Education

Learn about our educational philosophy, our curriculum, and what our residents do after residency.

Philosophy

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.

 

We approach teaching and learning with a mastery orientation, employing both strategy and effort. We approach all activities, including giving and receiving feedback, with a goal of improving one’s performance. We use experimentally demonstrated strategies to improve teaching and learning. All cases provide opportunities for learning and improving. Failure is another opportunity to learn and improve.”

Keith Baker, MD, PhD
Vice Chair for Education

Integrated intern year

Our new, integrated clinical base year (CBY) will prepare you to succeed. It is a transitional year that pairs traditional rotations such as internal medicine, surgery, and emergency medicine, with integrated rotations where you work side by side with advanced residents, including acute pain and surgical intensive care. Throughout the year interns will work side by side with their future medical and surgical colleagues while building connections with each other and the anesthesia department. This clinical experience is enriched by a longitudinal, year-long curriculum (one full day every other week on most rotations) that brings the interns together with anesthesia faculty for lectures, skills workshops, and simulation focused on learning relevant to your intern responsibilities and foundational to the practice of anesthesia.

Typical Rotation Schedule

The CBY is divided into 2-week blocks (26 in total). Twenty blocks are spent at the Massachusetts General Hospital, and six at the Newton-Wellesley Hospital to round out your clinical experience.

  • 6 blocks of Medicine (including 2 blocks of Bigelow)
  • 3-4 blocks of Surgery (including time on the Baker services)
  • 3 blocks* of “selectives”, including critical care, consult services, and medical or surgical subspecialties
  • 2-3 blocks of Surgical Critical Care (in the Ellison 4 ICU)
  • 2 blocks of Emergency Medicine
  • 1 block of Perioperative Pain (on the Acute Pain Service)
  • 2 blocks* of Anesthesiology (rolling start to “tutorial” at the end of the intern year)
  • 4 blocks* of electives, including options like medical education, research through ARC, transfusion medicine, and more
  • 2 blocks* vacation – vacation is given in two 2-week blocks

*No weekend or call responsibility

Tutorial

your “on ramp” to starting residency 

At Mass General, you’ll begin 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 you. Each staff member will work one-on-one with you for two weeks at a time. This format provides a continuity of learning that allows the you to grow quickly and without having to repeat steps. During tutorial, you are given first choice of cases from the entire operating room schedule, to ensure that you work on cases that match your present level and specific management needs.

Residents start in small groups at staggered times during the summer months, usually 5-6 at a time. This format, along with giving you first choice of cases, allows the tutor/tutee pairs to take part in operating room cases that are appropriate to teach the elementary skills of anesthesia.

During the tutorial month, you’ll also have lectures and an advanced simulation day at the Harvard Center for Medical Simulation. Tutorial will provide you a gentle introduction to the field of anesthesia and prepare you to provide a simple anesthetic to a healthy patient safely.

    Rotations

    – growth during residency

    We take a very deliberate approach to rotation scheduling for our residents. Subspecialties are introduced when you are ready, typically 3-6 months in. By the end of your CA1 year, you’ll have had at least a handful of subspecialties (which we target to your fellowship interests) in addition to at least one of our more complex case rotations, like thoracic or cardiac.

    Additionally, each time you revisit a rotation, the cases you are scheduled for should on average increase in complexity. As an example, during the first couple months on General Surgery, our schedulers will aim to get you exposure the full breadth of more common cases, deliberately scheduling you for cases you have not yet been exposed to (e.g., a mix of thyroid cases, breast cases, abdominal cases, etc). When you come back to General Surgery in your CA2 and CA3 years as a senior, you pick whichever cases you want. Or, if you prefer not to pick, the schedulers target more complex cases (e.g., complex liver resections, HIPECs, or patients with more complex comorbidities like LVADs).

    First call experience

    your “on ramp” to becoming an attending

    The first-call experience is designed to prepare you for independent practice.  As first-call resident, you will lead the call team (which includes faculty, residents and CRNAs), allocate resources, communicate with nursing and surgical teams, and manage the ORs overnight. Your first-call attending, who is there with you all night, is your backup and coach for everything you need.

    The three main learning goals for the first-call experience are: 1) Administrative: You will learn how to lead and coordinate the OR flow within a large hospital system. 2) Supervision: You’ll get invaluable experience developing plans with residents and CRNAs and then supervising them in the OR. 3) Teaching: You’ll learn what to teach, when to teach, and how to teach.

    An attending anesthesiologist is always on call with you and is present for all cases. The role of the attending is to support and teach, allowing you to take the lead and make the transition from resident to independent anesthesiologist. Our alumni tell us that this experience is invaluable after graduation.

      Didactics

      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 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.

      Rotation-Specific Didactics

      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.

      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.

      Journal Club

      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.

      What do our residents do after residency?

      All sort of things…

      There is no single “typical” path our residents follow — and that diversity of interests makes us stronger.

       

      [Note that this only touches on the first year out of residency, so doesn’t include dual fellowships, those who go back to fellowship, or those who join academic and private practice after fellowship.]