Beginning CA1 residents have an extensive “boot camp” didactic program. During the weekday mornings, these junior residents will have basic anesthetic assignments in which they learn the basics of anesthetic care, ventilator management, and procedural techniques. In the afternoons, residents will attend our didactic program. In their first two weeks, there are presentations by senior residents on such topics as room setup, airway techniques, and general anesthetic troubleshooting. In the subsequent two weeks, members of the faculty provide presentations on airway anatomy, cardiac physiology, transfusion medicine, and many others. Residents are expected to prepare themselves by reading the corresponding chapter in Morgan and Mikhail the night before in a “flip classroom” style learning environment.
Anesthesiology Grand Rounds occur every Thursday. Topics vary weekly. Prominent guests (for example, Jerome Adams M.D., Former Surgeon General of the United States) may provide “visiting professor” lectures. We also have a monthly quality improvement review of cases in which we focus on how to improve as a department and health system. CA2 residents present current controversial topics in a paired debate format. This “pro-con” approach allows the residents to present evidence in a manner that typically stimulates spirited discussion amongst the entire department. Senior CA3 residents deliver one formal evidence based grand rounds discussion on a topic of their choice.
The Department of Anesthesia offers a quarterly journal club. Typically an invited guest speaker leads the discussion of 2-3 recent journal articles. In this relaxed atmosphere residents have the opportunity to catch up with other residents, as well as learn how to critically evaluate journal articles. Our pediatric anesthesia division also hosts its own journal club that is optional for those interested and meets quarterly. The regional anesthesia division holds informal journal club presentations monthly during each block with the assistance of the faculty and fellows; all are welcome to attend.
Scheduled Resident Education
There are three resident didactic series that run in parallel throughout the year. A basic anesthesia level course, for CBY and CA1 residents, an advanced anesthesia course for the CA2s, and an advanced/consultant course for the CA3s. This is protected time and residents are relieved from OR duties so that they may attend. Topics are commensurate with the targeted level of training. These events are led by senior faculty and help residents prepare for the annual in-training examination, the ABA basic examination, the ABA advanced examination, and the ABA oral/practical examination.
The weekly lecture didactic series is supplemented by a Friday morning conference. Led by residents and attended by faculty, this conference offers keyword review questions and interesting case discussions. Frequent problem-based learning discussions and oral board review lectures are given by senior faculty who are themselves experienced examiners for the American Board of Anesthesiology. Typically, faculty provide a case scenario and residents take turns discussing how they would manage the patient. This is followed by a rapid-fire question and answer session on varied topics. Residents at all levels of training are expected to attend and this time is also protected.
VCU offers a robust online presence. A departmental intranet site hosts details for room setup, and rotation documents and provides links to key anesthesia texts. Many of these items have even become available to the members of the department on the VCU Anesthesia iPhone app. Through the VCU Health System, residents have access to a large repository of online journals and texts. Residents also host their own shared drive which offers resident review notes, lectures, questions, and podcasts.
Anesthesia residents are provided with our electronic medical system, EPIC. These question banks offer a personalized approach to keyword review and host thousands of practice questions. Weekly keyword topics and corresponding book chapters or journal articles are sent out to all residents for review. This helps facilitate daily conversation in the operating room. Our electronic medical record system, Cerner, allows for remote access at home. This allows residents to chart and review future cases in the comfort of their homes.
Point of Care Ultrasound
During the boot camp lecture series, junior residents will also enroll in an attending led point of care ultrasound course to teach residents ultrasound physics and how to make clinical decisions based on sonographic information. Areas covered include ultrasound for vascular access, transthoracic echocardiography (TTE), ultrasound-guided regional anesthesia and lung/abdominal examination.
This training is further enhanced by the routine use of ultrasound in the ICU, in the PACU, on the regional anesthesia service and during the CA3 TEE rotation. Residents are expected to complete a set number of examinations and review them with faculty. Additional instruction time with designated faculty is made during Friday morning conference and during down-time while covering the PACU or acute pain service.