Anesthesia Clerkship

The Department of Anesthesiology and Critical Care Medicine welcomes both Johns Hopkins medical students and students visiting from outside institutions ranging from our basic anesthesiology clerkship to advanced or specialty electives. We invite you to explore the details of our specialty and offerings below and hope you consider joining our department for an engaging hands-on experience!

Anesthesiology is the field of medicine dedicated to managing and treating patients in a dynamic setting while ensuring patient safety and comfort before, during, and after surgery. Anesthesiologists have the ability to work in operating rooms, intensive care units, inpatient floors, outpatient clinics, and as consultants. Unlike most fields of medicine, anesthesiology trains its physicians to be fluent in perioperative medicine, technical skills, critical care, and emergency situations. Anesthesiologists can also be thought of as “the internists of the OR” as the breadth and depth of knowledge crosses all fields of medicine including pathophysiology and pharmacology. They are the experts in airway management along with cardiac and pulmonary resuscitation, pain control and advanced life support.With more patients living longer and with a variety of chronic diseases needing complex surgery, anesthesiologists caring for such patients must be well versed in understanding that particular patient’s physiology and be able to anticipate issues regarding their individualized perioperative care.  Because of the nature of the field, anesthesiologists must have a thorough understanding of pharmacology, pathophysiology, and anatomy, and how surgical interventions and medications can affect chronic and acute problems. Furthermore, they are one of the few physicians that are able to simultaneously assess, diagnose, and treat with various interventions on a minute-to-minute basis. You can truly see medicine in action.Not only does the intellectual stimulation and hands-on aspects of the field make it very attractive, the patient interaction can also be very fulfilling. The ability to allay patients’ anxieties and fears prior to surgery is very rewarding as surgery can be one of the most frightening experiences many patients have encountered. It is satisfying to be able to assure the patient that you will do everything to ensure their safety and comfort, and that if a critical situation were to arise you are the physician on the team most adept at managing it.In addition to the ability to work in operating rooms, intensive care units, and both inpatient and outpatient settings, there are many options for further specialization within anesthesiology. The ACGME accredited fellowships include: Cardiothoracic Anesthesia with TEE certification, Critical Care Medicine, Obstetric Anesthesia, Pain Medicine, and Pediatric Anesthesia. There are also many non-ACGME accredited fellowships that allow physicians to concentrate on particular aspects of the field such as Ambulatory Anesthesia, Trauma Anesthesia, Transplant Anesthesia, Vascular and Thoracic Anesthesia, Regional Anesthesia, and Neuroanesthesia. Whatever interests you within the field of medicine, there is a way to incorporate it within a career in anesthesiology.

During your Basic Anesthesiology clerkship you will be working one-on-one with a senior anesthesia resident in operating rooms and procedural suites throughout the hospital to provide general anesthesia and monitored anesthesia care to a wide variety of patients. You will be an active participant in care and will have the opportunity to practice important life-saving skills including:

  • mask ventilation
  • oral and nasal airway placement
  • intravenous catheter placement
  • laryngeal mask airway placement
  • endotracheal intubation.

You may also have the opportunity to perform or assist with advanced skills such as:

  • arterial line placement
  • central line placement
  • epidural catheter placement.

The skills you will acquire during the basic clerkship in anesthesiology are broadly applicable to a wide variety of fields and are particularly useful in rapid response and code situations.

As a medical student on the Basic rotation, you are encouraged to be an active participant in your patients’ anesthesia care from start to finish—from conducting the preoperative evaluation prior to induction, to performing procedures during and after induction, to signing out to the PACU after emergence.

Anesthesia rotations are not just shadowing; you will be encouraged to get your hands dirty! You will receive one-on-one teaching in the operating room from anesthesia residents and attendings who are engaged, active teachers and who view you as an integral member of the team. You will have the opportunity to learn about physiology and pharmacology in real-time.

Anesthesiologists care for patients in a wide variety of settings both within and outside of the operating room—including the preoperative evaluation clinic, chronic pain clinic, surgical ICUs, pediatric ICU, PACU, and the OB ward—but the basic clerkship is primarily focused on intraoperative anesthesia care. If you are interested in the varied jobs of anesthesiologists outside the operating room, you may explore these in the last 2 weeks of your rotation (for 4 week rotations), or in the Advanced Anesthesiology clerkship.

Non-operative components of the rotation include:

  • 1 weeknight call (if you are doing a 2 week rotation) or 2 weeknight calls (if you are doing the 4 week rotation)
    • On these overnight calls, you will arrive at 3pm to meet a senior resident and take call overnight until 7am, at which time you will go home.
    • These calls will give you exposure to emergency cases, traumas, codes, and other types of cases that you may not otherwise see during the daytime.
  • Simulation sessions and didactics to augment your intraoperative learning experience during the rotation
  • An exit interview at the end of the clerkship which may include a discussion of fundamental anesthesia concepts, presentation of a medically challenging case, and performance in a simulation session to manage an intraoperative scenario

This is a week-by-week list of procedures, technical skills, and topics that you should aim to complete throughout the anesthesia rotation. These are cumulative, and you should continue to practice and build on the skills you learn each week.By the end of week 1, medical students will:

  1. Evaluate a patient’s airway before surgery
  2. Know the components of a basic room set-up, including IVs, airway, medications, and anesthesiology machine check
  3. Basic mask ventilation skills
  4. Attempt direct laryngoscopy and LMA placement
  5. Attempt peripheral IV placement
  6. Classify a patient based on ASA status

By the end of week 2, medical students will:

  1. Improve direct laryngoscopy, LMA placement, and mask ventilation skills
  2. Begin to understand the pharmacology of different medications used for induction, maintenance, and emergence
  3. Perform a focused pre-anesthesia physical and exam on a patient before surgery
  4. Attempt arterial line placement
  5. Interpret intra-operative monitors

By the end of week 3, medical students will:

  1. Name key indicators for extubation, both clinical and subjective criteria
  2. Explain the concept of MAC, particularly how it varies in different patients
  3. Identify co-morbidities that may affect anesthetic management
  4. Go through the steps of the ASA difficult airway algorithm
  5. Attempt more advanced airway techniques, such as video laryngoscopy

By the end of week 4, medical students will:

  1. Show proficiency in bag mask ventilation
  2. Give a detailed sign out to a resident/CRNA of a patient
  3. Set up a room for the start of a case (including drugs, airway, suctioning, etc).
  4. Start to develop an anesthetic plan based on a patient’s comorbidities
  5. Give suggestions for interventions during intraoperative management

Flexibility is a big part of anesthesiology. Each day varies greatly, so this is a just a rough guide to give you an idea of our basic day.The night prior: Check the posting for your assignment for the next day. Look up your patient(s) and discuss an anesthesia plan with your resident or attending.6:30 AM: Arrive to set up the operating room.** Medical students may elect to help their resident set up the operating room in the morning before the first case, but most will meet their resident in the PACU at 7 AM.7:00 AM: Meet the first patient in the preoperative area to perform a history and physical exam and to obtain consent for anesthesia.7:30 AM: Induction begins for the first case of the day.Time for breaks and lunch will be worked in based off of the flow of the day.Depending on case load, you will be typically be able to leave between 3 and 5pm.

Feedback is a big part of the Anesthesia Clerkship. We not only evaluate your performance, but also ask that you evaluate your learning experience.

Med Student Evaluation Form

Med Student Evaluation of Clerkship

Med Student Evaluation of Resident

Advanced, or specialty electives can be arranged after students have completed the basic anesthesiology elective. These are pre-arranged, custom-made electives that offer students the opportunity to explore areas of particular interest. The specialty electives are usually 4 weeks in duration but can be 3-6 weeks. The specialty elective can be either a clinical or research topic. A very popular elective is the Surgical Intensive Care Unit rotation. It is an excellent learning experience but is very competitive and reservations should be made at least 6 months in advance. The electives course list is available for viewing on the Johns Hopkins InfoNet.

There are lots of great resources available for you to learn the basics of anesthesia! Here a few suggestions:

Websites:

Openanesthesia.org –  this is a nonprofit webpage dedicated to teaching anesthesia! Check out the “keywords” section – a simple overview of common topics in anesthesia. Try the question of the day!

Life In The Fast Lane – A great FOAM resource. Check out their critical care compendium for great overviews of must know topics. Great for EKG education too.

Access Anesthesiology – A great resource for learning! Lots of videos and interactive tools, plus lots of books too. You can create a free account to read. Check out the procedural videos so you’ll ace your first art line!

Welch library has a department guide with a wealth of resources.

Podcasts:

Check out ACCRAC – Anesthesia and critical care reviews and commentary, by our own Dr Wolpaw!! He gives great explanations and makes you feel good about yourself with encouraging words at the end of the episode J

I also like emcrit – it’s a podcast by an EM doc who focuses on critical care. He’s been putting out this podcast for years. Go way back in the archives for some great basic concept episodes.

Books:

Anesthesia student survival guide – specifically designed for med student rotations.

Anesthesia Secrets – also manageable to cover a lot of this on your clerkship.

Jaffe – This is a CA1’s best friend when preparing for the next days’ cases. It gives an overview of surgical procedures and gives an outline for an anesthetic plan.

For ICU, check out The ICU book. A readable primer on all things ICU.

Really like to read? One of the larger textbooks is Barash. Not really for a med student rotation but if you do decide to become an anesthesiologist it’s good to know about.

REALLY like to read? Want to work on your biceps? Try carrying around Miller.

Videos:

https://www.youtube.com/watch?v=BfDYyoNFf_I – Basic Airway Anatomy, in a friendly Australian accent

https://www.youtube.com/watch?v=CrLJwwSnUws – Steps of Basic Endotracheal Intubation, short and sweet

https://www.youtube.com/watch?v=c0v5hpLQXZU – A more thorough explanation of endotracheal intubation techniques (from the NEJM so you know it’s good)

https://www.youtube.com/watch?v=Xms43IPHbwU – How to start an IV

https://www.youtube.com/watch?v=8hK04ai17-k – How to start an arterial line, also from the NEJM

https://www.youtube.com/watch?v=HE5QhsPRaPU- How to place a central line, from the NEJM again (those guys are so productive)

The Johns Hopkins Medical Institutions

Department of Anesthesiology and Critical Care Medicine

Johns Hopkins University School of Medicine

Sheik Zayed Tower1800 Orleans Street

Baltimore, MD 21287410-955-7615

Tina Tran, MD

Co-Director, Medical Student Education Program

Assistant Professor, Department of Anesthesiology and Critical Care Medicine

ttran32@jhmi.edu

Jed Wolpaw, MD, M.ED

Co-Director, Medical Student Education Program

Assistant Professor, Department of Anesthesiology and Critical Care Medicine,

Division of Adult Critical Care Medicine, Surgical Intensive Care Unit

jwolpaw@jhmi.edu