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The University of Utah School of Medicine

The University of Utah, the oldest institution of higher education west of the Mississippi, was founded in 1850. The 25,000 students attending the University represent all 50 states and more than 50 foreign countries.

The campus development program has kept pace with the University’s academic and research expansion. Over half of the 149 permanent buildings on campus have been built in the past decade. The focal point of the campus is the Marriott Library with holdings in excess of a million and a half volumes.

The University of Utah School of Medicine, as well as the College of Pharmacy, College of Nursing, Huntsman Cancer Institute, and Eccles Health Sciences Library are located at the foot of the Wasatch Mountains on the east boundary of the University’s 1500 acre campus immediately adjacent to the golf course and overlooking the Salt Lake Valley.

Letter from the Program Directors

What is it like to train at the University of Utah Anesthesiology Residency Program? Imagine learning from an exceptionally well-balanced faculty of over 40 with interests running the gamut from studying the mechanisms of the action of inhaled anesthetics, to health care policy development. Imagine doing 400 to 500 clinical cases a year in a multitude of surgical disciplines and a variety of practice settings. Imagine training in a city located in the shadows of the Wasatch Mountains where recreational opportunities of every conceivable variety abound.

The anesthesiology residency program at the University of Utah School of Medicine is based at the University of Utah Hospital in Salt Lake City. It is the only anesthesiology residency training program in the Intermountain West, a land area encompassing 10% of the continental United States. Although the program has trained many of the anesthesiologists currently practicing in the Rocky Mountain States, our graduates are currently in private or academic practice throughout the United States and abroad. This wide-spread network of alumni is especially useful to our residents as they enter the job market. Many of our graduating residents have found employment through this Utah connection.

The mission of our training program is to train individuals to become highly-qualified anesthesiologists. Our curriculum is designed with resident education foremost in mind. Our residents average 500 cases per year, covering the complete range of specialties and practice locations. They work under the close supervision of our faculty members, and an effort is made to ensure that each case is a learning experience. Thus, when they complete their training at the University of Utah, our resident graduates are in a position to assume the responsibilities of any type of anesthesia practice.

The clinical facilities employed for training are first rate. Our academic medical center, the University of Utah Hospitals and Clinics, is a state-of-the-art, 400-bed facility. A newly remodeled operating suite of 16 rooms is the site for nearly 20,000 anesthetic cases per year. There is a modern and newly built critical care pavillion, and our Pain Management Center is one of the best designed facilities in the country. Our residents and pain management fellows are exposed to leading edge pain management techniques. The pain management care team includes fellowship trained anesthesiologists, neurologists, physiatrists, psychologists, physical therapists, and advanced practice nurses. Our residents also received exposure to the latest advances in intensive care medicine when they rotate through the shock-trauma ICU at LDS Hospital. Here, a largely computerized unit utilizes state-of-the-art technology in caring for critically ill patients. Other partner hospitals in our training program include Primary Children’s Medical Center, the only pediatric hospital in the Intermountain West, the Veterans Affairs Medical Center in Salt Lake City, and LDS Hospital, a tertiary care facility located in Salt Lake City. The Department also operates a computerized patient simulator center. Here, our residents receive training and have the opportunity to practice their skills prior to working with patients. The simulator is also used for practicing one’s skills to become more proficient, without compromising patient safety and comfort.

Our first year anesthesia residents (CA1) develop their clinical skills by rotating through the main O.R. at the University Hospital and at the VA Medical Center. Most also do some obstetrics and intensive care training in their first year. The second year is largely devoted to subspecialty rotations, including cardiac, neurosurgical, pediatric, obstetric anesthesia, acute and chronic pain management, and intensive care medicine. Regional anesthesia is also stressed with one month dedicated to peripheral nerve blockade. The third year has extensive elective experiences. For those interested, significant research experience is readily available during the third year.

Our program is dedicated to training high-quality physicians. We strive to graduate physicians who will be valuable assets to their community. We expect our residents to become proficient in the technical skills required to provide anesthesia and to obtain the knowledge base to care for their patients. In addition, we strive to instill in our residents the knowledge and understanding of the practice of medicine--to care for the patient as an individual, not as a case. Finally, we hope that our graduates will be seen as physician experts in perioperative care in addition to experts in providing an anesthetic.

Educational experiences and activities include weekly grand rounds which consists of didactic sessions, lectures, clinical case review, simulator training, and mock oral examinations. We also have monthly journal clubs, visiting professor lectures, weekly research meetings, and in-operating room individualized instruction. From a didactic standpoint, our residents compare favorably to any other program across the nation. For the last 10 years, In-Training-Examination scores for our program have ranked between the 75th and 90th percentile of all programs in the country. Our anesthesiology board certification rate is greater than 95%.

Our program’s reputation has allowed us to gather a high-quality faculty that provides top notch patient care while engaging in important, nationally renowned research. They have been recruited from many different institutions across the United States, thus bringing different perspectives to our residents’ education. Their research interests are as diversified as their educational backgrounds. For residents interested in getting involved in research, there are multiple opportunities to do so. The Department has three dedicated basic science laboratories, as well as several rooms for clinical studies. In addition, the Department has a very active bioengineering research division headed by a nationally renown scientist, Dwayne Westenskow, Ph.D. Resident participation in research is strongly encouraged and residents are given travel money to present their scholarly work at national meetings. Approximately 20% of our graduates go on to careers in academic medicine.

Salaries and benefits are competitive and rank in the top 25% of programs nationally. Average "call" is every fifth night in-house, with the day after call off. Second and third year residents are financially supported to attend a one-week national meeting.

Salt Lake City is a clean, friendly metropolitan area of 1.2 million people. Selected as the host city for the 2002 Winter Olympic Games, Salt Lake City has outstanding recreational facilities located within the city limits. A total of 9 world-class ski resorts are located within a 50 mile radius of Salt Lake City, and Utah is justifiably known to have "the Greatest Snow on Earth."

In addition to the winter sport activities, Salt Lake City also is a center for outdoor recreation in the spring, summer, and fall. Numerous streams challenge the fly fisherman and the kayaker. There are a multitude of alpine trails for hiking, backpacking, and mountain biking. Golf and tennis are available throughout the metropolitan area. Spectator sports are also popular, with the NBA’s Utah Jazz and the University of Utah’s "Utes" drawing large crowds of enthusiastic supporters. Cultural activities are also available throughout Salt Lake City, including the nationally acclaimed Utah Symphony Orchestra, the Utah Opera Company, the Utah Ballet, the Salt Lake Repertory Theatre and numerous restaurants and museums. Salt Lake City has an affordable cost of living, and relatively plentiful rental housing.

Now that we’ve sketched something about our training program and surrounding area, we hope that you will want to know more. Congratulations on your selection of anesthesiology as a career, and best wishes to you as you pursue residency training. We look forward to hearing from you.

L. Lazarre Ogden, M.D.
Director, Residency Program, Department of Anesthesiology

Michael K. Cahalan, M.D.
Professor, Chairman, Department of Anesthesiology

The Department of Anesthesiology

The Department of Anesthesiology of the University of Utah School of Medicine has maintained national prominence both clinically and academically for over twenty years. Excellent training is available for candidates interested in an academic career or private practice.

Advantages: The Anesthesiology Residency

1. Uniform resident success in passing Boards, obtaining fellowship positions and employment.
2. Excellent case load mix and numbers (approximately 500 cases/resident per year).
3. All clinical rotations occur at University Hospital or affiliated hospitals within 2 miles. The close proximity of affiliated hospitals minimizes commuting times and facilitates lecture attendance.
4. All required training occurs in Salt Lake City; there is no need to send residents to other programs to fill deficiencies in training.
5. Training in subspecialties of pediatric, neuro, cardiac, and obstetrical anesthesia, as well as pain management are particularly strong.
6. Residents typically find housing within ten minutes or less drive from the hospitals.

The University of Utah and its affiliated hospitals offer a total of thirty residency positions in anesthesiology. The Department of Anesthesiology is approved by the American Board of Anesthesiology (ABA) and the Council on Medical Education of the American Medical Association for three years (CA1-CA3) of residency training. Residents are accepted into the program every July and January. The July positions (CA1) are awarded to senior medical students through the NRMP (National Residents Matching Program) or outside of the match. Internships (PGY1) are available through the Department of Medicine (Preliminary Medicine) at the University and at the LDS Hospital (Transitional Medicine) as explained later. Residency training is approved by the ABA and all of the affiliated hospitals are approved by the Joint Commission on Accreditation of Hospitals. Administration of all types of general and regional anesthesia is supervised by faculty anesthesiologists. This includes anesthesia for a wide variety of routine and unusual surgeries, anesthesia for cardiovascular and pulmonary procedures, neuroanesthesia, pediatric anesthesia, obstetrical anesthesia, handling of the emergency airway, dental anesthesia, the management of pain, and intensive care.

The CA3 year of training consists of advanced anesthesia training, research, or special training in clinical areas such as pain management, cardiac, obstetrical and pediatric anesthesia, and intensive care. Whenever possible, the CA3 year is tailored to the interest of the resident.

Simulator

In late 1996, the Department of Anesthesiology initiated the purchase and installation of a state-of-the-art anesthesia simulator. These devices link computer control of physiologic functions with extremely realistic mannequin responses to facilitate crisis management teaching sessions. Among the attributes of the simulator is the ability to measure and respond to all drugs administered and display appropriate physiologic responses. The mannequins are intubated, produce CO2, have pulses, respiratory excursions, changing pupils, measurable temperatures, etc. The anatomy is so sophisticated that pulmonary artery catheters can be placed during simulations. Pharmacologic responses include all common drug interactions, and display pharmacokinetic and pharmacodynamic data if desired.

The beauty of the patient care simulator is the ability to mimic rare events and practice response algorithms. Many of these events might never be seen in clinical practice during an entire residency; thus supervised experience with their management in humans is unlikely and unplanned. Examples of events that might fall under this description and benefit from simulator-based education include malignant hyperthermia, thyroid storm, pheochromocytomia, total spinal anesthesia, and difficult airway scenarios.

International Humanitarian Commitment

The Department of Anesthesiology has a long tradition of providing extensive third world anesthesiology teaching and clinical service. Eileen Csontos, MD, Co-Director of Anesthesia for Shriner’s Children’s Hospital, is a director of anesthesiology for Interplast, a national organization providing under-developed countries with surgical teams for pediatric congenital defect repair. Dr. Csontos and several other faculty have led many teams into Central American, Vietnam, Russia, and South America. Many residents participate in these trips as part of an elective rotation.

Invasive Procedures Laboratory

Under the direction of Raul Peragallo, MD, this laboratory teaches emergency and invasive procedures to anesthesiology residents. Examples of procedures that are taught in this laboratory include transcutaneous and transvenous pacing, translaryngeal and transtracheal jet-ventilation, retrograde-wire intubation, crycothyrotomy, chest tube insertion, pericardiocentesis, intraosseous needle insertion, and treatment of hyperkalemic cardiac arrest. The aim of this lab is to allow anesthesiology residents to gain expertise and confidence with potentially lifesaving emergency and invasive procedures that are infrequently performed in usual clinical practice. A cadaver crycothyrotomy lab is being organized and will be available to senior anesthesiology residents in 2004.

Fellowship Training (CA4)

A nationally recognized and ACGME accredited Fellowship in Pain Management is available through the Department of Anesthesiology and the University of Utah Pain Management Center. The Fellowship emphasizes an interdisciplinary approach to pain management, and includes participation by anesthesiologists and other medical specialists, Behavioral Medicine, Physical and Occupational Therapy, Pharmacy Practice and Nursing. All types of Chronic Pain are addressed: adult, pediatric, cancer and acute pain. Details of the Fellowship are available upon request.

Fellowship training in clinical and basic research is also available. The laboratory facilities of the Department of Anesthesiology and many other departments including the Division of Artificial Organs, Department of Pharmacology, and Division of Bioengineering are available to residents with an interest in research and/or academic anesthesia. Research is an integral part of this program, with strong encouragement for publication and presentation at national meetings. Research is funded by NIH Grants, Industry, other Governmental Grants, and Private Funding. General areas of research in basic science and the clinical anesthesia include: opioid anesthesia; CNS pharmacology; cardiovascular, respiratory and neurophysiologic changes associated with anesthesia; computers and instrumentation in anesthesiology and intensive care; cellular biochemical alterations associated with anesthesia; invasive monitoring, molecular theory of anesthesia; and methods and mechanisms of acute and chronic pain management.

Other fellowships, such as obstetrical anesthesia, neurosurgical anesthesia, and intraoperative echocardiography will be available to University of Utah graduating residents as requested and can be customized to fit individual educational goals.

Transesophageal Echocardiography

Transesophageal echocardiography is an important discipline at the University of Utah Medical Center.

In addition to providing clinical services in the operating room, cardiac anesthesiology faculty provide support to the intensive care unit and the Emergency Department.

Dr. Michael Cahalan, Professor and Chairman of the Department of Anesthesiology, is an internationally recognized researcher and lecturer in the field of echocardiography. In addition, the Division of Cardiovascular Anesthesiology is made up of faculty certified by the National Board of Echocardiography.

The clinical rotations at the University of Utah provide an extensive "hands on" experience with transesophageal echocardiography and a formal didactic program is in place to provide weekly lectures directed at successful completion of the American Society of Echocardiography certification examination.

Didactic Training in Anesthesiology

DIDACTIC TRAINING is provided by:

1. Two weekly teaching conferences covering basic and clinical sciences related to anesthesia. Didactic sessions are lead by departmental faculty and arranged to cover the American Board of Anesthesiology subject outline, which is the basis for the written Board examination.
2. In addition, case conferences are included on a regular basis.
3. Supplemental educational curriculum, during each subspecialty rotation. (Pain Management, Pediatrics, Cardiothoracic, Obstetrical Anesthesia, and Neuroanesthesia).
4. Journal Club - recent topics presented by residents and discussed by the staff and residents.
5. An annual Postgraduate Course in Anesthesiology is held every February in Park City, Utah. This is a five-day meeting of national repute, and includes many internationally-known speakers and participants. Clinical schedules are modified to allow most residents and staff to attend.
6. Special lectures by visiting professors.
7. Attendance at quarterly scientific meetings of the Utah State Society of Anesthesiologists which provide information on recent developments in the field and on matters of medical ethics, economics and hospital relations.
8. Department sponsored attendance at national anesthesiology meetings in the CA2 and CA3 years.
9. Practice oral boards examinations are given each Spring to all residents to prepare them for Board Certification.
10. Animal lab exercises in airway management and invasive cardiovascular monitoring.
11. "Keywords" topics from the ABA subject outline are summarized in one page and available for resident study.
12. Teaching tape files and CD ROM on Transesophageal Echocardiography (TEE).
13. Senior residents prepare a presentation for fellow residents and faculty.

ABA/ASA In-Training Examination

Residents are expected to take the In-Training Examination of the American Board of Anesthesiology (ABA). Result of this examination provide the resident and the Program Director specific information concerning resident knowledge in all areas of anesthesiology. This examination is given every July. After a resident has completed 36 months of Clinical Anesthesia training, the In-Training Examination will serve as the written examination of the American Board of Anesthesiology.

A Successful Program

Our graduates are recognized as well trained in all aspects of clinical and academic anesthesiology.

Objective outcome measures support this observation. Our residents are typically one to two standard deviations above the mean (90%) on in-service and board examination scores and nearly 100% are successful with written and oral ABA examinations on their initial attempt. As a result, they compete favorably for professional positions with academic or community hospitals.

Current 3 Year Curriculum

The Application Process

Physicians or students who wish to be considered for a CA-1 residency position should apply through the Electronic Resident Application Service (ERAS), a service which transmits residency applications, letters of recommendation (3), Dean’s Letter, transcripts, USMLE Scores and other supporting credentials to residency programs using the internet.

All applications received are screened by a review committee, and selected applicants are invited for personal interview. This is a mandatory part of the application process, which benefits both the applicant and the Department. The University of Utah Department of Anesthesiology is a participant in the National Resident Matching Program (NRMP).

Information on Available Internships

Formal training within anesthesiology begins with the PGY-2 year. The Anesthesiology Department recognizes that many applicants wish to move only once, and therefore has agreements with preliminary internal medicine internships at the University of Utah, as well as transitional internships at LDS Hospital. These internships have a separate application process, but allow priority ranking of applicants identified with the anesthesiology residency.

The addresses and telephone numbers for information on these internships are as follows:

Salt Lake City

Salt Lake City, the "Center of Scenic America" is the geographical center of the eleven Western States and the commercial, recreational and financial center of the Intermountain West. From its red-rock deserts and national parks in the south to its pine and aspen-forested mountains and Great Salt Lake in the north, Utah is a land of astounding scenic diversity. Eight National Parks are within an easy day’s ride from Salt Lake City. More than half of the State’s population lives within an hour’s drive of Salt Lake City on the western fringe of the Wasatch Mountains, known locally as the "Wasatch Front."

Salt Lake City was founded July 24, 1847 by the Mormon Pioneers, led by Brigham Young. Salt Lake City has evolved to become a major city, which is not only diverse and beautiful, but also safe and friendly.

Ready access to the mountain country surrounding the city and a four season climate invite participation in outdoor life including skiing, biking, hiking, boating, hunting and fishing. The forests abound with deer and elk; the streams with several types of trout and the marshes an abundance of ducks, geese, quail and pheasants. During the winter, the "Greatest Snow on Earth" settles on the Wasatch Mountains east of the city. Deep powder snow, every type of terrain, excellent lifts and trams, and internationally renown ski resorts (Alta, Snowbird, Park City, Deer Valley) are all less than an hour’s drive from the city. Sports facilities are readily available on campus. Both professional and college sports are easily accessible. Downtown Salt Lake City offers an outstanding wealth of arts and entertainment. At the Capitol Theatre, you’ll see Ballet West perform, as well as America’s most-traveled modern dance troupe, the Ririe-Woodbury. The City also has a Repertory Dance Theatre. The Utah Opera Company, and the nationally-rated Utah Symphony perform most Friday and Saturday evenings in Symphony Hall. The Utah Jazz (the 1997/1998 NBA Western Conference Champions), IHL Hockey, and AAA baseball all play in downtown Salt Lake City. Many fine restaurants with a wide variety of cuisines and prices can be enjoyed. Excellent wine stores and many coffee houses are easily accessible.