Curriculum

Our curriculum involves a combination of hands-on rotations and classroom didactics.

How We Train

Our four-year program offers intensive training in anesthesiology. Each year, you gain knowledge and experience and take on additional responsibilities.

CA-0/Clinical Base Year

During this year, you spend three months on the internal medicine inpatient service; one month in the Cardiac Intensive Care Unit; one month of emergency medicine; one month of ear, nose, and throat surgery; one month on the anesthesiology acute pain service; one month of operating room (OR) anesthesia; and three months on inpatient surgical services. You also spend one month in the Surgical Intensive Care Unit at The Mount Sinai Hospital, Elmhurst, or the Bronx VA. You have one month vacation.

We integrate you fully into the department right from the start of your training, with a special anesthesiology-focused orientation separate from the rest of the incoming house staff. As an intern, you can participate in departmental academic and social events even while you rotate off-service. You work closely with other departments, while remaining “based” in the Department of Anesthesiology. You participate in a structured didactic and simulation-based curriculum covering pain management and perioperative anesthesia.

CA-1 to CA-3

At this point, you transition from generalist physician to specialist anesthesiologist. Our three-month orientation starts with a six-week preceptorship that combines dedicated faculty mentoring, intensive didactics, and immersive simulator-based education. We pair you with a primary and secondary faculty preceptor and you work with these physicians exclusively during the month of July. This gives you continuity and a structured environment in which to learn practical skills in the OR and gain progressive independence and autonomy. There are daily morning lectures and multiple sessions in the simulator lab each week, to reinforce core concepts and practice crisis management skills in a safe environment.

After spending several months in the general ORs, you move to subspecialty rotations, which continue throughout residency, interspersed with general OR months. In the CA-3 year, you have some elective time.

Didactics

Our program offers daily didactics taught by committed and expert faculty. Morning lectures begin at 6:30 am (coffee and bagels provided), allowing time to set up for the first case of the day. In July and early August of the CA-1 year, we hold an introductory lecture series separately from the senior residents, which creates a more focused environment. For the rest of the year, all residents participate in the same lecture series, which covers a range of basic science, clinical anesthesia, pain management, and critical care topics. Morning lectures also include mock oral exams, board preparation lectures, and weekly sessions led by senior residents.

Wednesday mornings are devoted to either a moderated case presentation led by a senior resident and our department chair, a Morbidity and Mortality conference, or Grand Rounds featuring an invited guest speaker.

Thursday mornings alternate between journal club and “Levine Rounds.” Our hospital president and former chairman, David Reich, MD, leads the journal club, which focuses on current articles of interest in the anesthesiology literature. Journal club also teaches statistical methodology and critical appraisal of published research. During “Levine Rounds,” led by our program director, Adam Levine, MD, residents share interesting cases they’ve encountered, with Dr. Reich guiding a lively discussion of the clinical and basic science topics relevant to the case as it unfolds.

When We Train

We maintain strict compliance with the Accreditation Council for Graduate Medical Education and New York State Bell Commission rules regarding resident work hours. During most OR rotations, residents work an average of 55 to 60 hours per week. Generally, you have one overnight/late-night call followed by a post-call day per week, with one weekend day each month. You can make a request regarding call and vacation days before we finalize each month’s schedule.

On most days, the first OR cases begin at 8 am. The late-night/overnight call team arrives at 4 pm. Due to our high surgical volume, you can earn extra compensation by working later hours while not on call, while maintaining compliance with relevant work hour restrictions. There are separate call teams for the general ORs, liver transplant, cardiac, and obstetrics. The general team covers the pain management and hospital emergency airway services at night and on weekends.

Academic Tracks

Our department has a number of faculty actively involved in basic, clinical, education, and informatics research. We have multiple ongoing externally funded projects, as well as numerous smaller ones. We encourage you to participate in research throughout your time at Mount Sinai.

Eliasberg Research Scholar track
If you want to pursue a stronger focus on research, you can apply for the Eliasberg Research Scholar program midway through their CA-1 year: this program comes with an additional stipend, protected research time every month, as well as mentorship and benchmarks for progress.

Clinical Educator track
We offer opportunities to become a skilled medical educator. With the simulator lab at its center, the resident-educator track places you in charge of the curriculum and teaching for our very popular anesthesiology rotations. We see large numbers of medical students from Mount Sinai as well as other institutions, and run didactic sessions for Mount Sinai students in their year 1 and 2 basic science classes.

Subspecialty rotations

After you spend several months in the general OR during CA-1 year, we introduce subspecialty rotations. The CA-1 and CA-2 years include time in subspecialty rotations and in the general OR. CA-3 offers some elective time in CA-3. The required rotations are:

Pre-anesthesia testing/non-OR anesthesia (one month in years CA-1 and CA-2). You spend two weeks of this month in our pre-operative assessment clinic preparing patients for major surgeries in a multidisciplinary team that includes surgeons, anesthesiologists, and internists. You spend the other two weeks providing anesthesia for non-OR procedures such as endoscopy, bronchoscopy, cystoscopy, cardiac electrophysiology, and interventional radiology.

Neuroanesthesia (two months in years CA-1 and CA-2). During these two months, you are exposed to a wide range of neurosurgical and neuro-interventional procedures including major spine surgery, craniotomies, functional neurosurgery (i.e., deep brain stimulator placement), aneurysm clippings, and neuroendovascular procedures. Our surgeons perform a small but growing number of awake craniotomies.

Obstetric anesthesia (one month in the CA-1 year at Mount Sinai Hospital, one month in the CA-2 year at Elmhurst Hospital). At Mount Sinai, you have the opportunity to become fluent in neuraxial anesthesia and perioperative management of the parturient. Since the busy OR is also an academic center, we often see women with complex comorbidities presenting for childbirth. The second obstetrics month is at Elmhurst Hospital, a public hospital in a diverse neighborhood in Queens that offers exposure to a culturally different patient population.

Orthopedic/regional anesthesia (two months in years CA-1 and CA-2). This rotation offers you the opportunity to see and provide anesthesia for all  manner of orthopedic procedures, including work on hips, shoulders, knees, and toes. We have structured the regional anesthesia month to enable you to practice ultrasound-guided nerve blocks for a variety of procedures both commonplace and less so. You learn regional anesthesia techniques applicable to abdominal and even head/neck surgery.

Liver transplant anesthesia (one month in the CA-2 year). Mount Sinai is a busy liver transplantation center, performing more than 125 transplants (adult and pediatric) annually. During this rotation, you participate in a special simulator curriculum, and become proficient in major vascular access and perioperative transfusion medicine, as well as being introduced to intra-operative transesophageal echocardiography (TEE) and viscoelastic coagulation monitoring. You may also participate in major abdominal surgery cases such as liver resections, Whipple procedures, and adrenalectomies.

Pediatric anesthesia (two months in years CA-1 and CA-2). During these two months, you develop proficiency in perioperative care of children of all ages and levels of acuity. You gain experience with high-volume, low-acuity ambulatory pediatrics rooms as well as managing critically ill patients arriving to the operating room from the pediatric or neonatal intensive care unit. We offer training in pediatric advanced life support to all residents in the program. 

Cardiac anesthesia (six weeks in years CA-2 and CA-3). This busy rotation exposes you to an unmatched variety of cardiac surgical and interventional procedures. In the cardiac ORs, we see on- and off-pump coronary artery bypass grafting procedures, valve repairs and replacement, aortic root procedures, ventricular assist devices (VAD) placements, total artificial hearts, and heart transplants, with a strong focus on intraoperative TEE education. Outside of the ORs, Mount Sinai boasts one of the busiest cardio-interventional services in the state, including adult and pediatric cardiac catheterization, electrophysiologic procedures, and transcatheter aortic valve replacements.

Thoracic anesthesia (six weeks in years CA-2 and CA-3). This rotation allows you to gain proficiency in managing high-risk patients for a variety of video-assisted and open thoracic procedures, with a focus on the intricacies of one-lung ventilation and its attendant airway management concerns. You hone these skills on traditional thoracic surgery cases, as well as other cases that require one-lung ventilation or similar techniques (e.g., pediatric scoliosis tethering).

Post-Anesthesia Care Unit (one month in year CA-3). During this rotation, you oversee patients recovering from surgery in our two main recovery areas. Some are healthy, ambulatory, and about to go home. Others are critically ill, or have just undergone major surgery. Yet others are waiting, or should be waiting, for an intensive care unit (ICU) bed. This intense month may feel like you are running a mini-ICU, a capstone to the perioperative and critical care experience in residency.

Surgical Intensive Care Unit (one month in year CA-1). During this month, you care for critically ill post-operative patients as part of a multidisciplinary and multispecialty team. In addition to planned admissions (such as our high volume of liver transplantation patients), we receive a variety of unplanned admissions from all surgical services except cardiac/thoracic, neurosurgery, and ear, nose, and throat. We offer an institution-wide critical care didactic series during this time as well. You spend one week on the surgical nutrition support service (total parenteral nutrition and partial parenteral nutrition management) and central venous access service (central line placement for all inpatients).

Cardiothoracic Intensive Care Unit (CTICU) (one month in year CA-2). This residency builds on your experience in the ICU and with cardiac anesthesia. It exposes you to the post-operative management of patients who have undergone major cardiac surgery. You learn how to manage common post-operative changes and complications, and gain exposure to intra-aortic balloon pump management, extra-corporeal membrane oxygenation, VAD, and artificial hearts.

ENT/airway (two months in years CA-1 and CA-2). These two rotations let you observe and participate in both bread-and-butter ear, nose, and throat cases as well as complex head-and-neck resections and reconstructions. Many of the latter procedures require awake bronchoscopic intubation. You learn to work with the flexible fiber-scope. It is not uncommon for our residents to perform elective asleep bronchoscopic intubations as well during this rotation. You gain experience in using regional anesthesia for the head and neck for intraoperative care, post-operative pain, and airway management, with a variety of blocks such as infraorbital, supraorbital, and supratrochlear blocks as well as sphenopalatine blocks for sinus, base of skull, and nasal surgeries. You learn about superficial cervical blocks for most thyroid, parathyroid and neck dissections and infraalveolar blocks for buccal and tongue surgeries as well as superior laryngeal nerve blocks for most awake intubation techniques. You have the opportunity to master the emergency technique of needle cricothroidectomy and you can also gain experience placing transtracheal anesthesia during this rotation.

Elmhurst/Trauma (one month in years CA-1 and CA-2). Elmhurst is a city-run hospital in Queens. It is a Level 1 trauma center, a referral center for city health facilities in Queens County, and the closest hospital to Rikers Island Correctional Center and La Guardia Airport. You gain experience with trauma exposure, and take trauma call roughly every fourth night. During the day, you work on regular ORs, interacting with Elmhurst’s varied mix of adult and pediatric cases with increased opportunities for independence. 

Bronx Veterans Administration (VA) Hospital, Pain and general OR (one month each in years CA-1/CA-2 and CA-2/CA-3). This senior pain rotation focuses on chronic pain in the outpatient setting. At the Bronx VA pain practice, you get hands-on experience performing fluoroscopically guided blocks for chronic pain. As there are no pain fellows at the VA, you have plenty of opportunities to participate in and perform these procedures. You also spend a month doing operative cases.

Vascular anesthesia (one month in year CA-3). During this month, you learn the intricacies of caring for patients during high-risk major vascular procedures. 

Ultrasound (one month in year CA-3). With the growing role of point-of-care ultrasound in the perioperative environment, we require a one-month perioperative ultrasound rotation to focus on TEE. This month functions as a capstone experience to all of the time spent working with ultrasounds through the rest of your residency training. This rotation also aims to polish your preparation for the Applied portion of the American Board of Anesthesiology certification exam.