Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

November 2008

CRNAs

Question from applicant
Dear Dr. Macario,While I was on my rotation at Stanford, I was able to obtain some feedback from the current residents regarding CRNAs at Stanford. I would be interested to have your perspective. As I understand it, there currently aren't any CRNAs within the department. Do you think CRNAs will have a role within the department in the future? And if so, how do you think it might impact the residency program? Thank you.

Response:
Your question is a good one. Stanford anesthesia residents have rotations in 4 hospitals, and two of these hospitals, the Palo Alto VA Medical Center and the County Hospital in Santa Clara, do have a few CRNAs. The majority of the resident's time however is spent at the main Stanford University Hospital and at Packard Children's Hospital in which physicians provide all anesthesia care. Most academic anesthesia departments in the United States have CRNAs as part of the staffing for the growing number of cases in the operating rooms. We are currently evaluating whether to incorporate CRNAs in our department. In fact, a survey of our faculty this year showed that many are interested in working with CRNAs.

For those of you in the 2009 NRMP match, that means you'll finish your residency in 2013 and some of you will practice till 2050. A fundamental question then is: "What will the day-to-day job of the anesthesiologist be in twenty to thirty years?" One model that looks increasingly likely is for the anesthesiologist's advance medical training to be fully utilized and reserved for the most complex patients. This may require most graduates doing a clinical fellowship (last yr 12 of our 21 graduates signed on for a fellowship - a record high percentage!) to have the subspecialty expertise, in ICU, cardiac, or peds for example, to care for the sickest patients. Along with this, the physician anesthetist will likely supervise nurse anesthetists as part of an anesthesia care team for routine patients. Remember that there aren't enough anesthesiologists in the country to do all the anesthetics required, so working with CRNAs is commonplace for our trainees after residency even now. Residency programs that do have CRNAs believe that the best learning cases are reserved for the resident. The model we've used at Stanford up till now is for the best learning cases to be done by the residents, and the more routine cases performed by attending anesthesiologists solo. The faculty is currently deliberating the role of CRNAs in the department's future. Thank you,

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Stanford anesthesia interview day

Thank you for inviting me to interview Dr. Macario. I wanted to find out more about the actual interview day. What is the typical schedule for the applicants? Thank you, Jody

Alex Answers:
Dear Jody,
We have twelve interview days spread across December and January with 12-14 applicants per day. The day actually starts the night before with dinner at a nice Palo Alto restaurant (Nola's Restaurant is a favorite) with some of our current residents. In the morning, the applicants assemble in our conference room at 8 AM. Then I welcome all of you and give a 30-minute presentation summarizing the residency, followed by Dr. Pearl, our chair, who also speaks for 30 mins. This is followed by 3-4 interviews with faculty members, one of which is for 15 mins with Dr. Pearl. At noon, you will have lunch with current housestaff and the Chief Resident will give you a tour of the hospital. Sometimes if applicants want to meet with other faculty that gets scheduled for the afternoon. Otherwise we try to get people out the door by 2pmish.

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Question: Stanford Research Career Development Award

Dear Dr. Macario,

I am extremely interested in the Stanford Research Career Development Award program and will be submitting my application shortly. I just had a couple of questions I was hoping you could answer. When I come to interview for the Anesthesiology program at Stanford, will I have the opportunity to meet with potential research mentors? Also, my research interest is in basic pain mechanisms and therefore I am hoping to pursue a career in clinical pain management to complement this work; when do Stanford Research Award recipients usually complete clinical fellowships? Is it before or after the research time?

Thank you in advance, I look forward to hearing from you,

V


Alex Answers:

Dear V,

I am delighted to hear of your interest. The award, we now call it the FARM scholar for short for Fellowship in Anesthesia Research and Medicine at Stanford, really tries to provide the best environment possible for people to prepare for and succeed in academics, and is quite flexible. In terms of applying normally what we do is to wait after the Match as this allows you to get to know the dept better and who would be a good mentor, and lab. When you come interview we will have you meet Drs. Sean Mackey and David Clark. Another person you will meet with is Dr. Rona Giffard who is vice-chair for research. Please also look at the med school faculty outside the dept for potential mentors. One of the current FARM scholars has done this. In terms of the clinical fellowship that can come before, during, or after the research time depending on what seems like the best strategy overall.

Thank you,

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