The anesthesiology rotation or clerkship is one of the most exciting and educational experiences you will have as a medical student. It provides rich opportunities for students to expand their medical knowledge, gain proficiency in a wide variety of procedures, and explore the specialty in great depth. The skills and knowledge you acquire during the anesthesiology rotation will be of benefit to you no matter which specialty you choose.
For students seeking to pursue a career in the field, the anesthesiology rotation is of obvious importance. In an NRMP survey of 51 anesthesiology residency program directors, 84% indicated that letters of recommendation in the specialty were an important factor in making interview decisions. Given the importance of the rotation in the anesthesiology residency selection process, I am often asked how students can make a powerful impression. Below are recommendations for success during your anesthesiology rotation based on advice that I have collected from numerous residents and faculty.
Plan For The Next Day
The next day’s cases are typically assigned one day in advance to residents and attending physicians. If you can be linked to a resident or attending physician, then you will be aware of the cases you will encounter. If your patient is currently in the hospital, you can visit the patient, introduce yourself as a medical student member of the anesthetic team, and perform an anesthetic preoperative evaluation on the day before surgery.
Later at home, you can read about the patients, their medical problems, and anesthetic considerations related to their particular surgery. Your preparation will allow you to make the most of your learning opportunities during the case, and answer any questions directed to you from your superiors. With the knowledge gained, you'll be better able to ask insightful questions that will enrich your educational experience.
Arrive Earlier Than The Attending Or Resident
Ask the attending physician or resident what time they prefer you arrive, and then plan on being there even earlier. Your early arrival will allow you to help with the set up of the operating room, evaluate the patient prior to the case, and discuss your anesthetic plan with the attending or resident.
Help Set Up The Operating Room
Before the patient is brought to the operating room, everything must be checked and ready to go. That means a check of the anesthesia machine, monitors, ventilator, and cart. Are the gauges and monitors working? Are the backup systems in place? Many students find the anesthesia equipment intimidating at first, and unfamiliarity with monitors and gauges can leave you feeling unsettled. One of the best ways to speed up the learning curve in this important area is by assisting the attending or resident with the room set-up. Dr. Naveen Vanga from the Department of Anesthesiology at the McGovern Medical School shows you how to do just that in the excellent video below.
Meet and Evaluate The Patient Before The Case Begins
Your goal is to meet the patient and perform an anesthesia preoperative evaluation before the resident and attending physician. This evaluation can be performed the day before in hospitalized patients but will obviously have to take place on the day of surgery for ambulatory patients.
Become Familiar With the Anesthetic Preoperative Evaluation
Before the rotation begins, become familiar with the anesthetic preoperative evaluation. This will allow you to become a productive member of the team sooner rather than later. Some useful resources include:
Take Initiative In The Operating Room
Many medical students take passive roles in the operating room. Don't be one of them. There are numerous ways to be an active participant, and this can start as soon as the patient is brought to the operating room. Some examples:
Transfer the patient to the table
Move the stretcher out of the room
Place blood pressure cuff, pulse oximetry, and EKG leads on the patient
Position patient properly
Be careful not to take too much initiative. There are many other things you can do but it's best to ask for permission for more advanced tasks. Some examples include drawing up medications, inserting IVs, hanging fluids or blood, and placing central or arterial lines. And yes, you can ask to intubate! Opportunities to intubate come to those who ask. In some anesthesiology rotations, it may even be a requirement.
If You Were There At The Beginning, Plan To Be There At The End
With shorter cases, you may be present in the operating room for the entire case. During longer cases, your attending physician or resident may give you permission to participate in other cases, read, or take breaks. Be sure to return to the room before the case ends so that you can assist with extubation, and then transfer of the patient to the PACU.
Prepare For Procedures
The anesthesiology rotation will present you with many opportunities to perform a variety of procedures. Become familiar with the types of procedures performed, and read about how these procedures are performed. Know the steps involved, view relevant videos, and practice on simulators if available.
Remember that these opportunities are given to students who ask for them. Not everyone will say "yes," but nothing bad will happen to you if they say "no."
Anesthesiologists are known for their attention to detail. Show your superiors that you too have this important trait. By paying careful attention, you may identify or observe something of great importance. As an example, consider the patient who enters the maintenance phase of the case following induction of anesthesia and intubation. During this period, it is crucial that the patient is monitored carefully. How are the vital signs? What is the end-tidal oxygen and carbon dioxide? Is the fluid bag running low? How is the case progressing from the surgeon's perspective? Bring any concerns or important observations to your attending's attention.
Establish Rapport And Communicate Well With Patients
As a medical student, you may evaluate the patient before other members of the anesthesia team. This will be an opportunity for you to establish rapport with patients at very vulnerable times in their lives. Be prepared to encounter intense emotions in patients before surgery. Ruhaiyem described it well:
The thought of undergoing general anesthesia frightens many people worldwide. To some, the thought of going under general anesthesia strikes terror in their hearts more than the thought of the actual surgical experience.
Ruhaiyem was able to identify concerns of patients related to general anesthesia. They included postoperative pain, failure to wake up after surgery, postoperative nausea/vomiting, drowsiness or sleepiness following surgery, waking up during the surgery, paralysis following surgery, ICU admission, and competence and skill of the anesthesiologist.
Now that you are familiar with the reasons why patients may be anxious or fearful, consider how you would respond to such patients. Don't be afraid to discuss your approach with your resident or attending.
Work With Residents And Attendings On A One-To-One Basis
Highly structured anesthesiology rotations often assign students to a particular attending, resident, or CRNA for the day. Such rotations may allow for close contact between the student and the attending or resident. However, not all rotations are this structured, and it's not uncommon for students to sometimes be left to their own devices. This can present challenges for students seeking to develop a close working relationship with an attending physician, as is the case with students seeking to pursue a career in the specialty.
If you find yourself in this situation, a certain degree of assertiveness and self-motivation will be required to initiate and build strong relationships. If you know of students who have performed the rotation in the past, make inquiries to identify attendings known to be dedicated teachers and mentors. Anesthesiology residents are also a great source of information about faculty members who are strong student advocates. Once you identify these attendings, find ways to interact with and work closely with these individuals. Remember that you'll need frequent contact with the attending in order to secure the strong letter of recommendation you seek. One excellent way to strengthen the relationship is to volunteer to take call with the attending.
Of course, it's not enough to have quality time with the attending. You need to make the most of your time together. Read "How To Be A Star On Your Anesthesia Rotation" for more information about how to make a great impression.
More tips for anesthesiology rotation success can be found in our podcasts:
Anesthesiology Rotation Success: Part 1
Anesthesiology Rotation Success: Part 2
Dr. Samir Desai is the author of The Successful Match 2017 and the co-host of the Success in Medicine podcast.