How to train an Anesthesiologist

the American ExperienceSinh Nguyen MD

Instructor in AnesthesiaHarvard Medical School

Disclosure:HAVE NO PROPRIETARY, FINANCIAL OR PERSONAL INTEREST HAVE NO PROPRIETARY, FINANCIAL OR PERSONAL INTEREST OF ANY NATURE OR KIND IN ANY PRODUCT, SERVICE OR OF ANY NATURE OR KIND IN ANY PRODUCT, SERVICE OR COMPANY THAT COULD BE CONSTRUED AS INFLUENCING COMPANY THAT COULD BE CONSTRUED AS INFLUENCING THE MATERIAL PRESENTEDTHE MATERIAL PRESENTED

Undergraduate

• Everyone must graduate from a college

• Pre medical school requirements

• MCAT medical entrance exam

• They represent the best the the brightest

Medical School requirements• Physics, Calculus, Chemistry, Organic

Chemistry, English

• Good MCAT scores

• Letters of recommendation from undergraduate faculty

• Pass interview process

centralized application process

www.aamc.org

Medical school numbers

• 141 Accredited medical schools

• Private

• State sponsored

• One military medical school

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Medical School Training

• 2 year pre clinical training

• 2 years of clinical training in the hospital setting

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Preclinical

• book learning

• biochemistry, anatomy, pathology, biology, physiology, cardiology, genetics.

• United States Medical Licensing exam Step 1

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Clinical training• Application of learning to clinical practice

• Surgery

• Internal Medicine

• OB/GYN

• Pediatrics

• Family Medicine

• Emergency Medicine

• Research Project

• USMLE step 2

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Medical Doctor in US

• MD-Doctor of Medicine 4 years graduate

• JD- Doctor of Law 3 years

• PHD-Doctor of Philosophy 3 years

• PharmD- Doctor of Pharmacy 3 years

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–Hippocrates

“.I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according

to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my lif”

Anesthesiology Residency

• 4 years of post graduate training

• NRMP process

• regulated by ACGME and ABA

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Anesthesia Training

• 1 year of internship

• 3 years of anesthesia

• passage of ABA written boards

• passage of ABA oral boards

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Mass General Hospital anesthesia residency

• 100 operating theatre

• 25 residents

• 150 clinical and research faculty

`first anesthesia case

First day of Anesthesia training

CA1

• 1 month tutorial with one on one supervision of mentor faculty

• general anesthesia rotation

• obstetrics

• ICU

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CA2/CA3

• anesthesia specialty rotations

• pediatrics

• vascular

• cardiac

• neurosurgery

• thoracic

• icu

• pacu

• acute and chronic pain

• regional

• research

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Program regulations

• All anesthesia programs are regulated by ACGME

• resident duty hours must be logged

• cases must be logged

• all programs are review by RRC every 2-5 years to determine accreditation

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Safety First

Duty hours

• 80 hour work limit

• maximum of 24 hours shift

• institution must provide area for sleep

• one day off per week

• 10 hours rest after each shift

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Patient care focus

• pre anesthesia evaluation, assessment, preparation

• anesthesia conduct and plan

• pre-procedural pain management

• management of peri-operative complications

• crisis management

• triage of critically ill patients

• acute and chronic pain consultation

• regional anesthesia

• management of patient based on a systems practice

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What is the product?

• Peri-operative physician

• Integrated medical manager

• Risk manager

• Crisis manager

• Manager of efficient cost effective care

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What is the cost?

• 4 years undergraduate : 200,000 USD

• 4 years medical school : 250,000 USD

• 4 year residency : priceless

• lost of income potential during training relative to other fields

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Thank you