It’s the middle of residency recruitment season again, so as follow-up to WhoPassedGas’s post last November about “The Real Northwestern Anesthesiology,” http://forums.studentdoctor.net/threads/northwestern-anesthesiology.1040305/ I thought it’d be helpful to provide an updated perspective on the program. In all fairness, WhoPassedGas was absolutely right in describing this as a working program. For better or worse, our operative volume is tremendous, which means residents get to see a lot of different cases, but they also do get worked like donkeys. As far as the rest of her complaints, I think that had to do more with her personal situation than the program. All in all, the resident body, surgeons, and attendings here are actually quite nice.
I’m an attending at Northwestern. I was here for four years of residency, but did all of my schooling and fellowship elsewhere. For concern about professional repercussions, I’m reluctant to give too many details, but suffice it to say I’ve seen a handful of different anesthesiology departments. Having worked as both resident and attending here, I now see that the major problem in this place stems from its faculty.
There is department lore of darker days years back, but right now morale is horrible. We have about ten faculty left/leaving, most of whom are hardworking, clinically strong, and dedicated educators (and a couple of good riddance). The business structure of this place is complex, but basically about a year ago the hospital bought out the faculty group. Since then, the department has been progressively marginalized by both hospital administration and the university dean. On the one hand, the hospital is pushing for more clinical productivity with fewer resources, cutting staffing, nonclinical time, and budgets; on the other, the university is pushing for more academic productivity, using grants and publications as the measure. Attendings are overworked and feeling the squeeze, with everyone expecting us to do more with less. You’ll notice that nowhere in those productivity measures is education a priority.
That brings me to the second issue of faculty, the quality of this department’s educators. Northwestern is great at helping you pass boards, but its clinical direction is terrible. Let me tell you, there are a lot of anesthesiologists here who are scary freaks I’d never want touching even my in-laws. There’s the “airway team” here, which reminds me of those witches from Greek mythology--they cackle and fuss a lot but share just one eye, in this case a Glidescope. Suddenly I hit more advanced rotations as a CA2 and realized that no one had ever even taught me solid mask ventilation or direct laryngoscopy skills. The homeless-looking fiberoptic guru of the department exclusively uses the fiberoptic, and also always puts an A-line in even ASA1 patients. There’s the gyne anesthesiologist who’s certain to walk around the room and check patient positioning very carefully, especially when the stirrups are up.
Aside from the personalities, this is a huge department with a ton of sites to staff, so you’re essentially left to figure things out on your own for the entire first year. With so much pressure on clinical productivity, very few attendings in the general ORs spend any significant amount of time with you in the rooms. I start a case, then have to go see my next preop, wake up my other room, write some postop notes, give a break, etc. Basically, your entire CA1 year spent with the likes of the above is a waste. The saving grace of Northwestern is its subspecialty rotations. When you hit rotations like OB, cardiac, neuro, and critical care, you consistently work with a smaller group of people who are both clinically competent and educationally invested, for the most part. The problem is that when you hit these rotations, you’re so overwhelmed at having been so poorly prepared by that first year. Like I said, this place is great at helping residents with tests--there are plenty of very nice, gentle lecturers through CA1 year who help get the textbook stuff down. You know the saying--those who can, do; those who can’t, teach. The department is great about relieving residents for didactics and sim lab, but those settings don’t prepare you for being a functional anesthesiologist. Instead of CA2 rotations being exciting and challenging, they are overwhelming, scary, and defeating. I had so many thoughts of quitting during my CA2 year, in retrospect just because I had been ill-prepared by CA1 “educators.”
Don’t get me wrong--if you survive four years of training here, you’ll most likely be a solid clinician, pass your written and oral boards, and have great job options thanks to the Northwestern name. But until the department leadership makes some tough decisions--stand up to the hospital and university, hire better faculty and fire dead weight, reward those who do and teach--faculty will continue to feel overworked and bitter, which translates to residents who feel overworked and bitter.
I’m an attending at Northwestern. I was here for four years of residency, but did all of my schooling and fellowship elsewhere. For concern about professional repercussions, I’m reluctant to give too many details, but suffice it to say I’ve seen a handful of different anesthesiology departments. Having worked as both resident and attending here, I now see that the major problem in this place stems from its faculty.
There is department lore of darker days years back, but right now morale is horrible. We have about ten faculty left/leaving, most of whom are hardworking, clinically strong, and dedicated educators (and a couple of good riddance). The business structure of this place is complex, but basically about a year ago the hospital bought out the faculty group. Since then, the department has been progressively marginalized by both hospital administration and the university dean. On the one hand, the hospital is pushing for more clinical productivity with fewer resources, cutting staffing, nonclinical time, and budgets; on the other, the university is pushing for more academic productivity, using grants and publications as the measure. Attendings are overworked and feeling the squeeze, with everyone expecting us to do more with less. You’ll notice that nowhere in those productivity measures is education a priority.
That brings me to the second issue of faculty, the quality of this department’s educators. Northwestern is great at helping you pass boards, but its clinical direction is terrible. Let me tell you, there are a lot of anesthesiologists here who are scary freaks I’d never want touching even my in-laws. There’s the “airway team” here, which reminds me of those witches from Greek mythology--they cackle and fuss a lot but share just one eye, in this case a Glidescope. Suddenly I hit more advanced rotations as a CA2 and realized that no one had ever even taught me solid mask ventilation or direct laryngoscopy skills. The homeless-looking fiberoptic guru of the department exclusively uses the fiberoptic, and also always puts an A-line in even ASA1 patients. There’s the gyne anesthesiologist who’s certain to walk around the room and check patient positioning very carefully, especially when the stirrups are up.
Aside from the personalities, this is a huge department with a ton of sites to staff, so you’re essentially left to figure things out on your own for the entire first year. With so much pressure on clinical productivity, very few attendings in the general ORs spend any significant amount of time with you in the rooms. I start a case, then have to go see my next preop, wake up my other room, write some postop notes, give a break, etc. Basically, your entire CA1 year spent with the likes of the above is a waste. The saving grace of Northwestern is its subspecialty rotations. When you hit rotations like OB, cardiac, neuro, and critical care, you consistently work with a smaller group of people who are both clinically competent and educationally invested, for the most part. The problem is that when you hit these rotations, you’re so overwhelmed at having been so poorly prepared by that first year. Like I said, this place is great at helping residents with tests--there are plenty of very nice, gentle lecturers through CA1 year who help get the textbook stuff down. You know the saying--those who can, do; those who can’t, teach. The department is great about relieving residents for didactics and sim lab, but those settings don’t prepare you for being a functional anesthesiologist. Instead of CA2 rotations being exciting and challenging, they are overwhelming, scary, and defeating. I had so many thoughts of quitting during my CA2 year, in retrospect just because I had been ill-prepared by CA1 “educators.”
Don’t get me wrong--if you survive four years of training here, you’ll most likely be a solid clinician, pass your written and oral boards, and have great job options thanks to the Northwestern name. But until the department leadership makes some tough decisions--stand up to the hospital and university, hire better faculty and fire dead weight, reward those who do and teach--faculty will continue to feel overworked and bitter, which translates to residents who feel overworked and bitter.
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