Clinical Base Year
During the clinical base year, four months are spent on internal medicine wards, two months are focused on enhanced recovery after surgery (ERAS), and one month each is spent on rotations in emergency medicine, pediatric intensive care, and a pediatric sub-specialty inpatient unit. We start you in the OR as a group in June, instead of July. Time is also devoted to a quality improvement project, research, and electives, which may include cardiology, pulmonary medicine, nephrology, acute/chronic pain, radiology, and point-of-care ultrasound (POCUS).
CA-1 Year
In the CA-1 year, two months are spent on an introduction to clinical anesthesiology and three months are spent on a basic anesthesiology rotation. These are followed by rotations of one month each on surgical, advanced airway management, cardiac anesthesiology, neurosurgical anesthesiology, obstetric anesthesiology, pediatric anesthesiology, and regional anesthesiology. Three days are allowed for conference time.
CA-2 Year
In the CA-2 year, two months are spent on the non-cardiac thoracic anesthesiology rotation, and one month each is spent on rotations in cardiac anesthesiology, obstetric anesthesiology, neurosurgical anesthesiology, pediatric anesthesiology, regional anesthesia, chronic pain management, surgical ICU, vascular anesthesiology, and PACU/transthoracic echo (TEE). One month is also provided for an elective, and three days of conference time are provided.
CA-3 Year
For their final year, residents are required to complete a non-OR anesthesia/transthoracic echo rotation, and must spend a minimum of two months on advanced OR cases (the resident selects the most complex case on any day's schedule). They elect and design the remainder of their curriculum, based on the following focus areas: pain management, cardiothoracic anesthesiology, obstetric anesthesiology, critical care, pediatric anesthesiology, regional anesthesiology, enhanced recovery after surgery, or PACU, and experience at our Ambulatory Surgery Center. In addition, five days of conference time are provided.
Sample master schedules and additional details on specific rotations are below.
Didactic Conferences
Our didactic teaching schedule thoroughly prepares residents for successful completion of the American Board of Anesthesiology's written and oral exams. In the CA-1 year, new residents attend an introduction to clinical anesthesia lecture series twice a week in June and July. From September through June, all residents attend a weekly didactics program covering basic science and practice management topics, systems-based practice seminars, clinical anesthesiology, and program-based learning discussions of a clinical problem. Twelve journal clubs are held throughout the year. Faculty are assigned to each teaching session and a resident is assigned to help facilitate the problem-based learning discussions. In addition, group mock oral practice sessions are conducted by the department chair, faculty, or visiting professor at least once a month.
Workshops
Every six weeks, the didactic conference is replaced by a workshop or simulation session. Activities and topics have included advanced airway management; cadaver and ultrasound anatomy for regional anesthesia; interpersonal and communication skills using standardized patients; learning to teach; transthoracic echocardiography; transesophageal echocardiogram anatomy, image acquisition, and review of basic echo views; and ventilators.
Grand Rounds
Grand Rounds are held weekly. During the CA-3 year, residents prepare a Grand Rounds presentation, which is designed to make the resident the local expert on a topic of choice. Each resident must also prepare at least one poster for presentation at a state or national anesthesiology meeting.
Evaluations & Exams
Residents entering the CA-1 year are evaluated for successful completion of the introduction to clinical anesthesia rotation through evaluations, a practical exam, and a written exam. Thereafter, residents are evaluated quarterly. Evaluations are structured to comply with the American Board of Anesthesiology's standards and are used as the basis for awarding the Certificate of Clinical Competence as required by the ABA at the end of each six months of training.
Residents are required to take the ABA’s In-Training Exam annually and the BASIC exam at the end of their CA-1 year.
All residents participate in mock oral exams, which are structured in the manner of the ABA’s oral exam. Numerous simulation experiences are also given throughout the year, enabling our residents to feel fully prepared before tackling the Object Structured Clinical Exams, which are part of the APPLIED Examination in Anesthesiology for board certification.
Simulation
We utilize high fidelity simulation in the state-of-the-art Patient Safety and Clinical Competency Center (PSCCC) to enhance resident learning. Throughout their training, residents are guaranteed protected simulation time to learn through the use of mannequin-based scenarios, standardized patients, and multidisciplinary simulation. In addition, residents learn procedural-based skills including airway techniques, regional, and line placement, in the task training room within the PSCCC, and practice in situ multidisciplinary simulation at other sites, including the labor and delivery unit and the PACU. Past simulations have included utilizing TTE during a multidisciplinary code, troubleshooting coming off of bypass, pediatric and obstetric scenarios, and a front of neck access airway workshop.
International Outreach
The department is part of a global consortium involving several US academic anesthesiology departments and a teaching hospital in Lusaka, Zambia. As part of this consortium our residents and faculty travel to Lusaka, Zambia, where they work alongside Zambian residents assisting them in managing anesthesia cases in the operating room, teaching different anesthesia techniques and giving lectures with the goal of strengthening health care in underprivileged countries such as Zambia. By participating in global medical missions, the department enriches the educational experience of our residents.
| Jul | Aug | Sept | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun |
|---|---|---|---|---|---|---|---|---|---|---|---|
| OR | OR | OR | OR | OR | OB | Heart | SICU-1 | Airway | AP / Reg | Neuro-1 | Peds |
| OR | OR | OR | OR | OR | Peds | OB | Heart | SICU-1 | Airway | AP / Reg | Neuro-1 |
| OR | OR | OR | OR | OR | Neuro-1 | Peds | OB | Heart | SICU-1 | Airway | AP / Reg |
| OR | OR | OR | OR | OR | AP / Reg | Neuro-1 | Peds | OB | Heart | SICU-1 | Airway |
| OR | OR | OR | OR | OR | Airway | AP / Reg | Neuro-1 | Peds | OB | Heart | SICU-1 |
| OR | OR | OR | OR | OR | Heart | SICU-1 | Airway | AP / Reg | Neuro-1 | Peds | OB |
| Jul | Aug | Sept | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun |
|---|---|---|---|---|---|---|---|---|---|---|---|
| OB | Heart | Thor / OR | Thor / OR | SICU-2 | Pain | AP / Reg | PACU | Vasc | Peds | Elect. | Neuro-2 |
| SICU-2 | Pain | Heart | AP / Reg | OB | PACU | Thor / OR | Thor / OR | Elect. | Vasc | Neuro-2 | Peds |
| Peds | OB | Pain | SICU-2 | Neuro-2 | Heart | Vasc | AP / Reg | Thor / OR | Thor / OR | PACU | Elect. |
| AP / Reg | SICU-2 | OB | Heart | Thor / OR | Thor / OR | Pain | Peds | PACU | Neuro-2 | Elect. | Vasc |
| Pain | AP / Reg | SICU-2 | Neuro-2 | Heart | OB | PACU | Vasc | Elect. | Peds | Thor / OR | Thor / OR |
| Thor / OR | Thor / OR | AP / Reg | OB | Peds | SICU-2 | Neuro-2 | Pain | Elect. | PACU | Vasc | Heart |
| Jul | Aug | Sept | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Pain | OB | OB | AOR | OB | AP / Reg | Peds | NORA / FaTE | AP / Reg | Heart | Pain | AOR |
| OB | Peds | AP / Reg | AP / Reg | AOR | NORA / FaTE | AMB | OB | AOR | AP / Reg | Heart | AOR |
| AOR | AOR | NORA / FaTE | Pain | PA / Reg | Peds | Heart | AP / Reg | Pain | AMB | OB* | OB* |
| Peds | NORA / FaTE | AOR | OB | Thor / OR | AP / Reg | AP / Reg | AOR | Heart | OB | Peds | AMB |
| Heart | Neuro-2 | Vasc | AMB | AP / Reg | ERAS | Heart | Peds | OB | AP / Reg | AOR | AOR |
| AP / Reg | AP / Reg | Heart | Heart | AOR | OB | OB | NORA / FaTE | Peds | AOR | AP / Reg | AP / Reg |
Rotations
Each resident spends at least one month on the airway rotation, learning the advanced skills and techniques needed to safely care for patients with challenging airway characteristics. Under the guidance of our staff anesthesiologists and using the most advanced equipment, residents gain experience with jet ventilation, fiberoptic bronchoscope-guided intubation, vocal cord and laser surgery techniques, emergency airway compromise, awake intubations, caring for patients with airway tumors, and more. From an outpatient ambulatory setting to acute emergency encounters, residents will also learn how to approach a patient with an anticipated or unexpected difficult airway, and appropriately manage patients through myriad surgical procedures and into the postoperative recovery phase.
During the cardiothoracic rotation, residents gain experience in a variety of procedures, including coronary revascularization (CABG), valve repairs and replacements, percutaneous valve implantation, thoracic aortic surgery, invasive monitoring, transesophageal echocardiography (TEE), and administration of cardiovascular drugs and antiarrhythmic drugs. Residents typically spend a total of three months on cardiothoracic anesthesia during residency (one month each year), plus an additional two months on a thoracic rotation. In addition to intraoperative teaching, residents receive didactic lectures in the classroom, participate in a pig heart dissection lab on a yearly basis, have access to a TEE simulator, and participate in morbidity and mortality and echo rounds during their rotations.
Chronic pain management is offered as both a core rotation and as an advanced elective rotation. Our specialists within the Division of Chronic Pain Management collaborate with colleagues across several departments, including neurosurgery, neurology, physical medicine and rehabilitation, rheumatology, and orthopedics, to offer the latest therapies available for acute and chronic pain conditions. In this rotation, residents work with attending pain medicine physicians to offer consultations and a range of therapies for patients who suffer from chronic, intractable pain resulting from benign or malignant disease, including chronic low back pain sympathetically mediated pain, painful conditions following traumatic injury, diabetic and other neuralgias, cancer pain, and fibromyalgia. A variety of invasive and non-invasive treatments are utilized to help patients improve their quality of life, reduce their pain, and increase their functional status, including procedural (including fluoroscopy and ultrasound), implantable, medication, complementary, and psychological therapies.
Enhanced Recovery After Surgery (aka Perioperative Surgical Home/ Perioperative Medicine/ Improving Surgical Care and Recovery) is a model of practice that is patient centered and involves the coordination of patient care from the time that the decision is made for a surgical intervention, through a patient’s discharge to home or rehab. The division's goal is to use evidence-based medicine to improve perioperative care, patient safety, education, and satisfaction.
This innovative rotation helps the PGY-1 resident to understand the needs of surgical patients in the perioperative period. The residents typically spend 2 months on the rotation including 2 weeks of PAT. It further expands the non-operating room experience for anesthesia residents. Residents get exposure to preoperative optimization of high-risk patients, daily work in the perioperative environment, postoperative in-patient care, perioperative multimodal pain management, basic ultrasound skills and regional blocks. The didactics include bedside teaching, PBLD, self-study assignments and discussions with the attendings.
Albany Medical Center is the only Level 1 Trauma Center in the Capital Region, and as such, our residents are exposed to a diverse neurological caseload representing an extensive variety of pathology and specialty cases. During this rotation, residents become well-versed in the anesthetic management of emergent craniotomies, spinal trauma, and cerebral endovascular procedures. They also care for patients of all age groups with other intracranial problems including tumors, vascular anomalies, epilepsy, and movement disorders. The latest technology in somatosensory evoked potentials (SSEP) and motor evoked potential (MEP) monitoring is used to care for spinal patients. At the end of the first month, there is a boards-like oral examination; after the second month, residents are expected to give a presentation on a topic of their choice related to neuro-anesthesia.
Anesthesia residents spend at least two months on the obstetric rotation: One month during the CA-1 year and a second month in the CA-2 year, with the option to add additional months throughout the CA-3 year. With approximately 2,400 deliveries at Albany Medical Center annually, our residents obtain extensive experience in regional anesthesia. As the designated Level IV northeastern New York (NENY) Regional Perinatal Center, a significant number of high-risk, clinically complex obstetric patients come to Albany Medical Center for labor and delivery. These patients often necessitate urgent or emergent delivery, and an immediate anesthesia consultation and care. Our fellowship-trained obstetric anesthesiologists provide daily clinical education as well as a lecture series specific to the CA-1 and the CA-2 rotations. Joint journal clubs with the Department of Obstetrics & Gynecology, active simulation exercises with the OBGYN residents and nurses on labor and delivery, and routine preoperative huddle with the OBGYN team add to the educational curriculum as well as provide an excellent collegial environment.
Providers within the Division of Pediatric Anesthesia provide perioperative care for all pediatric patients having surgery at the Bernard & Millie Duker Children's Hospital at Albany Medical Center, as well as serve as a resource for other areas of the hospital where children are cared for. Approximately 8,000 pediatric patients receive anesthesia each year at Albany Medical Center, with all major pediatric subspecialties represented, including cardiothoracic surgery, cardiology, ENT, gastroenterology, general surgery, interventional radiology, neurosurgery, ophthalmology, orthopedics, physical medicine and rehabilitation, plastic surgery, and urology. Throughout their training, residents care for low- to high-risk pediatric patients, including critically ill children, who require surgical intervention. For example, a CA-1 could spend one day doing tonsillectomies and the next doing a Blalock-Taussig shunt on a critically ill newborn. Our fellowship-trained pediatric anesthesiologists utilize a curriculum that spans CA-1 to CA-3 to ensure our trainees graduate residency with the knowledge and skills to provide a complete anesthetic to the majority of pediatric patients they might encounter in general practice. This curriculum includes lectures, intraoperative problem-based learning discussions (PBLDs), and practice oral board examinations.
The PET (PACU, Echo, and Trauma) rotation is the first step in certifying all residents in Transthoracic Echo during their residency training. During this rotation, residents care for postoperative inpatients, outpatients, and ICU patients recovering from surgery in the Post-Anesthesia Care Unit (PACU), and for trauma patients in the Emergency Department and operating room. They learn how to handle airway emergencies in the PACU, as well as make decisions on management of pain, hemodynamics, and neurological status. Residents also learn how to help control nausea and vomiting issues, place invasive lines in unstable patients, provide regional blocks for "rescue" pain management, review central line placements, and evaluate all other possible serious postoperative complications. As one of the busiest trauma centers in New York State, more than 1,000 patients with severe injuries are seen at Albany Medical Center each year. Residents assist in the initial stabilization of these trauma patients and manage them in the operating room, gaining a broad and deep knowledge of trauma epidemiology, trauma-induced coagulopathy, massive transfusion, shock resuscitation, and fluid management. Formal point-of-care Focused Transthoracic Echo (FoTE) training during the PET rotation allows residents to become competent in performing a thorough point-of-care echo exam to determine the cause of immediate post-anesthesia or post-surgical complications. In addition, residents design and implement an in-situ simulation in the PACU to keep providers up-to-date on the latest in ACLS/PALS algorithms.
With a high volume and wide range of blocks, our regional anesthesia clinical rotation far exceeds ACGME requirements. Under supervision by our expert faculty, residents perform regional anesthetic blocks of the upper and lower extremities, chest and trunk, and neuraxial space using ultrasound-guided and nerve stimulator techniques. Single-shot and continuous catheter techniques are used as indicated. Residents also care for hospitalized patients, providing consultations for those with difficult-to-control pain secondary to surgery or trauma, spinal headache, ischemic limb pain, cancer pain, acute or chronic pain, or high opioid tolerance. They learn to use multimodal pain management as well as complementary therapies and interventional techniques, including peripheral and paravertebral catheters, blood patches, and stellate blocks. The robust clinical experience is complemented by a comprehensive curriculum that includes bedside teaching, a month-long didactic program, journal club, hands-on ultrasound workshops, and problem-based discussions.
During the CA-2 year, one resident at a time participates in the two-month thoracic rotation. Due to the high volume of complex thoracic cases, including pneumonectomies, lobectomies, and wedge resections, residents have tremendous opportunities to manage patients with a diversity of pulmonary issues. Most of these procedures require additional lines, one lung ventilation, and advanced airway manipulation techniques. We emphasize management of postoperative pain and have a low threshold for placing a thoracic epidural or paravertebral catheters for patients who are predicted to have significant postoperative pain. By the end of their rotation, residents are functioning independently in the thoracic room and can efficiently place a double lumen endotracheal tube or a bronchial blocker with minimal supervision. Residents become dexterous with navigating a fiberoptic bronchoscope, learn to proficiently place arterial and central lines, and manage the hemodynamic swings that occur during these complex cases. This rotation prepares our residents to troubleshoot and manage rapidly changing respiratory mechanics. We complement the rotation with didactics and lectures dispersed in the two-month period as well as a knowledge "pre-test" and oral boards-style "post-test."
Residents spend one month in the vascular rotation during the CA-2 year, frequently receiving one-on-one training, then continue to gain more experience during their advanced OR rotations. During this rotation, residents work with our board certified, fellowship-trained vascular anesthesiologists to provide care to patients undergoing major vascular surgeries, including thoracic aortic aneurysm repair, abdominal aneurysm repair, and peripheral revascularizations, as well as endovascular repairs for aneurysms. Our residents also gain experience in managing open and endovascular aortic and thoracic abdominal aneurysm repairs. These advanced cases familiarize residents with invasive monitors including A-lines, central venous lines, lumbar drains, and advanced cardiac output monitors, such as TEEs (transesophageal echocardiograms), pulmonary artery catheters, and FloTrac, an arterial cardiac output monitor. Further, while many institutions still perform carotid endarterectomies under general anesthesia, our residents become experienced with managing these complex cases under regional anesthesia.