Anu Doshi, MD
CA-1 year begins with a week-long orientation filled with simulations, lectures and reading assignments to ease you into the transition from the floors to the ORs. Over the following three weeks you are paired with a fellow CA-1 and attending, with pairs rotating weekly, so that you are under the direct supervision of an attending at all times while delivering your first anesthetics. This time is invaluable as you learn to troubleshoot problems like dysfunctional monitors and have all questions answered (including silly ones like how to fill a desflurane vaporizer)!
It is a difficult process getting accustomed to a new assortment of medications, a different workflow, and the constant stream of information that must be synthesized. The exhaustion from the first few days, however, is easily surpassed by the excitement from finally performing anesthesia. As you march through this initiation together, this month also serves as a unique bonding experience for CA-1s that builds a strong base for lifelong friendships.
Throughout the year you rotate through general surgery, orthopedics, ENT, obstetrics, gynecology, urology and plastic surgery. Each rotation helps you appreciate a different facet of anesthesia so that by the end of the year you feel comfortable and confident in your ability to perform regional blocks, neuraxial procedures, manage complex medical physiology, use a variety of airway tools, and appreciate different styles of anesthetics.
My typical day would involve coming to the operating room at 6 a.m. to draw up drugs, do a machine check and have lines ready. My anesthesia tech would greet me in the morning and make sure I had what I needed before I went to the preoperative area to check on my patient at 6:45. As most patients are screened by our preoperative clinic, I would often confirm that their medical history, allergies, NPO status and physical exam were reflected in Epic. Once their paperwork was complete, I would roll them back to the OR at 7:20 to induce, intubate and place any needed lines with the help of my attending. While all attendings are available for any concerns, most carve time out of the day to focus on a teaching topic relevant to my reading or my case. Additionally, our wonderful CRNA’s ensure that I would have 3 breaks in the day and be relieved in time for any afternoon lectures. The day would typically end after doing post op checks and reviewing my anesthetic plan for the following day with my attending.
One of my favorite parts of CA-1 year was overnight call. Our call structure is set up as a week of nights or weekend days with intermittent 24-hour Friday calls. Each time, you are paired with an attending and a CA-3. It is an opportunity to try out advanced cases and get practice with central lines and regional blocks. It’s also one of the few times you get to work directly with your colleagues in the operating room and learn life hacks that extend from learning to organize multiple infusions to how to approach upcoming rotations. Most importantly, it ends with a Friday morning breakfast, a tradition that has extended for years.
CA-1 year is full of exciting new challenges that are easily met with the support of peers and faculty. The surgical case demands and the complex medical physiology make each case an opportunity for learning. Even on “text book cases” you are encouraged to try new airway techniques, integrate regional anesthesia, and attempt new recipes for general anesthesia. You are even exposed to research early in CA-1 year through quality improvement projects and have the opportunity to present at Duke’s Academic Evening. Your experiences during CA-1 year provide tremendous avenues for growth and create a great foundation for your anesthesia training.