Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

July 2010

Medical school grades

Medical school grades, in particular during the 3rd year clinical rotations, are an important part of the residency application to any residency including Stanford Anesthesia. This is in large part because what the student does on a clinical rotation is the closest thing we have to what they will do as an anesthesia resident.

However, one of the challenges for all Residency Selection Committees is that each medical school has their own grading system. These schemes could have a letter "C" stand for average for a school that use an A/B/C letter grade system, or "commendable", or even "completed". Thankfully, grading keys that explain the grading system are often provided with the transcripts in ERAS. Residency programs spend a fair amount of time deciphering these grading structures when reviewing files. It is most helpful when the school provides a Table or Diagram indicating what percentage of the students get a particular grade on a particular rotation.

A recent study by Shimahara from the ENT department here at Stanford published in June 2010 in the J of Graduate Medical Education found that


64% of medical schools used either an H/P/F grading system

17% of medical schools used a variant of the A/B/C system in which A or Aplus is the highest grade

5% of schools including UCLA for example use a P/F system.

3% of medical schools used a grade point average with a high being 4.0.

11% of schools used either a combination of the aforementioned systems or grade systems that were "undecipherable"!

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Should you do a fellowship after anesthesia residency?

This question arises frequently among applicants and then as well once the person is in residency. I believe there are many advantages to a fellowship year including 12 more mths of clinical experience and seasoning before the anesthesia trainee is fully responsible for a patient, time to optimally prepare for the oral exam needed for board certification, and satisfying a curiousity about a particular subspecialty.

The reality is that anesthesiology has become so broad and deep that an additional year is needed to get indepth expertise in a clinical area. At the Stanford Anesthesia Residency two thirds of graduates are entering fellowships, the largest fraction ever.

The recognized fellowships by ACGME (which follow the same duty hour and competency rules as residencies) are:
1. Pain Medicine -- 80 programs and 223 fellows nationally
2. Critical Care Medicine -- 45 programs nationally (only half of approximately 120 positions filled however). In contrast, pulmonary medicine ICU has 133 programs with 1266 fellows, surgery has 94 ICU programs with 153 fellows, Medicine has 32 programs with 136 fellows, and Neurology 25 programs with 91 fellows.
3. Cardiothoracic anesthesia -- 33 programs with almost all of the 108 positions filled.
4. Pediatric anesthesia -- 151 Fellows in 2009.

If more anesthesia residents (total number of about 1500-1600 graduates per year) are to do fellowships, and there are fixed number of fellowship slots (N=approximately 600-700 for the 4 ACGME accredited fellowships), what other fellowships are available at Stanford?

Examples of non-ACGME Fellowships
Obstetric Anesthesia
Patient Safety & Crisis Management
Clinical Research
Laboratory Research
Management of Perioperative Services
Neuroanesthesia
Difficult Airway/ENT
Regional Anesthesia
Liver Transplantation
Pediatric Pain Management
Informatics

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Future plans for graduates of Stanford Anesthesia Class of 2010

The Stanford Anesthesia Class of 2010 just finished last week and are on their way to their next career step as follows:

Shea Aiken-----Cardiac Anesthesia Fellowship, Stanford
Rob Becker-----Private Practice, Fremont, CA
Jon Bradley-----Cardiac Anesthesia Fellowship, Stanford
Marisa Brandt-----Private Practice, Corvallis, OR
Stephen Fink-----Private Practice, Newport Beach
Darin Flynn-----Private Practice, Carson City, NV
Joyce Hairston-----Peds CV, Peds Anesthesia Fellowships, Stanford
Jenna Hansen-----Regional Anesthesia Fellowship, Stanford
Billy Hightower-----Private Practice, Detroit, MI
Vince Hsieh-----Peds Fellowship, University of Washington
Meredith Kan-----Stanford Attending
Zoe Kaufenberg-----Navy-San Diego, CA
Jessica Kentish-----Private Practice, South Denver, CO
Zeest Khan-----Cardiac Anesthesia Fellowship, Stanford
Milo Lochbaum-----Private Practice, OR
Nisha Malhotra-----Regional Anesthesia Fellowship, UCSD
David Parris-----Private Practice, San Francisco Bay Area
Tzevan Poon-----Internal Medicine Residency, University of Washington
Karim Rafaat-----Peds Anesthesia Fellowship, Stanford
Frain Rivera-----Private Practice, San Jose, Ca
Brooks Rohlen-----Private Practice, Seattle, Washington
Sam Seiden-----Peds Anesthesia Fellowship, Chicago
Stephanie Steinhoff-----Peds Anesthesia Fellowship, Stanford
Ying Tian-----Pain Medicine Fellowship, Stanford

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