Evolution of Anesthesiology Residency Programs

By May 20, 2019Uncategorized

Residency is a critical step after medical school. It is during this time that students become physicians, and learn how to not only care for patients, but also make life-or-death decisions. For residents in anesthesiology, this is of the utmost importance. While aspiring anesthesiologists may have had exposure to the field during medical school through sub-internships or electives, first-hand experience is the greatest teacher. Yet, residency education has evolved significantly over the past several decades, broadening its scope to include research, education, and pedagogy. Furthermore, tools utilized to evaluate potential residents, such as the National Resident Matching Program, are themselves undergoing evaluation to ensure that well-qualified applicants are in the pipeline to become anesthesiologists.

Residency, while an important and necessary stage in becoming a licensed, practicing physician, is not necessarily guaranteed. Fourth-year medical students are assessed in a variety of ways in order for residency programs to assess their aptitude as a future intern and/or resident1. Students must pass the United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3 prior to entering residency, preferably passing with high scores.
In addition to high board scores, students are encouraged to participate in research, with the goal of being published in peer-reviewed journals. Lastly, the more exposure that a student has to the field of anesthesiology, the better. Students who match successfully into their top program of choice have typically taken anesthesiology electives, potentially ICU or other sub-specialty field electives, as well as participated in away rotations. Each of these factors is integrated with the National Resident Matching Program, which conducts an algorithm that aligns student preferences with residency ranking lists.

preferably passing with high scores.
In addition to high board scores, students are encouraged to participate in research, with the goal of being published in peer-reviewed journals.

Lastly, the more exposure that a student has to the field of anesthesiology, the better. Students who match successfully into their top program of choice have typically taken anesthesiology electives, potentially ICU or other sub-specialty field electives, as well as participated in away rotations. Each of these factors is integrated with the National Resident Matching Program, which conducts an algorithm that aligns student preferences with residency ranking lists.

However, is the National Resident Matching Program totally consistent with ultimate student performance as a resident? Recent research suggests that the answer may be more nuanced than at first glance. In research presented at the 2018 American Society of Anesthesiologists meeting, Dr. Wajda of NYU Langone produced results for a long-term study that he and his research team conducted that compared National Resident Matching Program ranking with clinical performance2. Initially, ranking and performance were directly correlated at high ranking and decreased incrementally — however, at a certain low threshold, low ranked candidates appeared to be correlated with high clinical performance. The abstract, titled The Lowest Ranked Candidates on the NRMP List May Be Your Best Performers, sought to re-examine the accepted standardized metrics by which candidates are assessed as future residents by illuminating such distinctions.

Indeed, while traditional anesthesiology residency programs included intense overnight call shifts and multiple rotations across units, modern programs have aimed to include elements of research, education, and pedagogy3. Most competitive residency programs for anesthesiology now offer multiple incentives including scheduled time off for residents to attend at least one academic conference per year, even in non-research track programs. Furthermore, residency programs in anesthesiology may also include programing for seminars and other educational materials, as well as opportunities for residents themselves to be involved in teaching more junior trainees and/or medical students at affiliated medical schools. While still an undoubtedly difficult and rigorous time, residencies are now recognizing the holistic nature of a highly qualified anesthesiologist, requiring multiple levels of exploration and training, all of which contributing to developing future leaders in the field of anesthesiology.

1. Watt, Stacey, and Mark Lema. “What Makes a Competitive Anesthesiology Candidate?” ASA Guide To Anesthesiology For Medical Students, American Society of Anesthesiologists, 2019.

2. Wajda, Michael C. “The Lowest Ranked Candidates on the NRMP List May Be Your Best Performers.” American Society of Anesthesiologists, NYU Langone, 2018. https://urlzs.com/k9Bg

3. Stedman, Robin B. “Core program education: tracking the progression toward excellence in an anesthesiology residency program over 60 years.” The Ochsner journal vol. 11,1 (2011): 43-51.