Updated Anesthesiology FAQ for Med Students & Residency Applicants (2008-2009)

Many medical students have been asking for an updated FAQ to help them out with residency applications. So here it is, updated for the 2008-2009 application year. Thank you to PowerMD and VentdependenT who wrote and compiled most of this in its original format. If you have questions to suggest for inclusion that do not already appear, please private message me and I'll do my best.

How to make yourself a competitive candidate
- Is anesthesiology really as competitive as they say? What are my chances of matching?
- What USMLE scores do I need?
- I failed or had to remediate a basic science class. Should I mention this in my personal statement and/or interview?
- When should I take Step 2?
- Do I need to do research to match in anesthesiology?
- Who should write my letters of recommendation?
- What kind of personal statement should I write? Should I write a story or an expository essay?
- I want to apply for anesthesiology residency but my medical school won't let me do a rotation until November of my M4 year! What should I do?
- How important are extracurricular activities and leadership experience?

Information for DO applicants
- I'm a DO student interested in applying to MD residencies. What can I do to make myself competitive?
- I'm a DO student and have taken COMLEX. Should I take USMLE?

Anesthesiology rotations as a medical student: electives, away rotations, and how to succeed
- How many 4th year anesthesiology electives should I do? Do I need away elective(s)?
- When and how should I apply for away electives?
- What book(s) should I read?
- As a medical student, how can I make the most of my anesthesia rotation?
- How can I get more procedures as a medical student?
- How come I can't intubate / start IVs / mask ventilate? Am I stupid?
- I want to do a critical care elective. Should I do it in a surgical ICU or a medical ICU?

Internships (i.e. preliminary years and transitional years)
- Should I choose surgery, medicine, or a transitional year?
- Should I write a separate personal statement for internship applications?
- I'm switching specialties and have already done a year of OB / Family Medicine / Psychiatry / Pediatrics / Emergency Medicine. Will this meet my internship (CBY) requirements or do I have to repeat an internship?
- Is it better to do a challenging internship or a "cush" internship?

Categorical vs Advanced programs
- What's the difference between Categorical and Advanced programs?
- Is it possible to apply only to Categorical programs?
- If a program offers both Categorical and Advanced positions, can I apply to both?

Choosing programs to apply to
- How many programs should I apply to?
- What is the education like at average to low tier programs compared to "top" programs?
- What programs are considered to be "top" programs?
- Should I go to a program with or without CRNAs?
- What programs are known to be good for _____? (Fill in the blank with Regional, Pain, Cardiothoracic, Pediatrics, etc)
- Threads where current or former residents and/or faculty discuss specific programs. Cleveland Clinic Foundation (CCF) | Cornell | Jackson Memorial | University of Michigan 1 | University of Michigan 2 | Massachusetts General Hospital | MGH, Hopkins and Duke
- Why do some top programs fail to fill in the match?

Residency Interviews
- How many residency interviews should I attend?
- Is it necessary to attend the dinner the night before the interview?
- How can I prepare for interviews?
- What "tough questions" have people been asked during interviews?

General background on work and lifestyle
- Links to discussions which answer the following questions: Why choose anesthesiology? Is it boring? Are you well respected? Why choose anesthesiology and not surgery? What about getting along with surgeons?
- What is the lifestyle of a practicing anesthesiologist?
- I heard something about competition from CRNAs. What is a CRNA, and what effect do they have on the field of anesthesiology?
- How do anesthesiologists get paid, and how does this compare to how CRNAs get paid?
- Are there procedures that only MDs can do? What procedures can CRNAs and AAs do?
- What do anesthesiologists pay for malpractice insurance?

Q: Is anesthesiology really as competitive as they say? What are my chances of matching?

Anesthesiology is "moderately competitive" in the NRMP match. It's more competitive than FP, psychiatry and IM but less competitive than derm, rads, ortho, neurosurg, plastic surgery or rad onc. An average US MD candidate should feel pretty reassured that as long as they apply smartly to enough programs, they should get a residency position somewhere. It is also very possible for DO and FMG candidates to match provided that they have a reasonably strong application without glaring red flags.

Beyond that, it's hard to give exact numbers. You can inspect the NRMP data tables and interpret them for yourself.

In recent years, medical students have posted here saying they perceive anesthesiology to be getting more and more competitive and candidates need to be well above average to match. I think this is more fear than fact. The NRMP data, however murky, show clearly that the majority of US applicants match.

Q: What USMLE scores do I need?
Originally from PowerMD, revised by jennyboo.

USMLE Step 1 score:
There is more latitude here than some people think. If you have a good application in general, a lower score won't keep you from matching somewhere. A higher score can definitely compensate for a mediocre application. Keep the following guide in mind when setting expectations for receiving interview offers:
< 200 -- below average candidate
200-220 -- "average" candidate
230+ -- definitely an "above average" candidate

"Average" US MD candidates have definitely been known to match at "top" programs, and probably don't need to worry about being able to get a position.

USMLE Step 2 score:
Since people take step 2 at variable times, with variable results, it is much more difficult to determine the meaning of different scores in terms of matching or not matching anesthesiology. If you're step 1 score is 220+, and your application is at least moderately strong, you should consider waiting to take step 2 until after you receive interview offers (December or later). Alternatively, you will never be better prepared or more motivated to take step 2 than right after finishing third-year clerkships. You may want to take step 2 early if you believe you can score at least as well as you did on step 1, and want the peace of mind of not having a board exam hanging over your head until late in the year.

What if I'm really "average"?
http://forums.studentdoctor.net/showthread.php?t=115485

If you're graduating from a DO school:
http://forums.studentdoctor.net/showthread.php?t=112463
http://forums.studentdoctor.net/showthread.php?t=228909

What if I want to switch from another residency (medicine)?
http://forums.studentdoctor.net/showthread.php?t=202547

Q: When should I take USMLE Step 2?
From PowerMD.

If you killed step I then you can either: A)take it early 4th year and choose to not have the score submitted automatically to every program before you get to review it. B) take it after/late December after the majority of your interviews will be finished. You can just go for it early and submit the scores but why jeopardize things.

If you got killed on step I then take Step II EARLY! As in early August so the scores will be out by early September for ERAS time.

I'm a DO student and have taken COMLEX. Should I take USMLE?
From ventdependent.

For you DO's out there I suggest taking the USMLE I. If you blow it then don't submit it. If you missed the opprotunity to take that exam then take Step II CK and submit the score. PD's commented that taking the USMLE was the best addition to my application. I have heard of folks matching into good programs with COMLEX only but why risk it?

Q: Do I need to do research to match in anesthesiology?

No. Students with little or no research experience still get interviews and match at research heavy "top tier" programs. Even "elite" academic programs do not expect most of their residents to do significant research (they sometimes recruit foreign MDs with PhDs or other research background to fill their research gap).

Many if not most students have done one or two small "research" projects during medical school. Typically these may result in a poster, presentation, or abstract. This is pretty clearly "small time" and unlikely to develop a career doing any significant research, and most program faculty know that. Thus, the isolated "research project" does no more to make you stand out than, say, a medical missions trip or public health activism -- and it's probably equal to, but no better than, medical missions or political activism.

A long history of demonstrated commitment to research, on the other hand, is something you can use to sell yourself. For example if you have a history of multiple research projects, a small (just 1-2 for now) but growing list of publications, or a research-based degree (PhD), you can probably sell yourself really well to a research-heavy program, especially if you share research interests with some of their faculty.

However, most of us don't have declared research interests. This is not a disadvantage, so don't worry about it. Sell your other positive aspects.

Q: If I'm not interested in research or academics, does this mean I shouldn't apply to a program that's known for research?

No. Students with little or no research experience still get interviews and match at research heavy "top tier" programs. Even these programs do not expect most of their residents to do significant research (they sometimes recruit foreign MDs with PhDs or other research background to fill their research gap).

You can always graduate from a research-heavy residency and go into private practice. And they do not pressure or force residents to do research (in fact, residents are expected to spend their time learning clinical practice).

Q: How many 4th year anesthesiology electives should I do? Do I need away elective(s)?

Ideally, you should do one month of anesthesiology elective (presumably at your home school) before applying for residency. It's not impossible to successfully apply with less than this (for example, a week of anesthesia during your surgery elective) but it would be disadvantageous. A one-month elective during your M4 year will 1) allow you to really experience the field in greater depth and investigate if it's for you, and 2) help assure residency programs that you've seen enough to know you really want to go into it.

Some people do away electives at other institutions, anywhere from one away to three away (in addition to one at home). I would say one month at home and one month away is more than enough for an average candidate. Two aways would be the max I would do, if there are two programs you're particularly interested in seeing.

Keep in mind that if you do 3 months of anesthesia as an M4 (one month at home, two away), interviewers may challenge you by asking, "Why didn't you decide to broaden your education by doing something else?"


Q: When and how should I apply for away electives?

Pick your electives and apply VERY EARLY. Apply as soon as they begin accepting applications, and call before your application gets there to see if they will hold a spot for you until your paperwork arrives. Rotation slots at desireable programs are filled quickly, so if you leave it until early summer of your fourth year, you could be out of luck. There are a few schools of thought on doing outside electives:

Home vs. away: Some people believe you should do an elective at your home hospital first, or a program you don't hope to match. The idea being that you will learn something about anesthesiology, and do a few procedures, so that when you rotate at a program you hope to match, you will look competent. Many anesthesiologists I have spoke with when I was doing audition electives told me they expected very little of medical students except that they be enthusiastic, have common sense, and ask good questions. If you are a quick learner, it probably doesn't matter if you do a 'prep' elective first.

Audition electives increase your chance of matching: Some people believe that if you do an elective at a program you hope to match, you improve your chances because they will know you are serious about going there. Also, they have a chance to get to know you well. Of course, that can work against you. All it takes is one slip up either professionally, or socially, in front of an influential person, and you may lose your slot.

Audition "up" so you can match "down": The general idea is that by auditioning at a prestigious program you don't expect to match, and getting a prestige letter, you improve your chances of matching less prestigious programs that you have a realistic shot at. Some people use this strategy, but it's unclear whether it improves your odds or not.

The best months do do audition electives are July-October. November/December electives get in the way of interviews, and will be too late to help you with letters of recommendation.

Q: Who should write my letters of recommendation?
From PowerMD.

You can submit up to 4 letters in ERAS. More valid letter writers will most likely include faculty who knew you from your internal medicine or surgery rotations. An ICU letter will be a major bonus as well.

Folks match into anesthesiology without a letter from an anesthesiologist. I am not sure how common this is. Your best bet is to have one though. Here is how I landed mine: 1st I asked residents who would be a good person to get a letter from. Then I took a call night with that physician (good experience anyways...basically let me run the case) and subsequently asked him for a letter. Just one way of approaching this.

From jennyboo.

Academic anesthesiology is an inbred world. Residency programs will pay close attention to letters written by people they know and trust. Thus, a letter written by an anesthesiologist who works in that very program will go much further than one written by any physician (anesthesiologist or otherwise) they don't know, or know as dubious. There are also a few highly respected anesthesiologists who are known for being active in politics or research or otherwise on a national level -- a letter from this kind of person can also be a good thing -- but only if you really worked closely with them.

The American Society of Anesthesiologists (ASA) has prepared a FAQ to answer many basic questions of interest to a medical student who is considering a career in anesthesiology.
http://www.asahq.org/career/faq.htm

Thread on "why choose anesthesiology?" Covers lifestyle issues too.
http://forums.studentdoctor.net/showthread.php?t=79579

Regarding "isn't it boring?" questions:
This comes up somewhat frequently, probably because until you actually practice anesthesiology, it is hard to fully appreciate what an anesthesiologist does, and what that kind of responsibility feels like. Suffice to say, it is NOT a boring field if you like acute care medicine, hands-on management of patients, life-threatening problems, short but close doctor-patient relationships, the excitement of the OR, and having the best knowledge base in pharmacology and physiology in the hospital, and the skills to apply it practically every day.

http://forums.studentdoctor.net/showthread.php?t=195246

One forum member's reasoning for choosing anesthesiology:
http://forums.studentdoctor.net/show...7&postcount=10

Thread covering the issue of "boredom" in anesthesiology:
http://forums.studentdoctor.net/showthread.php?t=79579

Thread covering the issue of "respect" in anesthesiology:
http://forums.studentdoctor.net/showthread.php?t=117251

Thread covering the old and trite Surgery VS. Anesthesiology in the OR
http://forums.studentdoctor.net/showthread.php?t=198354

Thread covering "why do you love anesthesiology?":
http://forums.studentdoctor.net/showthread.php?t=71763

"So you want to be an anesthesiologist" thread:
http://forums.studentdoctor.net/showthread.php?t=71610

Q: What is the lifestyle of a practicing anesthesiologist?

Post by Jetproppilot regarding lifestyle, scope of practice, financial issues- one of the most informative posts I've seen from a private practice anesthesiologist:
http://forums.studentdoctor.net/show...0&postcount=19

Thead covering lifestyle issues specifically:
http://forums.studentdoctor.net/showthread.php?t=56048

This thread covers both lifestyle and what it's like to transition from residency to private practice:
http://forums.studentdoctor.net/showthread.php?t=82587

Q: I heard something about competition from CRNAs. What is a CRNA, and what effect do they have on the field of anesthesiology?

CRNA = certified registered nurse anesthetist. Numerous active discussions about CRNAs, supervision models, Anesthesiology Assistants (AAs) may be found on the CRNA Debates forum.

Q: What book(s) should I read?

NMS Clinical Manual of Anesthesia by Randall S. Glidden. A very brief pocket book introduction which can be very useful for 3rd or 4th year medical students doing their first anesthesiology rotation. Not sufficient for residents.


Handbook of Anesthesiology by Mark R. Ezekiel, MD, and MS. Another very small pocket book.

Anesthesia Secrets by James Duke. In question and answer format like all the other review books in this series. Appropriate for both medical students and junior residents as an introduction. I've known a decent number of residents who like this book for review too. Small enough to sneak into the OR and to put it down on the anesthesia cart (but not small enough to fit in your pocket).

Clinical Anesthesia Procedures of the Massachusetts General Hospital by Peter F Dunn, Theodore Alston, Keith Baker, and J. Kenneth Davison. Another review book, about the same size as Secrets, small enough to put on the anesthesia cart in the OR. In outline format and also touches on management of patients for a few specific common surgeries. Appropriate for both medical students and residents.

Basics of Anesthesia by Robert K. Stoelting and Ronald D. Miller. For years this book, known as "Baby Miller," was a very concise and simple introduction handed to new medical students as well as residents for an introduction to the specialty. The most recent edition is actually much more dense than previous versions so you will most likely not make it through if you are a medical student. A resident could take several months to read this. Rumor had it that you could read the old Baby Miller from cover to cover, memorize it, and pass the in-training exam during your CA1 year (when you have a grand total of 2 weeks of clinical experience).

Clinical Anesthesiology by G. Edward Morgan, Maged S. Mikhail, and Michael J. Murray. A good (some residents say a better) alternative to the old Baby Miller. I think it is pretty similar to the new Baby Miller. Again, excellent for a resident to go through in a few months. Unlikely that you would make it through this book in a month as a medical student.

Q: I am a resident who is on probation or being asked to resign by my residency program. What should I do?

Here are several discussions in the General Residency forum which may provide some insight.

- Getting on bad side of the program - http://forums.studentdoctor.net/showthread.php?t=574435

- Forced to Resign Residency Before Termination - What now? http://forums.studentdoctor.net/showthread.php?t=584783

- Terminating residents - http://forums.studentdoctor.net/showthread.php?t=562930

- Advice from user lobelsteve about how to fight a termination - http://forums.studentdoctor.net/showthread.php?t=640172

jennyboo said:

Many medical students have been asking for an updated FAQ to help them out with residency applications. So here it is, updated for the 2008-2009 application year. Thank you to PowerMD and VentdependenT who wrote and compiled most of this in its original format. If you have questions to suggest for inclusion that do not already appear, please private message me and I'll do my best.

How to make yourself a competitive candidate
- Is anesthesiology really as competitive as they say? What are my chances of matching?
- What USMLE scores do I need?
- I failed or had to remediate a basic science class. Should I mention this in my personal statement and/or interview?
- When should I take Step 2?
- Do I need to do research to match in anesthesiology?
- Who should write my letters of recommendation?
- What kind of personal statement should I write? Should I write a story or an expository essay?
- I want to apply for anesthesiology residency but my medical school won't let me do a rotation until November of my M4 year! What should I do?
- How important are extracurricular activities and leadership experience?

Information for DO applicants
- I'm a DO student interested in applying to MD residencies. What can I do to make myself competitive?
- I'm a DO student and have taken COMLEX. Should I take USMLE?

Anesthesiology rotations as a medical student: electives, away rotations, and how to succeed
- How many 4th year anesthesiology electives should I do? Do I need away elective(s)?
- When and how should I apply for away electives?
- What book(s) should I read?
- As a medical student, how can I make the most of my anesthesia rotation?
- How can I get more procedures as a medical student?
- How come I can't intubate / start IVs / mask ventilate? Am I stupid?
- I want to do a critical care elective. Should I do it in a surgical ICU or a medical ICU?

Internships (i.e. preliminary years and transitional years)
- Should I choose surgery, medicine, or a transitional year?
- Should I write a separate personal statement for internship applications?
- I'm switching specialties and have already done a year of OB / Family Medicine / Psychiatry / Pediatrics / Emergency Medicine. Will this meet my internship (CBY) requirements or do I have to repeat an internship?
- Is it better to do a challenging internship or a "cush" internship?

Categorical vs Advanced programs
- What's the difference between Categorical and Advanced programs?
- Is it possible to apply only to Categorical programs?
- If a program offers both Categorical and Advanced positions, can I apply to both?

Choosing programs to apply to
- How many programs should I apply to?
- What is the education like at average to low tier programs compared to "top" programs?
- What programs are considered to be "top" programs?
- Should I go to a program with or without CRNAs?
- What programs are known to be good for _____? (Fill in the blank with Regional, Pain, Cardiothoracic, Pediatrics, etc)
- Threads where current or former residents and/or faculty discuss specific programs. Cleveland Clinic Foundation (CCF) | Cornell | Jackson Memorial | University of Michigan 1 | University of Michigan 2 | Massachusetts General Hospital | MGH, Hopkins and Duke
- Why do some top programs fail to fill in the match?

Residency Interviews
- How many residency interviews should I attend?
- Is it necessary to attend the dinner the night before the interview?
- How can I prepare for interviews?
- What "tough questions" have people been asked during interviews?

General background on work and lifestyle
- Links to discussions which answer the following questions: Why choose anesthesiology? Is it boring? Are you well respected? Why choose anesthesiology and not surgery? What about getting along with surgeons?
- What is the lifestyle of a practicing anesthesiologist?
- I heard something about competition from CRNAs. What is a CRNA, and what effect do they have on the field of anesthesiology?
- How do anesthesiologists get paid, and how does this compare to how CRNAs get paid?
- Are there procedures that only MDs can do? What procedures can CRNAs and AAs do?
- What do anesthesiologists pay for malpractice insurance?

Click to expand...

Thank you! This is so incredibly helpful!

Thanks for all the amazing links/info guys.

Does anyone have any information on Anesthesiology fellowships? I'm particularly interested in Critical Care, but I can't really find too much about it out there.

I am currently a 3rd year Ross University Medical Student and am very interested in going into Anesthesia. I got over a 90% on Step 1. How difficult do you think it will be for me to get into an anesthesia residency. What steps do you think I should take?

CanGas said:

So Jet`s post on `Bow your head`was the impitus for this post. In the last while we`ve had a bunch of posts on stress, burnout and general questions on how to get into anesthesia and how to do well once you get in.

Well this forum has the answers. There are pearls of wisdom throughout the archive. Start by reading the FAQ`s that are already stickied but I`ve spent some time searching for some of my favorite posts on survival and succeding and compiled them here.

Perhaps others can add their favorite advice posts and get this stickied as a survival guide.

Yeah, I know tons of posts below are Jet`s. I`m not sucking up, the man just knows how to speak the truth.

The post that started the search (good advice for residents and med students in any speciality)
Bow Your Head
http://forums.studentdoctor.net/showthread.php?t=548150

Pre-residency tips :
Significance Of Foresight
http://forums.studentdoctor.net/showthread.php?t=269764

Jet Delivers Some Monetary Truth To Med Students You Aint Gonna Find Elsewhere
http://forums.studentdoctor.net/showthread.php?t=553150

Jets Opinions On Where You Match
http://forums.studentdoctor.net/showthread.php?t=254139

What Makes A Good Program
http://forums.studentdoctor.net/showthread.php?t=280394


Success in residency/anesthesia rotations
how to kick *ss on anesthesia rotations?
http://forums.studentdoctor.net/showthread.php?t=269969

Any advice for incoming CA-1s?
http://forums.studentdoctor.net/showthread.php?t=522941

Paging Jet: Advice for New CA-1's
http://forums.studentdoctor.net/showthread.php?t=545152

Holy S Hit I Just Gave The Wrong Medicine!!!
http://forums.studentdoctor.net/showthread.php?t=548067

What is it like to be chief resident in anesthesia?
http://forums.studentdoctor.net/showthread.php?t=180747

Being lazy
http://forums.studentdoctor.net/showthread.php?t=541988


Stress management
CA-1 year stress
http://forums.studentdoctor.net/showthread.php?t=184382

Resident burn out. Please help.
http://forums.studentdoctor.net/showthread.php?t=286011

Is Residency More Abusive Than It Needs To Be?
http://forums.studentdoctor.net/showthread.php?t=548667

Starting CA1...does it getter better???
http://forums.studentdoctor.net/showthread.php?t=548025

Difficult Days
http://forums.studentdoctor.net/showthread.php?t=552792

Stressed out at work?
http://forums.studentdoctor.net/showthread.php?t=509395


Life questions
family and lifestyle
http://forums.studentdoctor.net/showthread.php?t=84059

Anesthesiology and Marriage
http://forums.studentdoctor.net/showthread.php?t=471001


Life after residency
Are You Ready For Private Practice?
http://forums.studentdoctor.net/showthread.php?t=321509

Are You Ready For Private Practice? - 2
http://forums.studentdoctor.net/showthread.php?t=541161

Transition to Private Practice
http://forums.studentdoctor.net/showthread.php?t=267717

Private Practice Deftness
http://forums.studentdoctor.net/showthread.php?t=521241

New Attending Comments
http://forums.studentdoctor.net/showthread.php?t=300356

Write your own ideal contract
http://forums.studentdoctor.net/showthread.php?t=386575

questions about private practice groups/contracts
http://forums.studentdoctor.net/showthread.php?t=215815

CanGas

Click to expand...