Stanford Combined Internal Medicine/Anesthesiology Residency

The structure of our program is as prescribed by the ABA and ABIM guidelines.

• PGY-1 12 months of medicine internship (http://medicine.stanford.edu/residency.html)
• PGY-2 12 months of anesthesiology (http://med.stanford.edu/anesthesia/education)
• PGY-3 through PGY-5 6 months per year devoted to each specialty, alternating in three-month periods through senior-level rotations.

 Candidates should apply to (and need to interview at) both internal medicine and anesthesia residencies via ERAS as if they were applying independently to those residencies. They may then rank the combined medicine/anesthesia program independently of the other Stanford internal medicine and anesthesia residencies. The NRMP code for the Stanford combined medicine-anesthesiology program is 1820742C0.

• PGY1s in the combined program participate in once a month online module: the Stanford Successful & Transition to Anesthesia Residency Training (START) program along with the other anesthesia interns (http://aim.stanford.edu/project/start)
• Residents in the combined program:
  • Transition to medicine within the first 3 months of their PGY-3 year, to avoid 18 straight months of anesthesia. 
  • Continue to have an IM primary care continuity clinic throughout the five year residency. During medicine blocks, this clinic is 2-4 times per month. During anesthesia blocks, this clinic is once per month.
• Vacation time is taken proportionally equal to time spent in each residency in a given year.
• Residents are encouraged to attend all teaching conferences for both departments regardless of which department they are rotating through. They are expected to attend one teaching conference in each specialty at least once per month. Medicine teaching conferences include daily resident reports and noon teaching conferences, as well as weekly grand rounds. Anesthesia conferences include weekly grand rounds and weekly didactic lectures by class.
• Residents in the combined program take written exams for both residencies. Residents will take the medicine In-Training Exam (ITE) on an annual basis, and the anesthesia ITE on an annual basis starting in PGY-2.
• Residents will also participate in simulation programs provided by the both departments. Anesthesia Crisis Resource Management (ACRM) and EVOLVE take anesthesia residents through various crisis scenarios in the operating room. SCARED and SMART train medicine residents to deal with a variety of code and pre-code situations in the hospital.

Duration at Each Teaching Facility

Our residency program allows trainees to care for a wide variety of patients from Stanford Hospital and Clinics, Lucille Packard Children’s Hospital, the Palo Alto Veteran’s Affairs Hospital, and Santa Clara Valley Medical Center. 

More detailed ACGME, ABA, and ABIM Program Requirements for Combined Residencies

• Medicine
  • A minimum of 4 months of critical care (MICU, CCU) rotations
  • A minimum of 1/3 of Internal Medicine training occurs in ambulatory setting, and minimum of 1/3 in inpatient setting
  • A longitudinal continuity clinic of 130 one half day sessions over the course of training, including one clinic per month
  • The continuity clinic includes evaluation of performance data for resident’s panel of patients
  • Exposure to each of the internal medicine subspecialties and neurology, and an assignment in geriatric medicine
  • An emergency medicine experience of four weeks
  • Electives available in experience in psychiatry, allergy/immunology, dermatology, medical ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, palliative medicine, sleep medicine, and rehabilitation medicine
• Anesthesiology
  • Two one-month rotations in obstetric anesthesiology, pediatric anesthesiology, neuro anesthesiology, and cardiothoracic anesthesiology
  • A minimum of one month adult intensive care unit during each of the last 3 years
  • Three months of pain medicine, including one month in acute perioperative pain, one month in chronic pain, and one month of regional analgesia/peripheral nerve blocks
  • One month in a preoperative evaluation clinic
  • One-half month in a post anesthesia care unit
  • No single subspecialty, excluding critical care medicine, exceeds six months total

Question: Why would one train in two different specialties?

Answer: Combined training in Medicine and Anesthesia provides a trainee with a truly unique combination of skil lsets, allowing them to be well-positioned to be leaders in their fields. Many of our residents are interested in critical care, which is a natural intersection between Internal Medicine and Anesthesiology. Furthermore, as patients undergoing surgery become more and more complex, a strong knowledge base in Internal Medicine will inform one’s management of these patients. A natural passion for learning also drives many of our residents.

Question: How do I apply for the combined internal medicine-anesthesiology program?

Answer: Candidates should apply to both internal medicine and anesthesia residencies via ERAS as if they were applying independently to those residencies. They may then rank the combined medicine/anesthesia program independently of the other Stanford Internal Medicine and anesthesia residencies. The NRMP code for the Stanford combined medicine-anesthesiology program is 1820742C0.

Question: For the application itself, is there a preferred number of letters of recommendation and distribution between anesthesiology letters, medicine letters, or letters from other specialties?

Answer: Please apply as if you were applying to each residency separately with separate letters and essay (you may mention interest in combined program, of course). This is because the faculty in both departments will want the applicant to fully fit in their own programs, and because if the person doesn’t match in the combined program, we still strongly consider them for either a medicine only residency or an anesthesia residency only. Ideally, please also mention in your personal statement how you could see a combined Medicine-Anesthesia program fitting with your career goals.

Question: What is the process for coordinating the application process between the two departments?

Answer: Applicants to the combined program will need to interview at both the Internal Medicine and Anesthesiology programs. Once both residencies invite you for an interview, we work with the applicants to facilitate interview dates that are convenient.

Question: How is the training divided between the two residency programs?

Answer: The first year will be an internal medicine internship (PGY1), followed by one full year of anesthesiology training (PGY2). The remaining three years (PGY3-5) will have six months per year dedicated to each specialty, alternating in 3-month periods.

Question: Will residents in combined program have faculty mentors?

Answer: Yes. One of the hallmark features of Stanford is a strong belief in the importance of intensive faculty mentorship, and you will be matched with mentors from both Departments. One example is Dr. Cliff Schmiesing who trained in medicine and anesthesia and now has important leadership roles in preoperative assessment of high risk patients as well as hospital informatics. 

Question: What will graduates of this program do?

Answer: Most of the current residents are interested in critical care. However, with ongoing and future changes in medicine and healthcare, our trainees’ interests are just as dynamic. Certainly, graduates will be trained broadly to play an important role in organizing and providing care to the sickest and most complex patients. On one end of the spectrum the graduate could practice anesthesia full time and at the other end could practice internal medicine full time. In between are other exciting possibilities: for example, critical care, pain medicine, hospitalist work, and perioperative management of surgical patients.

Carlos Brun, MD

Associate Program Director
cbrunmail@yahoo.com