The PGY-1 year with Tulane Anesthesiology is a devoted internal medicine preliminary year, which far exceeded my expectations. My intern year was honestly a great experience for three main reasons—the friendships formed, the emphasis on education and the balanced schedule that allowed us to enjoy the fun, vibrant, city of New Orleans.
From the beginning, the IM department really welcomed us with open arms. The plethora of medicine residents, as well as preliminary interns in other specialties, made transitioning into residency and a new city very easy—you’ll come out of intern year with many friendships and an open invitation to all future social events. As a new CA-1, I know if I have a quick question about a patient, I have a friend in essentially every department that I can reach out to.
Academically, the IM program is incredibly strong and didactics are made a priority. The variety of services you’ll work with during your PGY-1 year, along with this particularly ill patient population, will allow you to master the presentation, diagnosis and management of the many comorbidities that will undoubtedly present in the perioperative setting and, in turn, have anesthetic implications. My foundation of medicine is more solid than ever and I feel very confident medically managing patients—whether they are on the medicine floor, the critical care unit or in the OR.
Although it is a fully devoted IM year, every 5 weeks we get exposure to the OR and different surgical cases because of the unique “4+1” schedule. Whereas other programs continuously work, at Tulane, every four weeks of IM is followed by a guaranteed “golden weekend” off and a “plus one” week– which is a time we get to work with our chosen specialty. This allowed us to have a nice break from the medicine world to get some time in the OR intubating patients, practicing placing IVs, meeting future anesthesia colleagues and ending the day relatively early with time to rejuvenate for the next cycle to begin. Moreover, anesthesia preliminary interns have a particularly good balance of inpatient rotations, with time evenly allocated between medicine wards and critical care, as well as some EM rotations— setting us up to graduate with all ACGME requirements fulfilled. Lastly, the final four weeks of our medicine year is blocked off as anesthesia elective time, so we actually get to end intern year a month early! With the endless amount of events and activities going on in New Orleans, this balanced schedule really makes starting residency a positive experience—with great people alongside the whole way.
Nellab Yakuby, MD
A typical day as a CA-1 at Tulane involves working either at the Main Campus in Downtown New Orleans or the Lakeside Campus in nearby Metairie. Downtown usually has the larger surgeries while Lakeside has a high volume of outpatient surgery like orthopedics/sports medicine, pediatrics, and GYN. My day starts by arriving to work around 6am to setup for the first case unless I have a more challenging case that requires more setup. At 630 I go to the pre-op area to discuss the case with my attending. This gives me time to start the IV, make sure the patient didn’t eat a breakfast biscuit on the way over, and get a cup of coffee with the other residents. At 715 I roll the patient to the OR. Typically my day ends around 3-5pm when I am relieved by a CRNA or the late-call resident. The residents are not the primary work force at Tulane which allows us much needed downtime and the ability to study. There are only a few residents downtown at one time which assures that we get the most interesting cases. The CRNAs are there to help and do not take away from your education or case volume. All nerve blocks, lines, epidurals, cardiac and transplant cases are done by residents. A few times a month I’m assigned to day call, which involves responding to codes and intubating emergently, which is great practice. During my first few months I started off with basic cases like general surgery, urology, orthopedics, and ENT. As I progressed through the year I was assigned to more and more challenging cases with increasing autonomy. The attendings are open and flexible, and they challenge us to formulate our own anesthetic plans. I also completed a month of SICU which has a significant level of autonomy in regards to patient care and procedures. CA-1 year also includes two months of obstetric anesthesia. As the only resident doing epidurals and spinals on the unit I became comfortable with epidurals very quickly, exceeding the ACGME minimum number of epidurals after only 2 weeks. Overall, I feel that the amount of support and supervision is balanced well with appropriate autonomy, allowing Tulane residents to become very competent and comfortable in the first year.
Christopher Cullom, MD