Curriculum

Anesthesiology Residency Curriculum 

Dignity Health St. Joseph’s Medical Center Anesthesiology Residency four-year program offers a robust and comprehensive training experience with opportunities to rotate to several affiliated institutions, including Mercy San Juan Medical Center, Shriners Hospitals for Children - Northern California, Valley Children's Hospital and and San Joaquin General Hospital.

The core curriculum for anesthesiology residents comprises a series of learning modules. The modules focus on basic and advanced topics outlined in the American Board of Anesthesiology (ABA) examination content outline, ABA certification requirements, leadership and healthcare systems fundamentals, and essential clinical skills. Residents will have daily lectures in the first month (July), and from then on, once-weekly lectures on the signed academic day (Friday) starting in August of each calendar year and extending through the end of June of the next year. 

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Clinical Base Year (CBY)

The categorical positions begin with an integrated internship at Saint Joseph Medical Center. The internship is designed to offer the intern  a foundation  in  medical  and  surgical  specialties, and  an introduction to anesthesiology. The curriculum of the year is divided into four-week block rotations.

Clinical Base Year (CBY) Rotation Schedule
Rotation - Length

• General Internal Medicine - 3 months
• Pulmonology - 2 month
• Critical Care Medicine - 2 months
• General Surgery - 1 month
• Infectious Disease - 1 month
• Emergency Medicine - 1 month
• Cardiology - 1 month
• Research & Procedures - 1 month
• General Operating Room - 1 month
  

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Clinical Anesthesia Year 1 (CA-1)

The curriculum will be intensive and progressive to help with skill-building and knowledge consolidation. It will focus on the basic principles of general anesthesiology necessary to function as an anesthesiologist. It begins with daily lectures during the first month followed by a half-day academic seminar every Friday, which is dedicated to interactive teaching, lectures, simulation, and board reviews. The first half of the year is dedicated to the general operating room where, the second half of the year allows residents to start subspecialty rotations, especially those with an interest in pursuing a fellowship. 

Clinical Anesthesia Year 1 (CA-1) Rotation Schedule
Rotation - Length

• General Operating Room - 7 months
• Critical Care Medicine - 1 month
• Obstetric Anesthesia - 1 month
• Neuroanesthesia - 1 month
• Acute Perioperative Pain Management - 1 month
• Cardiothoracic Anesthesia - 1 month
• Pre-operative Clinic - 0.5 month
• Post Anesthesia Care Unit - 0.5 month
  

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Clinical Anesthesia Year 2 (CA-2)

During this year, residents will continue to feed their careers with skills and knowledge with more detailed clinical exposure to anesthesia subspecialties. In addition, the CA-2 year gradually gives residents increasing levels of responsibility and autonomy with patient care, especially in the tasks already mastered in the CA-1 year. 

Clinical Anesthesia Year 2 (CA-2) Rotation Schedule
Rotation - Length

• General Operating Room - 1 month
• Critical Care Medicine - 1 month
• Neuroanesthesia - 1 month
• Regional Anesthesia - 1 month
• Ambulatory Anesthesia - 1 month
• Acute Perioperative Pain Management - 1 month
• Cardiothoracic Anesthesia - 1 month
• Thoracic Anesthesia - 1 month
• Pediatric Anesthesia - 2 month
• Chronic Pain - 1 month
• Obstetric Anesthesia - 1 month
• Elective - 1 month
  

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Clinical Anesthesia Year 3 (CA-3)

Senior residents have the opportunity to custom their training to what aligns with their personal and professional goals and ambitions. In addition to having the opportunity to engage in research projects, residents will meet all the requirements to sit for the Basic Perioperative Transesophageal Echocardiography Examination.

Clinical Anesthesia Year 3 (CA-3) Rotation Schedule
Rotation - Length

• General Operating Room (Advanced Clinicals) - 4 months
• Pediatric Anesthesia - 2 month
• Research - 1 month
• Cardiothoracic Anesthesia - 1 month
• Obstetric Anesthesia - 1 month
• Regional Anesthesia - 1 month
• POCUS/TEE - 1 month
• Non-Operating Room Anesthesia (NORA) - 1 month
• Elective - 1 months
  

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Didactic Series

Academic Day (AD)

As an integral part of the residency program, the academic day is designed to complement and enhance the resident’s experiential learning throughout the year. Starting in August of each calendar year and extending through the end of June of the next year, every Friday is dedicated to the core curriculum educational activities. Broad ranges of topics are selected to enable residents to learn about various aspects of clinical anesthesiology. These topics include interactive lectures, Problem-Based Learning Discussions (PBLD), simulation, written board reviews, and mock orals.

Educational Activities

The core curriculum for anesthesiology residents includes the following educational activities:

1. Expectation of Residents

The residents should review the learning objectives before each session, complete all required pre- readings assigned before each session. All attending residents are expected to actively participate in the discussions during the session. Also, residents are expected to review the pertinent medical literature on appropriate clinical subjects.

2. Self-Directed Learning Plans (SDLP)

We implement a curriculum using self-directed learning plans (SDLPs) based on clinical questions arising from the resident’s practice. The primary goal of this activity is to foster the development of the residents as adult self-directed lifelong learners and enable them to recognize and fill knowledge gaps.

3. Introductory Lectures Series
Session Duration: 2 hours
Time: Daily, 14:00-16:00
 
Residents will be presented a four-week, 2 hours daily orientation lecture series given by core faculty. Thereafter, resident didactic sessions will occur on Fridays. These lectures cover a broad range of introductory topics include pharmacology, cardiovascular physiology, renal physiology, ventilator management, nutrition, and basic resuscitation. Faculty assigns reading assignments from the Basics of Anesthesia by Miller. All residents are expected to read the assigned readings before the lecture.
 
4. Core Lectures Series
Session Duration: 2 hours
Time: Fridays 14:00-16:00

These lectures are used to build the resident’s knowledge base. These are two-hour sessions, one hour for lectures followed by a group discussion. The lectures are based entirely on the ABA basic examination content outline, which range from the intricacies of the anesthesia machine and monitors to a more in-depth approach to both fundamental physiology and pharmacology, along with the subspecialties of anesthesia. Basic examination, typically taken at the end of the CA-1 year, it’s the first of the staged exams series to qualify for board certification. Each session is followed by multiple-choice questions discussion on the topics covered in this lecture and high yield keyword review.

5. Problem-Based Learning Discussions (PBLD)
Session Duration: 1 hour
Time: Fridays, 13:00-14:00

The core content discussion is a multidisciplinary weekly conference comprised of one long problem- based discussion or multiple problem-based discussions on various topics. The PBLD sessions are based entirely on the ABA advanced examination content outline, which is the second in the staged certification examination series. These are interactive sessions where the staff moderates the discussion while the residents actively participate in the discussion.

6. Grand Rounds
Session Duration: 1 hour
Time: Third Tuesday of every month, 07:00-08:00
 
Monthly anesthesia Grand Rounds are held at 07:00 AM on Tuesday mornings. The mission of these series is to provide excellent lectures by accomplished speakers on cutting-edge topics in the field of medicine. Also, present important, interesting, unusual anesthesia problems and analysis of pathophysiological and therapeutic interventions in selected cases. Both members of  the department and visiting faculty present at this conference. Each resident gives two Grand Rounds presentations during their residency training. The resident selects a topic on a noteworthy issue raised during their patient care and does a thorough literature search, including information which both supports and disputes findings. Residents are guided and helped by a self-selected faculty mentor.
 
7. Journal Clubs
Session Duration: 1 hour
Time: Third Thursday of every month, 16:00-17:00

Journal Club is held every month and is moderated by CA-2 and CA-3 residents under the mentorship of assigned faculty. The residents discuss recent literature and provide the opportunity to understand how research conclusions assist in developing evidence-based medicine and best practices guidelines and critique articles for their scientific merit and pertinence. All residents are expected to attend and 1-2 residents present at each session. The main goal of these sessions is to encourage residents to follow peer-reviewed journals and develop the skills necessary to read such material critically.

8. Morbidity & Mortality
Session Duration: 1 hour
Time: Fourth Thursday of every month, 16:00-17:00

Monthly Mortality and Morbidity Conferences focus on discussing complications, their etiology, and relevant anesthesia decision-making. Residents are required to select and present a case for M&M during their CA-2 and CA 3 years. A faculty member guides these discussions. Presentations include a review of relevant literature guidelines and current practices both within the department and throughout the country. Time is allotted for questions and collegial exchange between faculty and residents. The main mission of these conferences is to discuss cases of unexpected morbidity or mortality to identify opportunities to improve performance and clinical outcomes.

9. Ultrasound Workshops
Session Duration: 1 hour
Time: Last Friday of Aug, Nov, Feb, May, 12:00-13:00

These hands-on workshops are designed to review the anatomy of peripheral nerves and blood vessels, ergonomics, and physics associated with ultrasound. Furthermore, learn the steps to optimize image quality for common applications, artifacts identification, target identification, scanning techniques, and understand needle approach techniques, which include in-plane and out- of-plane needle guidance. These sessions are conducted through hands-on practice scanning on a live model and peripheral nerve blocks and vessel cannulation using cadavers and phantoms.
 
10. Problem-Based Simulation Scenarios
Session Duration: 1 hour
Time: Last Friday of Aug, Nov, Feb, May, 16:00-17:00

These sessions include high-fidelity simulated problem-based scenarios focus on a safe learning environment and provide special training for incoming residents to teach them the basics of induction, emergence, and troubleshooting, and to develop and enhance procedural knowledge and efficiency, teach crisis management, and provide training to deal with complex catastrophic anesthesia complications. Besides, residents have the opportunity to develop management strategies to identify and predict difficult airways and learn alternate approaches to airway management. Also, residents get the chance to practice in difficult patient scenarios, including relaying bad news, obtaining informed consent, and discussing perioperative complications.

11. Transthoracic and Transesophageal Echocardiography Simulation Scenarios
Session Duration: 1 hour
Time: Last Friday of Sep, Dec, Mar, Jun, 16:00-17:00

These sessions start with reviewing the basic knowledge of ultrasound, including machines, types of probes, obtaining views and basic physics related to ultrasound, followed by teaching echo through high-fidelity simulation. The main goal of these sessions is to facilitate the acquisition of fundamental knowledge, basic psychomotor and technical skills required for transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), and to reinforce didactic learning.

12. Root Cause Analysis
Session Duration: 1 hour
Time: Semi-annual, 16:00-17:00

Each resident must present one Root Cause Analysis (RCA). Each resident is required to identify a problem and determine the basic underlying cause. During this exercise, residents will learn how to identify system errors and to suggest solutions.
 
13. Mock Oral Board Examination
Session Duration: 2 hours
Time: Semi-annual, 14:00-16:00

The purpose of the mock oral board examination is to prepare residents for the ABA standardized oral examination and elevate their level of critical thinking, patient care, and professional interactions to a consultant level during residency. Residents will participate in two-35 minute mock oral exam sessions.

Each 35-minute mock oral session is followed by incisive feedback on examinee style and response content. A written evaluation will be provided to each resident. These sessions may be individual sessions or group sessions, which involve also discussing high-yield content and allow residents to ask questions and engage in live discussions.

14. Objective Structured Clinical Examination (OSCE) Sessions
Session Duration: 2 hours
Time: Semi-annual, 14:00-16:00

Our residents participate in semi-annual mock Objective Structured Clinical Examination (OSCE). The mock OSCEs are based on the ABA Content Outline and include standardized patients, ultrasound models, simulated exam rooms, and monitors. Standardized checklists are used to evaluate residents on communication and professionalism, as well as understanding and application of medical knowledge.

15. Medical Ethics and Professionalism

The goal of these lectures is to introduce the residents to important and fundamental concepts in education, business, law, and communication, which impact the delivery of effective health care. These lectures focus on healthcare management, organizational structure, clinical instruction, ethics, healthcare economics, risk management, professionalism, research,  education  skills, physician leadership, and excellence in patient care.

16. Research/ Scholarly Activity

We encourage and support resident scholarly activity, and our program requires residents to participate in some type of scholarly activity during their residency training. The Department of Anesthesiology will have a Scholarly Activity Committee, which approves project proposals and supervise residents. These scholarly activities may include quality improvement projects, abstract presentations in national conferences, education-related service on national committees, research, or publication of a book chapter.