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We look for applicants with sincere interest in the specialty of anesthesiology, with solid academic credentials, who have a thirst for knowledge and are looking to be leaders in their field. We do not have specific number cut-offs for standardized exams. All of the applications are reviewed personally by the Program Director and the Associate Program Directors.
The anesthesia department employs approximately 1-2 faculty for every anesthesia resident. To cover our many locations as well as encourage an appropriate balance of resident autonomy and close supervision and education, our operating room ratios are typically 1 faculty member supervising 2 residents, reserving a true single-coverage 1:1 ratio for more complex cases (cardiac, complex vascular, thoracic, and transplant).
For most of the year, residents take overnight call in OB and on the West campus (OR call) and late call on the East campus. On the average, overnight call frequency decreases with advancement in residency, so CA-1s will take about 4 to 5 calls per month, CA-2s take 3 to 4 calls, and CA-3s take 2 to 3 calls per month. The number of late calls also decreases with advancement in training. Overnight calls are 24 hour call for CA-1s; CA-2s and CA-3s do not come in for overnight call until noon for West call, and 2:00 p.m. for OB call on weekdays; residents go home on the post call day around 7:00 am.
LATE CALL: For late call, residents stay to finish cases in late-running rooms on the east campus. The call usually includes three residents: Late 1 (first to leave), Late 2 (second to leave), and Late 3 (last to leave). Late 3 generally does not stay past 9:00 p.m.
WEST CALL: On West campus call, there is one CA-1 and one senior resident (CA-2 or CA-3) on call with one attending. OR cases are done until all the cases are finished. The call team also covers patients in the PACU and airway emergencies in the hospital which require intubation. Typical cases on west call include trauma (e.g. orthopedic injuries), general surgery cases (appendectomy, exploratory laparotomy, cholecystectomy), vascular surgeries, and any other cases that are considered urgent (e.g. D&C for bleeding patient, spine surgery for patient with cord compression).
OB CALL: OB call consists of 2 residents (1 senior and 1 junior) and one attending. Residents cover placement of epidurals or combined spinal-epidurals for patients in labor and anesthesia for C-sections.
OTHER CALLS: Residents on their ICU and Pain rotations are not in the general call schedule and take call specific to the rotation. Children's Hospital also has a separate call schedule that is coordinated through the rotation.
Many residents choose to live in the Fenway or Brookline neighborhoods, both of which are within walking distance of the hospital. The average rent for a 1 bedroom apartment in these areas ranges from $1200 to $1800/ month, with studios from $900-$1200/month. Other popular neighborhoods include the Northeastern University/Symphony area, Back Bay, and Beacon Hill. Some residents live in one of the many surrounding suburbs (Cambridge, Jamaica Plain, Newton, etc.) and commute to work by car. Rental prices in the suburbs tend to be lower than in Boston proper. Parking is available at the hospital garage for a weekly fee. The hospital is easily accessible by public transportation (the MBTA or "T," nearest stop is Longwood). Monthly MBTA passes for unlimited travel within the Boston area can be purchased through the hospital at a discounted rate.
Typically residents are assigned to an OR for the day and do the cases scheduled for that room until either the cases are finished (if before 4:30 pm), or they are relieved for lecture (at 4:30 pm). If there is no lecture scheduled and residents are not on late call, they are usually relieved by one of the late call staff by around 5:00 pm. The residents call the attendings that they will be working with to discuss the anesthetic plan for the next day's cases. The goal is to set up for the first case, see the patient in the holding area (to perform preoperative evaluation and obtain informed consent), and start the IV in order to be ready to go to the OR by 7:30 am. Depending on the complexity of the first case, residents arrive at the hospital between 6:00 and 6:45 am. Many of the outpatients will be seen prior to the day of surgery at the Preoperative Testing clinic. During the day residents are given the standard morning break (15 minutes), lunch break (30 minutes), and afternoon break (15 minutes). Non-OR based rotations such as OB anesthesia and Pain medicine will have a slightly later start time for the work day.
The ORs are equipped with an electronic anesthesia record, so that all vital signs are automatically entered into the anesthesia record (allowing time to focus on the patient rather than charting vital signs on paper). Additionally, the hospital has an online medical record system, allowing access to information about patients including lab values, blood bank information, consult, admit, or discharge notes, ECGs, radiology reports, and old anesthesia records.
A TEE reading room is available for use and has texts as well as audiovisual equipment and computers to allow for TEE-related study. In addition, an echocardiography lab with high-fidelity TEE and TTE simulators is available for practicing manual skills for TEE and TTE.
There are many other online resources that are extremely useful. The Anesthesia Wiki Library is a resource created by a former BIDMC anesthesia resident. It has information about specific surgical procedures, surgeon preferences, and basics for anesthesia management. ADEL (Anesthesia Department Electronic Library) is an online library specifically designed for the BIDMC anesthesia department by a former Chief Resident who is now a member of our attending staff. It includes links to resources for each rotation (such as online syllabi created by each subspecialty division) and videos for performing procedures (like central and arterial lines).
As an affiliate of Harvard Medical School, BIDMC residents are also given Harvard ID badge. This badge gives access to the Harvard Countway Medical Library, including many full text online journal articles. In addition, Beth Israel Deaconess has anesthesia libraries on both the East and West campuses, which house various useful anesthesia textbooks and subspecialty resources.
And finally, while there is a generous education allowance, the department also gives each resident a mini-iPad, Barash's Clinical Anesthesia, access to TrueLearn question bank, and access to many other anesthesia subspecialty books covering critical care, thoracic anesthesia, cardiac anesthesia, vascular anesthesia, and OB anesthesia.
We are incredibly proud of the response of our department and trainees to the COVID-19 (COVID) pandemic.
BIDMC was in the hot zone of the COVID surge in Boston. For approximately three months the operating rooms were closed to elective cases. Our department was on the front line of COVID care: Our staff intubated every COVID patient, staffed 9 ICUs (an increase over the 4 ICUs we typically staff) that included 3 PACU ICU teams utilizing anesthesia machines as ventilators, developed COVID intubation protocols and coordinated the training and simulation sessions for OR and ICU staff in the safe management of COVID surgical patients and parturients.
The protection of our trainees and staff was paramount; only the most experienced staff (therefore not trainees) managed the care of COVID patients' airways and surgical cases. In the ICUs, residents were critical to our ability to provide safe and effective care. Many of our residents volunteered to do additional ICU rotations to care for these patients; in the PACU ICUs, our residents further solidified their expertise by using several different types of ventilators, including anesthesia machines, in the management of severe respiratory failure. The residents caring for COVID patients always had adequate PPE and we scheduled additional off-time and used CRNAs to provide extra on-call support to help support our trainees during this challenging time. Our fellows helped organize and staff the COVID field hospital, Boston HOPE.
Currently, all patients are screened and elective cases are COVID tested prior to the OR. Now that we have confidence in the effectiveness of our PPE practices, our trainees are now involved in all cases regardless of COVID status. We have ensured that all staff members have adequate PPE and any time-out related to COVID (for testing, for example) is forgiven. Case numbers and missed rotations were tracked and schedules adjusted to make up for the OR downtime, so we anticipate all residents will meet their case minimums. During the height of the crisis we pared down our didactic schedule and converted to online formats and have now returned to a full — albeit virtual — didactic schedule, using the pandemic experience as an opportunity to explore additional modes of learning outside of the traditional lecture style talks. Finally, our critical care leadership is closely involved with hospital leadership in planning for any potential resurgence to minimize the effects on our day-to-day practice.
In response to the pandemic, our department also provided a robust wellness response to support our staff and trainees. Virtual social events, including happy hour, yoga, meditation, are provided by members or friends of the department, and we developed the HEALS (Hearing Each other And Lending Support) pager: a 24-7 confidential hotline for any member of the department to get support.
The Commonwealth of Massachusetts also has had a strong response to the COVID pandemic: there is mandatory masking and limits on large gatherings of people; as a result of these efforts we are in Phase 3 of reopening and our positivity rate is near 1%.
Our department has a strong history in supporting a diverse and inclusive anesthesia community. We seek to expand our efforts in promoting healthcare equity by adding healthcare disparities education to our curriculum, expanding the implicit bias training that is offered to our application review committee to our staff at large, and increasing our community outreach. We have access to the considerable resources of the Office of Diversity, Inclusion, and Community Partnership at Harvard Medical School (HMS). Dr. Nancy Oriol, HMS associate professor and an obstetric anesthesiologist in our department, runs the HMS MedScience program, which provides experience in healthcare careers to high school students at local Boston high schools. We also offer a summer internship for minority high school students underrepresented in medicine. Our residents are also active in seeking out opportunities to increase our visibility in support of Black lives and members of the LGBTQ community.