Evolution of Anesthesiology Residency Programs

Residency is a crucial step after medical school. It is during this training period that medical students develop into clinicians and acquire the skills to not only care for patients, but also deliberate on life-or-death decisions. For anesthesiology residents, this is of critical importance. While students seeking a career in anesthesiology may have had exposure to the field during medical school by experiences in sub-internships or electives, much of the clinical efficacy is gained through practice as a resident. However, residency education has evolved significantly over the past several years, widening its scope to include research, education, and pedagogy. In addition, methods utilized to assess residency candidates, for example the National Resident Matching Program, are themselves undergoing evaluation to maintain a steady stream of highly qualified applicants to the field of anesthesiology.

Residency, while a crucial and essential step on the road to become a licensed, practicing clinician, is not necessarily guaranteed. Final year medical students are evaluated in multiple ways as a means for residency programs to assess their projected quality as a future intern and/or resident1. Students must pass the United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3 in advance of entering residency, advantageously passing with high scores. Along with a high board score, students are encouraged to pursue research in anesthesia and/or surgical specialties, with the objective of achieving results as evidenced through the production of peer-reviewed publications. Finally, the greater the exposure that a student has to the field of anesthesiology, the more likely they are to enter the field. Students who match successfully into their top selected program have usually taken multiple anesthesia electives, including critical care or other anesthesia sub-specialties, in addition to participation in away rotations. All of these factors are summed by the National Resident Matching Program, which employs an algorithm to align individual student preferences with large-scale residency ranking lists.

Yet, is the National Resident Matching Program totally consistent with eventual student performance as a resident? New research suggests that this question may be more complicated than it seems. In research exhibited at the American Society of Anesthesiologists Meeting of 2018, Dr. Wajda of NYU Langone presented results of a long-term research study that he and his researchers conducted that compared National Resident Matching Program rankings with clinical performance2. At first, performance was directly related to high rankings and decreased incrementally — yet, at a certain low threshold, low ranked candidates were found to be correlated with high clinical performance. The abstract, entitled The Lowest Ranked Candidates on the NRMP List May Be Your Best Performers, aimed to explore the conventional standardized metrics by which candidates are assessed as future residents by detailing such distinctions.

In fact, while traditional anesthesiology residency programs emphasized intensive overnight call and multiple rotations across units, more recent programs have focused on including research, education, and pedagogy3. More renowned residency programs in anesthesiology now typically provide a stipend and scheduled time off for their residents to present at least one academic conference per year, even in non-research track programs. Moreover, residency programs in anesthesia may also include opportunities for seminars and other educational programming, as well as ways for residents themselves to participate in teaching more junior trainees and/or medical students at affiliated medical schools. While still an understandably intense and rigorous experience, residency training is now focused on training well-rounded anesthesiologists in order to create future healthcare leaders.

1. Watt, Stacey, and Mark Lema. “What Makes a Competitive Anesthesiology Candidate?” ASA Guide To Anesthesiology For Medical Students, American Society of Anesthesiologists, 2019.

2. Wajda, Michael C. “The Lowest Ranked Candidates on the NRMP List May Be Your Best Performers.” American Society of Anesthesiologists, NYU Langone, 2018. https://urlzs.com/k9Bg

3. Stedman, Robin B. “Core program education: tracking the progression toward excellence in an anesthesiology residency program over 60 years.” The Ochsner journal vol. 11,1 (2011): 43-51.

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