St. Luke's-Roosevelt Anesthesiology Residency Program

Message from the Chairman
About the Department of Anesthesiology
About Our Residency Program
Research Opportunities
Curriculum
Policies & How to Apply

A Message From The Chairman:
We are pleased that you are considering the Department of Anesthesiology of St. Luke's-Roosevelt Hospital Center for your residency training. Visitors to the Department are invariably impressed by residents' enthusiasm and satisfaction. Resident education is a central tenet of this department and its design and operations are structured around this essential mission. In our recruitment process, we not only look for individuals with an excellent educational background, but also with well-developed social skills.

To facilitate adjustment to the operating room environment, a new resident works with the same attending anesthesiologist for a period of one to two months. This attending also functions as the resident's faculty mentor for the remainder of the academic year. The faculty mentor is responsible for helping to develop the resident's study program and for regularly providing input on performance to the Department's Education Committee. Residents receive frequent feedback on their progress and the didactic program is continuously fine-tuned to better meet their needs.

The Department commits substantial resources to resident education. Journals, books and computers are readily available. In addition, every resident receives a stipend to purchase personal books and attend national anesthesia meetings. Attendance at lectures are mandatory. The success of our educational methods have been confirmed by our graduating residents who have consistently scored above the national average in the ABA/ASA Joint Council In-Training Examination and we anticipate that future graduates will continue to do so.

At St. Luke's-Roosevelt, the environment in which the resident works is second to none. Our clinical activities take place in modern operating rooms, labor and delivery suites, and critical care areas. The Department of Anesthesiology is in charge of the surgical intensive care unit. In addition, we have acquired state-of-the-art anesthesia and monitoring equipment. Every operating room is outfitted with six- to eight-channel color monitors for hemodynamic monitoring, mass spectometry for gas analysis, and a computer for automated anesthesia record-keeping. Each cardiac operating room has a dedicated echoscanner for transesophageal echocardiography, which is part of routine monitoring in cardiac surgery. Full automation is also the rule in the labor and delivery suites. When our residents graduate they have extensive experience with the most modern technology presently available in anesthesiology.

Our superb technological environment notwithstanding, we believe that the Department's greatest asset is its faculty. Just as we are cautious in the selection of our residents, we are even more circumspect in our selection of our faculty. Subspecialty training and a strong commitment to the Department's educational and research mission is mandatory for faculty appointment at St. Luke's-Roosevelt. Attending anesthesiologists are exquisitely aware that their performance evaluation is based as much on their educational and academic efforts, as on their clinical activities. We think that such measures have turned our residency program into a highly desirable and rewarding educational experience. You will be impressed by the enthusiasm of the faculty and the residents, as they will personally convey to you their satisfaction with the program. We look forward to your visit.

Best wishes,
Daniel M. Thys, MD
Chairman, Anesthesiology
St. Luke's-Roosevelt Hospital Center Professor, Department of Anesthesiology College of Physicians and Surgeons Columbia University

The Department of Anesthesiology

The Department of Anesthesiology is organized to satisfy the dual-site structure of St. Luke's-Roosevelt Hospital Center. The chairman of the Department is assisted by two site directors who have overall responsibility for the clinical activities at each of the two sites. The site directors also assume significant administrative duties.

The Department has nine divisions:
· Ambulatory Anesthesia
· Cardiac Anesthesia
· Neuroanesthesia
· Obstetric Anesthesia
· Pain Management
· Pediatric Anesthesia
· Regional Anesthesia
· Post Anesthesia Care Unit

Each division is headed by a physician with extensive training and experience in the particular subspecialty of anesthesia. The division heads are responsible for clinical and research activities, as well as for the education of the residents rotating through the subspecialty.

Our anesthesiologists participate in approximately 18,500 surgical procedures per year in the operating rooms of St. Luke's-Roosevelt Hospital Center. Of these, more than 60 percent are performed on an ambulatory or same-day admission basis. In addition, there are nearly 5,000 births each year, of which 80 percent receive anesthesia.

Residency Training Program

Educational Goals
The educational goals of the Department of Anesthesiology are to provide residents with knowledge training, and experience to meet the certification requirements of a consultant in anesthesiology.

A consultant anesthesiologist, as defined by the American Board of Anesthesiology, possesses adequate measures of knowledge, judgment, clinical and character skills, and personality suitable for:
· assuming independent responsibility for patient care;
· serving as an expert with the ability to deliberate with others who are providing advice and opinions in areas related to the practice of anesthesia, including all subspecialties; and
· functioning as a leader of the anesthesia care team.

Anesthesiology education consists of four years of training subsequent to the date that the medical or osteopathic degree has been conferred. It includes 12 months of non-anesthesia clinical training (Clinical Base Year) and 36 months of graded and increasingly complex clinical training in anesthesia (CA-1, CA-2, and CA-3 years).

The Department of Anesthesiology is committed to providing the anesthesiology resident with an optimal experience. The residency training program provides a solid educational environment in which to pursue academic, clinical, and research interests and has specific characteristics that distinguish the program in several significant ways.

Clinical Base Year
The clinical base year requirement consists of 12 months of clinical training in a program, other than anesthesiology, accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Anesthesiology residents join the St. Luke's-Roosevelt anesthesiology program after completing the clinical base year in another program of their choice.

For selected individuals, arrangements will be made to spend the clinical base year in the preliminary programs of the Hospital Center's Department of Medicine or Department of Surgery.

Clinical Anesthesia 1 (CA-1)
The first year of the residency training program in anesthesiology is designed to provide the basic knowledge and skills necessary to safely manage an anesthetic. Initially, the resident will work under the one-on-one supervision of a tutor. This early clinical experience is supplemented by daily introductory lectures and frequent assessment of the resident's progress. The AKT (Anesthesia Knowledge Test) is used to evaluate the resident's knowledge. It is administered as a CA-1 Pre-& Post Test in July, and after 6 months and after 18 months of training.

A CA-1 resident will spend approximately half the year at each of the two clinical sites. At the Roosevelt Division, the resident will be introduced to the special features of ambulatory anesthesia. At the St. Luke's Division, the resident will first encounter trauma anesthesia. Part of the critical care requirements set forth by the American Board of Anesthesiology will also be fulfilled during the CA-1 year.

Clinical Anesthesia 2 (CA-2)
The second year of clinical anesthesia is dedicated to monthly rotations through the subspecialty areas. Each resident can expect to spend one or two months in cardiac anesthesia, obstetric anesthesia, pediatric anesthesia, neuroanesthesia, regional anesthesia, critical care, and pain management.

Cardiac Anesthesia
The cardiac division provides anesthesia to approximately 500 patients each year undergoing cardiac procedures with the assistance of cardiopulmonary bypass. During this rotation the resident will become proficient in the placement of invasive monitoring lines and in the anesthetic management of patients with severe cardiac disease. The cardiac division is well recognized for its expertise in intraoperative echocardiography, to which the resident will be exposed on a daily basis.

Obstetric Anesthesia
The obstetric anesthesia division provides anesthesia to nearly 5,000 parturients each year, many of whom are in the high-risk category. On the obstetrical rotation, the resident will become adept in the use of epidural anesthesia, spinal anesthesia and combined spinal-epidural anesthesia, and will see a wide variety of major obstetrical problems. The OB Anesthesia team manages many high risk patients, and medically supervises the Labor and Delivery recovery room.

Pain Division
During the rotation through the pain division, the resident will learn to manage acute pain problems in the perioperative period. Residents will also be exposed to a multidisciplinary approach to chronic pain problems and perform multiple types of nerve blocks to alleviate patients' chronic suffering.

Pediatric Anesthesia
During the rotation the resident will learn basic principles of anesthetic management of children of all ages for a wide variety of procedures. In addition, a month is spent rotating to the Children's Hospital at New York Presbyterian Columbia University.

Clinical Anesthesia 3 (CA-3)
All residents during their senior year are offered elective rotations outside St. Luke's-Roosevelt Hospital Center. These rotations include one month of advanced neuroanesthesia and/or thoracic anesthesia at Memorial Sloan-Kettering Hospital and one month of advanced pediatric anesthesiology at Children's Hospital of Philadelphia (University of Pennsylvania).
In addition to these senior year electives, the Department of Anesthesiology offers every option recommended by the American Board of Anesthesiology for the CA-3 year.

Advanced Clinical Track
Residents who select this option are required to complete at least six months in advanced and complex clinical anesthesia assignments. The cases they will manage are considerably more difficult than those performed in the previous years. They may spend the remaining six months in advanced anesthesia training or in one to three selected subspecialty rotations.

Clinical Scientist Track
The clinical scientist track is designed for residents with strong academic ambitions who are willing to spend at least six months in research as an introduction to an academic career.

Option A
Option A is fulfilled by completing six months of advanced or subspecialty clinical training and six months of clinical or laboratory investigative experience in the CA-3 year.

Option B
Option B is reserved for residents who plan careers as academic investigators. After completing the CA-1 year, the resident must complete 18 months of clinical anesthesia training and 18 months of research. St. Luke's-Roosevelt Hospital Center, in cooperation with Columbia University, offers outstanding research opportunities for young investigators.

Didactic Program
The didactic program of the Department of Anesthesiology consists of frequent seminars, lectures and grand rounds.
Monday and Thursday -- Subspecialty seminars including echocardiography and regional anesthesia as well as mock oral examinations.
Tuesday -- Journal Club with visiting professors monthly.
Wednesday -- Department-wide Morbidity and Mortality Conference. Cases are presented by residents and discussed by staff members of the Department and core lecture/seminars separately for CA-1, CA-2 and CA-3 residents.
Grand Rounds -- Grand rounds are scheduled once or twice a month. They are usually given by a prominent lecturer from another medical center, who speaks on Wednesday morning and participates in the Morbidity and Mortality Conference thereafter.

Subspecialty Rotations-- many of the subspecialty rotations have didactic sessions during the resident's rotations.

Special Characteristics of Our Residency Program:

While the approach of the anesthesiology residency program of St. Luke's-Roosevelt is similar to other programs, our program distinguishes itself in several significant ways:

Number of Residents
To assure that each resident receives a quality education, our program is large enough to provide collegial interchange and growth, yet small enough to ensure that each resident receives a quality education with access to a wide spectrum of anesthesia cases and techniques. Our residency program is limited to twelve residents per year.

Individualized Attention
Since the number of residency positions is limited, we are able to provide residents with personalized attention. Upon arrival into the program, each resident is assigned to a faculty advisor. This staff member guides the resident through the initial anesthesia experience and provides advice throughout the program in matters related to clinical and academic performance, study techniques, subspecialty selection, and other issues. A dedicated and energetic faculty helps residents to readily identify with their advisors as role models and partners.

Educational Quality Assurance
The Department's Residency Evaluation Committee continually tracks the performance and progress of residents in the anesthesiology program. At the beginning of every clinical rotation, each resident is given an introduction and a set of educational goals for the rotation. Attending physicians follow the resident's progress and help the resident meet educational goals. The rotation concludes with an exit interview and
a detailed review of individual performance. Guidelines are provided for further increase in knowledge or improvement in clinical skills.

Computerized Case Tracking
A computerized case tracking system is a unique feature of the St. Luke's-Roosevelt anesthesiology program. The Hospital Center's operating rooms are equipped with the Compurecord Anesthesia Information Management System. This system generates an automated anesthesia record and keeps track of each resident's case assignments. During daily operatingroom scheduling, prior case assignments are taken into account so that each resident is ensured an equal share of interesting cases. In addition, the Hospital Center has a computerized patient order entry system, as well as Pharmacy, Radiology, and most other diagnostic test results available on-line.

Modern Environment
All of the operating rooms of St. Luke's-Roosevelt Hospital Center are located in modern facilities. At the St. Luke's Division, the operating room suite consists of 12 operating rooms plus two cystoscopy suites. Adjacent to the OR suite are the ambulatory suite, patient holding area, and the stage I and II recovery rooms.

At the Roosevelt Division, 16 operating rooms and two cystoscopy suites are complemented by a large ambulatory suite, the holding area, and recovery rooms.

The design of the OR suites provides functional patient flow as well as a modern and pleasing work environment. Each operating room is equipped with the most advanced anesthesia and monitoring equipment currently available.

Clinical Resources
The philosophical goal of the Department of Anesthesiology is to maximize the use of innovative technology so that the clinician has more time to focus on the patient. Elements that have been put in place to achieve this goal include:

Modular Physiologic Monitoring System
Each of the operating rooms is equipped with a modular state of the art monitoring system, as well as the recovery rooms, the critical care areas, the labor and delivery rooms, and the emergency rooms. The major advantage of having a single monitoring system is that information can easily be exchanged between the various patient care areas. Interconnected local area networks facilitate the transfer of information. The modular feature permits rapid introduction of new technologic advances.

Color Monitors
Each operating room is supplied with an eight-channel color monitor which displays full hemodynamic monitoring of every patient, including pulmonary artery catheterization and cardiac output determinations.

ST-segment Analysis
ST-segment analysis is performed automatically in each of the Hospital Center's operating rooms. With the aging of the population and the ever increasing prevalence of myocardial ischemia, the intraoperative recognition of ST-segment abnormalities is essential.

Hemodynamic Data Storage
The system is designed so that each patient's hemodynamic history is stored in the monitoring modules. As the patient moves from the operating room to the recovery room or intensive care unit, the patient's complete hemodynamic history moves along as well.

Gas Analysis
The new operating rooms are set up with the best proven gas monitoring system. Each operating room has individual spectrometry gas analysis system. The system identifies the anesthetic gases and vapors used which enhances patient safety.

Transesophageal Echocardiography
The cardiac anesthesia division has a worldwide reputation for excellence and innovations in transesophageal echocardiography (TEE). The Department of Anesthesiology is equipped to perform TEE in every patient undergoing cardiac surgery or with severe cardiovascular disease. The Department also plans to continue playing a leading role in developing this technology and educating other anesthesiologists in its use.

Administrative and Educational Resources
Automated Record Keeping
St. Luke's-Roosevelt Hospital Center is one of the first medical centers in the world to be equipped with a fully integrated Compurecord Anesthesia Information Management System. This system will automatically sample all the relevant physiologic and anesthetic parameters during surgery and store this information for record- keeping purposes. The system provides the anesthesiologist with a printed anesthesia record at the end of the procedure, and also facilitates the Department's quality assurance efforts and the daily assignment of residents for optimal educational benefit. The system also maintains departmental statistics, provides a database for departmental quality assurance, and automates patient billing activities.

Anesthesia Local Area Network (ALAN)
The Department has invested in extensive computerization with the installation of the Anesthesia Local Area Network (ALAN).

ALAN is extremely useful for administrative and educational activities. Thirty computer terminals are distributed throughout departmental locations. Members of the Department can use any of the terminals to access personal computer files.

The system is also provided with word processing, spread sheet, medical graphics, statistics, slide making, and data base programs. In addition to its administrative use, ALAN is a powerful educational resource allowing members of the Department to interact with the National Library of Medicine from any anesthesia computer terminal.

Libraries of the Department of Anesthesiology
At each Division, the Department of Anesthesiology houses a library and study area for residents. The libraries collect the majority of anesthesia journals as well as selected publications from other medical specialties, and they list numerous textbooks and multiple audiovisual educational programs.
A computer terminal with full access to ALAN is located in each library.

St. Luke's-Roosevelt Libraries
Medical libraries are located at both Hospital Center Divisions. The libraries, which are open seven days a week, provide access to an extensive collection of medical journals and texts. In addition, all computers in the hospital allow access to medical journals through OVID.

Columbia University

Anesthesia residents can take advantage of the facilities of Columbia University, including the Health Sciences Center Library and sports facilities. This library possesses one of the world's most extensive collections of medical and research documents.

Research Opportunities

St. Luke's-Roosevelt Hospital Center offers multiple opportunities to residents who want to participate in research activities throughout their training, even though the American Board of Anesthesiology does not require resident involvement in research until the completion of two years of clinical anesthesia.

Institutional Research Activities
Recognizing that patient care and teaching are best accomplished in an environment which encourages scholarly activities, St. Luke's-Roosevelt Hospital Center has a long-standing tradition of research excellence both through its Institute for Health Sciences and in its role as a teaching hospital affiliated with Columbia University College of Physicians and Surgeons. The Hospital Center's nationally and internationally renowned clinicians and research scientists have made and continue to make important contributions to the understanding of basic disease processes, to developing new therapeutic approaches, and to evaluating the efficacy of treatments.

At the Roosevelt Division, a large research facility is located in the Antenucci Medical Research Building. At the St. Luke's Division there is an animal care facility with fully appointed operating rooms.

The most recent addition to the Hospital Center's research endeavors is the Center for Research in Clinical Nutrition located at the St. Luke's Division. The Center, which is a collaborative effort of St. Luke's-Roosevelt, Columbia University, and Brookhaven National Laboratory, is leading the way in National Institutes of Health-funded studies of nutrition, body composition, and metabolism using highly sophisticated new instruments.

Departmental Research Activities
Clinical
An extensive computerized database within the Department of Anesthesiology facilitates clinical research endeavors. Anesthesiology as a medical specialty is ideally suited for the performance of clinical research. The administration of an anesthetic consists of a major but short-lived intervention in the homeostatic milieu of patients. The Department affords abundant and important opportunities to study the effects of these interventions.

Clinical Pharmacology
Members of the faculty have documented expertise in the performance of clinical pharmacologic studies in
the areas of ambulatory, obstetric, and cardiac anesthesia. Drugs that have been studied include new anesthetic agents, muscle relaxants, inotropes, and anti-emetics.

Regional Anesthesia
The division of regional anesthesia is a world leader in the study of new techniques for regional anesthesia. Studies focus on gross anatomy as it relates to regional anesthesia, pharmacology of local anesthetics, new techniques for regional anesthesia and patient outcomes after regional anesthesia.

Pain
The pain division is particularly active in clinical research. Efforts have focused on the study of new vehicles for drug administration (such as iontopheresis) and new methods for pain relief (cryotherapy).

Basic Sciences
The Department of Anesthesiology has made a major commitment to the development of basic research by its faculty. Substantial material resources and personnel have been allocated to this task. The primary goal of the Department's basic science research is to establish a direct link between the laboratory and the clinical environment.

Imaging Technology
The Department is active in developing new procedures and education in imaging technology. A well-equipped laboratory provides investigators with the latest in video editing and digital image storage techniques. In addition, there are opportunities to interact with the engineering and computer science departments of Columbia University.

Policies & How to Apply

Living in New York
The residency experience is enriched by cultural and recreational opportunities that only New York City can offer. Situated in the heart of Manhattan's West Side, the Hospital Center is just minutes away from Lincoln Center for the Performing Arts, Carnegie Hall, Broadway theaters, numerous museums, and an unlimited assortment of other entertainment possibilities.

Central Park is within walking distance, offering concerts under the stars, paths for biking and jogging, lakes for boating and ice-skating, and playgrounds for children.

Of course, there is no end to the variety of shops, restaurants, galleries, movies, and clubs you will find in and around the city. And if you prefer a more relaxed pace, eastern Long Island and upstate New York are easily accessible by car or public transportation.

If you are coming to visit us and want to learn more about New York's many attractions, contact the New York Convention and Visitors Bureau,
2 Columbus Circle, New York, NY 10019, (212)397-8222.

House Staff Policies
Housing
The Hospital Center maintains several apartment buildings for use by the resident staff in the immediate vicinity of both the St. Luke's and Roosevelt Divisions. The buildings offer convenient locations and cheerful accommodations at reasonable rents. All residents are guaranteed hospital housing. All requests for housing are to be made through the Department of Real Estate.

Work Hours
All residents participate in the on-call duties of the Department of Anesthesiology. The on-call schedules vary in different rotations, but are all in compliance with New York State Public Health Law, Part 405. Residents do not remain in the Hospital Center after night-call duties.

Benefits
The Hospital Center offers a full package of benefits, including student privileges at Columbia University. The standard hospital employee benefits package includes: individual and family health insurance, vision care and dental coverage, and accidental death and disability insurance. Residents are also entitled to annual paid vacations and at least one paid conference during the residency. Also, residents are part of the CIR union.

Application Procedure
Next Steps
Appointments to the advanced anesthesiology program are made through the National Intern and Resident Matching Program (the "match"). All applicants must be registered with the match and complete application forms supplied through ERAS.

All correspondence should be mailed to:

Anesthesiology Residency Program
Department of Anesthesiology
St. Luke's-Roosevelt Hospital Center
1111 Amsterdam Avenue
New York, NY 10025
Phone: (212) 523-2500
Fax: (212) 523-3930
www.wehealnewyork.org

Once the completed application and letters of support are received via ERAS, the Residency Selection Committee of the Department of Anesthesiology will notify applicants who have been selected for an interview.