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Anesthesiology and Perioperative Medicine

Anesthesiology Residency Program

Overview

Overview

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 of rapid learning and personal growth. The faculty provides a balance between the clinical, academic and research interest areas of anesthesiology. The Tufts Anesthesiology Residency is a comprehensive educational experience with a very strong clinical exposure across all specialties, a strong didactic program, a robust resident research program and an excellent track record of graduate success.

Introduction

The Anesthesiology Residency Program is an ACGME fully accredited three-year Advanced 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.

The Environment

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.

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.

Resident Progress

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.

Resident Scholarly Activity

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. For its size, our program has an impressive record of presentations at the regional and international meetings as well as publications by residents.

Resident Outcomes

Over the last 10 years, 52% of our residents chose an additional fellowship year. This percentage has increased over the years. 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.  In 2014, 8 out of 12 graduates chose the top fellowship programs including Duke, Hopkins, Cleveland Clinic and Brigham and Women’s.

Resident Life

A civilized work schedule, collegial environment, world class infrastructure, and a program that actively addresses resident concerns, are the hallmarks of resident life at Tufts. Graduating residents always remember their time at Tufts with a sense of pride, satisfaction and fondness.

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.

Josephine Hernandez, MD
Program Director
Anesthesia Residency Program
Tufts Medical Center
800 Washington Street, Box 298
Boston, MA 02148
Phone: 617 636 6044
Fax: 617 636 8384
Email: jhernandez@tuftsmedicalcenter.org

Gustavo Lozada, MD
Associate Program Director
Tufts Medical Center
800 Washington Street, Box 298
Boston, MA 02148
Phone: 617 636 6044
Fax: 617 636 8384
Email: glozada@tuftsmedicalcenter.org

Curriculum

PGY-1 Year - START (Successful Transition to Anesthesia Residency Training)

Although we are an advanced program, resident training begins with PGY-1-year, as all of our interns are enrolled into this online educational curriculum designed by the Stanford AIM lab. This has been demonstrated to improve readiness for anesthesia training. We continually communicate with the host PGY-1 programs, and provide them with curriculum guidance, mentorship support of research projects.

CA-1 year

Foundation Months:

Residents will spend an initial two months in the Foundation Curriculum. This introduces them to the fundamentals of our practice over two months

 It consists of four components.

  1. One week orientation period involving departmental and hospital orientation, simulation of normal and unexpected course of anesthetics, task training, anesthesia workstation and equipment training with biomedical engineers. Operating room assignments start after the completion of this initial training period.
  2. Introductory Lectures covering the fundamentals of anesthesia practice 2 hours 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.

Subspecialty exposure:

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. This ensures that our residents are very comfortable, in their anesthetic skills across specialties early on much more so than their counterparts at other programs.

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.

START- Prep and the ABA Basic Examination:

In 2013, Tufts joined the START-Prep consortium, led by Stanford University to create a novel, online curriculum to help prepare our CA-1s for this high-stakes exam. This was enhanced by providing protected collaborative study time an faculty moderated teaching sessions during the week. This has been highly successful as we had a 100% pass rate in the exam.

CA-2 Year

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. We have created additional experiences in our network which enhance resident experience:

A two-month critical care rotation in a multidisciplinary surgical intensive care unit, run by anesthesiologists, at the Lahey Hospital, a large suburban tertiary center. The unit is the source of the highly regarded textbook ‘Surgical Intensive Care Medicine’, O’Donnell and Flavio E. Nacul, 2nd Ed.

One month rotation to Rhode Island Hospital in Providence (Brown University School of Medicine) for additional level 1 trauma and complex case experience that is skewed towards, thoracic and major vascular cases. The environment is a private practice model in a large busy tertiary center.

Each Resident is assigned a research month to plan and pursue an academic project.

CA-3 Year

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.

Off-campus electives: (Almost all residents elect to go on these rotations)

Advanced Clinical Anesthesia and Transplantation – Lahey Hospital, Burlington, MA

Residents can elect to spend one or more months at our sister Tufts institution in Burlington, MA. Lahey is the area’s busiest solid organ transplant center and a leader in Liver transplantation. Residents gain experience in a different practice setting (large suburban tertiary center) and are exposed to operations they would not see elsewhere (live donor liver transplantation, IVC thrombectomies). They get additional experience in cardiac and vascular anesthesia and learn a variety of approaches to manage these patients.

Obstetric Anesthesia Elective at Brigham and Women’s Hospital, Boston, MA

At this renowned Obstetric center ,  Tufts residents further hone their OB anesthesia skills, participate in a high volume OB service and have opportunity to manage rare OB situations like fetal surgery

Pediatric Anesthesia elective at Boston Children’s Hospital:

In your CA-2 and CA-3 year there are opportunities for residents with an interest in pediatric anesthesia to rotate through one of the most esteemed children’s hospital in the country.

Research

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 NEARC 2011, they presented 18 of the 42 accepted abstracts and won 2 of the 4 awards presented. In 2012 and 2014 NEARC s also, Tufts residents won awards for their presentations.

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, cardiac transplantation, thoracic aortic surgery, coronary bypass grafts, valve repair and replacements ventricular assist devices and a TAVR program

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

At Tufts, we have one of the finest groups of neurosurgeons on staff in the region. As such, our residents get solid experience in this area. At graduation, our residents are competent and comfortable in taking care of almost any neurosurgical patient. Fellowship trained neuroanesthesia faculty members guide management in the OR and in the neuro critical care unit.

Neuroanesthesia rotations involve the anesthetic management of patients undergoing both elective and emergent neurosurgical procedures and radiologic interventions. Exposure is provided in all aspects of neuro and neuro-interventional surgery. This includes:

  • Complex procedures involving vascular lesions, AVM and aneurysm resection
  • Skull base surgery involving extensive neuro-physiologic monitoring
  • Posterior fossa surgery
  • Invasive radiologic procedures (embolization, stenting)
  • Awake craniotomies
  • Pediatric neurosurgical cases
  • Routine and complex spine surgery

Pediatric Anesthesia

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. Fellowship trained 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

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.

Obstetric Anesthesia

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 parturient 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.

Center for Preoperative Assessment (CPA)

Majority of elective surgical patients are now treated as outpatients, or get 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.

Didactic Program

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.

Customized program for CA-1s and Senior residents: 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. From September onwards, CA-1 residents have a faculty moderated didactic program following  the ABA Basic curriculum. This is reinforced by self-study modules form the online START-Prep program.

The Senior Curriculum Program is a lecture/seminar series that covers all the major advanced 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.

Frequent sessions with board-type practice questions, covering material taught in the core lecture blocks, help in resident preparation. All residents take the Annual In-Training Examination administered by the American Board of Anesthesiology as well as the Anesthesia Knowledge Test (AKT). The AKT is administered four times during the course of 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.

Simulation

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. This includes GASMAN for inhalational anesthesia kinetics and dynamics ACLS certification is mandatory and readily available to all residents. The department is in the process of modernizing its own high fidelity simulation laboratory and we have started bi-monthly simulation sessions on Anesthesia Crisis Resource Management(ACRM) Several senior 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.

Application Process

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
  • Personal statement
  • ECFMG Certification (if applicable)

Please contact Latescha Ettienne, our residency coordinator if you have further questions about our program.
 
Latescha Ettienne
Residency and Education Coordinator
Tufts Medical Center, Department of Anesthesia
800 Washington Street, Box 298
Boston, MA 02111
Phone: 617-636-9303
Fax: 617-636-8384
Email: lettienne@tuftsmedicalcenter.org

Why Choose Tufts Medical Center

Our program provides residents with world class education in a thriving academic environment that nurtures clinical excellence. The program allows residents to maintain a reasonable work-life balance. We take immense pride in seeing our residents bloom into successful academicians and clinical anesthesiologists of the future.