ASA May 2003 Newsletter

Several academic anesthesiology training programs across the country employ visiting faculty from abroad to assist in clinical care and resident education. At the University of Michigan, Ann Arbor, this tradition has been under way for more than 25 years and typically draws from English-speaking countries such as the United Kingdom, Ireland, Australia, New Zealand and South Africa. These visiting faculty members generally spend up to a year in the United States before returning home and are often replaced by other instructors from their home institutions who are sometimes referred to as “rotators.”

While less homogeneous, clinical training for rotators is several years longer than for anesthesiology residents in the United States. Most enter medical school directly from high school and spend five years as a student. They then spend a year as a junior house officer, which is comparable to being an intern in the U.S. system. Afterward, they become senior house officers and work in a variety of specialties for about two years. It is at this stage that they decide which specialty to enter (e.g., anesthesiology, pediatrics). Next, they spend an additional two years as senior house officers dedicated to anesthesia. Finally, they become specialist registrars in anesthesiology for five more years. After completing training as specialist registrars and passing the board examination, they are able to apply for a consultant position. Consultants are the equivalent of our attending or faculty anesthesiologists. Rotators typically come to the United States after they have completed the last stage of their training as specialist registrars and before they become consultants.

Most U.S. residents feel that rotators make valuable contributions to their education for a number of reasons. Rotators are typically enthusiastic educators and constantly question how medicine is practiced in their host training programs. Such questioning is academically stimulating and thought-provoking. Almost as a rule, they are young and approachable, they retain a strong knowledge of basic science as well as clinical medicine, and they bring unique perspectives to our residency programs. Valuable techniques and devices that are relatively uncommon in the United States may be more widely employed in their home institutions. For instance, the gum elastic bougie was introduced to the University of Michigan many years ago by rotators from the United Kingdom. While the bougie became a staple of airway management at Michigan, many faculty and residents from other institutions had never used them. Furthermore, the scope of anesthesia practice in other parts of the world tends to be broad where anesthesiologists provide direct care to patients for several days postoperatively. Rotators with this experience impart insight that can be a great advantage to trainees. Finally, visiting instructors allow a mutually beneficial cultural exchange beyond the instruction they provide in clinical medicine. For many rotators, this exchange is a major reason to work abroad.

Rotators also choose to work in the United States in order to get exposure to a medical environment that is not a single-payer, national health system. Many do not have the same level of experience with organ transplantation, regional anesthesia and complex medical patients as anesthesiologists at tertiary medical centers in the United States. Also, serving as visiting faculty prior to becoming consultant anesthesiologists gives rotators proficiency as independent practitioners. Many feel this independence is not only personally rewarding but also improves their resumes since it occurs at well-known teaching hospitals. Some rotators are interested in living in the United States, and the experience allows them to sample our lifestyle and medical practice.

Regardless of what brings them together, rotators and the residents they instruct are wholehearted supporters of the arrangement. When asked what advice they would offer to trainees, rotators make several consistent recommendations. Foremost among them is that multiple approaches may work for the same clinical problem. Given their comparatively long training period, they also stress that completion of residency is not the end of one’s education. They advise residents to develop anesthetic plans as if no faculty will be there to assist them, but they also encourage them to be open to suggestions from colleagues. Such an interest in new ideas is a sign of maturity, improves anesthetic care and symbolizes the tradition of international visiting instructors.

P. Robert Hubbs, M.D., is a CA-1 resident at the University of Michigan, Ann Arbor, Michigan.

return to top