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New anesthesiology graduates know a great deal, and yet still have a lot to learn. What do you need to know before you start your first job following anesthesia residency? You already know the basic science facts, and you’ve done three years of cases with a faculty member next to your right elbow at every crucial moment.
But are you ready to work alone?
When an anesthesiologist finishes their formal training, he or she has a brain full of academic teachings, and has performed hundreds of anesthetics in a university setting while being supervised by faculty members.
Turn the page to the first weeks of an anesthesia career in a private or community practice, and the setting is different: The new graduate must work by themselves, without supervision, in a new and unfamiliar hospital, alongside surgeons and nurses they don’t know.
It’s the most difficult transition in an anesthesiologist’s career.
I learned a lot in my first year(s) in private practice. What follows are links to the columns I wrote to bolster the knowledge base of the new graduate. In essence, these are the points of wisdom I wish I’d known when I finished residency. These are the pearls not available in the standard textbooks:
A discussion of the key differences between private practice and university anesthesia practice.
A summary of resources to prepare yourself to practice anesthesia outside of the academic setting.
An airway disaster can cost your patient’s life, and radically alter the career of a young anesthesiologist. This column offers advice on how to stay out of an airway disaster.
This column summarizes the qualities you’ll need to succeed as an anesthesiologist.
As an expert witness, I’ve seen dozens of cases of anoxic brain death cases. It only takes five minutes of botched anesthesia practice to cause anoxic brain injury, and this column offers advice on how to avoid becoming a defendant in a malpractice suit.
You’ll become a better anesthesiologist over the decades. Based on my 30+ years of experience, this column give advice on how to wake patients quickly and with excellent airway maintenance.
What are next 30 years of your career going to look like? No one knows for sure, but this column discusses the current trends, and where they are heading.
You’ll have to pass the oral exam to become board-certified. Here I offer advice, based on decades of giving mock oral examinations to residents at Stanford.
Smooth emergence from anesthesia is important in every case, from a craniotomy to a tonsillectomy to a facelift. I offer advice from 30+ years of experience.
Regional anesthesia is touted by university regional anesthetic specialists. In the community, you will have to decide how to give informed consent regarding nerve damage, and who is at prohibitive risk for any incidence of nerve damage.
In residency, you have four hands available, because your faculty member is at your assistance. In private practice, you’ll have to learn to anesthetize children by yourself. This column gives advice on solo practice of pediatric anesthesia.
You’re young, you’re green, and the surgeon is in a hurry. This column gives pearls on how to start an anesthetic as quickly and safely as possible.
A nurse telephones you regarding one of your patients in the Post Operative Care Unit. What one question do you ask to determine if the patient is acutely ill or not?
In university training, professors often attempt to make anesthetics interesting and unique. In private practice, a key objective is to keep anesthetics simple, i.e. following the KISS principle, or Keep It Simple Stupid.
Your work is not finished until you’ve extubated the trachea safely. What does the medical literature advise regarding the proper time and techniques regarding extubation, particularly in difficult airway patients?
Good luck with your first job! Keep reading, and don’t be afraid to ask your senior colleagues for advice and guidance.