What should I be looking for in an anesthesia residency?

[artiesoneleg1]

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MS3 here interested in applying for anesthesia next year, and I am starting to do some research into programs in order to decide where to do aways next year. Obviously, there are some personal factors that come into play with deciding on a residency i.e. size of program, location, plus more. However, what should I look for in a program that is not more subjective like what I have listed?

Current Residents: What do you wish you cared about more during residency selection? What do you wish you cared less for during selection?

Thanks for the help!

 

[nimbus]

Lots of big boy and big girl cases. They are the ones where I learned the most.

 

[dannyboy1]

Lots of big boy and big girl cases. They are the ones where I learned the most.

Yes. But also lots of bread and butter peds and regional as well. Remember when you graduate anesthesia residency you want to be comfortable as an attending. You won’t be asked to do complex peds or cardiac as an attending ( usually need a fellowship for that) but you will want to be comfortable with peds and blocks.

 

[Robotic Wis-Hipple]

MS3 here interested in applying for anesthesia next year, and I am starting to do some research into programs in order to decide where to do aways next year. Obviously, there are some personal factors that come into play with deciding on a residency i.e. size of program, location, plus more. However, what should I look for in a program that is not more subjective like what I have listed?

Current Residents: What do you wish you cared about more during residency selection? What do you wish you cared less for during selection?

Thanks for the help!

A few things;

Transplants. Even if you never want to do them after training. You should want to on someone else’s license. If you can do, and are comfortable in liver and lung transplants you can do anything in anesthesia.

A Dept that is well respected in the system/hospital. This is hard to ascertain while applying but typically is evident through things like a strong ICU presence or offsite TEE etc.

Autonomy as a CA-3. You should be running cases as a CA-3.

Fellowships. This is for if you decide to do advanced training. It will give you the backup program to match to at the least, good letters from known names, and the easy path to employment in the system if you so desire.

 

[bigdan]

*Not a current resident*

Agree with above posters. If you can scope it out, try to find out:
1. Is there autonomy at some level? Three years of just doing what someone else tells you to do without using any of your own brain cells is both harmful to you as a learner and a waste of your time.
2. The degree of sophistication of the educational system. I'm not saying try to find a place that gives you lectures every day, or lectures you instead of giving you hands on practice. But a place that has put thought/effort/money into your education likely cares about you as a learner in other ways, too.
3. Variety. There are right ways and wrong ways to do things, but rarely only ONE way to do things. You don't want to learn only "the XYZ residency program" way to do things.
4. Exposure to extremely difficult cases. I have no way to prove this, but - even if you just want to go push Propofol in a GI suite for the next 30 years - I strongly believe that if you train with routinely difficult cases, you'll be a better physician. You want some of that "**** hits the fan" swagger in your DNA, even if you rarely need to use those skills/instincts.

 

[Silo004]

2. The degree of sophistication of the educational system. I'm not saying try to find a place that gives you lectures every day, or lectures you instead of giving you hands on practice. But a place that has put thought/effort/money into your education likely cares about you as a learner in other ways, too.

I am a current CA-2.

The most important ones have been covered -- big cases, autonomy, variety of cases, high regional numbers, fellowship exposure if not placement -- but education is somewhat undervalued, especially the time to actually educate yourself.

You want to work hard during residency, even though it sucks. But you don't want to be at a malignant program that grinds residents to a pulp. Culture and program vibe are probably the most important outside of the things mentioned.

 

[AdmiralChz]

But you don't want to be at a malignant program that grinds residents to a pulp. Culture and program vibe are probably the most important outside of the things mentioned.

This is very important but also very hard to tease out during the interview process. Hopefully the residents you meet are honest with you (we always tried to be). The signs to look for: how many residents come to dinner and/or lunch (keep in mind size of program here), how do they appear (do they look exhausted), and what’s their overall demeanor? It’s subtle but you can spot a malignant program if you look close enough.

 

[deleted171991]

Hard cases, regional anesthesia, autonomy (in that order). These make the difference between a CRNA++ and an Anesthesiologist.

 

[ljc]

I am a current CA-2.

The most important ones have been covered -- big cases, autonomy, variety of cases, high regional numbers, fellowship exposure if not placement -- but education is somewhat undervalued, especially the time to actually educate yourself.

You want to work hard during residency, even though it sucks. But you don't want to be at a malignant program that grinds residents to a pulp. Culture and program vibe are probably the most important outside of the things mentioned.

Also a CA-2, and agree with this. I personally underestimated the education component when evaluating programs. I figured "oh whatever, all programs are probably about the same." Yes the more cases you do, the more you'll learn, doubly so if they are difficult cases. But if you don't have the education/time to consolidate that info, you'll just be a robot and never understand why we do things the way we do ("Well, that's how we always do it in these cases!"). Make a point of asking residents what they think of the didactics, how often they're able to attend (at our program, residents make it to maybe 40% of lectures... not cool), how much teaching occurs in the OR (ask for specifics, don't just accept "all the time!" or whatever, ask them how much time on a daily basis they expect their attending to spend 1-on-1 with them in the OR doing active teaching), and how much free time/reading days/education days they have to go consolidate the info/fill the gaps on their own.

In my opinion, a good/great program would have 90%+ didactic attendance, with at least 1-2 hours of didactics per week (do any programs just have full days of lectures every 2-3 weeks or something? that would be amazing), DAILY 1-on-1 OR teaching (why are you showing up to work if you're not learning anything?), and reading/education days once every month or two to allow time for consolidation.

 

[MiddleOfNowherrr]

Agree with above. Do everything in your power to train such that u can really separate yourself from a CRNA. You want to be an anesthesia Consultant not a protocol monkey that wrote a book report to get a nursing level “PhD” and now wants to be called “doctor.”
That being said, here are my two cents:
Make sure you get graded exposure to Big, tough cases, with lots of sick patients, and autonomy with those patients.
If interested in a fellowship go to a place with THAT fellowship.
I thought it was EXTREMELY helpful that i went to a program where i rotated thru several different hospital systems. May seem like a negative but its not—There are a thousand ways to do anesthesia, and learning how its done at different places was VERY helpful in acquiring street smarts that i didnt know i needed till i got to PP (ie experience with nearly all the different anesth machines—even the dinosaurs, infusion/drip devices, EMRs, some places use CMAC only, others glidescopes only, and u want to know how to do both...etc etc).
Transplant -esp LIVER- experience would be helpful bc these can involve so many different aspects of anesthesiology, that if you can do a liver, you can handle nearly anything ( lol except maybe peds hearts—those congenital hearts STILL get me). Not saying u have to go somewhere that u r at a new place every month, but its good to rotate offsite at least a couple times.
Prefer a place that doesnt concomitantly train CRNAs. Focus needs to be on cultivating more MDs and U dont want to fight with them to do cases—haha unless they put the CRNAS in the boring/bread and butter rooms and let the residents do the more complex stuff.
Of course, you want to be at a place where u can do all this and still study bc at the end of the day the goal is to get board certified, so yea make sure the residents fare well on the ITEs at the least (hard to really do unless you know someone personally bc all programs are going to sing their own praises when u interview with them—just sayin’).

 

[Nivens]

Recent grad, was on the admissions committee as a CA-3.

I agree with much of what's been said on this thread, except want to emphasize how difficult 99% of this stuff is to discern on an interview day no matter how many residents you talk to. This is especially true if you're trying to dissect out the differences between two good programs you are trying to choose between.

This is what I told applicants when they asked me how to choose a program, assuming you have options:

1) Geography

Pick a place you want to live for 4 years that makes sense for your situation. If your family is on the West coast, I'd personally think twice before picking an east coast program. There are so many great places to train- why pick one that's going to make getting home for a few days over the holidays a nightmare? Everybody's circumstances are different, but residency is a busy time, and it's hard to understand how that impacts your relationships when you're a medical student with (relatively) tons of freedom. Assuming you went straight through or took one gap year, we're talking about years 26-30 of your life here, the second half of a great decade. Spend it some place you really want to be.

2) Fit

Pick a place that vibes well with you, and beware the aspirational selection. By that I mean, if you don't really enjoy research and know you prefer a more hands-on teaching style, don't pick the super-prestigious program known for forcing their residents to publish like crazy and their "sink or swim" approach to intra-operative teaching! I see this constantly in residents picking specialties- they choose a path that matches an idealized version of who they wish they were, rather than one that is compatible with who they are.

3) Tiebreaker: Fellowships

If you need to pick between two strong programs and the above two items don't help you, go to the place that has the better fellowship in the subspecialty you think you might be interested in (if interested in fellowship). Fellowship match is more heavily influenced by connections than residency match, and many/most spots are filled internally (completely anecdotally- I have not attempted to confirm this with data). It's nice to have the option to stay put for a year if life is more complicated at the end of residency than it was at the beginning.


One final note: medical students are conditioned to believe there is one right answer to every question. Resist that mentality here: no spreadsheets! Truth is you'll probably interview at a few places that will make you happy and give you great training. If you try and make this decision based on stuff like prestige (overrated once you're in a certain tier), night float vs 24-hour call (you don't know what it's like to work either of them- I think 24-hour call >>>> night float!), and didactic schedules (they can and will change!) while ignoring the big-picture stuff I mentioned above, you're overthinking it.

Good luck.

 

[MoMoGesiologist]

What I wish I knew in retrospect: find a place that gets you out by 3-5pm that also has a good name. No other factor will contribute to your personal happiness and sanity than leaving work and still having time to do something/anything rather than passing out when you get home

 

[Mikkel]

1) program with sick patients. It doesn't matter if it's a sick patient going for an EGD.


2) program with attending diversity. You need to have attendings who have experience from different institutions. If you get inbreeding, you'll see only one way of doing things. You need to be able to pick and choose from their ways of doing things to figure out your style of practice.

3) program with multiple locations so you can be familiar with multiple protocols, equipment, nurses styles, administrative styles.

4) program where speed and efficiency are prized.

5) program that has bad attendings so you know what happens when things are poorly planned and how to get out of bad situations

6) program with little support from staff so you know how to handle yourself if you're the only one around in your room

7) program that has on call shifts at hospital where you're the only anesthesia provider for codes and airway emergencies (attending is at home)

8) program that has a few toxic surgeons so you know how to be a little bitch that doesn't fight back unless necessary.

 

[SolidWater]

1) program with sick patients. It doesn't matter if it's a sick patient going for an EGD.


2) program with attending diversity. You need to have attendings who have experience from different institutions. If you get inbreeding, you'll see only one way of doing things. You need to be able to pick and choose from their ways of doing things to figure out your style of practice.

3) program with multiple locations so you can be familiar with multiple protocols, equipment, nurses styles, administrative styles.

4) program where speed and efficiency are prized.

5) program that has bad attendings so you know what happens when things are poorly planned and how to get out of bad situations

6) program with little support from staff so you know how to handle yourself if you're the only one around in your room

7) program that has on call shifts at hospital where you're the only anesthesia provider for codes and airway emergencies (attending is at home)

8) program that has a few toxic surgeons so you know how to be a little bitch that doesn't fight back unless necessary.

You just described my program. Not sure that's a good thing. lol

 

[MoMoGesiologist]

Get out by 3-5pm

 

[nimbus]

Maybe some trauma so you won’t have to post this....

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