Within days of beginning the Anesthesiology/Critical Care Clerkship, fourth-year UF medical student Youlei Li was watching an intubation. Soon after, he was performing one himself. Soon after that, he was placing IVs.
“I was able to be very engaged in the care of patients,” Li said. “It was the first time where I felt like I wasn’t under extreme pressure. I was able to connect with the residents a lot easier, and in turn I felt like there was a mutual trust between us.”
The Department of Anesthesiology’s mandatory four-week clerkship allows fourth-year medical students like Li to learn skills such as managing airways and placing peripheral IVs that are essential for careers in all specialties. Students are paired with a resident and spend two weeks rotating in an operating room and two weeks rotating in an intensive care unit. To ensure students get the most out of the experience, every effort is made to place them in a specialty aligned with their career interest. Students also participate in at least 10 didactic sessions, many of which are immersive simulations followed by debriefing to solidify learning.
The clerkship provides a capstone experience after students spend their first and second years of medical school studying pharmacology and their third year participating in clinical rotations.
“We try to tie that all together in a high-acuity environment so it’s exciting for them and highly applicable,” said Chris Giordano, M.D., associate professor of anesthesiology and division chief of liver transplantation, who has directed the clerkship for nearly 10 years.
Because Giordano has held a variety of roles in the College of Medicine, he is well-versed in the material that students have already learned and knows how to fill in the gaps. He has refined a curriculum focused on skill building and understanding complex scenarios, taking student feedback into account. In addition to education on clinical topics including hemodynamic monitoring and acute pain, the curriculum includes lectures on teamwork and behavioral economics.
The mode of delivering the material is another major factor in the clerkship’s success. Anesthesiology attendings work hard to ensure that students feel included as active participants in the clinical learning. The clerkship also taps into the wealth of resources that the simulation center offers.
“The majority of what we do the medical students have never learned before in this fashion,” Giordano said.
All of these efforts have paid off. For the past four consecutive years, the clerkship has received the Golden Apple Award for Clinical Science for best clinical rotation, voted on by the graduating class of medical students. The success can also be seen in the increase in the number of UF students who choose to pursue anesthesiology as their specialty. The clerkship is sought out by students outside of UF, too. Hundreds of students typically apply for the four available extern spots each rotation.
Focus on student interests
A key highlight of the clerkship is its focus on placing students in clinical areas that align with their future interests, such as pediatrics, cardiology, or neurology. The department’s education office makes every effort to match students with their interests not only in one of more than a dozen specialty ICUs, but also in practice settings such as inpatient or outpatient. The feedback has been positive.
“One of the things we’re able to do is make the clerkship meaningful to students who are participating by relating it to whatever field they’re going into,” Giordano said. “We’re able to carve out the niches within our field that relate to their field.”
The residents also gain tremendously from the experience. Residency applicants routinely ask during interviews whether they will have opportunities to teach medical students, Giordano said.
“We draw the type of resident who really enjoys this situation and we’ve been able to deliver,” he said. “It’s been a mutually beneficial experience; both the students and the residents learn a lot from each other. The residents are looking forward to having a leadership role and an educational role, and the students are looking for mentors and people to look up to.”
Clinical instruction that prioritizes patient ownership
This January, the clerkship brought on Amanda Frantz, M.D., assistant professor of anesthesiology in the Division of Critical Care Medicine, as codirector of the clerkship. As an intensivist, Frantz helps to round out the experience on the critical care side and complements Giordano’s expertise.
For Frantz, expanding opportunities for engaged hands-on learning is key.
“My passion for this is to involve the medical students in their learning,” said Frantz, who has been involved with the clerkship since she completed her Critical Care Medicine Fellowship in the department and joined the faculty in 2017. “It’s vitally important to teach medical students patient ownership and instill a sense of responsibility for the patient; they’re not a bystander.”
Frantz involves students in patient care early on. She assigns her students ICU patient cases to present, and they participate in all facets of patient care. Given that critical care is a multidisciplinary and collaborative subspecialty, students get to learn from a variety of types of providers, including pharmacists and physician assistants.
Frantz doesn’t miss a moment to teach, either. On a recent morning rounding on the cardiac ICU, Frantz seized an impromptu opportunity to quiz her students on classes of medications, writing the answers with a dry-erase marker on the glass door of the patient’s room.
“I love teaching the clerkship because the students are excited,” Frantz said. “Their questions make me keep reading and learning myself. They teach me how to be a better communicator as I work to make sure each student walks away with a better understanding of the material based on their individual learning style.”
Appreciating the value of anesthesiology
At many institutions, anesthesiology is an elective rotation. By making the clerkship mandatory, UF provides a significant opportunity not only to train future physicians in vital skills, but also to spark their interest in the specialty.
Even for students who are not specializing in anesthesiology, the clerkship provides valuable knowledge and skills that they can incorporate into a different environment because anesthesia is so multifaceted, Frantz said.
“Medical students will absolutely take something away from the lectures and the shadowing that will impact their careers and the field they pursue,” she said.
David Drucker, a fourth-year medical student who matched into ophthalmology, said the clerkship increased his confidence in procedures such as intubation.
“I understand my limitations, but I feel confident enough that I won’t be terrified if I have to do an emergency intubation,” he said.
Most importantly, the clerkship gave him a new appreciation for the field.
“The value of anesthesiology was very clear to me,” he said. “Most impressive was seeing how many steps ahead the residents were in thinking and preparing for every situation.”
Drucker also said he enjoyed the opportunity to observe the physical process of anesthesiology and the effort that goes into keeping supplies such as syringes meticulously organized. “I was very impressed at how quickly they were able to do small tasks, all of which can have catastrophic consequences if there is a small error,” he said.
A culture of mentorship
Going forward, Giordano hopes to continue innovating. His goals include improving transfers of care through simulation, adding team training, and involving residents in the didactic portion.
Giordano’s care and dedication to his students were immediately apparent, Drucker said. “His skills as a communicator and teacher are gems, and he is a tremendous asset to our medical education,” Drucker said.
Allyson Tragesser, M.D., who received the 2022 J.S. Gravenstein Award for Excellence in Anesthesiology and joined the department in July as a PGY-1 resident, said her experiences with the department while a student were formative. As an undergraduate student at UF, her first shadowing experience in medicine was with Nikolaus Gravenstein, M.D., the Jerome H. Modell, M.D., Professor of Anesthesiology. During medical school, Tragesser served as president of the Anesthesia Interest Group. She also conducted research with Kevin Sullivan, M.D., professor of anesthesiology, on the postoperative effects of different endotracheal tubes in infants undergoing cardiac surgery.
“The department’s faculty members and residents have been incredible role models and mentors to me throughout my medical education,” she said. “I am thrilled and grateful to begin my anesthesia residency at the University of Florida.”