Clinical Base Year (PGY-1/CA-0)
We were deliberate and intentional in the design of the Tufts Anesthesiology Clinical Base Year to be multi-disciplinary in nature with a focus on the development of foundational skills in patient evaluation and assessment, clinical reasoning, and clinical management that will provide trainees with a strong base as they ultimately transition to their training in Clinical Anesthesiology. In addition to spending time with the faculty and residents of the Department of Anesthesiology and Perioperative Medicine, PGY-1 Anesthesiology Residents also rotate within the Departments of Surgery, Internal Medicine, Otolaryngology, Addiction Psychiatry, and Emergency Medicine. Foundational experiences in Critical Care Medicine are provided in the Surgical Intensive Care Unit and the Medical Intensive Care Unit (one month each). Rotations within the Department of Anesthesiology and Perioperative Medicine include: 1) Center for Preoperative Assessment, working collaboratively with a CA3 resident to develop the skills in obtaining a focused anesthetic preoperative history and physical exam; 2) Foundations in Pain Management, including experiences in the Pain Management outpatient clinic, on the Acute Pain Service, and on the Addiction Psychiatry Service; 3) Research, including completion of Tufts required research training and establishing an area/topic of interest for further investigation; and 4) Community Immersion, a year-long, longitudinal volunteer experience to learn more about and give back to the community surrounding Tufts. All PGY-1 Anesthesiology Residents end their intern year with a Clinical Anesthesiology rotation that serves as the transition point to their Anesthesiology training.
The last month of the CBY/PGY-1 year and the first month of the CA-1 year are comprised of the "Foundations in Anesthesiology" curriculum. This curriculum introduces trainees to the fundamentals of Anesthesiology and consists of four primary components:
Approximately one week of administrative-related and work-flow didactics, simulation (task trainers and high-fidelity simulations), and equipment training. Operating Room assignments start after the completion of this initial training period.
- Foundations didactic curriculum that focuses on the fundamentals of the practice of Anesthesiology. These faculty-facilitated sessions are held daily for two hours for the first 5 weeks.
- One-on-one OR assignments with faculty and/or senior residents for individualized clinical teaching and immersion. For each CA-1 resident, we attempt to limit the number of supervising faculty and/or residents to allow for consistency and more reliable graded autonomy. The duration of this closely supervised period is customized to each resident's individual development, but typically lasts for 6-8 weeks.
- "Shadow Calls" provide CA-1 residents an opportunity to gradually become familiar with the responsibilities of being the on-call junior resident and ensures that they are prepared to assume call duties in September.
Starting in October, the CA-1 residents benefit from early subspecialty exposure in anesthesia for ambulatory surgery, neuroanesthesia, pediatric anesthesia, obstetric anesthesia, critical care medicine (2 months in the Surgical Intensive Care Unit), and cardiothoracic and vascular anesthesia.
During the CA-1 year, emphasis is placed on airway management, monitoring, life-support, and the basic sciences underpinning the field of Anesthesiology. Under close faculty guidance, residents are given progressive responsibility and autonomy for total anesthetic management of patients in the operating room, in procedural units, as well as on the labor and delivery floor.
During 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, including liver and heart transplantation.
In addition to performing cases in the 15-room inpatient operating suite, 8-room ambulatory surgery operating area, residents complete one month of obstetric anesthesia at Tufts Medical Center and an additional month of obstetric anesthesia at Brigham and Women's Hospital. Residents also complete a required 2-month Pediatric Anesthesia rotation at Boston Children's Hospital. In-house subspecialty rotations continue in neuroanesthesia, cardiothoracic and vascular anesthesia, obstetric anesthesia, pediatric anesthesia, regional anesthesia, and anesthesia for ambulatory surgery, as well as 1 month in our outpatient pain management center.
CA-3 residents have approximately four months of electives that are customizable to each resident's career goals. During the remainder of the CA-3 year, residents continue to gain experience caring for complex patients by continuing to rotate through subspecialty areas. Senior residents are also provided with the valuable experience of supervising and teaching junior residents in addition to learning and practicing vital OR management skills through the role of "Junior ACIC".
The current options for electives are:
- Cardiothoracic ICU (Post-surgical unit, Anesthesia-Intensivist run)
- Cardiac Care Unit (Heart Failure and General Cardiology Unit, Anesthesia-Intensivist run)
- Advanced Airway Management
- Perioperative Echocardiography
- Additional months in the following subspecialties (acute pain, cardiac, chronic pain, neuroanesthesia, thoracic)
- Chronic Pain - Brigham and Women's Hospital, Boston, MA
- Chronic Pain - Beth Israel Deaconess Medical Center (BIDMC), Boston, MA
- Pediatric Anesthesia – Boston Children's Hospital, Boston MA
- Pediatric Cardiac Anesthesia – Boston Children's Hospital, Boston MA
- Pediatric Pain– Boston Children's Hospital, Boston MA
- Advanced Anesthesia for ENT Surgery with focus on Pediatrics – Mass Eye and Ear, Boston, MA
- Community Anesthesia at Lowell General Hospital
- International Anesthesia Electives
Our academic mission is built on the philosophy of capturing the maximum breadth of educational content through optimal resource utilization while always remaining learner-centric. By recognizing that comprehension of material occurs best when the teaching modality is congruent, we strategically incorporate lectures, simulation, in-training preparation, oral board practice, OSCE practice, and skills labs (echocardiography, POCUS, regional, vascular access) to provide the most high-yield educational experience for each of our residents. We strive to match the topic and format to create a synergistic learning opportunity where mastery of the content can be achieved.
The strength of our training program in Anesthesiology lies in the commitment of our faculty to resident education. A carefully designed and well-organized didactic educational series is integrated into the clinical experience. It is a priority of our department that residents be uniformly relieved of their clinical duties to be fully present for didactic sessions. The curriculum is learner-centric and is based upon the American Board of Anesthesiology Content Outlines for the BASIC, In-Training, ADVANCED, and APPLIED exams. Both junior and senior residents are scheduled for four hours of didactic activities per week, which unlike many programs is scheduled within the normal workday.
Each academic year, the resident didactic education program commences with a daily lecture series specifically for the CA-1 residents in July to mid-August (the "Foundations in Anesthesiology" curriculum). From September onwards, CA-1 residents have a faculty moderated didactic program, the BASIC Pathway, that is based upon the ABA BASIC Exam content outline. The ADVANCED Pathway is a lecture/seminar series that covers all the major advanced topics and subspecialty areas of Anesthesiology in a 2-year rotating curriculum.The ADVANCED Pathway is conducted immediately following Grand Rounds from 8AM until 12noon each Thursday. Specialty blocks are coordinated by Division Chiefs and cover respiratory, cardiac, pediatric, obstetric, and pain topics in addition to physics, pharmacology and renal/endocrine blocks. Additionally, residents participate in journal club sessions, mock Standardized Oral Exam sessions, high-fidelity simulation sessions, POCUS sessions, and wellness sessions during their protected didactic time. The BASIC Pathway follows a similar structure and is conducted each Thursday from 12:45 until 4:45PM.
Departmental Grand Rounds are held each Thursday, 7-8AM. Grand Rounds sessions consist of visiting speakers, faculty lectures, monthly QI/M&M sessions, annual trainings, and administrative meetings.
Simulation-based training is provided both in our in-department mock OR simulation lab and the Tufts University Clinical Skills and Simulation Center (CSSC). Both centers provides an interactive and supportive experiential learning environment for our residents. Our faculty enjoy teaching and closely supervising residents while they can practice essential problem-solving skills and the dynamics of a team approach to acute patient care. Occurring approximately on a monthly basis, the program covers a wide range of clinical scenarios with an extensive post-simulation debriefing. Training at the center includes ACLS, PALS, and procedural simulations. ACLS certification and recertification is built within the didactic curriculum.