The Mount Sinai School of Medicine Consortium for Graduate Medical Education, consisting of 13 institutions located in New York and New Jersey, sponsors more than 140 residency programs in virtually every specialty of medicine, enrolling in the aggregate more than 2,000 house staff. Consortium educational activities provided to all house staff, regardless of home institution or specialty.
It is well known to the members of the Department of Anesthesiology that starting anesthesiology residency is incredibly exciting as well as tremendously stressful. It is during this critical time when our residents acquire the fundamental skills and knowledge necessary to make the successful transition from intern to anesthesiology resident. Our residents are considered students of anesthesiology and participate in a unique and intensive three month-long educational program combining didactic, interactive, and clinical experiences created to provide an introduction to clinical anesthesia.
To assure a broad exposure to the clinical practice of anesthesiology during the orientation period, residents are assigned to care for a variety of patients undergoing a myriad of surgical procedures. During the first two months of training each resident is assigned to two preceptor attendings with whom they will work with in the OR on a one-to-one basis.
During the first month of study residents will attend the "Introduction to Anesthesiology" lecture series, a detailed course of study in the fundamentals of anesthesiology, anesthesia equipment, gas laws, uptake and distribution of anesthetic volatile agents, intravenous anesthetics, muscle relaxants, fluids, and electrolytes.
In addition to the clinical and didactic experiences our residents participate in a unique interactive program. During the first week of study our residents learn how to check an anesthesia machine in a series of formal small group, hands-on workshops. The residents are also given the opportunity to explore the workings of an anesthesia machine and review the machine's safety features during a two-hour interactive anesthesia machine dissection. As part of the interactive portion of the orientation program our residents participate in an extraordinary seven-week simulator program in our state-of-the-art HELPS Center. Working in small groups of two to three residents each resident can expect to receive approximately forty hours of simulator training. The curriculum was developed to teach the fundamental principles of clinical anesthesia. During the first three weeks of the program the residents learn the principles of applied physiology to the practice of anesthesiology, the steps and theory of an anesthetic induction and the sequences of a safe emergence from anesthesia. The resident are then given the opportunity to manage patients who develop perioperative hypoxia, hypotension, dysrythmias, and the difficult airway without the worry of patient safety, or the intervention of anesthesiology attendings.
The focus of the first year of the clinical anesthesia residency (CA-1) is on anesthetizing patients for general surgical, gynecologic, urologic, ENT, orthopedic, obstetric, and ambulatory procedures at The Mount Sinai Hospital and Elmhurst Hospital Center. During this year you will also rotate through Mount Sinai's surgical intensive care unit.
Clinical rotations are organized in blocks, each representing a specialized area of practice directed by an attending anesthesiologist who is a subspecialist in that field. Serving as block coordinator, he or she oversees your education and training. Several anesthesiologists may work in a given area, along with a team of fellows, residents and medical students.
In the second year (CA-2), you will be challenged with more complex cases in rotations through advanced subspecialty blocks. These include cardiothoracic, pediatrics, critical care anesthesia (including liver transplantation and vascular surgery), neuroanesthesia, the post-anesthesia care unit and pain management. You will also spend time at Elmhurst Hospital Center for experience in trauma anesthesia.
Core curricula have been developed for training in the subspecialty areas. At the beginning of rotations, residents receive a manual outlining the educational objectives and recommended readings along with selected reprints of pertinent articles.
CA1 and 2 subspecialties rotations:
During the third year, you will pursue one of two tracks approved by the American Board of Anesthesiology: the Clinical Scientist Track, which combines six months of advanced or subspecialty clinical training with six months of research; or the Advanced Clinical Track, with a minimum of six months of advanced and complex anesthesia assignments and up to four months of selected subspecialty rotations. CA-3 training provides the opportunity to manage complex cases, teach CA-1 and CA-2 residents and conduct clinical research.
Mount Sinai offers training in all recognized subspecialties. In collaboration with the Program Director, CA-3 residents can create programs uniquely suited to their own interests. Residents may pursue advanced training in the following areas:
The didactic program is structured to cycle through a 24-month continuum of education and training that occurs in parallel with the clinical educational program. It is designed to optimize the acquisition of increasingly complex knowledge, while maintaining the retention of essential, fundamental basic science and clinical concepts. The didactic program is furthermore based upon the concept of multi-modality education, whereby materials are taught using didactic lectures, group discussions, interactive workshops, “hands on” clinical experience, and in the simulator center, as appropriate.
The first four months of the residency is designated as the “Introduction to Anesthesiology.” It is during this critical time in their training when new CA-1 residents make the transition from PGY-1 (preliminary year) work to clinical anesthesiology. The didactic and clinical curriculum is designed to give the new residents the fundamental skills, knowledge and abilities so that they may assume the role of students of anesthesiology and to assure success during the remaining 32 months of training.
During these first 3 months of training, the residents are exposed to a broad range of clinical experiences and patient populations. No CA-1 is assigned to anesthesia subspecialty rotations during this time. During the first 6-8 weeks of the residency, the CA-1 residents are assigned to work (nearly exclusively) with two attending preceptors. At this time, the mandatory CA-1 curriculum consists of a rigorous program of didactic lectures, small group interactive sessions, workshops, laboratories, and simulator sessions. Throughout the month of July, the residents attend the “Introduction to Anesthesia Lecture Series”—a comprehensive lecture series designed to cover the broad topics of basic science and clinical concepts integral to the practice of anesthesiology.
During July and August, the CA-1 residents attend our “Introduction to Basic Anesthesiology Skills”—a comprehensive seven-week simulator-based program of lectures, demonstrations, laboratories, and small group interactive educational experiences. The residents are relieved from clinical duties by their attendings at various times of the regular workday. Topics covered include: anesthesia machine check and dissection; OR preparation; basic pulmonary and cardiovascular physiology as it applies to clinical medicine; and the management of basic anesthesia skills including, induction emergence, perioperative hypoxia, hypotension, arrhythmias, and the difficult airway.
All of the 6:30 AM Morning Conferences scheduled in July are attended by all residents, and are specifically designed as an introduction for the CA-1’s and as a review for the CA-2 and CA-3 residents. Cases chosen for presentation during our “Wednesday Morning Case Conference” involve basic anesthesia concepts and difficulties (e.g., ACLS, airway assessment and management, and differential diagnosis and treatment of hypotension). In August, Morning Conference and Case Conference continues these themes of basic education.
From September through December, the Basic Science Lectures and the associated Morning Conferences stress introductory knowledge, at a higher level than that in July and August. The Basic Science Lectures are scheduled specifically to follow the general format of the two introductory textbooks used by the residents (Morgan GE, Mikhail MS, Murray MJ (eds), Clinical Anesthesiology 3rd edition. New York, McGraw Hill, 2002 and Barash PG, Cullen BF, Stoelting RK (eds),Handbook of Clinical Anesthesia 4th edition, Philadelphia, Lippincott Williams & Wilkins, 2001).
From January through April, these sessions focus on more advanced anesthesia topics organized primarily by problem or organ system (e.g., transfusion, neuroanesthesia, cardiac anesthesia, etc.). Similarly, Case Conference discussions progress to more specific and case based subjects (e.g., pheochromocytoma, drug swap, and management of patient with cardiac transplant). During May and June, Morning Conference is used for written board preparation and review.
Below is a list and descriptions of the didactic conferences offered to the residents:
a. Introduction to Anesthesiology Lecture Series: This lecture series will occur in the morning from 06:30-07:15. Topics include: anesthesia machine and monitoring; intravenous and inhalation anesthetic agents; local anesthetics; ECG interpretation; vasoactive agents; and quality assurance issues.
b. Introduction to Anesthesiology Human Simulator Program: CA-1 residents participate in the mandatory simulator program held daily from 09:00-15:30 for the first six weeks of residency for several residents per session. The program utilizes lectures, demonstrations and human simulations to cover basic pulmonary and cardiac physiology, anesthetic induction and emergence, perioperative hypoxia, hypotension, arrhythmias, myocardial ischemia, and the management of the difficult airway.
c. Introduction to the Anesthesia Machine, Machine Check and Dissection: CA-1 residents participate in the mandatory demonstrations held daily during the first week of their residency. Using small and large group hands on demonstrations, the CA-1 residents are given the opportunity to learn and practice the anesthesia machine checkout, follow the flow of gases through the anesthesia machine with an emphasis on safety mechanisms and alarms, change gas cylinders, CO2 absorbant and dismantle and explore the scavenge system, circle system and bellows chamber.
2. CA-2 & CA-3: SIMULATOR CURRICULUM – (Tuesday and Thursday afternoons, 14:30-16:00 hrs, September-June) Two residents, working as a team, spend 90 minutes in our Human Patient Simulator Laboratory. The cases are presented in “oral board-like” format and the residents evaluate, optimize, and perform anesthetic management on each simulated patient. In addition to reviewing the management of critical anesthetic events, residents working in teams also learn crisis resource management skills, such as prioritizing, communication, task delegation, problem solving, and resource utilization. During the course of their training, the residents will encounter and participate in the following topics in the Simulator:
a. The Difficult Airway Course
The residents encounter a simulated patient, whom they can neither intubate nor ventilate. The ASA's Difficult Airway Algorithm, along with airway devices including LMAs, combitubes, transtracheal jet ventilation, and cricothyroidotomies are reviewed.
b. Advanced Topics in Anesthesia
The residents encounter advanced cardiovascular, pulmonary, and operative derangements including, but not limited to, cardiogenic and noncardiogenic shock, severe bronchospasm, massive hemorrhage, and myocardial infarction.
c. ACLS
The residents encounter, diagnose and treat supraventricular and ventricular arrhythmias including SVT, VT, VF, asystole, and PEA.
d. Critical Events in Anesthesia
The residents encounter, diagnosis, and treat anesthetic critical events including, but not limited to, the following; malignant hyperthermia, thyroid storm, pheochromocytoma, anaphylaxis, cardiac tamponade, tension pneumothorax, anesthesia and gas delivery system failure, and pulmonary embolus.
3. CA-2 AND CA-3 MOCK ORAL BOARD PREPARTION. (Wednesday afternoons, 14:30-16:00 hrs, September-June) Two residents, working as a team, spend 60 minutes during this oral board preparation. The team is presented a "stem question", are given time to prepare, and then must verbally discuss patient evaluation, optimization, and anesthetic management. Knowledge, patient care and communication skills are assessed.
4. DAILY MORNING CONFERENCES
a. Morning Conference: (Monday, Tuesday, Thursday and Friday from 06:45-07:15, July-June). All residents participate in this conference, which includes didactic lectures, demonstrations, case review, problem-based learning sessions, and multiple choice question review. The conference is organized to present and review basic topics during the first half of the year, and then to focus on the subspecialties of anesthesiology during the second half of the year.
b. Chairman Rounds/Journal Club: (Held bi-monthly, August-June 06:45-07:15). All residents receive the journal articles that scheduled for discussion for that academic year at the beginning of the year for this mandatory journal article discussion. The focus is on study design, data analysis and statistics, interpretation of data, and evidence-based medicine.
c. Program Director Rounds: (held bi-monthly throughout the year 6:45-7:15). All residents participate in program director rounds. The format is oral board format. A case from the daily OR schedule is presented by the resident who prepared the case. Topics include preoperative assessment, intraoperative plan, and postoperative care. Basic science principles will be emphasized in this oral board formatted educational session.
d. Written Board Review: (Monday, Tuesdays, Thursdays and Fridays, 06:45-07:15, May and June). All residents participate in the key word and written board review as a preparation for the ABA/ASA In-Training Exam and written boards. Multiple choice questions and answers are reviewed, as are key words that are obtained from ABA/ASA In-Training results.
5. DEPARTMENT-WIDE WEDNESDAY MORNING CONFERENCES
Wednesday Morning Lecture Series: (06:45-07:30 hrs, September-June) The lecture series is for attendings and residents from all Mount Sinai Medical Center campuses and major affiliates. The lecture series runs on a two-year cycle and covers a selection of topics from the ABA/ASA In-Training Content Outline and other topics of interest. CA-3 residents are occasionally assigned topics in their subspecialty to present or are given an opportunity to present the results of their research.
Grand Rounds: Once monthly, in lieu of a Wednesday Morning Lecture, a speaker from another Department or institution is invited to deliver an hour-long Grand Rounds lecture. Residents participate in the discussion that follows.
Morbidity and Mortality Case Conference: (Wednesdays, 07:30-08:30 hrs) Interesting or complex cases, or cases with perioperative morbidity and/or mortality are presented. The resident that was involved in the care of the patient is required to submit a brief case summary, a list of questions and copies of pertinent references from the medical literature, under the supervision of the attending that was involved in the patients’ care. A handout is distributed to all attendees well in advance of the conference. Attendings with expertise in the topics being discussed moderate the conference. The resident involved presents the case, and then discussion ensues involving other residents and attendings in an oral board-like format. The moderator emphasizes Socratic teaching methods for the residents and elicits the expertise of the Departmental faculty to present the relative merits of different clinical approaches. Evidence-based medicine is taught to the residents in this format.
Public Mock Oral Presentations (Two Wednesdays in May instead of case conference and basic science lecture) Two CA-2 or CA-3 residents, working as a team, spend 30 minutes during this public oral board preparation. The team is presented a stem question a few days in advance in order to given them time to prepare. The residents must verbally discuss patient evaluation, optimization, and anesthetic management in front of the Department. Knowledge, patient care, and communication and public speaking skills are assessed and graded by the faculty. Awards for best performances are distributed.
Cardiac Lecture Series: Weekly conferences covering core topics in cardiac anesthesia. Formats include journal club, lectures, and case conferences, with active resident participation in each of the formats.
Obstetrical Anesthesia Lecture Series: Conferences covering core topics in obstetrical anesthesia. Formats include journal club, lectures and case conferences, with active resident participation in each of the formats.
Pain Management Seminar: The pain management rotation includes weekly conferences covering core topics in the subject. Formats include journal club, lectures and case conferences, with active resident participation in each of the formats.
Critical Care Medicine Lectures: Residents on the Mount Sinai ICU rotation attend a lecture series presented by Critical Care Medicine attendings and fellows. Residents participate in daily ICU rounds and are asked to present their complicated cases and prepare small lectures on related topics to the group.
Monthly Research Conference: This conference includes discussions regarding the process of designing research projects, preliminary analysis and critique of IRB proposals, selected research topics and reviews of studies that are currently underway in the Department. Residents involved in research present their work to the group, but all residents are invited to attend.
