Anesthesiology, Perioperative and Pain Medicine

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Q&A with Stanford Anesthesia's Residency Director

December 2012

Stanford preliminary medicine internship

I asked Dr. Louise Wen to tell us how her Stanford preliminary medicine internship is going. Her answer is below and may be useful for those of you interested in learning more the categorical anesthesia program clinical base year (n=8 positions).

Louise writes: I am halfway through my internal medicine preliminary year as a categorical Stanford anesthesia resident and could not be happier with my decision to rank the categorical program as my first choice. The quality of our training and education in medicine is phenomenal, the anesthesia program actively includes us as members of the department, and I am building friendships and a social network that will continue to support me as I transition into my anesthesia residency.

The Stanford Internal Medicine department strongly prioritizes education, and the supportive culture of the hospital facilitates learning and fosters patience for the inevitable mishaps of the newly initiated trainee. I feel comfortable asking anyone questions like “Why,” or “Can you please explain,” or “How did you come to that decision?” If I have a pressing patient-management question and my team resident or attending are not immediately available, I can easily visit another team and know I will be properly assisted.

One of my learning goals for this year has been to understand the nuances in antibiotic decisions. I am touched by the kindness of residents, fellows, and attendings who eagerly share their tips and strategies on antibiotics. One infectious disease attending even delivered an extremely helpful intern-directed lecture after I approached her with questions. In those moments of personalized teaching, I am grateful to be at a program where teaching is prioritized.

During these past six months, I have also had ample opportunities for procedures, including multiple central lines, arterial lines, lumbar punctures, arthrocenteses, paracenteses, and ultrasound-guided IVs.

Imprint, which you can read more about at
http://askalex.stanford.edu/archives/2012/10/imprint-an-inno.html
teaches the basics of transthoracic echocardiography, which has been a valuable bedside cardiac and volume status assessment tool.

The anesthesia department has other ways to keep the prelim interns involved. Before residency starts, we are assigned big sibling, either a CA-2 or CA-3, to be our resource point person. Also, a few afternoons every month, we staff the pre-operative assessment clinic. And, we are invited to the various departmental social events, including tailgate parties, barbeques, and specific interest dinners (e.g. research, critical care), which offers opportunities for us to develop friendships and mentors among residents and attendings. The best part of the year so far is our month-long anesthesia rotation in the Stanford main operating room, where we work alongside our future anesthesia and surgical colleagues.

My desire to establish a social support system was another priority that drove my decision towards ranking the categorical track first. Whenever I have free time, I enjoy deepening the friendships with my medicine and anesthesia peers. Palo Alto is within ten minutes biking or driving from the main hospital, where we can enjoy delicious and affordable cuisine.

An overview of the medicine residency is at: http://medicine.stanford.edu/education/program.html.

Below is a typical on-call day for the interns at Stanford and the VA Palo Alto. We are on-call two to three times a week. On a non-call (no new admissions) day, interns leave between 4-6pm, depending on patient volume and acuity.

7am: Arrive at the hospital for signout. Overnight team assigns new patients and provides updates on overnight events for old patients.
7:30-9am: Pre-round on existing and new patients.
9-10am: Attending rounds.
10-11am: Morning report. Breakfast snacks, tea, and coffee provided.
11am-noon: Finish up attending rounds, execute plan, work on notes.
Noon-1pm: Noon conference. Hot catered lunch, vegetarian options included.
1-2pm: Continue working on executing plan and coordinating patient care. Finish notes on old patients.
2-2:30pm: Team teaching by attending.
3-7pm: This is usually the busiest period of the day. On call days, we admit new patients throughout the day, but a surge of admissions from the emergency department or direct admits from clinic happen during this period. During this time, the non-call team also signs out their patients to us and go home, so we cross-cover their patients.
7pm: Signout all patients to the night team. Forward our pagers to the night team.
7-9pm: Review plan with resident on new patients. Enter admission orders and coordinate patient care. Finish admission notes on new patients.
9pm: Leave the hospital to be in compliance with work hour restrictions. Both the team resident and night resident work to help the day interns leave the hospital by 9pm.

I am grateful to have the opportunity to receive my preliminary year training with the Stanford medicine department. If I had to go through the process again, I would definitely rank it first again.

Thank you Louise for reflecting on your time here so far. Alex

Stanford Anesthesia Resident Women's Night

Every year for the past few years there is an Anesthesia Resident Women's Night for housestaff to catchup a bit and enjoy each others company. CA3 Vivianne L. Tawfik, MD, PhD who is a FARM Research Fellow in the Scherrer Lab organized the event.

She writes: Stanford Anesthesia residents are busy with schedules that sometimes make it difficult to get a group together but on November 15th, 2012 the stars were aligned and twenty five women residents got together for a wonderful night of good food and great conversation! Women from all three classes had the chance to relax and get to know each other outside of the OR. It was an opportunity for CA1s to ask questions informally about the program or specific situations they encountered and for all to learn that they were not the only one to miss an easy I.V. in front of a senior attending or sleep past their alarm on a day with a big case! Discussion of work-life balance was heard throughout the evening as we exchanged stories of the difficulties of trying to keep up relationships, attempts to continue outside interests and when best to start a family. Everyone had a wonderful time and left feeling more connected to their wonderful classmates in the Stanford Anesthesia program!

Thanks Vivianne for hosting!
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