Ryan Mitchell, MSIII
University of Oklahoma College of Medicine Anesthesiology Co-Chief Extern
For nearly all medical students, anesthesiology is one of the more challenging specialties to gain exposure to throughout medical school. Unfortunately, at many schools, anesthesia rotations are only offered as an elective during the clinical years, while at other schools it may not be offered at all. Additionally, it tends to be an abbreviated experience compared to many of the other rotations. This poses a problem to medical students who are interested in learning more about what anesthesiologists do and what the specialty has to offer. The University of Oklahoma Department of Anesthesiology addressed this challenge through the creation of an anesthesiology extern program to broaden exposure and opportunities in anesthesiology. This article will explain the extern program and the benefits it provides students with the intent to educate and hopefully inspire medical students to advocate at their home institutions for the creation of a similar program.
The anesthesiology extern program runs throughout the year and is offered to incoming third-year through fourth-year medical students. The program is taken concurrently with students’ clinical rotations, as shifts are completed during weekday evenings and on Saturdays. On weekdays, one student is assigned to the adult trauma operating rooms, and one student is assigned to the obstetric unit. On Saturdays, one student floats between pediatrics, obstetrics and trauma. Participating student externs must apply and be accepted into the program at the beginning of each year. Accepted student externs then go through a training process to familiarize them with the operating room and anesthesiology equipment and to teach them duties that must be completed each shift. Once trained, students work on average at least two shifts per month throughout the year. Each shift is financially incentivized, making the program unique among all the specialties on the medical campus, and popular among cash-strapped medical students.
Duties and responsibilities that student externs are trained to complete during their shifts include work typical of an anesthesia technologist, including preparing invasive monitoring arterial lines and “hotline” warmer sets for overnight trauma operating rooms, restocking critical anesthesia equipment in the anesthesia machines, and epidural and spinal carts, and turning-over and setting up anesthesia machines and equipment for emergency C-sections. As these are essential tasks, the extern is a valuable member of the anesthesia team, and coordinates with and supplements the anesthesia technologists. In addition to required duties, students can work one-on-one with anesthesiology residents and attendings, participating in various hands-on procedures including performing endotracheal intubation, starting IVs, observing epidural, spinal and central line placement, and assisting in perioperative care of the patients.
Overall, students gain various benefits from participation in this anesthesiology extern program. These include the acquisition of basic skills and understanding of the preparation required for safe anesthesia care, such as setting up lines and checkout of an anesthesia machine. Further, students improve their procedural skills through consistent, repeated exposure that is superior to an isolated rotation. Arguably the most important aspect is the opportunity to function as part of the anesthesiology team, gaining valuable insight into the responsibilities and challenges of the specialty through action and in-depth conversation.
While not every student that participates in the student extern program chooses to pursue the field of anesthesiology, the externship still offers invaluable experience to all that participate. Students that choose to pursue surgical specialties gain operating room exposure by observing trauma and C- section cases, increase their comfort level in the operating room and learn about equipment utilized in the operating room. For students that have a passion for the anesthesia specialty, they can interact with and develop relationships with anesthesiology physicians in one-on-one scenarios, seek out mentors in the field and find writers for letters of recommendation. These relationships that are formed also help to present students with opportunities to participate in case write-ups and research.
In conclusion, the author strongly encourages and highly recommends medical students with interest in anesthesiology to advocate at their home institutions for the creation of a similar program or opportunities that allow students to get a closer look at anesthesiology beyond the limits of formal rotations.