SUNY Downstate Health Sciences University
Department of Anesthesiology
A day in the life of an anesthesia resident
OR assignments are posted the afternoon prior, usually by 4pm in order for the resident to have enough time to look up their patients for the next day either at the hospital or via remote access which is available for all of our major clinical sites. After looking up your patient and reading about your cases, you will call your attending to discuss your plan for each case and any other topics you would like to discuss during the day. All of the hospitals have very busy ORs with a great variety of surgical subspecialties allowing for experience with general cases, ENT, plastic surgery, GI, transplant, orthopedics, vascular, neurosurgery, urology, oncologic surgery, and more. The majority of the patients who come to our centers have an ASA physical status of 3 or more leading to a great education of difficult to manage patients that will allow you to practice anywhere you would like to after graduation.
Arrive at the hospital and change into scrubs and set up your room for the day. (sometimes earlier depending on the complexity of the case)
Didactics which will either include an assigned topic for a resident to present. An oral boards style case presentation, or a journal club article for discussion. Residents are expected to participate and engage in discussion and teaching of junior residents and medical students during this time. On Thursday mornings, our OR start is a bit later due to grand rounds and educational activities. On grand rounds day, we meet in a lecture hall with department provided breakfast in front of us for a lecture provided by an attending or visiting speaker. All residents are expected to present for at least one grand rounds presentations. Following grand rounds, a portion of the CA1 class will be excused from clinical duties for case based discussions lead by an attending. CA2 and CA3s receive oral board training and case based discussions once a week as well, usually in the afternoon.
See your first patient of the day to establish report, discuss informed consent and place an IV.
First cases of the day begin. During this time, you learn skills that include inducing and maintaining anesthesia, regional blocks for pain control, intubation, arterial line placement and central line placement depending on the complexity of the case. As you develop your skills, the attendings will allow you to gain more and more independence for decision making. Attendings are very amenable to plans that are created by the resident and the residency program encourages hands on learning from using ultrasound to practice echo in the OR as well as to look at anatomy for regional blocks to using video and fiberoptic laryngoscopy in order to have some experience so your are prepared in emergency and critical situations. Attendings will typically stay in the room for awhile to discuss anesthetic concerns and teaching points of the case as well as to discuss any other topics that might arise. The attending will then leave you alone in the room so that you can practice gaining independence. Attendings are always immediately available to help if you have any questions or concerns. Often you will have a medical student or a junior resident in your room with you as well which allows for opportunities for further solidifying your knowledge by teaching others.
This time is very variable depending on what type of cases to which you are assigned. Usually during this time, the first cases of the day are ending where you will practice emerging the patient and extubating and then transferring the patient to PACU where you will hand off to the PACU nurses and resident so your patient can continue to recover. You will learn how to anticipate and manage postoperative pain, postoperative nausea and vomiting, as well as many other post anesthesia events. Often during this time, your attending will also give you a morning break. Throughout the morning, we continue to help each other with pre-opping and placing IVs in our co-residents patients to help make the day run smoothly.
11:00am -1:00 pm
During this time, you will be relieved for a half hour lunch break. Usually by the resident that is assigned to the 11am-8pm shift or the 12pm-10pm shift. If you prefer buying lunch, each of the sites has a cafeteria or café. There are also local deli’s as well as a couple of food carts in order to get lunch. Often around this time as well, add on and emergency cases are added to the schedule. As you develop your clinical skills and knowledge, you will be awarded with more complex cases. The large number of emergency cases helps with becoming fluid with your ability to think on your feet and shift from case to case as the day requires.
Usually around this time, the ORs are starting to calm down and you will soon be relieved of your duties to go home or to go to additional educational activities. One of the benefits of this program is the relief order which allows the pre-call CA1-CA3 to go home first so that they can rest and enjoy their afternoon before their 24 hour call the next day. Regular day CA3 residents are relieved first, followed by regular day CA2 residents followed by regular day CA1 residents. (This relief order is subject to change if any of the classes have big exams to study for in order to provide more time for studying). Afternoon didactics include regional workshops in the cadaver lab, simulation experience, journal clubs, case based learning discussions, and echo workshops. Educational activities are protected time and you be relieved in order to attend these opportunities.
Look up your cases either at the hospital or at home using remote access depending on your preference. Have an enjoyable dinner and call your attendings to discuss the plan for the next day. Many times, you can discuss with your attending in the afternoon before leaving work.
Residents on Call
A 24 call day typically begins in the same manner as a regular day OR person. One of the big perks of SUNY Downstate resident’s call schedules is that weekday calls include a 3 hours call break. Typically some time between 11am and 1pm, you will be relieved from OR duties and have a protected 3 hour call break where you are free to relax as you wish (most of us nap!) without being called back to the OR or other clinical duties. Around 3:30 to 5pm, when you come back form call break, you will begin to relieve the regular day residents and then you will be available and on call for any emergency and urgent cases that might come up during the evening and overnight. Kings County Hospital is a level one trauma center and Brookdale Medical Center is a level two trauma center both of which can become quite busy overnight leading to great hands on experience with emergency intubations, difficulty airways, arterial line placement, central line placement, massive transfusion protocols, and other trauma care. You will also be available for all of the emergency floor codes and intubations that require airway intervention. The call teams consist of a CA3 team captain, a CA2 resident, and a CA1 resident and an attending who work together as a team to keep the ORs and floor codes running smoothly throughout the night. Typically between 6pm and 8pm, we all order dinner together from one of the many many great restaurants in Brooklyn which is generously paid for by the attending on call.
CA1 through CA3 years allow for opportunities to branch out and learn more of the subspecialty areas including regional anesthesia, airway management, ICU, PACU, obstetrics, neurology, pain and cardiac cases. Because of the many clinical sites and the number of residents that we have, it allows some fluidity in our program to reassign residents if an interesting subspecialty case arises. All of the hospitals are easily accessible by public transit or driving depending on your preferences.
During rotations such as airway management and regional, you are encouraged to look at the OR schedule and to call your attending the night prior to discuss which patients may benefit from type of different airway management or regional technique respectively. On airway management will go from OR to OR depending on need and complexity of cases to assist with airway intervention as well as going to floor codes and emergency intubations. During regional rotations, you will be available to assist in the ORs for surgical blocks as well as in the preoperative and PACU areas for blocks for pain control. We have multiple ultrasounds which allows for the resident and attending to practice ultrasound techniques on many different patients.