Welcome to the Anesthesiology Residency Program at Tufts Medical Center. We are pleased that you have chosen Anesthesiology as your medical specialty. During your training here you will develop knowledge and skills to become an outstanding anesthesiologist and perioperative specialist. Our department fosters an environment based on respect for all individuals. The faculty provides a balance between the clinical, academic and research interest areas of anesthesiology.
Content and Organization
Clinical Subspecialty Rotations
The Anesthesiology Residency Program at Tufts Medical Center is a fully accredited three-year program (CA-1 to CA-3) and provides clinical and academic exposure to all specialty areas. The surgical case mix is skewed towards a complex and high risk referral base, resulting in challenging clinical experiences for the residents throughout the three years of training.
In spite of the complex, academic nature of the clinical experience at our institution, Tufts Medical Center and the Anesthesiology Residency are not overwhelming in size. As a result, the residency program and department have maintained the intimacy and familiarity amongst the staff and residents that fosters an environment for growth and learning. Over the years, residents and staff have chosen the department because of this unique mix of challenging work in a comfortable, supportive environment.
Tufts Medical Center also differs from many academic centers in that it provides adult, pediatric and obstetric care all under one roof. This offers our residents a considerable advantage of continuous exposure to these areas throughout their three years of training.
Over the last 10 years, 52% of our residents chose an additional fellowship year. Our board certification rates are better than the national average and we successfully place our graduates into the best practices and the most competitive fellowships. Currently 63% are practicing in the private setting, while 37% are in academic practice.
Our staff of attending anesthesiologists is committed to resident teaching. Each resident has the opportunity to reach full potential through personal attention and individualized assignments. Our wide variety of patients and surgical specialties allows us to modulate case selection for each resident according to capability and progress. Equilibrium exists among didactic teaching, interactive seminars and clinical instruction. Resident participation and input is expected and evaluation of faculty and programs by the resident occurs on a regular basis.
Residents are required to prepare and publish case reports, reviews, and research projects as part of their educational program for which they are provided protected time. Editorial assistance and academic mentoring to assure success in these pursuits is provided under overall guidance of the Vice Chairman for Research. The Tufts CTSI (clinical and translational science institute) and other university resources are readily available for academic productivity.
The Clinical Competence Committee reviews the progress of each resident based on attainment of ACGME competencies. These are evaluated by faculty and program leadership on a regular basis using a web based confidential evaluation system (New Innovations). The residents also evaluate the faculty and the program in a confidential anonymous fashion on a regular basis. Regular conferences of individual residents with the Chair of the Clinical Competence Committee serve to monitor and discuss their progress and goals. Each resident is paired with a dedicated faculty advisor to guide them through their training. Peer selected residents from each class are included in the departmental education committee and take active part in the continuous programmatic assessment and reform.
We are committed to nurturing a dynamic environment that promotes the learning, teaching and practice of the clinical, intellectual and ethical aspects of our specialty. Our program remains well positioned to seek out innovative educational opportunities for our residents and to produce tomorrow’s leaders in Anesthesiology
Thank you again for your interest in our program. We look forward to hearing from you.
Iqbal Ahmed, MB BS FRCA
Anesthesia Residency Program
Tufts Medical Center
800 Washington Street, Box 298
Boston, MA 02148
Phone: 617 636 6044
Fax: 617 636 8384
Konstantin Balonov, MD
Associate Program Director
Chair, Clinical Competence Committee
Tufts Medical Center
800 Washington Street, Box 298
Boston, MA 02148
Phone: 617 636 6044
Fax: 617 636 8384
Content and Organization
Residents will spend an initial two months in the Foundation Curriculum. This consists of four components.
1. One week orientation period involving task training, simulation, and anesthesia workstation training with biomedical engineers. Operating room assignments start after the completion of this initial training period.
2. Introductory Lectures covering the breadth of anesthesia practice 2 hrs every day for the first 5 weeks.
3. Operating Room assignments one on one with faculty for hands-on experience and close supervision. For each new resident, assignments are restricted to a limited number of faculties in July and August. One of these faculty members is the resident’s assigned advisor. In our experience this leads to a smoother and rapid attainment of competencies due to less stylistic differences that new residents get exposed to in the beginning of their training. The duration of this closely supervised period is customized to the individual needs and progress of the learner but generally lasts for 6-8 weeks.
4. "Shadow Calls" with the call team where CA-1 residents gradually get familiar with call responsibilities and get prepared for taking their first call in the Fall.
Our program ensures subspecialty exposure in the latter half of the CA-1 year. All residents in the first year rotate through ambulatory surgery, neuroanesthesia, pediatrics, obstetrics and cardiothoracic anesthesia.
During the CA-1 year, emphasis is placed on airway management, monitoring, life support and the basics of anesthesiology. Under close faculty guidance, residents are given progressive responsibility for total anesthetic management of patients in the operating room, as well as the labor and delivery floor.
In the CA-2 year, residents are afforded an appreciation for the expanding role of the anesthesiologist outside the Operating Room, as well as responsibility for management of more complex patients and procedures in the Operating Room.
Apart from clinical anesthesia responsibilities in the 15-room inpatient operating suite, the 8-room Ambulatory Surgery Center and Obstetric anesthesia Service, anesthesia residents participate in all departmental responsibilities, including preoperative and postoperative evaluations, conferences, and medical student teaching. Rotations through specialty areas in anesthesia allow for in-depth exposure to fields such as neuroanesthesia, vascular, thoracic, cardiac, obstetric, ambulatory anesthesia, regional anesthesia and pain management. Several rotations through pediatric anesthesia in the first two years provide an intense exposure to this important subspecialty area. A two-month critical care rotation in a multidisciplinary surgical intensive care unit at Lahey Clinic and a one month rotation to Rhode Island Hospital for a rotation in combined trauma and complex case assignment are rotations taken at hospitals affiliated with Tufts Medical Center.
Each Resident is assigned a research month to plan and pursue an academic project.
The CA-3 year offers the residents an opportunity to choose rotations in specialty areas that coincide with personal interests and possibly future plans. CA-3 residents rotating through specialty areas are assigned cases of considerable complexity - often cases that would be considered fellowship material in other programs.
Residents may choose to spend as long as six months in one specialty area, and the remainder of the year spent with complex and advanced assignments across other specialty areas. Most residents choose to structure their CA-3 year spending two to three months in different specialty areas. Residents at this level have the opportunities to supervise and teach junior residents and have increased clinical responsibility and independence.
A Clinical Scientist Track (CST)is also offered by the program and up to six months can be devoted to laboratory or clinical investigations. Results of this investigational work are expected to be presented at a local, regional or national forum and departmental resources are available to facilitate these endeavors.
All residents are provided with protected research time which on an average is six weeks during the training period. Our residents have been consistently one of the strongest contingents of presenters at the New England Anesthesia Residents Conference (NEARC) for the past 5 years. In the most recent NEARC 2011, they presented 18 of the 42 accepted abstracts and won 2 of the 4 awards presented.
Clinical Subspecialty Rotations
Each subspecialty is directed by a member of the anesthesia faculty with outstanding academic, administrative and clinical qualifications. Every rotation is educationally structured, monitored and periodically evaluated. Case assignments are based on clinical needs as well as educational objectives.
Adult Cardiac Anesthesia
The Division of Cardiothoracic Anesthesia is responsible for providing anesthesia for the full range of cardiothoracic surgical procedures including minimally invasive coronary artery surgery, transplantation, thoracic aortic surgery, coronary bypass grafts, valve replacements and assist devices.
Residents in this subspecialty rotation gain extensive training in clinical cardiothoracic anesthesia, cardiovascular pharmacology, management of mechanical circulatory support and transesophageal echocardiography (TEE). Additional time is spent in the Arrhythmia Center and the Cardiac Catheterization Lab. A cardiothoracic anesthesia teaching conference is held biweekly.
Residents rotate on the adult cardiac anesthesia service towards the end of the CA-1 year. A more intense CA-2 year rotation is combined with cardiac call responsibility. The optional CA-3 rotation allows the resident to concentrate on the complete management of the cardiac patient. A fourth year fellowship in cardiac anesthesia focuses on complex adult and pediatric cases and includes a course in TEE diagnostics.
Neuroanesthesia involves the anesthetic management of patients undergoing both elective and emergent neurosurgical procedures and radio logic interventions. Exposure to all aspects of neurosurgery, including complex procedures involving vascular lesions, skull base surgery involving extensive neuro-physiologic monitoring and posterior fossa surgery, AVM and aneurysm resection as well as invasive radiologic procedures (embolization) is provided.
The Floating Hospital for Infants and Children (est. 1894) is part of the Tufts Medical Center complex and offers comprehensive primary and tertiary care. Pediatric trauma patients are airlifted to the medical center from throughout New England under the auspices of the Kiwanis Pediatric Trauma Institute. Attending pediatric anesthesiologists are available 24 hours a day to help residents provide anesthesia for these and other critically ill infants and children. At Tufts Medical Center, pediatric anesthesia training is a continuum in addition to a minimum of three 1 month dedicated pediatric anesthesia rotations. Residents have their first exposure to the anesthetic care of children during their CA-1 year. CA-3 residents may elect subspecialty rotations in pediatric anesthesia with emphasis on the critically ill child, the premature infant, neonatal emergencies, and cardiothoracic anesthesia. A weekly pediatric anesthesia fellow conference is part of the teaching program which residents are encouraged to attend. Due to continuous exposure to pediatric patients throughout the training, our residents are probably among the most competent and confident pediatric care givers at the time of graduation.
Regional anesthesia is very much a part of everyday anesthesia practice at Tufts. Whether used as the sole anesthetic or in combination with general anesthesia, regional anesthesia becomes part of every resident's repertoire early in the CA-1 year. All CA-1 residents start learning regional techniques as part of their PACU and OB rotations. CA-2 residents are assigned a dedicated 1 month regional anesthesia rotation in which most of them complete their ACGME nerve block requirement. They have an additional regional rotation in their CA-3 year to further hone their skills.
The Department of Anesthesia plays an active role in Tufts Medical Center's Labor and Delivery suite. The high risk nature of the obstetric population provides a large proportion of operative deliveries, as well as complex medical and obstetric problems including multiple gestation, pre-eclampsia, prematurity, diabetes and cardiac disease.
We participate in the care of these patients through an active consultation service, which provides antepartum assessment and medical management. The Department of Anesthesia provides epidural pain relief to more than 70% of the laboring patients, and works closely with the Department of Obstetrics in the intrapartum and postpartum management of these patients.
Residents participate in the Obstetric Anesthesia service throughout the three years of training. As residents become more experienced in the management of the obstetric patient, they are given increasing responsibility in clinical care. At the completion of the residency program, residents are competent in the management of the complicated obstetric patient, and can comfortably provide regional anesthesia to parturients in elective and urgent situations.
Senior residents can (almost all do) choose an elective in advanced obstetric anesthesia at the Brigham and Women's Hospital in their CA-3 year.
Ambulatory Surgery Center
Our Ambulatory Surgery Center has eight operating rooms and spacious preoperative and recovery areas. The Center efficiently accommodates a large number of patients. Pediatric patients may stay with their families in private rooms in the preoperative and postoperative areas.
The residents' ambulatory surgery exposure resembles a private practice setting. Residents learn to manage patients efficiently in a tightly organized environment, aiming for early recovery and discharge.
Post Anesthesia Care Unit
Care of the patient in the PACU is a natural extension of the anesthesia care of the surgical patient. Issues encountered here are diverse, some overlapping the areas of surgical anesthesia, critical care medicine, and pain management, while others are unique to the PACU. During a one-month rotation, the resident work closely with an experienced staff of PACU nurses and a pharmacist, as well as surgical colleagues. A supervising staff anesthesiologist makes bedside teaching rounds throughout the day with the PACU resident.
Surgical Intensive Care Unit
A two-month rotation in the surgical intensive care unit at Lahey Clinic during the CA-2 year provides clinical training in all aspects of the critically ill patient. Management of septic shock, multiple organ failure, respiratory failure, acute renal failure, hepatic insufficiency and arrhythmia diagnosis is a fundamental part of the training experience. All patients are managed by residents on a co-primary basis with an intensivist. Comprehensive treatment strategies in the SICU include nutritional support, hemodynamic resuscitation, advances in mechanical ventilation, infection control and issues related to sedation and analgesia.
Residents share in-house call duties with their surgical colleagues and other anesthesia residents. Educational experience is fostered through literature review and four conferences each week. Residents learn to recognize and treat acute illness and to defend their rationale for management strategies.
Preoperative Assessment Clinic
The majority of elective surgical patients are now treated as outpatients, or are admitted on the day of surgery. This clinic was created to assure comprehensive and timely preoperative evaluations. The center is staffed by anesthesia attendings, assisted by residents and nurses. Complete preoperative evaluation and risk assessment as well as laboratory and consultative services are provided. Patients are given information on all aspects of perioperative anesthesia.
Other subspecialty rotations include Thoracic and Vascular Anesthesia.
The strength of our Training Program in Anesthesiology lies in the commitment of our faculty to resident education. This is accomplished by the integration of strong, well organized didactic lecture series into the clinical experience. It is a priority of our department that residents be uniformly relieved of their clinical duties to attend departmental lectures. The Didactic Lecture Series is based upon the content outlined by the In-Training Council of the American Board of Anesthesiology and the American Society of Anesthesiologists. The program provides 6 hours of didactic activities per week, which unlike many programs is scheduled within the work day.
The Resident Education Program commences with a daily lecture series specifically for the CA-1 residents through the month of July. Basic concepts of anesthesia are covered in considerable depth in small group sessions. The Core Curriculum Program is the central resident lecture/seminar series that covers all the major topics and specialty areas of anesthesia in a 2-year rotating curriculum. All residents are relieved for 2 hours every Wednesday and Thursday between 3 and 5 PM to attend these lectures. Specialty blocks are coordinated by section chiefs and cover respiratory, cardiac, pediatric, obstetric and pain topics in addition to physics, pharmacology and renal/endocrine blocks. Additionally, residents participate in Morbidity and Mortality and Journal Club sessions and are required to give formal presentations on topics of their choice throughout the year.
Morning 15 minute Keyword Sessions are conducted 4 times a week at 6.45AM.
Department Grand Rounds are held for the entire department each Monday between 7 - 8 AM in the morning.
Written examinations are held twice yearly, covering material taught in the core lecture blocks. Also, our residents take the Annual In-Training Examination given by the American Board of Anesthesiology in March. Residents also required to take the Anesthesia Knowledge Test (AKT) four times during the course of their training. Our intensive study program has produced a success rate for ABA specialty certification that exceeds the national average.
Formal mock oral practice examinations are given to all residents twice a year and provide self-assessment and training in an environment of simulated stress.
All residents are sponsored to attend the Anesthesia Crisis Resource Management Course (ACRM) at the Harvard Center of Medical Simulation (CMS) at MIT in Cambridge, Massachusetts. Simulation based training is also provided at the Tufts University Clinical Skills and Simulation Center (CSSC). Training at the center includes ACLS, PALS, and procedure simulations. Simulation software designed to teach various aspects of anesthesia theory and practice is readily available as well. ACLS certification is mandatory and readily available to all residents. The department is in the process of modernizing its own high fidelity simulation laboratory.
Selection to our residency program is highly competitive. Listed below are the requirements for entrance to the Core Residency Program in Anesthesiology at Tufts Medical Center.
Applications are accepted through the Electronic Residency Application Service (ERAS), which is administered by the Association of American Medical Colleges. AAMC developed ERAS to transmit residency applications, letters of recommendation, dean's letters, transcripts, and other supporting credentials from applicants and medical schools to residency directors using the Internet.
Additional requirements and documentation are as follows:
3 letters of recommendation
Competitive USMLE scores
ECFMG Certification (if applicable)
Please contact Latescha Ettienne, our residency coordinator if you have further questions about our program.
Residency and Education Coordinator
Tufts Medical Center, Department of Anesthesia
800 Washington Street, Box 298
Boston, MA 02111