Residency -- Case Western Reserve/UH Hospitals Anesthesiology Review

Sep 17, 2020
1
10
Status
  1. Resident [Any Field]
Hello,

I am a current resident here at Case Western/University Hospitals in the Department of Anesthesiology. When I was applying for residency, I remember having some difficulty in finding recent information about this program online. There were a handful of posts floating around the internet from years ago. Since that time, we have had a new Chair and a new Program Director—both have been here a couple of years now. With the application process now being held entirely virtually, I thought I would put some thoughts together about the program to help anyone considering it! What I am writing is based on my experiences here and what I hear my co-residents discussing. The first thing I want to say is that I have very much enjoyed my time here at UH. When I came here as an MS4 applicant, I was struck by how close-knit the anesthesia residents seemed to be to one another, and how collegial they seemed with the attendings and other OR staff. That has absolutely been my experience here as well.

UH is an integrated four year program. During Intern year, you rotate three months on inpatient internal medicine (usually one month cardiology, one month general medicine, one month inpatient renal), one month of emergency medicine, one month SICU, one month CTICU, one month ENT (inpatient head and neck surgery), one month acute pain service (pre-/post-operative nerve blocks), one month chronic pain (primarily clinic with ~1 day/week for procedures), one month QI project/research (this is a fantastic month in which to prepare for and take Step 3), one month peri-operative medicine consult service (run through the Department of Medicine), and then an eight week anesthesia bootcamp (Start paired with a senior resident in the ORs and gain more independence from there. Lectures, workshops interspersed throughout). I found the intern year very humane, with reasonable hours—the longest being in the ICUs. The Department of Medicine is very education focused, the Emergency Medicine Department is very supportive and treats you as one of their own. The experiences on ENT have been variable, but certainly not overtly malignant from anything I experienced or have heard. The rest of the year, you are with the Department of Anesthesiology! Even as an intern, I felt like I was able to work closely with the senior residents and many attendings, and so by the time I entered the ORs at the end of intern year, I already had personal relationships with many of the staff.

One of the strongest characteristics of the program is how receptive and action-oriented our program director and associate program directors are. Several years ago, interns were not having the best experiences on their rotations, and so the Department of Anesthesiology re-vamped them—got rid of some and added others (dropped surgery, added perioperative medicine and acute pain). Obviously a late admission on the medicine service is a bummer, but I heard next to no substantial complaints from my cohort class with our intern year experience. I really enjoyed it. I loved the month to prepare for whichever board exam you need to take. I loved the early exposure to acute/chronic pain and to critical care. I was nervous about starting residency—UH was very warm and welcoming. The year starts in late June for residency orientation, and you get five weeks of vacation your intern year (four weeks vacation for the other three years).

For the three clinical years of anesthesia, you get to rank your preferred rotation schedule. The cardiac junior month comes very early, with residents starting anywhere from the fall of CA-1 year through the beginning of CA-2 year, depending on your track. Two months of peds always follows your cardiac junior month. When you do cardiac junior seems to be the major variable in your track. Many other rotations fall more randomly (general ORs, ortho, labor and delivery, gyn, the outpatient surgery center, etc). You do a total of six months of ICU over the course of residency, with two months in intern year, and the remaining four months interspersed starting in your CA-2 year. Your CA-2 year, you spend less time in the general ORs, as you are doing your acute pain junior/possibly senior month, time in the units, echocardiography (TEE)/liver transplant, cardiac senior month. Elective time starts in CA-2 year and the program directors are very receptive to any ideas on how to use those rotations, be it POCUS in the ED or various externships.

No one struggles to get their case numbers. Every case is available here. Liver transplants, AAAs, trauma, peds, etc. Rainbow Babies and Children is the stand-alone peds hospital on campus, and also does everything—they have their own set of operating rooms.

We do get a nice education stipend—around $500 intern year and $1000 starting in CA-1. I think the current intern class may have had a higher stipend, but I don’t know that for sure. This can be used for books, board exams, video series (Pass Machine is popular here), TrueLearn (very popular), anything educational. An additional stipend is awarded for conference attendance if you are presenting. Residents attend conferences across the country (in normal times..). Midwest Anesthesia Residents Conference is always well attended. Residents go to ASA every year, as well as conferences for crit care, peds, pain, etc. Research opportunities are definitely available in any area, if you are willing to apply yourself. I am working on a couple different projects right now.

A big bonus to UH is the moonlighting policy. You are paid for all late duties in multi-hour blocks (anything past 6:30pm—this was a recent policy update). You are assigned ~2 a month, and then the rest are opened up for a first come, first served policy. They go quickly. People trade late duties—and those go quickly as well. The income supplementation can be very significant. Moonlighting in the ICU is also available once you have completed your cardiac senior rotation—these are also popular. Various other moonlighting for the cardiac ICU is also available. Even if you do not think you will be interested in a significant amount of moonlighting, the option of doing so is a big plus for UH.

There has been a surge in caseload following the initial COVID shutdown of non-essential surgeries. The result has been some longer hours, with unscheduled (still paid) late duties. The program leadership has been aware and has been working to contain that. The nice thing is that with the generous financial compensation, the sting isn’t too heavy. The last several weeks have improved, so that could be ebbing. That being said, we are encouraged frequently to log our hours accurately, and I have not heard of anyone violating ACGME duty hours. Shooting from the waist, the average week is probably about 60-65 hours. I don’t really think of this as a ‘workhorse’ program, though the hours were a bit longer in the past few months. No one is shuffling around hollow-eyed and mumbling. We have been told that this was a combination of surgical backlog from COVID and several anesthetists leaving for various reasons. Apparently more are being hired. One part of me could go for a couple fewer hours after a long week, the other part of me recognizes that this is residency and the time to get as much exposure as possible. I will say this—the hours are significantly better than how I always pictured residency.

Call is 16 hours M-F, starting at 3pm. Weekend call is 24 hours, 7a - 7a. You obviously have a post-call day. You get a few a month. You get two safe weekends a month, on average. CA-3 are supposed to get less weekend call.

Education occurs every week, with departmental grand rounds (Wednesday Anesthesia Conference) from 7-8am. CA-1’s have designated time for lectures until 11am. CA-2/3’s do as well from 12-3pm. These lectures are given by the faculty, usually in their area of expertise. We provide regular feedback on specific lectures, and often touch base with the education chief to make sure the education sessions are working for us. This has seemingly been a focus the past few years. Lecture slides are posted on the residency website. Keyword discussions are also regularly scheduled. The lecture schedule is posted weeks ahead of time. This year, from my understanding, 12 out of 13 residents passed Basic on their first attempt. Some attendings teach a lot in the OR, others not so much.

One thing that mattered to me was that whichever program I chose have a lounge specifically for anesthesia residents. We have that here, and I think it does a lot to bind our program together. Our lounge is nearby the ORs and anesthesiology offices, but physically separate from both. We have the couches, tables, computers, a big television, fridge, and microwaves. One wall is entirely windows overlooking the courtyard. The Department recently approved a budget for a professional remodel of the space, but that is currently on hold due to COVID non-essential work precautions. On that note, the OR hallways have a lot of windows as well—having natural sunlights between cases is a small, but nice, perk.

We have three chief residents: education, scheduling, and wellness. They are always open for questions and helping with any concerns. The chair of the department is critical care trained, as is the program director, as is one of the associate program directors. Many of the attendings completed a critical care fellowship, which brings a valuable flavor to the program. The other ADP is peds cardiac trained, though she is stepping down. The selection for the new ADP is currently ongoing, but the residents were asked to put names forward and vote on their nominee, which is suggestive of how supportive the program is.

Residents are encouraged to seek out fellowships. Since I have been here, critical care, chronic pain, and acute pain have been the most popular, with residents matching all over this last year—crit care with U Michigan, Cleveland Clinic, Texas Heart (dual crit care/cardiac), here at UH. Acute pain in Pittsburgh, University of New Mexico. Last year, chronic pain matched at Michigan, UVA, Pitt, etc. I know I am forgetting more. Currently, critical care, pediatric anesthesia, and chronic pain fellowships are offered here at UH. A cardiac fellowship is currently being organized.

We use iPro on iPads to chart in the ORs. The rumor on the street is that the department will be buying iPads for each provider in the near future. As of now, the iPads are communal. On the computers, we use AllScripts. Not anyone’s fav, but you do get used to it. We have Omnicells in each OR.

Grievances: there is not a systematic relief system—one day you might be relieved at 3:00 sharp, another might be 6:07. You never really know when you will be done for the day, but as I mentioned before, the cumulative hours seem reasonable for residency. Education is a solid ‘good,’ and improving from there.

I did not go to medical school in the Midwest, and did not have family or friends living in Cleveland. I would say about a third of the residents live on the east side of town, a third downtown, and a third live on the west side. There is a mix of married and single residents. There is a mix of MD and DO. A mix of home owners and renters. At least least half of the residents have some sort of connection to Ohio, but certainly not all (I don’t!). Many want to pursue fellowships, but not all. A sizable percentage of the attendings trained here at UH or at the Cleveland Clinic—and they have liked it enough to base their careers here. For those unfamiliar with Cleveland, UH Cleveland Medical Center and Cleveland Clinic Main Campus are about three blocks from one another, with Case Western Reserve University, the Cleveland Museum of Art, the Natural History Museum, and the Botanical Garden are all bundled together as University Circle.

I am very glad that I am a resident at UH. The program is warm and close knit—residents hang out outside the hospital. The program leadership are very eager to constantly improve the program, and little changes are often being implemented at the suggestion of residents. We commonly have department-wide town hall meeting as an open forum to discuss any issues. I feel like I am getting a strong educational experience, while also being able to have a life outside the hospital.

Best of luck in the interview process!
 
  • Like
Reactions: 9 users

Taco Time

7+ Year Member
Feb 20, 2013
145
257
Status
  1. Medical Student
That's extensive to say the least. Wish every program had this much info out there.. My integrated intern year had no Anesthesia didactics and we were scrum for the most miserable inpatient rotations in the hospital. We had to beg our off-service rotations to even let us take Step 3 with our home program not backing us at all
 
About the Ads

linkin06

We are all witnesses.
10+ Year Member
Dec 20, 2008
796
162
Status
"We use iPro on iPads to chart in the ORs"

perfect...now you can chart and tweet on one device!
 

Silo004

7+ Year Member
Mar 5, 2011
176
97
Status
  1. Resident [Any Field]
Interviewed and got great vibe from everyone. Wife damn near vetoed going, unfortunately. Still like my program but the grass always seems greener.
 

AnkiDude22

2+ Year Member
Mar 19, 2018
1
0
Status
  1. Medical Student
What does the average accepted USMD applicant app look like? ~USMLE, Letters, Research, etc? What would you recommend to stand out for this program?
 

Omppu27

El Tiburon
7+ Year Member
Aug 12, 2011
2,121
670
Pawnee, Indiana
Status
  1. Resident [Any Field]
I thoroughly enjoyed my interview there. Residents seemed truly happy. PD is young and super invested in the program. Might've ranked it higher if I wasn't dead set on getting out of that region of the country.

That said, I remember they recently (~3-5 years ago?) had accreditation issues because of test scores? I remember I brought it up during an interview and was given an answer along the lines of, "we can only do so much, at the end of the day residents need to take responsibility and study." Big turn off for me. N=1, but perhaps you could expand on this?

Edit: I will say though, after being a couple years into residency, I do understand where the interviewer was coming from with that answer. Just didn't think it was the right thing to say at the time/place.
 

abolt18

Cool cool cool cool cool cool cool cool cool cool
7+ Year Member
Apr 24, 2012
3,234
2,170
Status
  1. Resident [Any Field]
I thoroughly enjoyed my interview there. Residents seemed truly happy. PD is young and super invested in the program. Might've ranked it higher if I wasn't dead set on getting out of that region of the country.

That said, I remember they recently (~3-5 years ago?) had accreditation issues because of test scores? I remember I brought it up during an interview and was given an answer along the lines of, "we can only do so much, at the end of the day residents need to take responsibility and study." Big turn off for me. N=1, but perhaps you could expand on this?

Edit: I will say though, after being a couple years into residency, I do understand where the interviewer was coming from with that answer. Just didn't think it was the right thing to say at the time/place.
Haha prior to your edit I was thinking "the truth hurts!"
 
  • Like
Reactions: 1 user

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads