management.
Residents participate in the management of patient going for neurosurgery. They must be able to manage acute brain bleeds (subdural hematomas, rupture aneurysm , etc.) The must recognize and be able to discuss the implication of various lesion in the brain on anesthetic management. We have an new neuro-invasive radiology suite where we manage many cases that where performed with a craniotomy. These case will challenge even senior members of anesthesia teams.
Residents are actively involved in performing various nerve blocks under ultrasound guidance. Pain Management for chronic backache after multiple surgeries, failed back syndrome, decisions regarding multi-modal approach to chronic pain management, e.g. ongoing physiotherapy, pharmacological interventions, behavior modification and psychiatry consultation, etc.
Ambulatory anesthesia is the most significant subspecialty of anesthesia in recent years. In order to meet the needs of the community, more than fifty percent of all cases are managed on a day surgery basis. There are six operating rooms dedicated to ambulatory surgery, with additional rooms for endoscopic procedures. The Ambulatory facility provides an extremely favorable environment for residents to learn the techniques of this exciting subspecialty, which allows even complicated procedures to be performed safely and returns patients to their homes and work environment expeditiously and with minimum loss of function.
Preadmission Testing (PAT)
Patients are seen in the PAT by an anesthesiologist who does medical assessments and orders appropriate tests, thus increasing efficiency and saving valuable time for the patient. Residents are assigned to PAT in order to enhance their preoperative assessment skills.
Scholarly Activities And Educational Programs
Residents are strongly encouraged throughout their residency training to take an active role in the departmental clinical research projects. Arrangements have been made in the past to facilitate the use of an animal laboratory. A research meeting is held once a month at which time residents are encouraged to present their ideas for research projects. A staff member will assist the resident in presenting this project for IRB approval. The research team consists of a research assistant, Dr. Homel and volunteers to assist with the research project in data collection, patient follow-up, etc.
Book Chapter Assignment
CA-3 residents are assigned topics on clinical anesthesia and they are expected to obtain the latest information on these topics through literature search, journals and textbooks, etc. A faculty member is assigned to the resident to supervise this academic activity.
Additionally, CA-1, 2 & 3 residents are assigned topics for keyword presentations, Friday morning short topic presentations, Journal Clubs and PBLDs.
Presentations At Meetings/Case Reports
Residents submit unusual & interesting case reports for presentation at national meetings. Opportunities are provided for the residents to attend these national meetings and present their case reports when accepted. Once these cases are presented at the national meetings every effort is made to submit these case reports for peer review publications.
Short Topic Presentations
Also considered as one of the residents’ scholarly activities. For details please refer to the Didactic Activities section listed above.
In addition to the academic activities, which include conducting Board Reviews for written examinations, at the departmental expense, residents are encouraged to attend a review course in anesthesiology in order to assist them in passing the ABA written exam. Also, as an overview of the ABA oral examination process, the anesthesia faculty conducts mock oral examinations with the residents
Also considered as one of the residents’ scholarly activities. For details please refer to the Didactic Activities section listed above
All resident are evaluated according the ACGME six core competencies:
• Medical Knowledge
• Patient Care
• Practice-Based Learning and Improvement
• Interpersonal and Communication Skills
• Systems-Based Practice
The goals and objectives for each required subspecialty has been rewritten such that these core competencies have been addressed. The goals and objectives for each subspecialty are available electronically on New-Innovations and residents are required to read and fulfill the goals and objectives as they rotate through the subspecialties.
Resident Evaluations are completed electronically by all the faculty for all the residents, using New-Innovations. These evaluations are reviewed and the summarized data is discussed at the Clinical Competence Committee (CCC) meetings, which are held twice a year. In the CCC meeting, Milestones are assigned for each resident by the CCC members, based on the review of all the evaluations, Case Logs, Simulation experiences and ABA-ITE results and submitted biannually to the Residency Review Committee (RRC). Following the CCC meeting, the preceptors are provided with a copy of their assigned resident’s final evaluation report and Milestones for review with the resident. A signed copy of the final evaluation report and Milestones is placed in each resident’s file.
The Department also has a system in place for evaluation of attendings by residents. This takes place twice a year. The objective is to identify attendings with superior teaching skills and ability. These evaluations are then used to delegate teaching responsibilities to these attendings. A cumulative written report of these evaluations are distributed to each attending. Confidentiality is maintained while preparing these reports.
At the time of the evaluation of the attending faculty, the residents also evaluate the program regarding the effectiveness of the goals and objectives being met, the strengths and weaknesses of the program etc. Appropriate actions will be taken by the Residency Program Evaluation Committee regarding the above mentioned evaluations to improve the training program.