Our primary focus is growth. It does not matter if you are just starting out or if you are a master clinician, our goal is singular — we want you to improve.
Practically speaking, this means that we expect our residents to take on challenges, show us their weaknesses, ask questions, engage in discussion, seek feedback and push themselves to grow.
Application of evidence-based approaches to learning is one way that we promote more effective growth for our residents. Retreats and lectures focus on concepts such as deliberate practice, growth mindset, spaced retrieval, and self-regulation.
In emphasizing the development of high-yield learning, our goal is developing master clinicians who continue to grow and pursue expertise long after they complete our Program.
Deliberate practice is an effective learning approach that involves systematic, purposeful practice to improve. It is one of the many strategies we promote to encourage efficient learning for our residents.
We believe that the best learning occurs right at the edge of comfort – not too hot, not too cold. This is particularly important in onboarding our residents, and in preparing them for the transition to becoming attendings. To improve learning and smooth out these transitions, MGH offers a unique tutorial and first call experience.
At Mass General, each resident begins with a unique month of tutorial, designed to make the introduction to the field of anesthesia smooth and successful.
During the tutorial month, two staff members are assigned to each resident. Each staff member works one-on-one with the resident separately for two weeks. This format provides a continuity of learning that allows the resident to grow quickly without having to repeat steps. New residents who are being tutored are given first choice of cases from the entire operating room schedule, ensuring that residents work on cases that match their ability level and present specific management issues.
Residents start in small groups at staggered times during the summer months, usually four at a time. This format, in conjunction with giving the tutorial staff first choice of cases, allows the tutor/tutee to take part in operating room cases that are appropriate to teach the elementary skills of anesthesia.
During the tutorial month, residents are also provided with a basic lecture each afternoon, a weeklong simulator course and a day at the Harvard Center for Medical Simulation. Tutorial provides a gentle introduction to the field of anesthesia for new residents and prepares them to provide a simple anesthetic to a healthy patient in a safe manner. This tutorial is the foundation on which the resident will build for the next three years.
The Anesthesia Residency Program offers the first-call experience to senior residents to help prepare them for independent practice. Each night, the first-call resident leads the resident call team, allocates resources, communicates with nursing and surgical teams, and manages the OR overnight.
The first-call resident is responsible for supervising the residents doing cases and is their primary backup for questions and help. The first-call resident teaches junior residents, often assisting them in the management of cases and techniques they have not previously encountered. An attending anesthesiologist is always on call with them and is present for all cases. The role of the attending is to support and teach, allowing the first-call resident to take the lead and make the transition from resident to independent anesthesiologist. This experience has proved to be invaluable for our graduates.
Robust Clinical Experience
Massachusetts General Hospital admits more than 48,000 inpatients annually. Our patients are often complex and acutely ill. Similarly, many of the operative cases are quite involved. Challenging cases include solid organ transplants (e.g., heart, lung and liver), penetrating and blunt trauma (Mass General is a Level I trauma center), open major vascular, complex thoracic, and more.
Residents are given a level of supervision appropriate to their level, along with a caseload that provides a broad clinical experience. Our goal is to always have the resident in the “driver seat” but with ample support. These cases are challenging but we provide you the support you need to achieve — another example of “Goldilock” learning. This quickly builds technical expertise, good judgment, leadership and decision-making skills, allowing residents to become confident in dealing with the most challenging perioperative issues.
In addition to caring for patients in the operating room, residents learn to manage perioperative cases in the intensive care unit (ICU), recovery room, neuroradiology suite, proton therapy center, MRI suite, endoscopy suite, and electrophysiology and cardiac catherization labs.
Extracurricular Opportunities and Support
The Program offers robust support to help our residents develop complementary professional skills.
Dr. Devan Bartels, teaching ultrasound in Botswana
The DACCPM has an exceptional record of developing young physician-scientists to become innovators and research leaders. The meshing of patient care and medical science at MGH results in the rapid translation of new scientific ideas and developments (such as inhaled nitric oxide, short acting nondepolarizing muscle relaxants and new medical devices) into practical applications that help patients worldwide. The MGH receives more NIH research funds than any other independent teaching hospital. Read more about our department’s research effort here.
During residency, we provide support in a variety of structured and unstructured ways to help develop our residents as investigators and scholars.
- Our Travel Support Program provides financial assistance to cover costs of meeting travel, lodging and registration for participating residents. Residents participating in any capacity can take advantage of this during residency. Residents who are presenting original research can take advantage of this yearly.
- Our CA3 Research Track comes with six months dedicated to research during the final year of residency. These robust offerings are complimented by our top-notch statisticians, an innovations lab and engineering group, and plenty of opportunities for presenting your work. This program is designed to function as an on-ramp to a career as a clinician-scientist. Those interested in starting as faculty on a T32 should have little difficulty making the transition with this offering.
- Should you choose to stay at MGH as new faculty, one of our mechanisms for fully developing your research potential is our Mentored Scientist Research Track – an NIH funded Training Grant (5T32-GM007592), which currently supports seven trainees in Harvard anesthesia departments. Trainees spend 75–80% of their effort on research (required by NIH). Though most trainees choose mentors at Harvard Medical School, one of its affiliated hospitals, or at Massachusetts Institute of Technology, we are extremely supported of investigation and encourage individuals to select any mentor in the Boston. Most of our Training Grant alumni continue on in research with additional mentoring during early-stage research career development. Over 85% of T32 program alumni over the last 15 years have obtained independent external funding for their research.
Patient Safety & Quality Improvement
All of our residents now participate in a longitudinal online spaced education course in patient safety and quality improvement. This weekly online course takes our PGY-1s and CA-1s through 8 vignettes to teach them about the important aspects of the field. Additionally, all of our CA-1s participate in a QA Committee meeting to better understand this process, DPH reportability and root-cause analysis.
Check out this video, highlighting one of our recent resident-led QI initiatives, which won the Anesthesia Patient Safety Foundation Resident Quality Improvement Award.
Residents with further interest can apply to join the Department’s Quality and Safety Improvement Committee (QSIC), a process improvement group comprised of faculty, fellows, residents, CRNAs, nurses and administrative staff. It is very common to have device inventors, pharmacists and health information technology experts participate for input and collaboration. Learn more about this group in the article linked here (PubMed login required).
To complement our departmental M&M format, our residents created “Resident M&M,” a novel resident-centered, resident-organized monthly M&M conference that provides an alternative forum for residents to present their own cases to their peers. Residents report high satisfaction with these sessions, and have identified multiple systems issues that have spawned numerous resident-led quality improvement and curriculum development projects.
Finally, residents who wish to focus on quality improvement choose to do a one-month QI Elective. Residents who participate are mentored by the heads of the QA and QSIC Committees. The month is comprised of a set of specified readings and a resident-led project.
Interested residents can participate in one of two different types of Global Health experiences.
- “Little” trips: The focus of these 1-2 week trips is the provision of anesthesia care to overseas patients in need.
- “Big” trips: These one-month trips focus on educating local caregivers to improve the quality of care for patients in the area long-term. These trips are co-sponsored by the SEA-HVO.
Recent international rotations have taken residents to countries including Botswana, Uganda, Rwanda, Ethiopia, the Philippines, China, Vietnam, Columbia and Peru.
The Program offers several mechanisms for developing skills in medical education.
Informal opportunities include intra-operative teaching of our medical students during their anesthesia rotation, onboarding of our new residents prior to their one-on-one Tutorial, teaching and supervision of junior residents when taking on the First Call role, and plenty of didactic presentation opportunities.
Residents with deeper interest have a few more options:
- Harvard Macy Course for future academic clinician-educators: A three-day intensive course on skills in teaching and learning AND developing scholarship in medical education. Residents can apply Travel Support funding to cover the cost of participation in this program.
- Simulation Elective at the Center for Medical Simulation: This one-month senior elective allows interested residents immersive training in simulation and debriefing at this world-renowned facility.
- The Partners Center of Expertise in Medical Education offers a number of resources to help promote education, education scholarship and education administration.
- Additionally, residents interested in Medical Education Scholarship can collaborate with one of several medical education researchers in the department.
Each night, the first-call resident is tasked with allocating resources, prioritizing cases and communicating with nursing and surgical teams.
Senior residents who wish to take this to the next level can participate in a focused one-month long Perioperative Administration Elective, which allows residents a much deeper experience with many facets of administration. These include areas such as strategic planning, budget planning, and hospital resource triage.
Much of the clinical teaching at Mass General takes place in or around the operating room or at the bedside. Emphasis is placed on case-related teaching in individual and small-group settings. Residents rotate to join clinical teams for one or two months at a time, in more than 12 specialty areas. Teams generally include two to six residents, occasionally a fellow, and four or five specialist attending staff. This deployment provides team members with the kind of small-group intimacy that would otherwise be difficult to foster in institutions as large as Mass General.
Specialty Rotations include: Critical care, Pain management, Cardiac anesthesia,Pediatric anesthesia, Neuroanesthesia, Thoracic anesthesia, Vascular anesthesia, and Obstetric anesthesia.
To provide more robust training opportunities, the department draws upon the resources of other Mass General departments, other Harvard-affiliated hospitals and the Massachusetts Institute of Technology to arrange non-traditional or research fellowships for residents with special interests. Additional rotations are available at area medical centers, including Children’s Hospital Boston, West Roxbury VA, Massachusetts Eye and Ear Institute and the Shriner’s Burn Institute. Finally, a multitude of electives and international rotation opportunities exist for interested trainees (see Extracurricular Opportunities, above).
Residents, fellows, faculty and staff attend Grand Rounds presented by experts in the field of anesthesia.
The Program offers a number of formal didactics.
Grand Rounds and Case Conference
Grand Rounds are an integral component of resident education in the Department of Anesthesia, Critical Care and Pain Medicine (DACCPM). Grand Rounds feature faculty from Mass General, other Harvard-affiliated hospitals, the Massachusetts Institute of Technology, as well as national and international guest lecturers who are leading scientists and experts in their field.
Designed for residents to explore actual or theoretical cases based on information taken from a number of medical disciplines, Case Conference is held on Thursday mornings from 8:00 am to 9:00 am. The hour is typically led by a staff member with resident involvement. The goal is to engage in an interactive discussion with the audience regarding preoperative, intraoperative and postoperative anesthesia care. It provides an opportunity for residents to make key decisions based on the cases that are presented, and to defend their medical reasoning with evidence.
The Morbidity and Mortality Conference is held every two months in place of a Case Conference. This conference provides residents with the opportunity to take part in the department’s continuous efforts to improve quality and safety. Theoretical and actual cases are discussed where near-misses could have resulted in less than optimal clinical outcomes. The discussions are bolstered by literature-based evidence, are non-punitive and are aimed at reinforcing the department’s adherence and commitment to safety and safe medical procedures.
The Journal Club occurs bi-monthly, providing a format for the residents and faculty to review current literature pertaining to anesthesia practice. The sessions are led by residents and involve extensive review of the evidence prior to discussing the designated article. The goal of the club is to foster evidence-based practice with critical appraisal of the literature.
CA1 Core Lecture Series
An integrated lecture series of approximately 40 weekly lectures specifically targeted to the CA-1 resident (September – June). Basic topics of anesthetic management are presented by DACCPM faculty and include, but are not limited to, airway anatomy, pharmacology, physiology and physiologic derangements, as well as introduction to subspecialty anesthesia. These topics are presented in sequence with the goal of building upon a gradually deepening understanding of fundamental concepts.
CA2/3 Advanced Lecture Series
These weekly lectures by faculty are on topics that are central to becoming a consultant in the field of anesthesia, including vascular access, neuropathic pain, regional anesthesia and coagulation, endocrine diseases, and anesthesia as it is used in transplant surgeries. These are presented at the level of continuing medical education (CME) courses.
The Intensive Care Unit (ICU), pediatric, obstetric, neuro, acute pain, chronic pain, preoperative clinic, orthopedic, thoracic and cardiac anesthesia clinical subspecialty rotations conduct weekly didactics, which are in addition to the departmental lectures. This “micro” level of didactic training facilitates case-related teaching. Teams can follow specific cases from the outset, and team members benefit and learn from discussing clinical care decisions with colleagues.
Though studies for the exams is not central to our educational philosophy, we do want to make sure that our trainees feel adequately prepared and comfortable going into the exams.
To make sure our residents feel comfortable going into the exams, we provide our residents with the following resources:
- Board Review lecture series, on Thursday mornings
- The most recent ACE exam for each resident, purchased from the ABA for high quality practice
- Mock Oral Exams, yearly
- “As requested” Mock Oral exams (from one of our oral board examiners)
- Mock OSCEs, yearly
Our residents are phenomenal, and the heart of our program!
We are lucky to be able to recruit top candidates, both nationally and internationally. Our residents bring diverse perspectives and backgrounds, enriching the program further and deepening the care experience that our patients receive.
We cultivate camaraderie in several ways. After Tutorial, CA-1 residents come together for a fall weekend retreat, beginning with a daylong Outward Bound experience at Thompson Island located in the Boston Harbor Islands National Park Area. This outdoor team-building experience is followed by a retreat where residents are familiarized with the learning environment.
Click here to get to know our residents a little better!
Throughout their training, residents participate in a variety of social events where they get to know each other and form lasting friendships including:
- Resident picnics and dinners
- Beer and wine tastings
- Sporting events including softball and bowling
- Annual Spring Fling
- Poster sessions
Living in Boston
A world-class city with a small-town feel, Boston is rich in history and culture and home to more than 50 colleges and universities. Boston is known for its sports teams and for its major cultural institutions like the Boston Ballet and the Boston Symphony Orchestra. There are many museums, galleries and restaurants to visit, along with a thriving local music scene for interested residents.
Most area attractions are within walking distance or a short trip on public transportation. Mass General is located right by the city center, which is surrounded by a number of neighborhoods where our residents live. Some of the better-known areas include Harvard Square, Beacon Hill, Back Bay, South End and the North End.
Boston is also centrally located to major destinations in the Northeast. New York is just four hours away by bus. Train lines such as Amtrak and the MBTA local commuter rail make traveling in New England and along the coast easy. We are in close proximity to Cape Cod, Martha’s Vineyard and other major travel destinations. International flights are also available out of Boston’s Logan International Airport, approximately a 15-minute cab ride away from the hospital.
What do our residents do after residency?
All sort of things...
Take a look at the chart below that shows where graduating residents in the “Class of …” went immediately after graduation. The graph is admittedly an over-simplification, as many of our graduates will do academic practice after fellowship or will do more than one fellowship (e.g., cardiac and critical care). There is no single “typical” path our residents follow — and we love that!
Graduating Class of 2017