A Day in the Life of a UTMB Anesthesiology Resident
JP Wondra, MD - PGY-1 (Intern Year)
"An advantage of residency at UTMB is that it uses a “split-year” internship schedule. Instead of a traditional anesthesia residency with one year of internal medicine followed by 3 years of clinical anesthesia, UTMB starts clinical anesthesia rotations during the first year of training. Interns begin clinical anesthesia training sooner and start developing skills such as intubations, lines, pushing drugs and all the fun things that drew you to anesthesia in the first place. While still providing a comprehensive internal medicine foundation that spreads some medicine rotations to the second year, this curriculum integrates interns into the anesthesia department from the start. You work with anesthesia faculty and residents from the beginning, rather than being separated from your department during a traditional intern year. It also provides a more longitudinal anesthesia training experience to help master difficult concepts and skills. I enjoy the variety of mixing anesthesia rotations with medicine rotations. This schedule also allows for some lighter rotations during second year so you have additional time to study prior to taking the Basic board exam."
Lauren Rein, MD - CA-2 (Operating Room Rotations)
“I usually start my day in the OR around 6am. On Wednesdays, Thursdays, and Fridays, we have resident lectures at 6:30am before cases, and we meet our patients and faculty in holding after lecture. Together with the faculty, we bring our patient to the OR for a 7:15 start time. I intubate and place lines - faculty are there to support me if I need extra hands. Although my patients are asleep for the majority of my workday, I am constantly providing patient care. I manage my patients’ comorbidities and treat intraoperative hemodynamic changes as they arise. I get a morning, afternoon, and lunch break, and I look forward to catching up with peers and faculty in the department lounge during those times. Typically, the day ends around 4:30pm. When I get home, I open up the EMR to read about my cases for the following day and then call faculty to discuss anesthetic plans. After a quick walk and dinner, I usually head to sleep around 9pm.”
Tejas Kollu, MD - CA-1 (OB Anesthesia)
“A day on OB typically starts at 6am. Residents come in and make sure the operating rooms are set up (MSMAIDS along with pumps programmed with pressors) and all the epidural carts are appropriately stocked with medications and neuraxial anesthetic kits. At 6:40, residents attend a daily lecture on obstetric anesthesia topics ranging from anatomical/physiological changes that happen during pregnancy to neuraxial anesthetic complications. Residents will then take handoff from the on-call residents and learn about the laboring patients and the cases scheduled for the day. The OB day team usually consists of 3-4 residents and two faculty. Throughout the day, residents alternate between providing anesthesia care (spinals and combined spinal epidurals) for cesarean sections and placing epidurals on the laboring floor. Residents will work until 4:30pm. At that time, the OB call team takes over and learns about any high risk patients and the running epidurals on the floor. Some nights on call can be very busy, consisting of epidural requests, tubal ligations, and crash/urgent/splash c-sections. Although our night residents work hard, we become very comfortable with our skills and ability to take care of any obstetric patient that walks into the hospital.”
Amit Aggarwal, DO - CA-2 (OR Call)
“There are two types of OR call at UTMB: Senior (SR) and Junior. CA-1’s and interns are first exposed to Junior call. As a Junior, your responsibility is to be the resident in the OR for any cases that may come your way. You are the person carrying out the case with the assistance of the SR resident and faculty on call with you. Cases can range from simple I&D’s to emergency appendectomies or cholecystectomies to traumas to kidney transplants and the occasional roll back craniotomy. It is a great opportunity to gain early exposure to complex cases. On weekends this means working a 24-hour shift from 6:45am. Junior call is also great because you can remain focused on only one case (yours) at a time. There are no responsibilities outside of the OR when you are in a room. When not in a case, your time is spent relaxing in the lounge, sleeping in your call room, or assisting the SR with any emergent airways on the floor. Further along in your training, you can be assigned SR call. First and foremost, the SR acts as support for their two Juniors, giving breaks, assisting with induction and emergence, and performing the preoperative assessment for any emergent or add-on cases the call team will have. The SR also acts a sort of junior faculty, assisting with the prioritization of cases, helping to formulate an anesthetic plan, and being available for any intraoperative problems the residents in the OR may have. The SR also carries the code pager and is responsible for responding to any emergent airway in John Sealy, Jennie Sealy Hospital, or Shriner’s Burn Hospital.”
Sager Mulay, MD - CA-3 (Shriners Burn Hospital)
“The Shriner' s Pediatric Burn Hospital is one of our most unique experiences here at UTMB! You will rotate there as a CA-2 and again as a CA-3 as an elective. At Shriner's, you will learn valuable skills such as awake nasal fiberoptic intubations, pediatric central lines (subclavian and femoral), and volume resuscitation. Pediatric patients are transferred from all over the world following catastrophic injury such as flame burns, electrical burns, acid burns, inhalational injury, adverse medication reactions including Steven Johnson’s and Toxic Epidermal Necrolysis, and all the sequela these lead to. Because of this exposure, you will become very confident taking care of acutely critically ill patients in the operating room. You will see a variety of cases, from acute burn debridement and grafting to outpatient procedures such as burn scar contracture releases and occasionally major reconstructive cases. Aside from the clinical experience, the people that work at the Shriners are very kind and compassionate; they make you feel like family on day one.”
Mario Palma, MD - CA-1 (Surgical ICU)
" After the morning lecture ends around 7:15 am, you’ll head to the SICU and start chart reviewing and checking on your patients before rounds. We cover a wide variety of patients including vascular, cardiothoracic, general surgery, gynecology, ENT, plastic surgery, and transplant patients requiring critical care. On a typical day you will cover 2-3 patients. On most days there will be a medical student working with you who will present your patient during rounds, so I usually go over their presentation beforehand, filling in any gaps. Rounds start between 9-10am and are great for teaching. Faculty cover anything including ventilator management, hemodynamics, sepsis, infectious disease, hematology, and more. After rounds, you’ll enter any orders that weren’t entered during rounds and do any procedures that your patient needs. These include arterial lines, central lines, bronchoscopy, etc. You’ll spend the rest of the day following up on labs and communicating with the various teams and consult services that are also caring for your patient. Afternoon rounds start around 4pm and are designed to update the overnight resident and faculty about any changes that happened with your patients during the day. On most days, your shift ends when afternoon rounds are done.
Zachary Culp, MD - CA-3 (Anesthesiology Pain Service)
“The “Block Team” starts their day around 6:15 am. We look at the OR schedule the day before so we know what start cases we need to prepare for regional anesthesia. Once our first patient arrives, we bring them to the block room where we place our block and then transfer their care to the OR anesthesia team. On busy days, we spend most of the morning placing blocks either prior to surgery in the block room or post-op in the PACU. Sprinkled throughout the day will be acute pain consults that we are alerted to by either the EMR or our pager. After lunch, we round on acute pain consults on the floor with our faculty. After rounds, we finish our notes, complete any more blocks in the PACU, and start to plan for the next day. We finish our day by emailing the surgeons and anesthesia residents the planned blocks for the following day and follow up on all the blocks we placed that day. By the end of the rotation, I felt very comfortable placing all of the most common blocks, as well as some lesser used blocks. It was very rewarding to provide almost immediate pain relief to these patients.”