We invite you to take the time to read up about what it's like being an anesthesiology resident on various rotations during training by reading below:
Personally, this was one of my favorite rotations during my intern year! I learned a lot from the ENT residents and was able to do some hands-on procedures.
You usually work Monday - Friday with everyday there being a focus on different topics. For example, Monday would be ear day and people would come in with complaints of hearing loss or vertigo. Then Friday would involve the patients with head and neck cancers, and you would get the opportunity to scope. The day usually starts around 8 a.m. and you go to the little work area that has the designated computers for the residents to use. From there you would go to the front board to see which patients were roomed and put your name near the patient you wanted to assign yourself to. I would then go back, and chart review them real quick to see if they had been there before or if they had any test relating to their exam (ex: an audio test for a person complaining of hearing loss). From there you see your patient and ask any pertinent questions. There is a lot of Spanish-speaking patients so if you do happen to speak Spanish, I would try to get certified as an interpreter if not no worries there is a phone in every room with the interpreter on speed dial. At the beginning the interactions tend to take longer because you are not sure what to ask but you can get pretty fast at the end of the rotation since a lot of the problems you get to see over again. From there I would go start my note and come up with a plan based on what the patient had presented with. If I ever had any questions the ENT residents were great and would always answer my questions and help me formulate a plan especially since they knew I was primarily not very knowledgeable about ENT issues. Then I would present to the attending or sometimes the chief resident so I could staff the patient and we would go back into the room to check out the patient together and inform them of the plan.
During the rotation you’ll get to do things like clean a patient’s ears, inject steroids into keloids, perform minor biopsies in clinic, and scope patients that come in with concerns of hoarseness. It was a great opportunity to be more hands-on and practice your skills! The frequent scoping is awesome because you start getting use to how to use a fiberoptic scope which will help come CA-1.
Take the time to enjoy this month! You generally will get out around 3-4 pm depending on patient load and you also get your weekends free. Use the time you are in clinic to learn as much as you can from the residents/attendings because they will give you some great tips on their perspective in the OR managing airways. It’s also nice to make these connections as you will see them again within a year but in the OR with you as their anesthesiologist.
Categorical anesthesiology residents are introduced to anesthesiology at Ben Taub on the Mentor Mode rotation. During the four-week rotation we are paired with a CA-1, CA-2, or CA-3 each day to become acquainted with not only the Ben Taub system but also the basics of OR anesthesia. The rotation aims to familiarize interns with basic anesthetic plans, OR set up, anesthetic monitors, intraoperative medications, managing IV lines, intraoperative documentation, and building strategies for optimizing the patient throughout the surgery. We also begin to practice our procedural skills like intubation, IV placement, and arterial line placement. There is no pressure to have these skills completely mastered by the end of the month! This is our time to learn, practice, and get our feet wet while getting to know our upper levels and future department.
The typical day actually starts the evening before, when we are assigned our teams and cases for the following day. Usually, the upper-level resident on the anesthesia team would reach out to me to discuss the plan, any special set up required and a general time to meet the next day. My days would normally start at 6:30 a.m. As the mentor mode intern, I tried to set up as much of the room as I could independently (MSMAIDS!!), made sure that the patient consent was done and that they had at least one working line. It's nice to take the initiative and start doing consents and lines independently after the first week. Your upper level will of course walk you through the first few! Ask all the questions you can think of, your upper is a wealth of information for everything from anesthesia practice all the way to what to expect from the next few years of residency.
Preop is the anesthesia team's time to shine. Spend a few minutes with your patient! Do a thorough physical exam and make sure to have your stethoscope on you at all times. Some patients are familiar with anesthesia, but some may have questions or fears, so it is important to gauge their comfort level and ensure that their questions have been answered! Once the surgical team and OR are ready, you and your team will transport the patient to the OR. Once in the room: induce, intubate, and monitor the patient throughout the surgery before emerging and extubating at the end of the case. You can participate as much as your comfort and your team allows. My teams tried to get me as involved as possible in all steps of the process (including charting- something no exposure to in med school). Once the case is done, the patient gets transported to the PACU where the upper level will sign out to the PACU nurse (something you can start to learn on mentor mode as well).
The best part about mentor mode is getting to know our future colleagues and learning from many different people. More than anything, the rotation allows us to develop a sense of comfort in the operating room. We begin understanding when to administer certain medications or when to make changes to the ventilator (or literally how to turn it on). It can be overwhelming at times to be learning an entirely new specialty, but the residents and attendings at BCM are wonderful and supportive that the learning curve starts to seem less steep. This rotation is a great break from the medicine of intern year and gets you excited for your anesthesiology career ahead!
Anesthesiology residents rotate through many unique services within the medical center throughout their intern year at Baylor College of Medicine. All of these rotations encompass adult medicine, except for one, the Transitional Intensive Care Unit at Texas Children’s Hospital.
Many aspects of this rotation make it a valuable learning experience. It is an opportunity to care for pediatric patients, which differs significantly from the typical adult population throughout all other blocks. Common pathologies include chromosomal anomalies and conditions involving pulmonary hypertension, tracheostomies, and organ transplants. Many patients in the TICU have complex medical needs that require a thorough understanding of pediatric physiology. Coordinating their care as frontline providers lays the foundation for providing a safe anesthetic in the future. Plus, this rotation allows anesthesiology interns to work at a world-renowned pediatric center - Texas Children’s Hospital – even before the pediatric anesthesiology rotation in the CA years.
While on service, the anesthesiology resident will split the unit of 14 patients with a pediatric first-year resident. The day will begin at 6 a.m. with sign-out from the overnight resident who provides any events or updates on the patients. Next, the resident will review overnight vital signs, labs, and imaging, see the patients, and check in with nurses and parents/caregivers. Multi-disciplinary bedside rounds start at 8:30 a.m., involving first-year residents, a pediatric critical care fellow, a supervising pediatric critical care attending, a nutritionist, a respiratory therapist, a pharmacist, and critical care nurses. The family-centered approach emphasizes collaborating with parents and caregivers to create a care plan.
After rounds, daily lectures and scheduled simulations provide education regarding pediatric critical care medicine. Finally, the resident will use the rest of their shift to conduct further assessments and evaluations on patients, check in on their families, and work on notes and orders. Overall, this is an incredibly unique rotation within the PGY1 curriculum and, as such, provides many benefits to our education.
I usually get to the ORs a few minutes before 6:30 a.m., earlier if the case requires a bigger setup. If there’s still no cases posted in my room when I arrive, I wait at the OR board for the board runner to determine my fate. Otherwise, I head to the OR and run through MSMAIDS. I start my machine check, prep my equipment, draw up meds, and ask the anesthesia techs for any special equipment.
After the room is ready, I head to pre-op to see my patient. I review their history, look at their airway, get anesthesia consent, and place an IV. A lot of our patients speak Spanish, but there’s always multiple interpreters available in the pre-op area during the mornings. If there’s time, I’ll grab a quick coffee, and then at 7:25 a.m., I get ready to bring the patient to the OR.
After arriving in the room, monitors are placed, and a time out is performed. We then start induction. After the airway and any additional lines are secured, I walk to the lounge for my morning break where there’s usually some other coresidents to hang out with. I head back to the OR, and then the attending often does some teaching. Afterwards, I start preparing meds for the next case. Once the case finishes and we extubate, the cycle rinses and repeats– on average, we do about 2-3 cases every day.
I get sent to lunch between 11 a.m. and noon, and I head down to the Ben Taub Bistro where I use some of my call money to buy lunch. I go to the lounge to eat where I’ll get to see and talk to some of other residents.
After lunch, I head back to the OR to finish up my cases, and before I know it, it’s 3 p.m.. This means the call team has just arrived, and if I’m a regular day person, I’ll go home soon hopefully. Once dismissed, I check Epic for tomorrow’s assignments. Everyday looks different when you’re in the general ORs. You can be doing outpatient gynecology cases one day and ICU take backs the next. My first day of CA-1 year in the Ben Taub ORs was even a cardiac case. Other cases include general surgery, ortho, neurosurgery, plastics, ENT, and ophthalmology. If it is a Monday or Wednesday, we have protected didactic time at 4 p.m. If I have time, I’ll try to preop with tomorrow’s attending before lecture, otherwise I’ll do so after class. Lecture usually ends between 5 and 6 p.m., and then it is time to head home for the day!
We spend most of CA-1 year at Ben Taub, and it ends up becoming like a home base for us. You’ll get to work with most of the attendings multiple times, so the faculty get to know you well and watch you progress throughout the years! Also, since most of the CA-1s are at Ben Taub at any given time, we get to see each other pretty frequently! It’s nice to know that you can always find someone to talk about the cool case you’re doing or to vent about something frustrating. You’ll get to provide anesthesia for a variety of cases and take care of a range of patients from young, healthy patients to older, cardiac patients. You finish the year feeling comfortable with bread-and-butter cases and with a strong foundation as you get ready to start your subspecialty rotations in CA-2 year!
Baylor residents have the unique opportunity to rotate at the Michael E. DeBakey VA Medical Center, one of the largest and most renowned VA centers in the country. Whether or not you choose to practice in a VA setting later, this experience is invaluable, offering insights into a distinctive healthcare system and patient population that few get to explore.
At the VA, we complete rotations in general OR, cardiac anesthesia, and regional anesthesia. With only 2-4 residents at the VA each month, you’ll often be prioritized for the most educational cases, ensuring a rich learning experience.
The schedule for OR rotations is fairly consistent. Residents typically arrive between 6:00-6:15 a.m., change into VA scrubs, and begin setting up the OR. This involves performing a machine check, drawing medications, and retrieving narcotics from the central Omnicell. For more complex cases, such as neuro or cardiac, setting up infusions may require an earlier start, but the OR is usually ready by 6:50 a.m. You’ll then greet the patient in the pre-op area, conduct a same-day assessment and physical exam, and review the anesthetic plan. The process is streamlined since most veterans have already been consented for anesthesia in the pre-op clinic. After placing necessary lines (e.g., PIV, arterial lines), the patient is taken to the OR for a sharp 7:30 a.m. start time.
Case turnover varies by rotation. For example, an orthopedic room might handle 3-4 cases per day, while a neuro or cardiac room typically schedules 1-2 cases. Most rooms finish between 3 and 4 p.m., after which residents pre-op for the next day’s cases before heading home.
While rotating at the VA can be challenging initially due to their unique EMR and intra-operative recording system, you’ll quickly find it becomes straightforward. During my first rotation as a CA1 at the VA, I was impressed by the diversity of cases, the excellent teaching from our anesthesia attendings, and how well-resourced the operating rooms are, making it easier to deliver top-quality care. But above all, it’s incredibly rewarding to know that you’re providing care for our nation’s veterans.
As residents rotating in ICU Baylor St. Luke’s Medical Center, a large quaternary care hospital, we have the privilege of caring for a diverse population of high acuity patients. We routinely care for patients following heart or lung transplantation as well as those with mechanical circulatory support devices such as VADs, Impellas, and various ECMO configurations. Treating acutely ill patients with specialized support devices and unique physiology can be challenging at times, but new residents quickly become comfortable guiding care with the support of seasoned faculty, fellows, mid-level providers, and nurses.
Mornings consist of chart review, pre-rounding, and then team rounding starting at approximately 7:30 a.m. The team usually consists of two fellows (one cardiac anesthesia fellow and one critical care fellow), two anesthesia residents, and multiple midlevel providers along with an ICU attending who is on service for one week at a time. With a patient census on average between ten and twenty, there is an excellent balance between discussion-based and practical hands-on learning.
The majority of notes and orders are finished during morning rounds; therefore, most afternoons are spent caring for patients in the immediate post-operative period, performing procedures, or learning from our attendings during informal teaching sessions. From placing arterial lines on VAD patients without pulsatile arterial flow, inserting central lines or dialysis catheters, to practicing TTE technique and interpretation, the procedural experience during the month is a perfect complement to bring to your future practice both in and out of the OR. The mix of medicine and anesthesiology world-class attending faculty are great at tailoring teaching to each resident’s interests and taking time during afternoon rounds to point out interesting findings on POCUS or quickly sketch a patient’s VVAV ECMO configuration.
All in all, the BSLMC’s ICU rotation is a tremendous learning opportunity and a unique rotation even within the Texas Medical Center. Although this is an unparalleled experience for any resident pursuing a fellowship in critical care or cardiac anesthesia, every resident who rotates through the service becomes a better anesthesiologist by the end of the month.
I started my CA-2 year with the MD Anderson Acute Pain Service rotation. My time at MD Anderson provided excellent training in the use of ultrasound, performing a variety of regional nerve blocks, and the management of complex post-surgical pain on their Acute Pain service. MD Anderson is a phenomenal cancer institution with a very busy surgical service with over 40 ORs and a strong collaboration amongst the anesthesia and surgical departments. On the acute pain service, you’ll treat patients with acute postoperative pain, and often patients with acute on chronic pain postoperatively.
The structure of this rotation is divided into two weeks of covering the service during the day and two weeks of covering the service during night shifts. During your week of days, the morning starts at 6 a.m., receiving sign out from your co-resident on the night shift, discussing the morning blocks for the day, and then preparing for those blocks. Pathology varies widely ranging for massive abdominal resections, hemipelvectomies, amputations, and spinal surgeries. To match the variety of cases, there’s an equal diversity of blocks including transversus abdominis plane (TAP), quadratus lumborum (QL), erector spinae plane (ESP), paravertebral, interscalene, supraclavicular, sciatic/popliteal, and femoral/adductor blocks. As a resident you will get great exposure to truncal blocks in these morning cases, and a variety of peripheral nerve blocks post-operatively or often pre-operatively. Depending on the caseload, there are often multiple first-cases that require blocks. After completing blocks for these cases with your attending, you’ll meet with the nurse practitioner to split the list to round on floor patients and field new consults for the day (typically one-two per day). You’ll be able to follow your block and consult patients and assess the effectiveness of your interventions, monitor for complications and side effects, and craft personalized pain regimens. You’ll continue to follow the OR schedule for blocks for cases to follow later in the day. You’ll sign out at 6:30 p.m. to the night residents during one week of days and leave at 3 p.m. on the other week of days.
During your week of nights, sign out for the night resident is at 6:30 p.m. from your co-resident or the nurse practitioner. You’ll be responsible for covering the patient list and seeing patients who come out of the OR late for post-block assessments. Occasionally, you’ll split the list with the night nurse. After rounding on your patients for the night and checking your orders, you’ll head to your call room! Often the nights are calm, but you will be paged based on patient needs. In the morning prior to sign-out, you’ll help set up ORs with first case start for blocks for the day resident. Sign out between the night and day resident usually happens around 6:30 a.m.
Throughout your whole rotation, the Acute Pain Service team is wonderfully collaborative and supportive of this experience for residents. Residents will come to this rotation with a variety of experience in regional techniques and the faculty are all eager to train and help improve your skills. The nurse practitioners and block nurses are excellent resources during your rotation as well, providing tips on writing orders, coordinating care, and systems-learning that comes with rotating at a new center.
This service provides that fantastic opportunity to perform multiple regional blocks for surgeries and manage an inpatient pain service.
The day starts at 6:30 a.m. where the resident on the service works with the designated CRNA on the regional service to set up for the regional blocks needed for first case starts. The plan regarding which patients are suitable for nerve blocks and what said blocks would entail is decided the day prior with the regional attending who rotates a week at a time (allowing for great continuity with learning and mentorship). Blocks are mainly provided in the pre-op holding area, with an up-to-date ultrasound machine and efficient movement with all staff (surgeons, nurses, anesthesiologists, etc) having the same objective of getting the block done in a reasonable time.
The day progresses with multiple blocks, involving both single shots, catheters and often multiple blocks per case. When the first wave of blocks finish, there is an opportunity to round on the inpatient pain patient list. This list includes those who received either a single shot peripheral nerve block, peripheral nerve catheter or epidural in the previous few days. In addition, the regional resident calls patients who have already left the hospital after their surgery and either still have a peripheral nerve catheter in place, or have just received a single shot block the day prior. This allows for excellent feedback to assess how effective the block was and how significant the pain relief was for the patients.
As the day continues, any nerve blocks that arise are all solely done by the regional team. Whenever there is opportunity, the regional attendings often go through various learning topics with the residents and develop a great rapport, having a week straight to work with the same individual. The day ends with communication with the attending on service regarding which blocks to expect for the next day, and then sign-out to the CRNA covering the pain pager overnight. This sign-out typically happens anywhere from 3-4 p.m.
Overall, this is a valuable rotation that promotes regional skills and autonomous management of an inpatient pain panel.
As CA-3s, we spend three consecutive months at Texas Children’s Hospital, which is our sole pediatric site. The incredible reputation of Texas Children's is not only sought out by patients in the surrounding region, but it is a destination for families around the world seeking specialized care. As residents on this rotation, we get to be a part of that!
Most days formally begin with a lecture at 6:15 a.m.—facilitated on Zoom these days out of caution for COVID. Lecture topics have a prescribed section of reading from Coté A Practice of Anesthesiology for Infants and Children, available online via TMC library access, and allow for thoughtful discussions with attendings and other trainees about core topics in pediatric peri-operative care. Cases start at 7:30 a.m. most days, so you come in as needed to prepare for your cases for the day — usually around 6 a.m., to account for lecture time. The unique thing about caring for kids at Texas Children's is you can be in a “simple”. Ophthalmology outpatient room for the day, but have patients whose ages range from less than 1-year old to a legal adult, with medical histories that range from ASA 1 (healthy with no other active medical issues) to ASA 3 (medically complex with lots of organ system pathologies to be mindful of). And the unpredictability of pediatric airways demands a level of attention and acuity no matter how straight forward the case may seem. We also get to be a part of more complex cases such as craniofacial surgeries, multi-level spinal fusions, and even bedside NICU procedures.
This rotation requires you to really hone in all of the skill sets that have been shaped during your first two years of residency. Having a kind, adaptive bedside manner is so important when discussing the anesthetic plan with kids and their families. Facilitating comprehensive multidisciplinary communication between the operative team, peri-operative staff, and Child Life Specialists (your new best friends) is crucial to having a smooth workday. Each day is full and very rewarding, as you build rapport with kids and their families to help make an otherwise fearful experience enjoyable for them. And let’s face it, kids are so much cuter than adults any day of the week.
There are so many wonderful pediatric anesthesiologists we get to work with and learn from in our three months at Texas Children's, with a true focus on our training and well-rounded exposure to pediatric anesthesiology. So whether you’re interested in a pediatric fellowship or not, you’ll leave with a robust, diverse pediatric anesthesiology experience.
As residents, we have the opportunity to rotate at the renowned Texas Heart Institute for several months, beginning as early as our CA-1 year. Here, you will be involved in cases ranging from AV fistulas and EP cases in the cath lab, to more involved cases such as CABGs, robotic and open valve repairs, LVADs and placement of other mechanical circulatory support devices, kidney/liver/lung/heart transplants, and aortic procedures requiring deep hypothermic circulatory arrest, to name a few. The array of cases is diverse, and you will be granted an appropriate level of autonomy and access to increasingly complex cases as you progress through your training.
On a typical day, I wake up around 5:30 a.m. and aim to arrive at the hospital between 6 to 6:30 a.m., depending on how long it will take to set up for my case. Today, my first case is a “straightforward” CABG. I perform a basic OR set-up as per usual, draw up drugs, and set up any drips that we may need. Our anesthesia techs are invaluable and assist with setting up our monitors, transducers, fluid bags, ultrasound, and ensuring we have all the supplies we need. At around 7:00, I meet my patient in pre-op, obtain consent, and discuss the anesthetic plan with my attending. Once everything is ready, I roll my patient into the OR by 7:30 a.m. For this case, I obtain a pre-induction arterial line before proceeding with induction of general anesthesia, intubation, and placement of a central line and pulmonary artery catheter. We place a TEE probe and perform a quick exam with the CV anesthesia fellows on their “echo month” before I take my morning break. Fortunately, the remainder of the case progresses uneventfully. At this institution, we perform our own blocks and epidurals if needed for the case. Today, we perform a parasternal block at the end of the case and then transport our patient to the ICU.
Depending on the schedule for the day, I may be assigned to another case, asked to relieve another resident/fellow, or dismissed home. There is a daily release order for the residents and fellows that takes into account how late we stayed the day before and any upcoming calls that we have. Overall, the system is fair and well-balanced. We take a handful of in-house calls every month, which involves arriving at noon, finishing up the cases for the day, and then covering any emergent cases or airways that occur overnight. The hours for the rotation are reasonable, and there is an appropriate balance between being occupied with complex cases at work and having enough time to relax and decompress outside of the hospital.
This rotation provides excellent exposure to high-acuity cases and trains us to become comfortable with managing extremely sick patients in the operating room. I consider this rotation to be one of the best aspects of our training here at Baylor. I personally enjoyed my experience so much that I will be staying next year and pursing a cardiac anesthesia fellowship at THI.
As residents, we get to rotate through the Labor and Delivery floor as CA-1s, CA-2s and CA-3s. It allows us to care for laboring patients and learn how to take care of our complex obstetric population. During this rotation you will become familiar with the unique physiology and management of our parturient patients. We work very closely with our OB colleagues to assess and care for patients on the labor deck. We work up every patient that comes through triage by performing a detailed history and physical and explaining our role in pain management. We place and manage epidural catheters for laboring patients and perform spinal blockades in the operating room. As a senior resident, we help oversee the labor deck patients, communicate concerns to the OB team and assist with technically difficult procedures.
I arrive to the L&D floor at 6:30 a.m. I briefly chart check the patients on the deck for any issues. Afterward, I check on the underclassmen and help stock both the delivery rooms as well as operating rooms with emergency drugs and supplies. Handoff takes place at 7 a.m. where the night team will provide patient information to the oncoming day team. Afterward, we have an interdisciplinary board huddle at 8 a.m. with the OB team, nursing and NICU team to go over our current patients and patients we are expecting to arrive throughout the day for scheduled c-sections or inductions.
Each day, a resident is assigned elective cases such as scheduled cesarean sections, bilateral tubal ligations and external cephalic versions. The rest of the junior residents are assigned to help manage the labor deck patients. As the CA-3 on service, I make sure that the elective cases can proceed on time and that the labor deck patients are all assigned a resident to take care of them. I am also responsible for seeing patients on the follow-up list who had spinals or epidurals within the past 24 hours. Communication is key during this rotation; I carry a phone and am in constant contact with the OB team as well as my attending. Caring for laboring patients is exciting but also requires continual reassessment and to always be prepared for potential emergencies such as STAT c-sections, shoulder dystocias or postpartum hemorrhage.
Around 3 p.m., I start to prepare for afternoon handoff to the night team. I make sure that the epidurals we have placed are functioning well and update my patient list with any changes that occurred throughout the day. At 3:30 p.m. we begin our handoff to the incoming night team.
Overall, the rotation is an excellent opportunity to get hands-on experience with maternal-fetal physiology and to provide various modes of pain relief and anesthesia for a special population. Getting to be a part of one of the most joyful moments in our patients’ lives is a privilege.
As a CA-1 and an early CA-2, our priority is learning how to manage patients perioperatively. That includes preoperative patient evaluation, intraoperative management, and recovery from anesthesia. The best time to practice these skills is during overnight call shifts, where we encounter various cases throughout the evening at our level one trauma center, Ben Taub General Hospital. On a typical call shift, we arrive at 2:30PM ready to relieve our day time colleagues by taking over the remaining cases for the day. Prior to doing so, we prepare the designated emergency operating rooms to ensure we are ready to start a case if necessary. As operating rooms begin to come down in the evening, we switch over to a rotating system where junior residents take turns doing cases for the remainder of the night. Cases can range from multiple gunshot wounds requiring massive blood transfusion to a minor toe amputation for a patient with diabetic neuropathy.
During the second half of CA-2 year and as a CA-3, we begin to take senior call shifts here. This is our opportunity to put leadership, teamwork, and everything we’ve learned over residency into practice. When we arrive in the afternoon, we meet with the operating room charge nurse and our boardrunner attending to gauge the status of the ORs in order to plan relief for the anesthesia day team. Once we have a good plan in place, we take over recovery room (PACU) duties from the PACU day resident. This includes holding the emergency airway pager and the trauma pager which will alert us to potential emergent intubations within the hospital and the imminent arrival of a trauma, respectively. We are responsible for assessing these patients and making clinical decisions that can be the difference between life and death. In between managing hospital-wide emergencies, we supervise junior residents and student nurse anesthetists in the operating room, perform regional blocks, and evaluate/treat patients in the PACU.
The most grueling part of a call shift at Ben Taub is the arrival of code one trauma, which describes a critically injured patient who must receive life-saving emergency surgery. As one of the busiest level one trauma centers in the United States, one or more emergencies may arrive in a moment’s notice. Patient outcomes are often directly impacted by our team, so being prepared is an absolute necessity. As anesthesia residents, we must act quickly to assess the patient, start an arterial line, obtain IV access, and manage hemodynamics while our surgery colleagues work to control the source of bleeding. These cases can be challenging, but solidifies foundational concepts, hone technical skills, and develop clinical decision acumen that is necessary to become a practicing anesthesiologist.
