Fig. 57.1
Career pathway of an anesthesiologist. PGY postgraduate year, CA clinical anesthesia year
Throughout the clinical anesthesia years, there are mandatory rotations residents must complete throughout their residency. These include mandatory rotations through surgical anesthesia, critical care medicine, and pain medicine. The surgical subspecialty rotations must include rotations through obstetric anesthesia, neuroanesthesia, cardiothoracic anesthesia, and pediatric anesthesia. If the resident satisfactorily completes his or her rotation through a specialty, they can continue to do subspecialty rotations, although the cumulative time that can be spent in one subspecialty cannot be more than 6 months. Also, these subspecialty rotations must show increased responsibility and learning opportunities.
Residents must also rotate through other perioperative rotations, which include post-anesthesia care unit, pain management, and preoperative evaluation. Of the three mandatory months of pain management, 1 month may be spent in chronic pain, another month in regional pain management, and a last in acute perioperative pain management. Although the vast majority of these subspecialty rotations must be completed during the 36-month clinical anesthesia rotation, a total of 2 months of critical care and 1 month of pain medicine can be completed during the clinical base year.
Residents are also required to obtain minimum number of certain cases to ensure they see a variety of patients during their residency. These include both specific case types, as well as procedures (Table 57.1). There are stated case minimums for cardiac surgery, noncardiac thoracic surgery, vascular surgery, and intracranial surgery. Also, residents must show that they are involved with patients undergoing vaginal and cesarean deliveries (including high-risk obstetrics). A minimum number of spinal and epidural are required as well, as are a minimum number of peripheral nerve blocks performed. Also, there must be evidence of pain evaluations (separate from a nerve block) for patients who are suffering from either acute or chronic pain. It must be documented that patients with complex, life-threatening injuries, such as trauma or burn patients, must also be treated by anesthesiology residents during their training. Finally, to ensure that the resident has cared for an adequate number of pediatric patients, there are minimums based on patient’s age.
Table 57.1
Minimum case/procedure requirements during anesthesia residency
Case/procedure | Minimum number |
|---|---|
Vaginal delivery | 40 |
Cesarean sections | 20 |
Cardiac surgery | 20 |
Vascular | 20 |
Intrathoracic (noncardiac) | 20 |
Intracerebral | 20 |
Epidurals | 40 |
Spinals | 40 |
Complex | 20
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