Graduating from medical school is only part of what makes you a doctor. Before you can practice, you need to learn the skills of your chosen profession through hands-on training in a residency program. Residencies give you work experience in your chosen field, as apprenticeships do for tradespeople. If you want to be an anesthesiologist you'll have to spend four years in clinical work experience after medical school.
Residency programs in the United States are reviewed and accredited by the Accreditation Council for Graduate Medical Education, or ACGME. Their review process lets you know you'll receive an appropriate level of training while you're in the residency, and future employers or partners can assume you're well trained. Residency requirements are different for each medical specialty, ranging from three to six years. To be an anesthesiologist, you'll have to work in general medicine for one year of internship, then do three years of supervised work in an anesthesiology residency.
As an anesthesiologist you'll work primarily in surgery, but it's important to have a solid grounding in general medicine first. That's why there's a requirement for one years' internship. When you start your residency you'll spend your first year on routine cases with an experienced anesthesiologist supervising you closely. In the second year you'll work in a wider range of cases, gaining exposure to the specialized skills needed in different types of surgery. In the third year you'll gain experience in more complex procedures, and exercise more independence.
Accreditation by the ACGME tells future employers that your training program met a known standard, but it doesn't say anything about your own abilities. Most anesthesiologists take board certification exams, which establish your personal understanding of the profession. You'll take a preliminary exam, called the in-training examination, during your residency. It's a sort of "you are here" to show how well you're learning. The formal board examinations come in two parts. The Part One exam is a multiple-choice exam that tests your knowledge. Part Two is an oral exam, testing your clinical judgement, expertise and communication skills. If you pass, you become a board-certified anesthesiologist.
If you want to go past the basics of anesthesiology, you might opt for a joint residency or a fellowship. The Board of Anesthesiology has joint training programs in place with the Board of Pediatrics and Board of Internal medicine, so you can do a single five-year residency and qualify in two specialties. You'll have to pass a set of certification examinations from each board. If you've already earned board certification in anesthesiology, you can specialize further in critical care medicine, hospice and palliative care or pain management. That takes one more year of work experience, and another set of board exams.
Before you get into a residency, there's the little detail of training as a doctor. That takes four years in a premedical undergraduate program, then four more years in medical school. Your first two years of medical school are mostly spent in the classroom, then you get your first work experience during clinical rotations in the third and fourth year. Not all schools offer a rotation in anesthesiology, so ask about that before picking a program. Do as much networking as possible during your clinical rotations, and volunteer or job-shadow with working anesthesiologists. Some early mentoring, or assistance getting into a good residency, can pay dividends later in your career.
- Washington University School of Medicine in St. Louis: Anesthesiology
- American Association of Colleges of Medicine: Specialty Information -- Anesthesiology
- American Medical Association: Residency Programs -- An Inside Look
- American Medical Association: Making the Most of Your Residency
- Stanford School of Medicine: Anesthesia
- Duke University School of Medicine: A Day in the Life of a Duke Anesthesiology Resident
- American Board of Anesthesiology: Combined Training Programs
- American Board of Anesthesiology: Examinations and Certifications
Fred Decker is a trained chef and certified food-safety trainer. Decker wrote for the Saint John, New Brunswick Telegraph-Journal, and has been published in Canada's Hospitality and Foodservice magazine. He's held positions selling computers, insurance and mutual funds, and was educated at Memorial University of Newfoundland and the Northern Alberta Institute of Technology.