Vanderbilt University School of Medicine

The anesthesiology residency in the Department of Anesthesiology at Vanderbilt University has a clear vision of training the future generations of anesthesiologists as perioperative physicians. As a categorical 4-year program, this starts from the minute that our residents arrive in their PGY1 year. The intern year involves 2 months of perioperative medicine, 3 months of Critical Care Medicine, 1 month of Pain Medicine Clinic, and 1 month of anesthesiology, all with supervision by anesthesiology residents, fellows, and faculty. The remaining months are made up of a combination of medicine (e.g. heart failure service) and surgery (e.g. colorectal and CT services) rotations. This approach provides residents with true integration into the department from day 1, while also allowing them to learn from experts in medicine and surgical disciplines with whom they will work over the next 4 years. Additionally, our interns participate in a longitudinal Quality Improvement Curriculum based upon IHI Open School.

After intern year, our residents move to the core training in OR anesthesia. This curriculum is built upon the idea of graded increases in case difficulty and responsibility. We challenge our residents to rapidly gain this skill set, and thus almost all of them are in advanced rotations (e.g. CT, Peds, Neuro, Vasculohepatic/Liver transplant) during their CA-1 year. Beyond the core in the OR, our residents continue to get excellent training in Critical Care, Pain, and Perioperative Medicine. We have several unique offerings that are listed below.

1. Perioperative Medicine Curriculum: A core belief in our department is that Perioperative Medicine is a central component of anesthesiology now and in the future. As such, we have developed and implemented a longitudinal 4-year training curriculum in Perioperative Medicine. Residents spend a total of 5 months of this rotation with a graded increase in responsibilities. This includes 2 months in the intern year and 1 month in each subsequent year of residency. In addition, interns have a non-clinical Professional Development Rotation in the middle of the year that focuses on training in the leadership and management skills needed to create and implement an Enhanced Recovery Program and run a Perioperative Consult Service, including an understanding of informatics, risk profiling, and quality improvement. By the CA-3 year, residents are facile in directing the care of patients on a wide variety of ERAS care pathway and also constructing individualized care plans for the sickest patients who are followed by our High-Risk Surgical Encounter Service, a sub-section of our overall Perioperative Medicine team. A further description of the curriculum can be found here (Disruptive Education: Training the Future Generation of Perioperative Physicians.Anesthesiology, 2015).

2. Global Anesthesiology Elective: All CA-3 residents have the option of doing an ACGME-approved global anesthesiology rotation at Kijabe Hospital in Kijabe, Kenya. This is a referral hospital about 50 miles northwest of Nairobi. During this rotation, residents are supervised by Dr. Mark Newton, a Vanderbilt faculty member who has been at Kijabe for 20 years, as well as other Vanderbilt faculty. Residents participate in a wide range of learning opportunities, ranging from directly providing anesthesia and ICU care to teaching KRNA (Kenya Registered Nurse Anesthetists) and students. Teaching opportunities include didactics, small group discussions, and high-fidelity simulation sessions in the recently-opened Kijabe Simulation Center - the first high-fidelity simulation center in Kenya. In addition to this opportunity, CA-1 and CA-2 residents who have a desire to become leaders in global health can also participate in this elective, resulting in several months in Kenya throughout their training. Those taking advantage of this opportunity take an active role in assisting in a portion of the research studies occurring within the ImPACT Africa grant program. More information about this program can be found at Vanderbilt International Anesthesia.

3. Echocardiography and Cardiac Device Management Electives: As one component of our focus on training comprehensive perioperative physicians, all residents have the opportunity to participate in a robust training curriculum for TEE and TTE, as well as learning the management of cardiac devices, including LVADs and Pacer/ICDs. This curriculum occurs over two months of training dedicated solely to learning these skills from recognized experts in the field. Training starts in our simulation lab and then moves into a robust clinical experience. Additionally, we have a longitudinal ECHO conference every week where residents and faculty review TEE and TTE exams. Through this curriculum, all residents have the opportunity to acquire the case numbers to qualify for Basic Perioperative TEE Certification from the National Board of Echocardiography and the knowledge base to easily pass the written exam.

4. Simulation Training: Simulation training starts the moment that our residents arrive on campus, even before clinical duties. They participate in an intern bootcamp that involves partial task trainers (e.g. central line and chest tube placement) as well as simulated perioperative emergencies. During residency, they participate in simulation for adult, pediatric, and obstetrical crises several times each year. Most recently, these are being used in the simulation lab as well as in-situ, such as in the ICU, PACU, etc. Additionally, residents have the option of doing simulation research electives or participating in our global health simulation research studies in Kenya during their CA-3 year.

5. Non-cardiac Ultrasound: In addition to the extensive echocardiography curriculum mentioned above, residents also receive training in all other forms of ultrasound. During intern bootcamp they receive training on the use of ultrasound for vascular access; and later in residency they receive training on vascular ultrasound to assess for DVT. Our residents also receive extensive training from experts in ultrasound for regional anesthesia, with most graduating with over 150 blocks not including thoracic or lumbar epidurals. Additionally, our residents take ATLS early in their training and receive instruction in that class and afterward on the FAST exam and gastric ultrasound. Finally, our residents receive instruction on lung ultrasound.

Finally, beyond these experiences, we also have a concept of ‘Majors’ for our residents. That is, in addition to the excellent training that they receive in all aspects of anesthesiology and perioperative medicine, we encourage our residents to plan their CA-3 year (and before) to include electives in at least one of four major domains: a) basic/translational/clinical research, b) educational research, c) informatics, or d) global health/health policy. Our philosophy is that we want to train the next generation of leaders and we want to encourage the process of career planning in the formative stages.