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Clinical Pearls

ASA Monitor Today

Follow this section for practical sound bites from experts in the field of anesthesiology on issues for which controlled data may not exist.

January 25  |  January 20  |  January 13

Optimizing Anesthesia Residency Opportunities

January 25

Pedro TanakaIn the April issue of ASA Monitor, I'll share my journey from a private physician at an academic center in Brazil to Stanford University Department of Anesthesiology, Perioperative and Pain Medicine. The article will highlight variations in medical education and residency requirements in different countries.

In advance of the full article, here are answers to questions common to students exploring a career in anesthesiology.

How does a medical student decide they want to pursue an anesthesia residency, and what makes for a good resident?
Understanding the timeline leading up to a residency program is a key place to start. We can talk about, theoretically, what it is to be an anesthesiologist, and the importance of understanding the concepts of physiology and pharmacology, but does that theoretical understanding make you a good anesthesiologist? The earlier the exposure to the field, the easier it is to understand the expectations in anesthesiology. Most undergraduate students may know that they want to go into medical school, but not yet know in which field they want to specialize. If a student’s initial motive is to become a physician, they can choose to specialize in anesthesiology when they prepare for residency and choose their specialization within anesthesia during their residency. Most students come out of college thinking, ‘I want to help the community,’ ‘I want to do good for humanity,’ ‘I want to be empathic for the underserved community.’ Medical school provides the opportunity for students to explore a variety of departments. By the third year of medical school, students will start to realize if they’d like to apply for anesthesia residency programs, because by then they have been exposed to a variety of clinical clerkships and have been shadowing different departments like family medicine, obstetrics and gynecology, or surgery. By the time you rotate through these, students start to think about what will fit for them as a specialty.

Can you offer any tips for finding solid opportunities throughout medical school?
By the time you rotate through your clinical clerkships, you start to think about what fits for you as a specialty. Some medical students come in their first year and find good mentors in a specialty. In my first year of medical school, I started working with a mentor who used to be a chronic pain physician and so my focus started in that route, because I had this mentor who was an amazing person. There are many context-dependent factors in terms of what you’re exposed to in your medical school student trajectory.

How important is the role of the mentor in the resident’s journey?
During my residency in internal medicine, I had the opportunity to shadow my now wife, who also works in anesthesiology. While shadowing her, I took an interest in the OR and ICU, and the use of critical decision-making and procedural skills. Professors and mentors can influence their residents’ interests. Students and residents may make career decisions based on their experience with a mentor, so it’s important for educators to always be honest when students ask about experiences in the field of anesthesiology.

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Staffing ratios & Patient Outcomes

January 20

Amr E. Abouleish, MD, MBA, FASA highlights a study examining anesthesiologists covering overlapping anesthesia cases and the staffing ratio impact on patient outcomes in this retrospective, matched cohort study of major noncardiac inpatient surgical procedures done in 23 U.S. academic and private hospitals (JAMA Surg 2022;157:807-15). In contrast to previous studies on anesthesia outcomes using claims database, this study utilizes a large database that is populated by the EMR that provides more granular and detailed data. Read his insights on how this study provides evidence that this inability to flex staffing to meet “demand matching” leads to worse patient outcomes.

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New heart failure guidelines

January 13

The American Heart Association and the American College of Cardiology, with the Heart Failure Society of America, recently updated their joint practice guideline for the management of heart failure. Most notable in their top take-home messages is the inclusion of SGLT2i, which are recommended in all classes of heart failure, including the prevention of heart failure in at-risk patients. Read more in the SEE Question of the Month.

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