Residency

Overview

Thank you for your interest in Cleveland Clinic’s Anesthesiology Residency Program at the Cleveland Clinic. Our four year integrated categorical residency includes a world class learner centered, interactive, level specific , curriculum (including a longitudinal perioperative ultrasound curriculum, level specific high fidelity simulation based education, a comprehensive OSCE curriculum, and periodic oral board practice examinations) that prepares our graduates for a life -long career as leaders in Anesthesiology and perioperative medicine. Our residents 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 renowned experienced anesthesiologist educators. We take pride in our outcomes focused, patient centered high impact research and in our innovative culture and welcome you to join our team.

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

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 Part 1A and 2 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)

Application Process

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

USMLE Step 2 may be completed after the deadline; however, successful completion of both Step 2 CS and CK is required prior to matriculation.

Deadline

While there is no definite deadline, we strongly encourage that all applications be submitted on or soon after September 15th. Interview spots fill very quickly.

Interviews

Offers for interviews will be made via email starting late September. Interviews will be held on Mondays from October through January. Applicants are invited and highly encouraged to attend dinner the night before with our residents. Hotel accommodations will be provided.

For More Information

Carlos Trombetta, MD, MEd, CHSE
Residency Program Director Anesthesiology Institute
Staff Anesthesiologist

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

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.

In addition, 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

Rotations & Research

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
• Internal medicine
• 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 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.

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 partners, 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, including:

• Neuroanesthesia
• Cardiac and thoracic anesthesia
• Pediatric anesthesia
• Major vascular anesthesia
• Anesthesia for liver transplantation
• Non-operating room anesthesia
• Anesthesia for life threatening pathology

Residents will also gain additional experience in the management of the difficult airway 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.

CA-2 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.

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.

Additional sub-specialty exposure is gained in:

• Anesthesia for Ambulatory surgery
• Obstetric Anesthesia
• Pediatric Anesthesia
• Neuroanesthesia
• Anesthesia for Vascular Surgery
• Adult and Congenital Cardiothoracic Anesthesia
• Surgical Critical Care

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.

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 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.

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.

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.

Resident Research Coordinators

• Gausan Ratna Bajracharya, MD (Bajracg@ccf.org)
• Jason Hale, MD (halej3@ccf.org)

Meeting Attendance and Presentations:

The Anesthesiology Institute encourages and supports residents to attend all major national and regional anesthesia meetings. Residents are adequately funded and allocated meeting days away from work are used for their participation in them. As per Institute policy, every resident can 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.

Staff Anesthesiologist-in-charge of Resident Research:

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

Related Resources:

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

Didactic Education & Resources

The Anesthesiology Institute's didactic 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

• 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.

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.

Simulations of interest can include:

• 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 and transesophageal simulator, allowing our residents to through deliberate practice and high repletion enhance their procedural skills. This area also houses a central venous access, pulmonary catheter and trans-venous pacing simulators.