Anesthesiology Residency

Two to three weeks prior to the Basic and Advanced exams, the daily resident conferences will become targeted board review sessions to help prepare residents for the exam.

Monday, Tuesday, Thursday, from 9:45 am to 10:30 am and Friday, from 11:15 am to 12:00 pm.

There are regular departmental conferences from 7:00 am – 8:10 am on Wednesdays and include grand rounds, clinical practice reviews (CPRs), Journal Club, visiting speakers and Outcome Process and Peer Review (OPPs) conferences. Residents are expected to actively participate in all of these conferences either in person or virtually.

The curriculum of the didactic lecture series is based on the American Board of Anesthesiology (ABA) Content Outline. The sessions follow the Basic and Advanced Examination topics and are interactive. Every July these conferences focus on introductory Anesthesiology topics for the new CA 1 class.

Every Wednesday morning from 6:30 am – 7:00 am: residents make short presentations on high yield topics identified from the knowledge gap reports of various standardized Anesthesiology tests (e.g. ITE, basic and advanced exams). These sessions are supervised and moderated by a faculty member.

There is one monthly session dedicated to the practice of the OSCE exam. The ABA content outline for the OSCE exam is covered in these sessions. Every session is followed by debriefing and feedback.

There is a dedicated 2-week rotation in CA-1 for Point of Care Ultrasound (POCUS), along with a regular hands-on workshop. POCUS and echocardiography (TEE and TTE) training also includes didactic lectures for basics functioning and principles and hands on training sessions on our TEE and TTE simulator. The ultrasound training sessions cover regional, thoracic and abdominal ultrasound.

The residents cover an online quality improvement course (IHI) during PGY 1 year. In CA 1 year, under faculty supervision, residents are required to complete and present a quality improvement project. The departmental quality improvement team is a great resource for residents to identify and execute quality improvement projects.

Residents are also encouraged to complete a clinical study or research project worthy of submission to a peer-reviewed journal during residency training.

The resident can use some of their elective time to complete ongoing research projects. The residents are encouraged to present posters, case reports and clinical trials at regional and national conferences.

During FCS (PGY 1) anesthesiology rotation, there are two extensive 1:1 simulation sessions. The first session contains basic anesthetic techniques practice e.g. intravenous access, monitors, machine check, OR preparation, induction of anesthesia and airway management. The second session occurs after two weeks and contains advanced anesthetic techniques e.g. arterial line placement, neuraxial anesthesia, and use of ultrasound for intravenous access and regional blocks.

During the CA1-3 years, the simulation curriculum is covered during two monthly simulation sessions (Wednesday afternoon). The sessions vary from team-based, crisis management scenarios to development of technical and communications skills using simulated patients and simulators. Simulation and didactic curriculum also include sessions focused on training of ultrasound techniques (POCUS/TEE/TTE/FAST).

How is the Fundamental Clinical Skills (FCS) Year organized?

The Fundamental Clinical Skills (FCS) year has 13 rotations, each 4 weeks long. There are 12-14 weeks of General Surgery and Internal Medicine, 8 weeks of MICU and Anesthesia and 4 weeks of ER, Neurology and Electives. All rotations are at Lahey’s main campus.

What types of cases will I see in the Operating Room?

Residents are exposed to a variety of cases ranging from minor ambulatory procedures to complex liver transplants and cardiothoracic cases during training. Lahey is a regional leader in liver transplants, urologic oncology, colorectal, cardiothoracic and catheter based cardiac procedures.

Are residents involved in resuscitations?

Yes, residents will be assigned during the daytime and while on call at nights to be part of the resuscitation team under supervision of a faculty.

How much elective time is offered; is there a lot of freedom in the CA-3 year?

During the FCS year, there are 4 weeks of electives. During the CA-3 year, there are 3 months of electives for residents to augment their clinical experience. CA-3 year is organized in a way that residents practice and experience planning and executing anesthetic care in semi-independent fashion with indirect supervision by faculty.

Are complex transplant cases available to residents?

Lahey has a robust liver and kidney transplant program. We are a regional leader in liver transplantation and residents actively participate in the transplantation and non-transplantation care of these patients.

Is simulation just available or is it integrated as part of the curriculum?

Simulation is considered an integral part of residency training and is incorporated into our curriculum. The simulation sessions starts from FCS year and continues throughout the CA years. During CA years, there are biweekly simulation sessions ranging from simple technical exercises to complex clinical scenarios, incorporating OSCEs that will prepare the residents for the Anesthesiology Board Examinations.

When do new residents begin taking call?

During the Clinical Anesthesia (CA) years, residents will start taking call  in August  of their CA-1 year. Projected call during the clinical anesthesia years of training is approximately every fifth night when averaged over a month.

How is the cardiothoracic anesthesiology experience?

There are three cardiac rotations, one at each year of residency, and two thoracic rotations (CA-1 and CA-3 years). Additional CA-3 elective time to augment the cardiothoracic experience is available. Residents will also get cardiothoracic cases as a part of their Advanced General OR rotations and when on call. Lahey does approximately 600 on pump cardiac cases a year and 250-300 thoracic cases. TAVR and other catheter based cardiac procedures are in addition to these cases.

Are trainees exposed to transesophageal echocardiography (TEE)?

Residents will learn TEE during their Cardiac, Transplant and TEE rotations. A dedicated TEE elective can be taken during FCS and CA-3 years. Our Simulation curriculum includes regular didactic sessions using our TEE/TTE simulator (with VR capability). A monthly TEE conference also covers basic and advanced topics in TEE. Advanced hemodynamic monitoring, including TEE and advanced transthoracic cardiac ultrasound, is an important part of resident training at Lahey.

Do residents take the Basic Perioperative Transesophageal (Basic-PTE) Exam?

It is not a requirement of the program to take the Basic-PTE examination, but all residents should have the skills and knowledge by the end of their residency to sit for the exam if they wish.

What exposure do residents have to regional anesthesiology?

The department has a robust Acute Pain and Regional Service (APS). The Regional and Acute Pain rotations provides a high volume regional experience that is rich in variety; placing neuraxial, compartment, and peripheral nerve blocks and catheters on surgical, trauma, and medical patients throughout the hospital under ultrasound and fluoroscopic guidance. Residents will also perform neuraxial and regional blocks and catheter on cases they are assigned to on their General OR and Subspecialty Rotations. The residents’ regional experience will be augmented by our Simulation equipment, which includes simulators for neuraxial and ultrasound guided upper extremity, lower extremity, and truncal regional techniques. Residents can also elect additional Regional and/or Acute Pain rotations during their CA-3 year (Electives).

How is the obstetric and pediatric anesthesia experience?

There is a three-month rotation in Pediatric Anesthesia at Boston Children’s Hospital and a two-month rotation in Obstetric Anesthesia at the Brigham and Women’s Hospital during the CA-2 year.  There is a one-month rotation in Obstetric Anesthesia at Beverly Hospital during the CA-3 year.  Boston Children’s Hospital and Brigham and Women’s Hospital are located in the Longwood Medical Area of Boston, approximately 17 miles from Burlington. Beverly Hospital is approximately 20 miles east of Burlington. Trainees will require their own transportation.  Parking will be paid for by the department. 

Are residents allowed to moonlight?

CA-2 and CA-3 residents are eligible to moonlight in the surgical critical care unit (SICU) at Lahey on the weekends and daily OR shifts from 5:30 pm – 7:30 pm, subject to approval by the Program Director and the Director of the Clinical Competence Committee.

Weekday moonlighting in the SICU will be allowed only if the residents have an allowable day off after the moonlighting shift (e.g. vacations, holidays).

Only those CA-2 residents who have passed the ABA Basic exam and have done at least one month of SICU rotation will be eligible to moonlight.

Moonlighting residents may not be on a J1 visa.

Is there a faculty mentorship program for residents?

Mentors play an important role in the training of residents. Early during the FCS year, a faculty member is assigned to each resident. The mentor will stay in contact with the new resident throughout the first year, providing guidance and direction when needed and connection to their home department during their important year of transition. During the CA-1 year, residents choose a mentor from the faculty based on professional and personal preferences who will stay with them for the duration of their residency.

What professional leadership opportunities are available to residents?

The Lahey Anesthesiology Department and the Graduate Medical Education Committee (GMEC) offer many leadership opportunities at the departmental and institutional level. A full list of committees with opportunities for residents is available.

How are residents prepared for their oral board exams?

Daily resident conferences include a monthly mock oral board examination session to prepare residents for the exam. The Department includes faculty who are current and past ABA examiners, writers, editors, and examination committee members. Residents who want additional practice sessions, can arrange mock oral examinations with the appropriate faculty.

How are didactics structured?

Didactics take place Monday, Tuesday and Thursday mornings from 9:45 am – 10:30 am. On Fridays, lunch is served with the lecture at 11:15 am. In addition, there is a resident-led keyword didactic session on selected Wednesday mornings from 6:30 – 7:00 followed by the departmental conference from 7:00 – 8:10 which includes Grand Rounds; Clinical Practice Reviews (CPRs); Journal Club; visiting speakers; and Outcome, Process and Peer review (OPPs) conferences. Finally, in addition to the didactic lecture series covering a curriculum based on the ABA content outline, residents participate in simulation sessions, wellness activities, and meetings with the program director on selected Wednesday afternoons. Residents are expected to actively participate in all of these conferences.

Do residents attend national conferences?

Residents are encouraged to attend and present posters/papers at regional, national and international conferences.

Can residents travel to meetings during their training?

Residents are encouraged to participate as presenting authors or committee members at regional, national, or international professional conferences by granting limited professional time for such activities. Otherwise, residents utilize their personal vacation time to attend professional conferences of their choice.

Is financial support provided to attend national conferences?

The Alumni Association (AA) and Department of Anesthesiology, Perioperative and Pain Medicine supports traveling expenses for residents who are presenting authors at regional or national conferences according to the departmental and AA reimbursement policies. Residents are responsible for all other conferences and extra expenses.

What is the education allowance?

Residents can receive an annual GMEC allowance which they can use for educational purposes such as books providing they meet certain criteria set annually by the GME. The department provides three anesthesiology books for each residents at PGY-1 and CA-1 year.

What opportunities are there for research?

The department and institution considers research an important part of resident training and promotes research and other scholarly activities. Residents participate in a quality improvement project and are encouraged to participate in a research project during residency. Residents have opportunities to join either ongoing research or start a new research project under the supervision of a faculty member.