Residency

Overview

Welcome

Thank you for your interest in Cleveland Clinic’s Anesthesiology Residency Program. Our four-year integrated categorical residency includes a world-class, learner-centered, interactive curriculum. This curriculum includes level specific, high fidelity simulations, comprehensive OSCE sessions, periodic oral board practice examinations, and a longitudinal, perioperative ultrasound education program. In the clinical setting, our residents also function as an integral part of our care team and actively participate in the care of patients with complex surgical pathology across all surgical subspecialties alongside distinguished and experienced anesthesiologist educators. Furthermore, as part of a world-renowned research institute, we take pride in our outcomes-focused, patient-centered high impact research and our innovative culture. This prepares our graduates for a life-long career as leaders in Anesthesiology and perioperative medicine. We welcome you to join our team!

	Christopher Troianos, MD, FASE Chairman Anesthesiology Institute
	Carlos Trombetta, MD, MEd, CHSE Residency Program Director Anesthesiology Institute

Current Residents

PGY1 Class

Bryan Benson, MD, PhD

• Hometown: Natick, MA
• Medical School: Case Western Reserve University
• Clinical Interests: Critical care, Microvascular failure in sepsis
• Personal Interests: Hiking, weightlifting, environmental sustainability, skiing

Benjamin Carnes, MD

• Hometown: Findlay, Ohio
• Medical School: Case Western Reserve University School of Medicine
• Personal Interests: Travel, food, beer, sports

Jennifer Choi, DO

• Hometown: Buena Park, CA
• Medical School: Western University of Health Sciences, Pomona
• Personal Interests: Movies, trivia, hiking

Alec Clayton, DO

• Hometown: Farmington, Utah
• Medical School: Touro University Nevada College of Medicine
• Clinical Interests: Chronic pain management
• Personal Interests: Weightlifting, hiking, skiing, cooking, fishing

Philip Dunn, DO

• Hometown: San Bruno, California
• Medical School: Western University of Health Sciences
• Personal Interests: Photography

Aaron Hawke, DO

• Hometown: Elyria, Ohio
• Medical school: Ohio University Heritage College of Osteopathic Medicine
• Personal Interests: Traveling, reading, rock climbing, concerts

Joseph Hezkial, DO

• Hometown: Mississauga, Ontario
• Medical School: Touro COM-Middletown
• Personal Interests: traveling, cooking, soccer, hiking, bowling, video games, Mitchell's ice cream

Anna Kanarr, MD

• Hometown: Alpena, Michigan
• Medical School: Central Michigan University College of Medicine
• Personal Interests: baking, hiking, scuba diving, knitting, gardening, spending time with my husband and dogs

Alexander King, MD

• Hometown: Reno, Nevada
• Medical School: University College Cork, Ireland
• Clinical Interests: Cardiothoracic Anesthesia, Critical Care
• Personal Interests: Skydiving, Scuba diving, Magic: The Gathering, Climbing, Console gaming.

Yerin (Erin) Koh, MD

• Medical School: Jacobs School of Medicine (University at Buffalo)
• Clinical Interests: Pain (Acute & Chronic), Cardiac anesthesia
• Personal Interests: Exercise (gym), outdoor activities, exploring coffee shops/restaurants & spending time with friends and family!

Danielle Kumpf, MD

• Hometown: Pittsburgh, PA
• Medical school: Penn State College of Medicine
• Clinical Interests: cardiac and ICU
• Personal Interests: Downhill skiing, hiking, college football, hockey

Sean McManus, DO

• Hometown: North Andover, MA
• Medical School: Lake Erie College of Osteopathic Medicine – Bradenton
• Clinical Interests: Pediatric anesthesia, regional anesthesia, critical care
• Personal Interests: Villanova basketball, Boston sports, traveling with my wife, going to the beach with my dog, fantasy football, running

Allan Migirov, DO

• Hometown: NYC, New York
• Medical School: New York Institute of Technology
• Personal Interests: Eating pizza, cooking and trying new foods, traveling, spontaneous road trips to somewhere random, being outdoors, learning something new, spending time with family and friends.

Ronald Nowak, MD

• Hometown: Cleveland, Ohio
• Medical School: University of Toledo
• Personal Interests: CLE Browns football, travel, fitness, camping

Stephania Paredes, MD

• Hometown: Cali, Colombia
• Medical School: Universidad Icesi
• Personal Interests: Animal lover, outdoor activities and tennis.

Nirav Patel, MD

• Medical School: University of South Florida
• Clinical Interests: Chronic Pain Management
• Personal Interests: Playing and watching sports (rooting for my Florida Gators), reading the Newspapers (like an old man), exercising, learning new things, traveling, being with my Residency Class.

Danielle Phillips, DO

• Hometown: Rochester, NY
• Medical School: Des Moines University
• Clinical Interests: Cardiac anesthesia, intensive care
• Personal Interests: Running, cycling, board games, NFL, trivia, cooking

Brian Potocnik, MD

• Hometown: Aurora, Ohio
• Medical School: The University of Toledo COM
• Personal Interests: Golf, Water sports (slalom skiing / wakeboarding), Soccer, Cleveland Sports (Tribe, Browns, Cavs)

Stephen Seibert MD

• Hometown: Cassadaga, NY
• Undergraduate: Tulane University
• Medical School: Albert Einstein College of Medicine
• Clinical Interests: Chronic pain management
• Personal Interests: Football, playing guitar, fitness, the beach

Peter Shehata, DO

• Hometown: Toronto, Canada
• Medical School: Kansas City University
• Personal Interests: Travel, working out, hiking, volleyball, trying new restaurants, spending time with family/friends

Chelsea Skinner, MD

• Hometown: Port Clinton, OH
• Medical School: The Ohio State University
• Personal Interests: Playing with my dog, hiking, boating, fishing, running/lifting, rec sports, fantasy football, OSU football (go bucks), happy hour

Morgan Stafford, MD

• Hometown: Raleigh, NC
• Medical school: Wake Forest School of Medicine
• Personal Interests: Running, hiking, baking, travel, exploring new ice cream parlors and coffee shops

Eric Wang, MD, MPH

• Hometown: Appleton, Wisconsin
• Medical School: Baylor College of Medicine
• Clinical Interests: Cardiothoracic Anesthesia, Critical Care
• Personal Interests: Traveling, Playing Basketball, Watching Sports (especially the Green Bay Packers and Houston Rockets), AYCE (all you can eat)

CA-1 Class

Brandon Beck, DO

• Hometown: Findlay, Ohio
• Medical School: Liberty University
• Personal Interests: hiking, kayaking, running with my dog, trying out new breweries

Emily Bitticker, MD

• Hometown: Dover, Ohio
• Medical School: University of Cincinnati College of Medicine
• Personal Interests: Making dank Spotify playlists, watching mind-numbing television, re-watching movies, pretending to know what's happening at team sporting events, mountain biking, spring-board diving, attending concerts, driving (stick) for recreation, flying in airplanes with windows, frolicking barefoot in the countryside

Sean Blackburn, MD

• Hometown: Warren, MI
• Medical School: Wayne State University School of Medicine
• Personal Interests: Hiking, kayaking, cooking (eating), tennis

Scott Breeden, DO

• Hometown: Bloomington, Indiana
• Medical School: Marian University
• Personal Interests: Running

Brett Gentle, DO

• Hometown: Goshen, Indiana
• Medical School: Marian University College of Osteopathic Medicine
• Clinical Interests: Cardiac Anesthesia
• Personal Interests: Golfing, Soccer, Hiking, Cycling

Levi Kellogg, MD

• Hometown: Clear Lake, Iowa
• Medical School: University of Iowa Carver College of Medicine
• Personal Interests: Exercise (weightlifting, recreational sports), reading, trying new bars and restaurants, hammocking

Aaron Kruger, MD

• Hometown: Kansas City
• Medical School: Texas Tech Health Sciences Center
• Personal Interests: Jiu Jitsu

Jennifer Kumar, MD

• Hometown: Orange County, CA
• Undergraduate: UC Berkeley
• Medical School: Case Western Reserve University
• Personal Interests: tennis, hiking in the national parks, reviewing restaurants, visiting theme parks

Frank Kushnar, MD

• Hometown: Lakewood, Ohio
• Medical School: Ohio University Heritage College of Osteopathic Medicine
• Personal Interests: Hiking, Bird Watching, Biking, Camping

Isabel Londono, MD

• Hometown: Manizales, Colombia
• Medical School: Universidad de los Andes
• Personal Interests: travel, volleyball

Bo Park, DO

• Hometown: Tampa, FL
• Med School: LECOM Bradenton
• Personal Interests: Netflix, video games, cooking

Hannah Parks, MD

• Hometown: Pittsburgh, Pennsylvania
• Medical School: Temple Medical School
• Personal Interests: scuba diving, hiking with my dog, white water rafting, crocheting, watching Netflix, eating, having picnics, and playing volleyball with my coresidents!

Neel Patel, MD

• Hometown: Mississauga, Canada
• Medical School: Central Michigan University College of Medicine
• Personal Interests: table tennis, volleyball, board games, PC gaming

Stephen Pavelko, MD

• Hometown: Perrysburg, OH
• Medical School: University of Toledo College of Medicine
• Personal Interests: Travel, fitness, football, basketball, spending time with my wife and daughter

Duncan Polot, MD

• Hometown: Ann Arbor, MI
• Medical School: Western Michigan University
• Personal Interests: Rock climbing, hiking, board games, ice cream, playing with my cat

Sean Pugh, DO

• Hometown: Columbus, OH
• Medical school: Ohio University
• Clinical Interests: Critical care/cardiac anesthesia
• Personal Interests: traveling, sports, breweries>

Matthew Serna, MD

• Medical school: wright State Boonshoft school of medicine
• Clinical interests: acute pain and perioperative medicine
• Personal interests: Cleveland sports, Ohio State football tailgates, weightlifting, mountain biking and other outdoor pursuits (hiking, fishing, climbing), writing

Dan Vanzant, DO

• Hometown: Cleveland, Ohio
• Medical School: OUHCOM
• Personal Interests: Spending time with family and friends, Outdoor activities such as hiking, geocaching, boating, and fishing as well as online gaming

Nicholas Visos, MD

• Hometown: Clifton, Virginia
• Medical School: Eastern Virginia Medical School
• Clinical Interests: chronic pain
• Personal Interests: Volleyball, Formula 1, Reality TV

Michael Walters, MD

• Hometown: Columbus, Ohio
• Medical School: Cleveland Clinic Lerner College Of Medicine
• Personal Interests: Cooking, visiting natural parks, Traveling, Broadway shows, Sporting events

Shaman Whitson, DO

• Hometown: St. Peter, MN
• Medical School: Pacific Northwest University of Health Sciences
• Personal Interests: Landscaping, gardening, running, and spending time with my wife and kids

Ayah Zegar, MD

• Hometown: Hilliard, Ohio
• Medical School: Northeast Ohio Medical University
• Personal Interests: concerts, nail art, beach bumming, comedy shows, cooking

CA-2 Class

Abey Abraham, MD, Chief Resident

• Hometown: Newcastle, UK
• Medical School: University of Leicester
• Clinical Interests: Cardiothoracic Anesthesia and Critical Care
• Personal Interests: Obstacle Course Racing, Trail Running, Burpees, Rock-Climbing, Ninja-Warrior, 80s Glam Metal

Gausan Bajracharya, MD

• Hometown: Kathmandu, Nepal
• Medical School: Manipal College of Medical Sciences, Nepal
• Clinical Interests: Critical Care, Cardiothoracic Anesthesia
• Personal Interests: Bicycling, playing guitar, spending time with family, cooking

Zinan Cheng, DO

• Hometown: Buffalo, NY
• Medical school: Touro College of Osteopathic Medicine, Middletown NY
• Personal Interests: Cooking, lifting, fishing, video games, history

Larissa Combs, MD

• Hometown: Indianapolis, IN
• Medical School: Indiana University School of Medicine
• Personal Interests: running, cycling, yoga, hiking, breweries, pizza & ice cream, cooking, baking, traveling

Calvin Davis, DO

• Hometown: Skaneateles, NY
• Medical School: Nova Southeastern University
• Personal Interests: Weightlifting, beach games, board games, traveling

Tony El-Hayek, DO

• Hometown: Canfield, Ohio
• Undergraduate: The University of Akron
• Medical School: Lake Erie College of Osteopathic Medicine
• Clinical Interests: Chronic Pain Management, Acute Pain and Regional Anesthesia
• Personal Interests: Soccer, golf, tennis, biking, bowling, traveling, trying new restaurants/breweries

Connor Eliott, MD

• Hometown: Easton, CT
• Medical School: University of Virginia
• Personal Interests: Reading, Hiking/camping, Cooking, Avoiding burpees, Guitar/piano

Michael Lamorghese, DO

• Hometown: Cleveland, Ohio
• Medical School: Ohio University Heritage College of Osteopathic Medicine
• Clinical Interests: General Anesthesia, Pediatric Anesthesia, Obstetric Anesthesia, Regional Anesthesia
• Personal Interests: Basketball, Triathlons, Weightlifting, Foosball, Singing Italian Opera, Exploring New Cities and Restaurants, Craft Beer and Coffee, Cleveland Sports, Overall Health and Wellness

Mee Jee Lee, MD

• Medical School: Case Western Reserve University School of Medicine
• Clinical Interests: Pediatric anesthesia

Helen Leung, MD

• Hometown: Easley, SC
• Medical School: Northwestern University Feinberg School of Medicine

Xiang Li, MD

• Hometown: Dalian, China
• Medical School: Shanghai Jiaotong University School of Medicine
• Clinical interests: Critical Care
• Personal interests: hiking, watercolor painting, piano

Evan Parker, MD

• Hometown: Elmira, NY
• Medical School: SUNY Upstate Medical University, Syracuse, NY
• Clinical Interests: chronic pain management
• Personal Interests: guitar, board games, backpacking, photography, cooking

Nirav Patel, MD

• Undergraduate: University of Florida
• Medical School: University of South Florida Morsani College of Medicine
• Personal Interests: Playing and watching sports (rooting for my Florida Gators), Reading the Newspapers (like an old man), Exercising, learning new things, Traveling, Being with my Residency Class

Julia Peceny, MD

• Hometown: Crown Point, Indiana
• Medical School: Indiana University School of Medicine
• Personal Interests: Cats, volleyball, kayaking, hiking, gardening

Nicholas Prayson, MD

• Hometown: Shaker Heights, Ohio
• Medical School: Case Western Reserve University
• Clinical Interests: Chronic Pain Management
• Personal Interests: Travel, cooking, hiking, sports and spending time with friends and family

John Raduka, MD

• Hometown: Thiensville, Wisconsin
• Medical School: Eastern Virginia Medical School
• Personal Interests: Cats, climbing, hiking, snowboarding, sleeping, Netflix

Gurjit Saini, DO

• Hometown: New York City
• Medical School: Chicago Osteopathic Medicine
• Personal Interests: Ballin’ on a budget

Joe Salloum, MD

• Hometown: Cleveland, Ohio
• Medical School: The Ohio State University College of Medicine
• Clinical Interests: Quality Improvement, OB Anesthesia, Regional Anesthesia
• Personal Interests: Volleyball, snowboarding, visiting family overseas, Cleveland sports

Carly Smith, MD

• Hometown: Indianapolis, IN
• Medical School: Indiana University School of Medicine
• Personal Interests: yoga, running, my dog, pediatric anesthesia, SICU

Jahnavi Trivedi, MD

• Hometown: Saint Louis, MO
• Medical School: Saint Louis University
• Personal Interests: travel, cooking

Lucas Upperman, MD, Chief Resident

• Hometown: Canton, OH
• Undergraduate: Kent State University
• Medical School: Northeast Ohio Medical University
• Clinical Interests: Critical care
• Personal Interests: Running, hiking, kayaking, Cleveland sports, dogs, cooking

Kan Zhang, MD

• Hometown: Tokyo, Japan
• Medical School: Tokyo Medical and Dental University
• Clinical Interests: Cardiac anesthesia, Echocardiography, Congenital heart disease
• Personal Interests: Wine, Musicals, CrossFit

CA-3 Class

Nevin Cherian, MD

• Hometown: Saint Louis, Missouri
• Medical School: Saint Louis University School of Medicine
• Personal Interests: Bicycling the Towpath Trail, SCUBA, board games, bar trivia. Established fan of the Saint Louis Blues, freshly adopted fan of the Browns

Courtney Chow, MD

• Hometown: Portland, OR
• Medical school: Creighton University
• Personal Interests: food, travel, puppies

Nick Daskalakis, DO

• Hometown: Portland, OR
• Medical School: Western University of Health Sciences
• Clinical Interests: Pediatric Anesthesia
• Personal Interests: CrossFit and any other functional fitness, trying new restaurants and cooking new recipes, fishing, any sport with a racquet (especially tennis), Portland Trail Blazers basketball, Traveling, and spending time with my 2 year old Australian Shepherd Rainier

Andrew Gruenzel, MD

• Hometown: Dayton, Ohio
• Medical School: University of Cincinnati College of Medicine
• Clinical Interests: Academic - Pain management
• Personal Interests: Hiking, cooking, collecting vinyl

Jason Hale, MD

• Medical School: Baylor College of Medicine

Nate Johnston, MD

• Hometown: Richmond, VA
• Medical School: Eastern Virginia Medical School
• Personal Interests: Swimming, Business of medicine, Cooking, Coffee, Stock Options trading

Adriana Martin, MD

• Hometown: Porto Alegre, Brazil
• Medical School: Universidade Federal do Rio Grande do Sul
• Personal Interests: outdoor activities, yoga, snowboarding, traveling

Nick Moses, MD

• Hometown: Willoughby Hills, OH
• Medical School: University of Toledo
• Personal Interests: golf, fishing, Cleveland browns, steak

Lana Moy, MD, Chief Resident

• Hometown: Chicago, IL
• Medical School: Chicago Medical School
• Personal Interests: new authority on Jackbox party games and virtual happy hours, fulfilling my need for speed at electric go-kart racing tracks, hopeful beginner skier with no concussions or contusions yet, cooperative tabletop board games, and baking with mentees

Junaid Mukhdomi, MD

• Hometown: Dallas, Texas
• Medical School: Chicago Medical School
• Clinical Interests: Pain Management, Neuromodulation
• Personal Interests: Basketball, weightlifting, traveling

Shari Oesterreich, MD

• Hometown: Hillsboro, IL
• Medical School: Washington University in St. Louis School of Medicine
• Personal Interests: Anything outdoors - hiking, biking, kayaking, paddle boarding; tennis - played in college; spending time with family

Philip Ramirez, MD

• Hometown: everywhere, most recent Chapel Hill, NC
• Medical School: UNC Chapel Hill SoM
• Clinical Interests: Critical care and mentoring
• Personal Interests: family fun, BBQ

Sarah Rogers, MD

• Hometown: Cleveland, Ohio
• Medical School: Northeast Ohio Medical University

Afrin Sagir, MD

• Hometown: Cochin, Kerala, India
• Medical School: Manipal University, India
• Personal Interests: Travel, Hiking, Bollywood dancing, Volleyball

Matt Sikora, DO, Chief Resident

• Hometown: Cleveland, Ohio
• Medical School: Ohio University Heritage College of Osteopathic Medicine
• Personal Interests: Cleveland Sports mainly the Cleveland Browns, Working Out, OB Anesthesia, Movies, Fishing, Going on walks with my fiancée and our dog Kirbie

Thida, MD

• Hometown: Yangon, Myanmar
• Undergraduate: Smith College
• Medical School: Geisel School of Medicine at Dartmouth
• Clinical Interests: Cardiac Anesthesia
• Personal Interests: Hiking, Traveling, Running, Dog training

Oscar Tovar, MD

• Medical School: Texas A&M Health Science Center College of Medicine
• Personal Interests: Food, Cooking, traveling to eat, Eating, Drinking, Gastronomy

Alix Wright, MD

• Hometown: Akron, OH
• Medical school: Case Western Reserve University School of Medicine
• Personal Interests: cooking, eating, video games, gardening, camping, hiking, yoga, travel, spending time with my husband, family, friends and my two cats

Shan Zhou, MD, PhD

• Hometown: Hunan, China
• Medical school: Wuhan University, China
• Personal Interests: Harvest my own veggies in my backyard

Program Details and Rotations

Cleveland Clinic has a world-renowned reputation and a role as an international quaternary referral center. Patients with serious medical conditions come here for some of the most complex surgical procedures performed in the world. In this extraordinary clinical environment, our residents routinely manage some of the most challenging cases that anesthesiology has to offer, all while enjoying a broad experience in all aspects of perioperative medicine.

Clinical Base Year (PGY-1):

The Anesthesiology Institute is proud to sponsor a comprehensive and unique Clinical Base Year (CBY), specifically designed to prepare first year residents for advanced training in our anesthesiology residency. The CBY is comprised of 13 four-week modules of training, including experiences through the following areas:

• Perioperative medicine
• Hospital internal medicine
• Hospital pediatrics
• Endocrinology
• Infectious disease
• Nephrology
• Cardiology
• Pulmonary medicine
• Acute pain management and regional anesthesia
• Adult surgical Critical Care
• Cardiovascular and thoracic surgical Critical Care
• Emergency Medicine

The CBY includes four months of General Anesthesia including a gradual two-month orientation process. During this period, the basics of anesthesia are taught in the classroom, OR and simulation settings. In a “boot camp” setting, our residents experience selected common and uncommon anesthesia crises, in a supervised and safe environment.

All scheduling, advising and evaluation for the internship is controlled by the Anesthesiology Institute. In addition to a broad clinical experience, this internship prepares the first-year resident for a smooth entry into the CA-1 year. Regular participation in anesthesiology conferences and activities makes the CBY resident a full participant in the Anesthesiology Institute.

CA-1 Year:

In the CA-1 year, residents build on the concepts and skills introduced in the CBY and continue to administer anesthesia using a wide variety of techniques for the main general anesthesia surgical areas. Residents will complete anesthesia rotations dedicated to surgical subspecialties including orthopedics, neurosurgery, ENT, urology, and plastic surgery.

Additionally, the CA-1 resident will have additional critical care exposure in both our 30-bed Surgical ICU and 95-bed Cardiovascular ICU, both of which are managed by the Anesthesiology Institute. This gives the residents the opportunity to help manage complex and acute critically ill patients encountered here, where technologies for advanced cardiovascular support are commonplace, second to none.

The CA-1 residents spend some time in our newly remodeled pre-anesthesia clinic co-managed with our Internal medicine colleagues, allowing for a comprehensive preoperative patient evaluation and the initiation of multiple perioperative ERAS protocols.

During the postoperative anesthesia care unit rotation, the residents have the opportunity to manage postoperative complex patients from multiple surgical subspecialties, allowing them to understand the continuum of perioperative care.

CA-2 Year:

After intense exposure to the fundamentals of Anesthesiology during the CBY and CA-1 years, the CA-2 year introduces residents to the more complex anesthesia sub-specialties, these include the following:

Our Neurosurgical experience involves the management of a broad range of case complexities, from simple spine procedures to complex awake craniotomies. Being one of the largest stroke centers in Northeast Ohio, our residents get to experience acute neurosurgical emergencies, giving them the opportunity to solidify their management strategies.

Our residency program’s cardiac and thoracic anesthesiology rotations are world class. Cleveland Clinic has been recognized as the number 1 hospital by US News and World Report for 26 consecutive years for cardiac care. During the residents’ rotations through the cardiac ORs they have the opportunity to work with world class surgeons and anesthesiologists performing the most complex and challenging surgical procedures. Residents witness the most vanguard techniques in cardiac and thoracic surgery, allowing them to be excellently prepared in this very challenging area of anesthesia.

Residents will also gain additional experience in the management of difficult airways during a special module dedicated to ENT anesthesia, where a step wise milestone and procedure-based curriculum enhances resident exposure to simple and complex airway management techniques.

Additional exposure to obstetric and regional anesthesia provide a longitudinal learning experience that help solidify the residents’ knowledge in these sub-specialties.

Our pediatric anesthesia experience is divided into two different locations. At main campus our residents get the opportunity to work with dedicated world class anesthesiologists in the management of complex pediatric surgery cases. From complex congenital cardiac surgery to a simple adenoidectomy, the CA-2 pediatric anesthesia rotation prepares our residents to manage pediatric cases. Additionally, our residents also rotate at the area’s largest pediatric hospital, Akron Children's Hospital for a second Pediatric Anesthesiology exposure, allowing to consolidate through deliberate practice, high repetition and turn over their pediatric anesthesia experience.

With approximately 165 liver transplants per year, our CA-2 anesthesiology residents have the opportunity to cover liver call throughout the year. This allows our residents to effectively learn the management of these complex cases, enhance their transfusion and intraoperative critical management strategies.

CA-3 Year:

The CA-3 year provides the senior resident with a wealth of opportunities to fine tune their clinical and leadership skills, while providing anesthesia and intensive care with significant autonomy to some of our sickest patients. Our CA-3 residents rotate through anesthesia subspecialty areas giving them the opportunity to solidify their management strategies. We have found that additional time in obstetric anesthesia, pediatric anesthesia, cardiac anesthesia and critical care are of great benefit.

While in the cardiac ORs, our residents rotate for a dedicated transesophageal echo module, where their primary responsibility is to learn this skill. Many of our residents pursue basic TEE certification or get an important head start in their TEE knowledge as they move on to fellowships where this skill is required.

During the months assigned to the general ORs, the CA-3 residents direct the overnight and weekend call teams and learn how to efficiently utilize OR resources and anesthesia personnel by working at the anesthesia control desk, giving them an invaluable on the job experience in personnel, time and resource management.

We also offer elective rotations at several of Cleveland Clinic’s regional facilities, including Hillcrest, Fairview and Lutheran Hospitals, where our residents have access to a community and private practice feel for anesthesiology, engaging in experiences that enhance their autonomy, supervisory skills as well as their regional anesthesia practice.

As part of one of the largest pain practices in the country, our residents’ rotations through our chronic pain clinics enhances their understanding of the multiple different invasive and non-invasive strategies for chronic pain management, as well as perioperative management of this very complex patient population. As part of the CA-3 electives, our residents have the opportunity to work in a community based chronic pain practice, where they gain experience and manage complex pain patients with adequate supervision.

CA-3 residents have the option to take elective time for advanced clinical research (up to six months) for scholarly purposes.

Approximate Annual Surgical Volume:

As a world class Institution, with a target on innovation and patient safety, Cleveland Clinic’s different surgical services encompass a huge gamut surgeries and procedures. This allows our anesthesiology residents to be exposed to a wide range of surgeries, from the most common elective ones, to complex and experimental procedures. Our residents are part of the care team, hand in hand with anesthesiology leaders in multiple surgical sub-specialties, creating an environment of learning and discovery.

Here are some numbers that reflect the annual vast surgical experience at Cleveland Clinic’s main surgical ORs:

• 60,448 total surgical procedures
• 17,936 ambulatory surgical cases
• 10,651 pediatric procedures
• 8,216 cardiac procedures
• 713 pediatric cardiac procedures
• 1,192 thoracotomies
• 141 critical care beds (SICU and CVICU)
• 9,574 acute pain patients
• 2,317 new chronic pain patients
• 8,979 chronic pain procedures
• 53 heart transplants
• 133 lung transplants
• 174 kidney transplants
• 190 liver transplants
• 8,488 deliveries
• 6,588 major orthopedic procedures
• 766 major spine cases
• 4,518 neurosurgical procedures
• 2,346 vascular procedures

Our resident’s critical care exposure is enriched by the complexity of our patients, as well as the diverse settings where this care happens, from a dedicated liver transplant ICU to a unit dedicated to cardio-pulmonary mechanical assist devices and transplantation. The care that our residents provide these patients enriches their anesthesiology education, communication skills and team effectively.

Curriculum and Training

The Anesthesiology Institute's didactic curriculum component of the residency is matched in intensity and scope to the clinical experience, with the goal of providing diverse opportunities each week for residents and faculty alike to interact and enhance learning. Conferences and educational activities are designed to be challenging to residents, specific for their level of training.

Didactics

• In line with keeping our residents appropriately protected from unnecessary COVID exposure, we have modified our didactic activities format to virtual lectures when at all possible.
• Anesthesiology Institute Grand Rounds are weekly Institute-wide topic presentations given by faculty, residents, or renowned national and international leaders in the field as part of our Visiting Professor Lecture Series. M&Ms are held during Wednesday mornings on a weekly basis.
• Thursday Education Half Day each resident class, from CBY through CA-3, are relieved from all clinical duties to attend educational activities on topics ranging from basic pharmacology and physiology to complex sub-specialty material.
• Curriculum is geared towards ABA Keywords and preparation for both parts of the ABA Board Exam as well as the annual In-training Examination (ITE) and Anesthesia Knowledge Test (AKT).
• We embrace a learner centered, interactive approach using problem-based learning, case-based learning, crisis resource discussions, simulation scenarios, interactive case discussions and faculty moderated resident led presentations.
• Faculty-led special topic and sub-specialty review sessions occur on a monthly basis.
• Outcomes Research Weekly Lecture Series - an optional lecture series for interested residents and fellows, dedicated to basic and advanced clinical research training, with special emphasis on research design, statistics, ethics, manuscript writing, and presentation. Lectures given by Outcomes Research Faculty - some of the most highly regarded and published leaders in Anesthesia research.
• Journal Clubs are held weekly throughout the year, addressing important and relevant topics of the ever-changing aspects of anesthesiology.
• Sub-specialty rotation-based lectures, including lecture series for residents on critical care, cardiothoracic anesthesia, obstetric anesthesia, pediatric anesthesia, etc. These are discussed during the resident’s specific rotations, in small group settings.
• Mock Orals are provided twice a year by faculty members, several of whom are ABA Board Examiners. This experience is enhanced in the CA-3 year, helping our residents to prepare for this component of the ABA Applied exam.
• OSCE (Objective Structured Clinical Exams) experience is provided for our CA-2 and CA-3 residents to assist with preparation for the ABA Applied exam.

Simulation

Anesthesiology residents have access to over 59,000 square feet of some of the most cutting-edge simulation space in the world. Utilizing responsible practices, we have been able to re-start our simulation activities.

Multidisciplinary Simulation Center - focused on both individual and team-based learning, this center features a fully functional ICU and operating room, complete with the same equipment and capabilities found elsewhere in the hospital. The center is equipped with:

• A wide variety of task and procedural-based simulators
• Multiple infant, child, obstetric and adult human high fidelity patient simulators
• State-of-the-art audiovisual recording and assessment system

Our didactic curriculum is enriched with a strong high fidelity simulation foundation, with cases that have a progressive increase in complexity, exposing our residents to the bases of all areas of crisis resource management, situational awareness and effective teamwork, both at the main simulation center and at the bedside in different in-situ locations.

These are some of the topics we address in our simulation sessions:

• Central and peripheral IV and arterial access practice workshops
• Neuraxial anesthesia workshops

• Peripheral nerve blocks
• Transthoracic and transesophageal echocardiography simulation
• Complex anesthesia crisis and emergencies
• Obstetric emergencies
• Vascular surgery emergencies
• Neurosurgical emergencies
• ENT emergencies
• Regional anesthesia complications
• PACU/ICU emergencies
• Crisis management
• Team communication

The Debra Ann November Pediatric Airway and Pulmonary Mechanics Lab - a technologically advanced simulation lab dedicated to the complexities and unique challenges presented by the pediatric airway. Equipped with a high-fidelity bronchoscopy simulator, a fully functioning anesthesia machine, ICU ventilators, and infant and child-sized task trainers and high fidelity simulation mannequins, residents will gain both fundamental and advanced skills in pediatric airway management as well as a better understanding of pediatric anatomy and pulmonary physiology.

The Archie Brain Difficult Airway Simulation Center - features a simulated operating room complete with a functional anesthesia machine, operating room equipment, and a human patient. This unique center allows residents to not only fine tune basic airway management skills, but also develop an effective and skillful approach to the difficult and failed airway. Residents will have access to a high-fidelity bronchoscopy simulator, a variety of supraglottic airways and airway management devices, and a proprietary one-lung ventilation simulator.

Cardiothoracic Anesthesia Simulation Area – features multiple advanced airway and bronchoscopic simulators as well as a transthoracic/transesophageal echo simulator, and a central line, pulmonary catheter and IV pacer simulator; allowing our residents to practice and through deliberate, high repetition enhance their procedural skills.

Benefits

Residency Program Benefits

Our residents are able to enjoy 20 vacation days each academic year.

Insurance

Cleveland Clinic offers a comprehensive health plan which covers residents and fellows as well as their immediate family members (spouse and eligible children) at 50% of the healthcare premium that all other Cleveland Clinic caregivers pay. Trainees are covered as of their actual start date so long as they complete online enrollment within 31 days of their start date.

Educational Allowance

An educational allowance is granted each academic year and may be used for books, moving expenses (incoming trainees only), laptops, USMLE/COMLEX, professional society memberships, board review, etc. Although currently on hold due to COVID-19 restrictions, we anticipate this to go back to normal in the near future.

Once meetings become “in person” again, the Education Institute will fund up to $1,500 per academic year for CA1-CA3s for meeting attendance provided an abstract or poster is presented and the resident is the first author.

Additional funding for travel and meeting attendance may be available through the Center for Anesthesiology Education Office pending an approval process. Meeting attendance does not subtract from vacation days.

Salary

Please refer to the table below for new salary rates, effective April 1, 2020:

Additional Benefits

• Free access to Cleveland Clinic Fitness Facilities (state-of-the art cardio and weight machines, Olympic sized swimming pool, basketball courts, fitness classes)
• Mini iPads provided to all incoming anesthesia residents
• Access to "Access Anesthesiology" plus a multitude of other electronic resources provided through the Cleveland Clinic Alumni Library
• On-call meal allowance
• Nicely equipped resident lounge
• In-house moonlighting opportunities (for those who qualify and meet requirements)
• Access to different educational resources including TrueLearn, Anesthesia Toolbox and Board Vitals

How to Apply

Anesthesiology Residency Application Process

The Anesthesiology Institute offers 22 categorical positions each year, comprised of a unique, integrated Clinical Base Year (CBY) followed by three years of Clinical Anesthesia (CA1-CA3). All positions are filled through the National Residency Matching Program (NRMP).

How to Apply

The Anesthesiology Institute participates in the Electronic Residency Application Service (ERAS) for all positions. Our application requirements are the same as the standard ERAS application:

• Complete Application
• CV
• Personal Statement
• Medical Student Performance Evaluation (Dean's Letter)
• Transcript
• USMLE Step I Transcript
• Three Letters of Recommendation

Please add a paragraph to your personal statement discussing what it is about the Cleveland Clinic program that appeals to you. Program specific personal statements will be held in high regard.

USMLE Step 2 may be completed after the application deadline.

We understand the USMLE Step 2 this year this has been an additional challenge due to restriction imposed by COVID-19, and will take this into account when reviewing applications.
USMLE Step 2 CK may be completed after the application deadline, but its results will be considered before the final residency rank list. Successful completion of both Step 2 CS and CK is required prior to matriculation.

We understand difficulties obtaining letters of recommendation due to restrictions imposed by COVID-19. Regardless of the letter writer’s specialty, letters highlighting your best qualities will be considered and useful for our recruitment committee to recognize your performance in different areas and experiences.

Deadline

While there is no definite deadline, we strongly encourage that all applications be submitted on or soon after October 21st 2020.

Interviews

Offers for interviews will be made via email starting early November. Interviews will be virtually held on Thursdays from November through January via a ZOOM platform; camera presence will be required. The night before each interview date we will have an event where the scheduled candidates will have the opportunity to meet current residents in the program in the setting of a virtual social mixer.

For More Information

Carlos Trombetta, MD, MEd, CHSE, FASA
Residency Program Director Anesthesiology Institute
Staff General and Cardiothoracic Anesthesiologist

Shirley Dotson
Residency Program Coordinator
ANED@ccf.org
216.444.2356
Residency Office Phone: 216.445.2115

Program Leadership

Carlos Trombetta, MD, MEd, CHSE, FASA
Program Director

Originally from Venezuela, I completed my medical school at the Universidad Central de Venezuela, Escuela de Medicina “Luis Razetti” in Caracas, Venezuela; following which I pursued an anesthesiology residency and cardiothoracic anesthesia fellowship in its University Hospital. I eventually moved to Cleveland and enrolled in the Cleveland Clinic’s Anesthesiology Residency Program and Adult Cardiothoracic Anesthesiology Fellowship. I have been working as staff for both the general and cardiothoracic anesthesiology departments since then. I have always had a passion for medical education, and this led me to enroll and complete a Masters in Healthcare Professions Education from Cleveland State University/Cleveland Clinic.

My passion for medical education and especially simulation based medical education; made me pursue Certification in Healthcare Simulation Education (CHSE) and recognition for the Cleveland Clinic’s Simulation center from the American Society of Anesthesiologists.

When I am not thinking about medical education, I am probably planning my next trip, I really enjoy international travel, fitness, looking for new hikes to go explore the outdoors, and Italian cooking.

Sandeep Khanna, MD
Associate Program Director

I serve as the Associate Program Director and divide my time between the Departments of General Anesthesia and Cardiothoracic Anesthesia. After completing my residency training, I pursued fellowships in Cardiothoracic Anesthesia and Medical Education. My research interests include airway management, perioperative hemodynamics and liver transplant anesthesia. I love playing tennis and hanging out with my family. Our favorite activities include outdoor biking, watching movies and impromptu dancing.

Samantha Stamper, MD
Associate Program Director

I was born and raised in Pittsburgh, Pennsylvania. I received my Bachelor of Science in Forensic Chemistry at West Virginia University. I also received my Doctor of Medicine degree from WVU and then returned to Pittsburgh for anesthesia residency at Allegheny General Hospital. After residency, I completed a fellowship in regional anesthesiology and decided to join the staff following graduation. From a clinical standpoint, I split my time between general anesthesia, our acute pain management service, as well as AMET (acute medical emergency team). I love my role as Assistant Program Director because I feel that in addition to excellent patient care, education is at the heart of everything we do. Outside the hospital I love spending time with my dog, my family, and watching any and all of Pittsburgh’s sporting events.

Mariel Manlapaz, MD
Associate Program Director

I was born in the Philippines and lived in Manila until 13 years old. My family immigrated to California, and I ended up at Stanford University where I not only obtained my Bachelors in Biological Science, but I also met my husband. After a brief stint at Chiron as a research associate, I went to medical school at University of California Irvine. Much to my chagrin, I moved to Cleveland to do my anesthesia residency and cardiothoracic fellowship, since my husband had already matched here for his residency. To my surprise, I loved being at the Clinic, and Cleveland has become our home where our three boys have flourished.

Currently I specialize in neuro-anesthesia and liver transplants. In addition to my role as associate residency program director, I am also the director of the Perioperative Medicine Anesthesia Fellowship. I am very interested in how adult learners learn and am currently finishing my Masters in Education for Health Professions Education. I am looking forward to leveraging my new found knowledge and experience to help residents reach their full potential.

Outside of medicine, my husband and I love experiencing and learning about other cultures and ways of life. We have taken our boys all over the world and have had amazing adventures and have met many wonderful people!

Maged Argalious, MD, MBA, MSc, MEd, FASA, FASE
Vice Chair of Education

I serve as Vice Chair for Education for the Anesthesiology Institute and as Chair of the department of General Anesthesiology. I served as the Associate Program Director for our residency program from 2007 to 2013 and as the residency program director from 2013 to 2019. I value feedback (both giving and receiving) as an essential influence on learning and am a big fan of the Kolb’s experiential learning theory. My subspecialty areas of interest are anesthesia for liver and multivisceral transplant, vascular anesthesia, and perioperative medicine. I enjoy playing tennis, watching European soccer, and working alongside a phenomenal and dedicated education team.

Resident Life

A Message from our Chief Residents

Welcome and thank you for your interest in the Cleveland Clinic’s Anesthesiology Residency Program! The Cleveland Clinic is a world-renowned medical center that serves as a unique training environment to facilitate our goal of training residents to become experts and leaders in the field of anesthesiology.

Training and Curriculum

We provide a unique Clinical Base Year (PGY-1) that offers six months of anesthesia training throughout intern year. Our staff present lectures that focus on key topics for the ABA Basic and Advanced exams. These lectures are given during protected academic time on Thursdays where residents are relieved of their clinical duties to attend these lectures. In addition, our program provides weekly grand rounds, simulation activities, practice OSCEs, and semi-annual mock oral boards. Within our department, research is encouraged but not required for our residents. For those who wish to pursue research, our program works closely with the Outcomes Research Department which is the largest anesthesiology research group in the nation. This department provides guidance and resources for our residents to achieve their research goals.

The strength of our program is the diverse and complex clinical case exposure. The main facility includes more than eighty cardiac, thoracic, vascular, pediatric, and general ORs. The Cleveland Clinic attracts medically complex patients worldwide and gives our residents the opportunity to care for a diverse patient population. Our residents gain exposure to a wide variety of surgical cases including but not limited to liver, kidney, small bowel, heart, and lung transplants, as well as complex heart and vascular cases. The “Cleveland Clinic Experience” gives our residents the confidence to handle any clinical scenario with ease and expertise upon completion of residency.

Resident Life

Our program fosters a community of friendship and support for our large residency program. There are several Institute sponsored events throughout the year, and our staff frequently host holiday events in their homes for residents. Cleveland is a booming, affordable city that can fit anyone’s lifestyle. It offers a robust restaurant scene, a growing number of breweries including the nationally recognized Great Lakes Brewery, a variety of music and ethnic festivals, and a solid professional sports scene. For outdoor enthusiasts, the city offers many hiking and biking trails within the Metro-Parks, a large fishing network, nearby camping, and lakefront beaches. In addition, Cleveland has an internationally recognized theater district, symphony orchestra, and art museum. Cleveland’s surrounding neighborhoods and school districts offer the ideal location for you and your family. All this makes Cleveland the perfect place to call home during your training.

Whether your career goals include academic medicine, private practice, or fellowship training, our residency program is designed to provide you with a strong foundation to succeed and excel as an anesthesiologist.

Contact our Chief Residents

• Abey Abraham, MD (ABRAHAA@ccf.org)
• Lana Moy, MD (MOYL@ccf.org)
• Matthew Sikora, DO (SIKORAM@CCF.ORG)
• Lucas Upperman, MD (UPPERML2@ccf.org)

A Day in the Life of Our Residents

Hi everyone! My name is Isabel Londono and I am a second-year resident. This year we begin our full-time anesthesia training. We spend most of our time in the OR, but we also go to the surgical ICU, cardiovascular ICU, acute pain service, preoperative clinic, post anesthesia unit, cardiology, and obstetrics. Although intern year was a combination of Internal Medicine, ED, and Anesthesia, it gave me enough time in the OR to prepare for this year.

A typical day for me starts around 5-5:30 am when I wake up, eat breakfast and head to the hospital. I live 15 minutes away so it is a short commute. After changing to my scrubs, I get the OR ready for the first case. Each Staff is assigned to 2 resident rooms so they are present for induction, wake up and any other time I might need them. I always get a 15-minute morning break and a 30-minute lunch break. Lunch time is awesome because I go to the resident’s lounge where most of my co residents are also having lunch. My day normally ends around 5 pm. When I get home, I preop my patients for the next day and discuss them with the staff.

I love spending time with my co residents and exploring Cleveland during the weekends. During the summer months, I usually go out with my classmates to play volleyball in the afternoons. We even signed up for a tournament that we play Friday nights!

Isabel Londono, M.D.
CA1 Resident, Cleveland Clinic.
Email: LONDONI@ccf.org

Depending on your year and rotation you will stroll into the hospital to our row of anesthesia lockers either on anesthesia-time (earlier) or consult-time (later). If you are on a medicine/consult service, usually as an intern, you will meet with your anesthesia buddy or medicine colleagues and split up a list of new consults or follow-ups. Most people enjoy our consult services intern year as you generally are not slammed with a huge list of patients and a ton of new consults. You will spend a good amount of time in H15 - the general resident lounge. It is a common place to do notes, eat lunch, catch some updates on sports, and chat with your fellow anesthesia comrades. I think all our residents would agree H15 is the cool place to hang with its proximity to both the OR’s and the cafeteria.

But what about being on an actual anesthesia rotation? Most cases start at 7:30am, you will get to your OR a little before then and have your airway gear, drugs, and monitors all lined up and ready to go. Patients will show up at your OR and you will pepper them with the usual pre-op questions before rolling them in and getting them off to sleep with your staff. Morning break providers will come around and give you a quick 15-minute bathroom/coffee break and then again for lunch time where you will head back to H15 and catch up with your co-residents. With the completion of surgery, you will wake your patient up and wheel them off to PACU with the surgical resident for a quick sign-out to the nurses.

Some of the other rotations you’ll hear about are acute pain where you’ll do an abundance of nerve blocks and SICU which is run by very nice anesthesia staff and fellows who are willing to help with anything you get stuck on. Everyone will agree our SICU is a fantastic learning and bonding environment and not something to fear your intern year. You’ll also run into some pediatrics and OB anesthesia a little later in your residency years where you will have a few months outside the main campus at peripheral Cleveland Clinic hospitals to diversify your experience with some new attendings, surgeons, and OR environments. When you step into cardiac and liver transplants during your CA2 year and see IV poles packed with smart pumps, lines crossing every limb of your patient, and Belmont chugging away, you’ll know you made it to the big leagues. These cases are not for the T-ball league in our hospital.

Lastly, and possibly most importantly, what about the fun stuff not at work? Most large academic hospitals will give you great challenging training, but they do not all give you a life outside of residency. The name Cleveland Clinic may imply a stern-faced, all-business, polished-shoe kind of image, but instead you will find a group of trustworthy accountable friends. While COVID has really slowed our social activities, this component of residency has been a high point for us. Volleyball leagues, cookouts, beach days, bar crawls, game nights, and so on. In general we organized our own events and parties to avoid the “awkward work social events” as any normal group of friends would do, (I put this in past tense because COVID has temporarily complicated our extensive event planning). We know it is hard to get a “vibe” without on-site visits, but we hope this helps you understand who we are as a residency!

Calvin Davis, D.O.
CA2 Resident, Cleveland Clinic.
Email: DAVISC20@ccf.org

Research Opportunities & Conferences

Anesthesiology Resident Research Opportunities:

Cleveland Clinic's Center for Anesthesiology Education and the Anesthesiology Institute are committed to the continual growth of the knowledge base of anesthesia. To support this endeavor, we actively encourage our residents to take part in quality clinical research as a part of their four years of training.

Spearheading our research program is the Department of Outcomes Research, the clinical research arm of the Anesthesiology Institute. This team of world-renowned researchers, clinicians and statisticians is working on clinical research to improve patient outcomes. The department also serves as the administrative center for the international Outcomes Research Consortium, a group of more than 110 clinical investigators, spread across four continents and arguably the world's largest clinical anesthesia research organization.

In addition, within the Anesthesiology Institute, we have a resident research committee comprising of staff and two resident research coordinators. The role of the resident research coordinator is pivotal in connecting interested residents with appropriate research mentors. In addition, the research coordinators help coordinate the activities of Annual Anesthesiology Institute Research Day, which serves as a platform to present and recognize high quality research projects conducted by residents and fellows with the guidance of their staff mentors.

Getting Involved with Research as a Resident:

Every resident is given ample opportunity to get involved with clinical research at an early stage, starting in the clinical base year. The Department of Outcomes Research offers the "Fundamentals of Clinical Research" lecture series to all residents throughout their training. This is a certification course conducted every year which focuses on the basics of research methodology and statistical tests, with emphasis on conducting ethical and clinically relevant research. Interested residents can also approach either of the two research coordinators who can then put them in contact with research mentors with ongoing or future research projects. We also maintain a database that keeps track of all the major research projects throughout our Anesthesiology Institute. This allows us to identify research opportunities for our residents and ensure that they have quality research projects to work on. In addition, residents can also avail up to six months of dedicated research time as an elective during CA-3 year in accordance with current ACGME guidelines. The Cleveland Clinic is an active member of the MPOG Outcomes group, giving our resident access a data base comprised of over 12 million cases, which can be analyzed for research purposes.

Anesthesiologists in charge of Resident Research:

• Alparsalan Turan, MD
• Ehab Farag, MD, FRCA

Resident Research Coordinators

• Gausan Ratna Bajracharya, MD
• Jason Hale, MD
• Afrin Sagir, MD

Meeting Attendance and Presentations:

The Anesthesiology Institute encourages and supports residents to attend all major national and regional anesthesia meetings. Once meetings resume to an “in person” format, residents will again be adequately funded and allocated meeting days away from work used for their participation in them. As per Institute policy, every resident will be able to attend one national and one regional meeting along with the OSA (Ohio Society of Anesthesiologists) meeting every academic year. Specifically, the Institute supports attendance to the American Society of Anesthesiologists (ASA National Meeting) and the Midwest Anesthesia Residents Conference (MARC Regional Meeting) and encourages all the residents to share the complexity of their anesthesiology case experience, by actively participating and presenting posters as well as oral presentations, giving our residents the opportunity to enhance their communication and presentation skills, as we prepare them to further their academic careers.

In order to meet the academic milestones of the residency program for graduation, residents are required to either publish at least one peer reviewed article or submit and present at least one abstract to a regional or national meeting during their four years of training.

Related Resources:

• Outcomes Research Consortium
• Collaborative Institutional Training Initiative
• American Society of Anesthesiologists (ASA)
• The Ohio Society of Anesthesiologists 

Resources

Training at Cleveland Clinic

We invite you to explore our Graduate Medical Education website to discover the reasons why Cleveland Clinic offers an ideal teaching and learning environment as well as to learn more about our rich tradition of excellence in the “education of those who serve.”

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