Mike Plakke, MD
The CA-3 year brings opportunities to put together everything that was learned over the course of residency, and start building confidence towards independent practice. It is your first chance to play the role of “senior resident,” team leader, and begin to develop teaching skills.
Various electives can be tailored to your interests, be it clinical skills, research, fellowship, or private practice. Many of these are invaluable sources of skill and knowledge. The faculty members in every subspecialty division in Duke are world-renowned, and by the third year of clinical anesthesia, resident relationships with attendings start to feel more and more like peer-to-peer interactions. You start to ponder and discuss more thoughtful questions like, “How do I talk someone through performing a thoracic epidural?” rather than asking how much isoflurane to turn on after induction of anesthesia.
Several rotations unique to CA-3 residents are unanimously revered. The cardiac rotation at the Durham VA (across the street from Duke University Hospital) provides the opportunity to work one-on-one with cardiac fellowship-trained anesthesiologists. Residents learn how to perform and interpret a comprehensive transesophageal echocardiography (TEE) exam. We work directly with cardiac surgeons and cardiologists during multidisciplinary meetings to discuss challenging patient cases and review cardiac imaging studies. CA-3 residents also become adept at placing regional nerve blocks and catheters at the Duke Ambulatory Surgical Center (ASC, also across the street from Duke University Hospital), where you are the sole “block resident” for a large and varied case load of orthopedic and breast operations. During this rotation, you will routinely place 10-20 blocks per day, including paravertebral blocks which are standard of care for breast resections at the ASC. Possibly the best rotation of CA-3 is called Advanced Clinical Training (ACT). During the ACT rotation, we deal with the crème de le crème of surgical cases, including pheochromocytoma resections, total spinal fusions, awake craniotomies, and intracranial aneurysms just to name a few. We also get to supervise CA-1 residents during this rotation and realize how far we’ve come since our early days of practicing anesthesia, and how much harder it is to tell someone how to perform a complex task rather than doing it yourself.
Other advanced rotations available to CA-3s include: Advanced OB (I did an ex-utero intrapartum therapy case and multiple C-sections on parturients with congenital heart defects), Advanced Pediatrics (I did a tracheal resection on a 34-day-old neonate and a congenital diaphragmatic hernia repair), Advanced Neuroanesthesia (I did five awake craniotomies and at least five T2-pelvis spinal fusions), Chronic Pain, Acute Pain, Regional (one and a half months). You also have the opportunity to travel abroad in Central America or Africa to practice anesthesia with multiple faculty members.
The “on-call” experience as a CA-3 is fantastic. You play the role of team leader, directing a group of three CRNAs and one junior resident, under the guidance of a faculty member at night or on the weekend. You are not responsible for being in the ORs for cases; instead, you supervise other team members and come up with perioperative plans and treatments for all of the patients requiring (often urgent) operations. This “board-running” experience allows us to start to realize what our jobs will be like after residency.
Almost all CA-3s attend at least one academic conference per year, generally the American Society of Anesthesiologists meeting (with the giant Duke Anesthesiology Alumni event every year) and another if you are able to present a case or research report. I was able to travel to San Diego and Honolulu for academic conferences (and even saved a little time for sightseeing).
At Duke, most senior residents elect to pursue fellowship. In my class, 12 out of 14 of us became fellows, and two are out in the “real world.” By the end of residency here, we feel like we have seen almost everything and are either ready to go show the world what we can do, or dive even deeper into a subspecialty of our choice. Many of us decide to stay at Duke for another year of training, as we currently offer ten fellowships in numerous subspecialties (just peruse the rest of our website!)
Outside of work, CA-3 allows for more than ample time to enjoy Durham’s incredible food and brewery scene, athletic events, scenic hiking around Jordan Lake and Eno River and along the American Tobacco Trail, or travel west to Asheville and the Appalachian Mountains, or east to the beaches along the Atlantic Ocean.
I can’t say enough positive things about my residency at Duke Anesthesiology, and this blurb only gives you a small glimpse into the amazing variety and depth of experiences you will have if you decide to come here too.