Anesthesiology Residency

Message from the Residency Program Director

The Department of Anesthesiology’s academic mission continues to be resident and medical student education. The residency training program as a whole grew substantially over the past two years, both in size as well as in the availability of clinical, educational, and research opportunities. We have integrated a Clinical Base Year into our Anesthesiology program.

The Clinical Base Year has become the most competitive point of entry into anesthesia training programs. Our RRC is moving towards a mandatory, integrated four-year program. In recognition of these recommendations, the decision was made to add a Clinical Base Year. 

The Clinical Base Year curriculum is composed of forty-seven weeks of mandatory “core” rotations, two weeks of “elective” time and three weeks of much appreciated vacation. Core rotations include general internal medicine/geriatrics, neurology, oncology, emergency medicine, adult critical care medicine, and clinical anesthesiology. Elective options are available in adult critical care medicine, ENT, and various consult service electives including echocardiology, endocrinology, gastroenterology, infectious disease, nephrology, pulmonary medicine, and rheumatology

In the clinical anesthesia realm,we have seen significant increases in the resident case experience with intrathoracic procedures, clinical neuromonitoring (EEG, SSEP, and MEP), TEE, and regional anesthesia in both the adult and pediatric populations. The resident group has easily satisfied all RRC minimum case requirements. All residents complete training with an appropriate balance of case types and procedural experience.

The Regional Block rotation, under the direction of Dr. Domsky, has been expanded. The resident on this rotation is free from other OR duties and is expected to identify potential block candidates on the days’ schedule, evaluate and consent the patient, and perform the regional block under faculty supervision. Care of the patient for the operative procedure is assumed by the anesthesia team in the OR and the resident is then available to perform another block.

The TEE experience has been updated with the addition of a bimonthly departmental TEE conference. Each resident can electively participate for two months during their senior year focused on performing and interpreting TEE exams in the clinical setting as well as some additional time on the cardiac rotation.

The Difficult Airway Rotation, under the guidance of Dr. Goldberg and the airway group. Resident case assignments for the one-month rotation are tailored to allow multiple opportunities to become more facile with a number of different airway management devices including the intubating LMA, light wand, fiberoptic scope, Glidescope® and Bullard® laryngoscope. The resident on rotation also spends a clinic day with one of our ENT surgeons performing topicalizations and indirect laryngoscopies on selected oral cancer patients.

The Perioperative anesthesia rotation, under the direction of Dr. Deal and the perioperative group, provides anesthesia services outside of the traditional operating room setting. This service has grown at a double-digit pace for the past two years. The case types encountered during this rotation include GI endoscopy, diagnostic and interventional radiology, interventional cardiology and in vitro fertilization procedures. The remote nature of many of these sites, as well as the relatively high incidence of significant medical issues, poses a particular challenge for those providing off-site care. In addition, the off-site environment provides a rich arena for exploring issues related to systems-based practice.
 
The use of simulator-based training in the anesthesia program has continued to expand on a yearly basis. Since 2005 the introductory tutorial program for CA-1 residents has utilized the Simulation Center for the anesthesia machine review, ACLS certification, sedation certification, LMA training, and the difficult airway training session. The simulator is also being utilized to satisfy some of the airway competency criteria developed by Dr. Burden and the airway group. Additionally, all CA-1 residents spend one of their first days working through the central line simulation program. All CA-1 residents participate in a full-day training session in the Simulation Center prior to commencing their clinical activities. Under the leadership of Dr. Burden the simulation laboratory has begun a research mission. Studies are underway about how to best teach students, and what programs to best use to enhance patient safety.

The department continues to sponsor on-site Anesthesia Crisis training for all anesthesia residents utilizing the space and equipment resources of the Simulation Center. The full-day crisis experience is a mandatory part of the curriculum, and is designed to help residents improve their crisis management and team building skills. A follow-up course for CA-3 residents, was recently introduced. This course is intended to provide CA-3 residents with the opportunity to review critical event management principles and practice their application in the simulated setting, thereby reinforcing the learning achieved during their prior course. A secondary goal is documentation that all resident participants have achieved a minimum level of competency in the multidimensional aspects of crisis management. Competency is assessed utilizing both a team performance self-assessment, as well as individual performance assessments provided by the course faculty.

Resident involvement in departmental research has increased dramatically over the past recent years. The introduction of our quarterly research conference, providing a venue for the presentation of projects in various stages of development to the department for discussion, seemed to be the catalyst for increased resident interest. We continue to support all residents interested in the Clinical Scientist Track (CST).

We remain committed to nurturing a dynamic environment that promotes the learning, teaching, and practice of the clinical, intellectual, and ethical aspects of our specialty. Given the extraordinary level of faculty commitment to resident education, our outstanding facilities, and increasingly diverse clinical caseload, I believe that our program will continue to graduate anesthesiologists of distinction.

Irwin Gratz, D.O.
Residency Program Director
Gratz-Irwin@CooperHealth.edu