A Day in the Life of a
Mount Sinai Anesthesiology Resident
During my first year of anesthesiology residency at Mount Sinai, I gained a firm grounding in giving anesthesia for most general surgical, gynecologic, obstetric, neurosurgical, ENT, and orthopedic procedures. I felt confident and prepared at the end of the year to tackle these cases on my own, and found that most attendings were giving me more opportunities to work independently. In medical training you can never rest on your laurels for long, so naturally July 1 came around and I became a “senior” resident with a host of new responsibilities and opportunities. In addition to completing more advanced rotations (cardiac, thoracic, liver transplantation, pediatrics, PACU, a second month of neuroanesthesia, and a second month of SICU), as a CA-2 I also had new responsibilities on call. I began taking OB calls, and my responsibilities on general OR calls shifted more to assisting and “backing up” CA-1's for complex cases and for floor intubations. Because day-to-day schedules and call responsibilities vary depending on our rotation, to give a typical “day in the life” perspective I have broken down the year into some key rotations.
I arrive at approximately 5:30 a.m. to set up my room. This is more involved than on any other rotation and usually takes about an hour. Most cases are scheduled to start at 7:15 a.m., so at 6:30 a.m. I pick up my drugs from the pharmacy and try to sneak in a cup of coffee before meeting my patient in the holding area at 6:45 a.m. There I will review their preoperative history, place a large bore IV and frequently an arterial line and bring them in the operating room by 7:15 a.m. After induction, we place a central line under ultrasound guidance and frequently a pulmonary artery catheter. Sometimes we work alongside fellows, but frequently it's just a resident and an attending. During the pre-bypass period, my attending will walk me through the TEE exam and we will plan anesthetic management for the post-bypass period. There is ample opportunity to talk about topics in cardiac anesthesia, to learn about TEE, and for more coffee! After I drop off my patient in the cardiothoracic ICU, I will either start another case or, if my room has no more cases, check out the schedule for the next day and see any preops that I may have. We do two months of cardiac anesthesia and one month of thoracic anesthesia during out CA-2 year. Because of the early start of cases, we don't attend the morning resident lectures.
Liver Transplant Anesthesia:
This month is really unique in our residency because all of our call duties consist of being available for liver transplants. On our non-call days, the schedule is essentially the same as for all of the general OR rotations. I would arrive at 6:30 a.m., set up my room, and then attend lecture at 6:45 a.m. (mercifully with free breakfast and coffee). At 7:15 a.m., when lecture lets out, I finish setting up my room, check out drugs, then see my patient in the holding area—all in time for entering the OR by 8 a.m. During this month OR assignments are geared toward cases that reinforce skills that are needed for liver transplants: mainly liver resections, vascular surgeries, and large surgical oncology procedures. The emphasis is developing comfort with placing invasive lines and familiarity with transfusion techniques and intraoperative coagulation studies.
Approximately every third day I would be on-call for liver transplants. On other days I would be back up in case there would be more than one transplant. On those days when you are the first call you are not required to work unless there is a transplant; however, you have the option to moonlight for supplemental pay. Liver transplants are challenging and long cases, but the attendings are excellent and there is a lot of opportunity for teaching. Whenever you do a liver transplant you get the next day off.
We do two months in a row of pediatrics during our second year. Although challenging, I thought this was a good thing because the second month allowed you to build on your skills from the first month. The day-to-day schedule is essentially the same routine as the general OR schedule I described above, but usually I would leave a little more time to set up in the morning. Many days on pediatrics are very hectic due to a few very busy pediatric surgeons and dentists. During my month, I did pediatrics cases every day, mostly a mix of ENT, dental, urologic, endoscopic, ophtho, MRI, and some general surgery and plastics cases. After this rotation I feel ready to do “bread and butter” pediatrics cases myself, and I did enough challenging pediatrics cases to get a feeling for whether that was something I would want to pursue further with fellowship training.
For more information about other resident's experiences, please continue to read stories from Sam Demaria, CA-2 Resident, Dean Lao, CA-1 Resident and Michael Mazzeffi, CA-1 Resident.
Dean Lao, CA-1 resident
I think one of the things that sets Mount Sinai's CA-1 year apart from other programs is the nurturing way in which they ease the transition from the floors to the operating room environment. During my first two months, I worked one-on-one with my preceptor (Charles Ellis). During the first few weeks of residency, there are so many things you don't know, ranging from technical skills (setting up and placing IVs, intubating, placing arterial lines) to pharmacology and physiology (induction doses for medications, MAC for inhaled anesthetics). It really helped to work with the same attending in July and August who knew my particular weaknesses and had the patience to give me more than one attempt at intubating a patient. For more complex cases, I was sometimes assigned to a room with a more senior resident, who is basically there as an extra pair of hands. As the weeks progressed, the proverbial umbilical cord got longer; by the second week of August, I started working with a different attending every day. At that point, you begin to learn many different ways to do procedures and deliver an anesthetic for the same case.
In addition, I was allowed to leave the OR twice a week for the first eight weeks to attend human simulator sessions, which cover the basics of anesthesia from induction to emergence. There are nearly 100 tasks you must perform in order to induce general anesthesia. There is always pressure to "get the case started" in the real ORs, so it is initially very difficult to become aware of all that is happening. The simulator allows you to slow down the process and think through why you are preoxygenating a patient or giving one induction agent over another. The human simulator also allows you to work in groups and manage both common and uncommon intraoperative complications in a realistic environment without putting patients at risk. After killing the human simulator a few times, I returned to the OR with a new sense of awareness and more confidence in my ability to manage intraop hypoxia and hypotension.
Finally, you do not take overnight call during the first month of residency. I was usually allowed to go home after doing a few preops for the on-call team. This is valuable time you need to read the first few chapters of baby Miller or Lange, review the things you learned in lecture/simulator, and familiarize yourself cases for the next day.