Rebecca Donald, MD
The transition from intern year to CA-1 year is very exciting and a little scary too! This is the year you put away your white coat and dress shoes and don scrubs and comfy shoes; you trade your patient lists and rounding sheets for the history and plans for your patients in the operating room. CA-1 year starts with a week-long out-of-OR orientation led by select attendings and our academic chiefs. It is filled with lectures, simulation and reading assignments to help you grasp the basic concepts of anesthesia. Not only is this a time to learn about how the ventilator works; the basics of anesthetic induction, maintenance and emergence; and general principles of fluid management, it is also a great opportunity to strengthen bonds with classmates and get to know upper-level residents and attendings even better. You are finally about to start doing the work you’ve been waiting to do, and it is a very exciting time!
Following the week of classroom orientation, you transition to the operating room where, for those first three weeks, you are partnered with a fellow CA-1 and supervised by an attending or a CA-3 resident. During this time, you learn to troubleshoot dysfunctional monitors and beeping IV pumps, and all of your questions are answered (even the simplest of questions, such as how to connect the suction canister and tubing so that it actually sucks!). The CA-1 pairs rotate weekly, so you can learn from each other while also being under the direct supervision of the attending or upper-level resident as you deliver your first anesthetics.
After orientation is over, you transition to caring for patients on your own in the operating room. I think most anesthesia residents remember the feelings of nervous excitement the first time we were left alone in the OR with our patients. Fortunately, the attendings are never more than a text message or page away. They are always happy to help troubleshoot equipment, answer questions about medications, and teach about patient-specific issues. In fact, one of the things that impressed me the most about CA-1 year was how patient the attendings were with me as I did things I had never done before and how much they enjoyed teaching me as we cared for patients together. You quickly learn that anesthesia is a “team sport” and we are all here to care for patients and keep them safe before, during and after their operations.
CA-1 year is comprised of rotations that allow residents to learn the basics of anesthesia, and it provides a solid foundation for the transition to specialty rotations that come at the end of the year. Throughout the year, you rotate through the main ORs for general surgery, gynecological surgery, orthopaedics, plastic surgery, urological surgery, and ENT. You also spend a month on the obstetric floor learning to care for those special patients and improving your neuraxial skills. A month in the surgical ICU provides some out-of-OR time that allows you to learn how to take care of ill, post-operative patients, while also allowing you to reflect on how your intraoperative anesthetic impacts patients postoperatively. Spending a month across the street at the Veterans Affairs Medical Center provides a change of scenery from the Duke ORs and offers the opportunity to care for our veterans. The VA is an enjoyable rotation as you are able to do some procedures that you may not have done before. What is more, the attendings at the VA enjoy teaching and provide a great learning environment. Another favorite CA-1 rotation is at Duke Regional Hospital (DRH) which offers a glimpse into what private practice anesthesia is like. The attendings and CRNAs at DRH appreciate having residents as part of the care team and are happy to provide “pearls” to help you provide better care to your patients. This is a great opportunity to learn from other skilled anesthesia providers away from “Big Duke.”
Preparation for a typical day consisted of reading about my patients the night before and developing an anesthetic plan. Most of our patients are screened in the preoperative anesthesia clinic, so the majority of their information is already compiled into a note in the computer. After reviewing their medical records, I spoke to my attending via phone to discuss the patient’s comorbidities, any anesthetic concerns, and to finalize an anesthetic plan together. After a good night’s rest, I arrived at the hospital at 6 a.m., checked my machine, prepared my lines, and drew up my drugs. Around 6:50 .am., I’d meet my patient and attending in the preoperative area to confirm allergies, pertinent medical history and NPO status; to perform a physical exam; and to complete the necessary paperwork. At 7:20 a.m. I’d transport my patient to the OR, hook him/her up to the monitors, induce, and place lines with the help of my attending. While the attendings are always available in the moment for questions or concerns, they also dedicate time each day to teaching about about patient or case-specific topics. While the days are busy in the ORs, thanks to the CRNAs, I reliably received a morning break, lunch break, and afternoon break, and was relieved for lecture in the afternoons. Not only do the CRNAs relieve us from the OR, they also prove to be valuable educators as they have been providing anesthesia for longer than we have. The CRNAs understand that we are early in our anesthesia careers and they are always willing to help as well as offer tips and tricks for how to better care for our patients.
One of the most valuable experiences of CA-1 year is taking call. CA-1s are paired with a CA-3 and an attending for Friday night call, weekend call, and night call. Call offers the opportunity to learn anesthetic management and technical skills from your upper-level and attending, as well as to provide anesthetics for advanced cases that you may not have done before during a typical day in the OR.
Finally, although you spend a great deal of time in the OR, CA-1s also have opportunity to engage in research and participate in quality improvement projects with colleagues in the CA-2 and CA-3 class. Any research or interesting cases can be presented at Duke Anesthesiology‘s Academic Evening, which is an annual, departmental event that celebrates the research and discoveries of your colleagues outside of the OR.
While CA-1 year is challenging, it is also very exciting and rewarding. You learn to manage complex medical patients, navigate difficult airways, provide general anesthesia with a myriad of drugs combinations, and explore regional anesthesia techniques. It is amazing to look back on the year and to see how far you have come under the mentorship of faculty and the support from your peers.