Program Overview

We are proud to announce that our program just obtained its fifth consecutive 5-year accreditation from the Accreditation Council for Graduate Medical Education – and with it, an approval for permanent expansion of our program to educated 96 total residents.

Mount Sinai's attending anesthesiologists, recognized globally as experts in the field, are responsible for assuring the highest quality patient care while facilitating the education of residents. Their role changes over time in tandem with your growing responsibilities; when you demonstrate increased clinical knowledge and the ability to manage cases alone, attendings act only as consultants.

Our program, which boasts an extremely favorable faculty to resident ratio, is taught at The Mount Sinai Hospital and our teaching affiliate Level One Trauma Center, Elmhurst Hospital Center. Each facility employs unique approaches in the care of diverse patient populations. Together, they ensure your exposure to a broad cross-section of clinical experiences and practices.

Each year, approximately 46,000 anesthetics are administered at Mount Sinai Hospital. This caseload includes 3,200 cardiothoracic procedures, 2,500 neurosurgical operations, 4,500 cases involving pain management, 10,000 spinal and epidural procedures including 6,000 obstetrical cases, 6, 000 cases managed with peripheral nerve blocks, and more than 9,000 anesthetics administered to ambulatory surgical patients. Over the course of our program, you can expect to administer approximately 1,500 anesthetics, in addition to gaining ICU, post-anesthesia care unit and pain management experiences.

We provide both a three- and four-year educational curriculum. Our residents have the option to participate in our four year integrated curriculum or are free to pursue their clinical base year at the institution of their choosing. Our four-year program began on July 1, 2010, when 12 PGY-1 residents joined our program as part of our new ACGME-approved four-year anesthesiology curriculum. The PGY-1 year of training is predominantly at Mount Sinai and consists of three four-month rotations, including internal medicine.

Three months are spent on medical wards and one month in the CCU; general surgery. Three months are spent on surgical services and one month in the SICU; and four individual month-long rotations, including Introductory Anesthesiology, Acute Pain Management, Otolaryngology, and Emergency Medicine.

If you choose to pursue your PGY-1 at another institution the programs must be accredited by the Accreditation Council for Graduate Medical Education. The year may also be spent in Canadian institutions approved by the Royal College of Physicians and Surgeons of Canada and affiliated with medical schools approved by the Liaison Committee on Medical Education. It must also be devoted to a specialty other than anesthesiology, including training in a transitional year, internal or emergency medicine, pediatrics, surgery or any of the surgical specialties, obstetrics and gynecology, neurology, family practice or any combination approved by Mount Sinai's program director. During your PGY-1 year it is strongly recommended, although not mandatory, that you complete two months of critical care and one month of Emergency Medicine.

A Program of Discovery

A Mount Sinai resident in anesthesiology undergoes a three-year program of discovery, one that leads progressively from an understanding of the fundamentals to a mastery of the techniques and technologies, required to provide the highest caliber of advanced clinical care. Our training program-which bridges the Mount Sinai campus and two academic affiliates-will expose you to a comprehensive spectrum of cases under the direction of acclaimed attending anesthesiologists in a supportive environment. Here, you will be encouraged to assume increasing clinical responsibilities to become proficient in all aspects of anesthesiology.

Patients with coronary artery disease, fulminant hepatic failure, abdominal aortic aneurysms, inflammatory bowel disease, cerebral neoplasms, and multiple trauma present in our operating rooms each day. We are challenged to determine how our physiologic and pharmacologic interventions can optimize these patients preoperatively, stabilize them intraoperatively and enable them to have relatively pain-free postoperative courses.

This may require the knowledge of 2-D color flow Doppler, multiplanar transesophogeal echocardiography, total circulatory arrest, jugular venous bulb saturations, jet and high frequency oscillation ventilation, fiberoptic and laryangeal mask airway facilitated tracheal intubations, infusion techniques and devices, and neuroaxial and peripheral nerve blocks of all varieties. These are among the procedures preformed daily by members of the Department of Anesthesiology.

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.

A Program of Specialization

Our expanding role as perioperative physicians as well as our knowledge of anesthesia has created the need for subspecialization within the practice of anesthesiology. Mount Sinai's status as a tertiary care center places the resident side by side with leading specialists in the field of anesthesiology and other medical disciplines ensuring exposure to a large number of unusual and challenging cases.

Mount Sinai is currently one of the busiest liver transplant center in the country. In fact all solid and hollow organ transplants are being preformed at Mount Sinai including heart, lung, liver, small bowel, pancreas, and kidney. Many of our patients require multiple, simultaneous organ transplants such as combined liver, small bowel, and kidney-pancreas transplantation. These cases provide our residents with the unique opportunity to care for those patients with the most complex medical conditions.

In addition, active cardiothoracic and vascular services provides resident with the clinical material needed to develop expertise in anesthesia for coronary artery bypass surgery, aortic repair surgery, valve replacement and repair, correction of congenital heart defects and mechanical support of the failing circulation.

Residents rotate through all of the anesthesiology subspecialties including cardiac, thoracic, pain management, pediatrics, obstetrics, orthopedics, ENT, trauma, critical care, and neuroanesthesia.

A Program of Research

We are actively involved in the pursuit of new knowledge through both basic science and clinical studies. While theories of platelet function at a cellular level and the affect of hepatic metabolism of anesthetic agents are being investigated in our laboratories, clinical research flourishes in the department with major support from the National Institute of Health, Anesthesia Foundation, and industry. Drug and equipment studies take place in our operating rooms while other major clinical projects including the evaluation of hemostasis during cardiac surgery; optimization of labor analgesia and the anesthetic care of the geriatric patient are being conducted.

To ensure high quality projects, the Department of Anesthesiology's research committee meets monthly to discuss and review study design. Residents are encouraged to participate in ongoing studies, or to develop and implement their own protocols under the supervision of faculty members. Monthly resident journal clubs serve as a forum for timely research review, statistical and study design, and critical thinking.

A Program of Technology

Patient monitoring has moved to occupy a central position in the delivery of anesthesia care. Anesthesiology residents at Mount Sinai realize that state-of-the-art monitoring, computerized automatic recording keeping, and anesthesia delivery systems, receive primary emphasis in the department's clinical practice.

During their training anesthesiology residents at Mount Sinai will be taught to monitor their patients with state-of-the-art devices such as multiplanar transesophageal echocardiography, color-flow Doppler, thromboelastoghraph, and jugular bulb catheratization. Mount Sinai was one of the first academic centers in the country with automated computer record keeping and state-of-the-art infusion and inhaled anesthesia delivery systems in every operating room.

Our department has the distinction of also being the first beta site in the country and the only program in the New York metropolitan area to feature Human Patient Simulators. These full-scale patient mannequins have palpable pulses, breath and heart sounds, pupils that react to light, oxygen consumption, and carbon dioxide production. Through the interaction of sophisticated cardiovascular, pulmonary, and pharmacological mathematic modeling they realistically respond to simulated drugs and interventions. Our simulators (three adult, one of which is mobile, and a child), are housed in a new, state-of-the-art education complex located in our office space.

The HELPS Center (Human Emulation, Education and Evaluation Lab for Patient Safety and Professional Study), occupies 1,600 square feet, features two conference rooms and two fully functional simulator rooms, each with patient monitoring, computer record keeping and anesthesia delivery systems. At the heart of the center exists a state-of-the-art audiovisual system which includes two fifty inch plasma cells, overlaid "Smartboard" technology, dedicated LCD projection, multiple camera instillations, a slide-to-video projector, and the ability to play and create VCR, CD, and DVD presentations. Automated touch screen controls gives the user the ability to conduct local, national and international telemedicine conferences from any location in the center. In our attempt to recreate a myriad of patient interactions and events using simulation, the center also houses two virtual reality bronchoscopes/colonoscopes and a robotic intravenous placement trainer. State-of-the-art simulators and supporting audiovisual equipment renders our educational center unique and technologically unrivaled.

A Program of Study

The process of instruction at Mount Sinai begins with your own desire to learn. You will explore new knowledge investigate unfamiliar techniques and think of yourself as a practitioner-in-the-making, responsible for decisions as though patients depended on you alone.

We expect you to be self-motivated in building your own repertoire of anesthesia skills through independent study as well as interaction with attending anesthesiologists. Learning is a unique and personal process. In our department, we appreciate that people have diverse learning styles. Consequently, we offer a variety of teaching modalities, including a didactic program of daily morning conferences, and subspecialty and weekly basic science lectures. Interactive learning, which emphasizes resident participation, is offered during weekly case conferences, daily mock oral board preparation, and Human Patient Simulator interactions.

A Program on the Cutting Edge

Just a few years ago, who would have thought that orthotopic liver transplantation was possible? Now, approximately 200 such procedures, including living-related donor and split donor procedures, are being performed at Mount Sinai annually, intimately involving the Department of Anesthesiology in the perioperative care of patients. Similarly, heart, kidney, and kidney-pancreas transplantations, radical resections of tumors, as well as laparoscopic procedures of every kind are becoming routine here.

We are constantly seeking knowledge, developing strategies, and mastering new technologies in order to provide optimal anesthesia care. Our operating suites are equipped with state-of-the-art cardiovascular and respiratory gas monitors and the majority of our operating rooms employ automated anesthesia record-keeping systems.

 

Chairman's Message

David L. Reich, M.D.
Professor and Chairman
Department of Anesthesiology

Anesthesiology is an exciting and dynamic specialty. Advances in knowledge derived from the community of academic anesthesiologists have revolutionized our practice, making anesthesia a much safer intervention. As an academic Department of Anesthesiology, our primary mission is the provision of superb clinical care in an environment of uncompromising patient safety. Additionally, we are leaders in education and research.

For our patients, we provide the highest quality of care, beginning with the period before surgery and culminating in an outstanding Pain Management service-a continuous spectrum of care. Other portions of this site provide additional patient information.

For physicians in training, The Mount Sinai Health System is an ideal setting in which to pursue your post-graduate education in perioperative medicine. As a resident or fellow here, you will be taught by renowned educators in anesthesia, intensive care, and pain management, and exposed to research that is expanding the boundaries of perioperative medical knowledge. You will also receive training in anesthesia subspecialties, developing the concentrated expertise that we believe is essential for the future practice of anesthesiology. Our program will provide you with the foundation and skills needed to not only become a superb specialist, but also to lead the way in search of new insights in perioperative medicine. We welcome your interest and inquiries.

 

Director's Message

Adam I. Levine, M.D.
Associate Professor of Anesthesiology

With the expansion of modem anesthetic practice, contemporary anesthesiologists will be called upon to utilize their unique skills and expertise to assume a variety of exciting clinical and administrative responsibilities and roles. In Mount Sinai's Department of Anesthesiology, we are dedicated to helping you do so. Our program provides innovative learning experiences, as well as opportunities to care for a wide variety of medically complex patients undergoing challenging surgical procedures.

As Program Director, I am extremely proud of our department's commitment to resident education. Our diverse and enthusiastic staff serve as excellent role models and instructors, and all of us are gratified to see residents complete our program equipped with the tools needed to succeed in their future endeavors, whether they be academic, clinical, or research-oriented.

Come join us in our pursuit of educational and clinical excellence.