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Anesthesiology Residency Interview

20 Questions and Answers by Ryan Brown

Question 1 of 20

What does the future of anesthesia look like?

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Anesthesiology Residency Interview Questions

  1. 1.

    What does the future of anesthesia look like?

      Although the basic process of anesthesia for most surgeries will likely remain the same: put the patient to sleep before the surgery and wake them up after the surgery, there are still several areas of active growth in the anesthesia field. One of these areas is the ability to identify regions of the body to anesthetize with local anesthetic. The ability to numb and immobilize a region of the body (e.g., the foot) that the surgeon will operate on allows for better post-operative pain control and potentially allows minimizing systemic analgesic and sedation drugs and their toxicities.

      Ryan's Answer

      "Manufactures of intraoperative anesthesia monitors are currently researching ways to predict hemodynamic instability before it occurs. This would allow anesthesiologists to respond to these warnings and potentially avoid or at least reduce the extent of hemodynamic instability. I think the future of anesthesia will involve an increased focus on developing models to predict poor intra-operative outcomes."

  2. 2.

    Are there any types of surgeries or anesthesia, such as one-lung ventilation or coronary artery bypass surgeries, that residents feel like they don’t get enough experience in at this institution?

      This is an interview question you can ask the interviewer. This question is a more useful one than the typical 'what are residents' case numbers like?' since virtually every program has no problem getting their residents to do more than the numbers required. This question assesses any weaknesses in the program that may conflict with your goals. For example, a common response is that the program may not do some types of organ transplants.

  3. 3.

    Why did you want to go into medicine?

      This question from medical school interviews frequently resurfaces in residency interviews. The goal of this question is to assess if your reasons for pursuing medicine are consistent with your reasons for pursuing a career in anesthesia. While they don't have to be the same reasons, they should at least be complementary.

      Ryan's Answer

      "I went to medical school because I wanted to provide acute care in which I made decisions that could save a patient's life. I also wanted to have deep and meaningful conversations with my patients and their families. During my time in medical school, I experienced some of these during my ICU rotations. My goals most aligned however, with the role of an anesthesiologist or critical care doctor in the OR, where quick decisions based on constantly changing information needed to be made. I also found in anesthesia that my conversations with patients required a strong level of trust and confidence as a majority of my patients would be put to sleep through their surgeries."

  4. 4.

    What role do you see nurse anesthetists playing?

      Careful! This is an extremely hot button topic in anesthesia and virtually all anesthesia providers have very strong opinions on this subject. Some providers don't believe the profession should exist and that nurse anesthetists are a danger to patient care. Others believe they serve an important role. Stay politically correct and acknowledge your limitations in that you do not have sufficient knowledge and experience in anesthesia to make a fully informed judgement yet.

      Ryan's Answer

      "As I have not yet worked with nurse anesthetists or in anesthesiology, I have not formed an opinion. I have only learned of the opinions of those around me during my clerkships."

  5. 5.

    What are some challenges in the field of anesthesia?

      This question assesses your familiarity with the field and your ability to notice subtle problems with the field. The unstated question here is also 'how should they be fixed?'

      Ryan's Answer

      "One of the challenges I have observed from my anesthesia rotations is disagreements between the surgical and anesthesia teams on issues such as intraoperative fluid management. For myself, I will try to talk to the surgeons before more complex surgeries, such as traumas or organ transplants to reduce the risk of intraoperative disagreements. I also will focus on reading anesthesia texts so that I can make evidence-based arguments during these disagreements. In the event that I have a disagreement with the surgery team that I cannot resolve and has potential to affect my patient's care, I will call my attending for guidance."

  6. 6.

    Your five-year old patient in the preop area starts crying and doesn’t let anyone touch him. What can you do?

      Comfort the child. Let the child sit in their parent's lap. Avoid examining them more than necessary. Most hospitals allow parents or guardians of children to enter the OR with them so children can sit on their parent's lap as they fall asleep. While you always would like to have at least 1 IV before taking a patient into the OR, in children, you may not have one and must rely on gas anesthetic in the OR with flavored scents to induce sleep. Don't suggest giving oral Versed/midazolam (a medication to calm them down) in the preoperative area right away. Non-medication approaches are always best, but this option exists if you need to control a child.

      Ryan's Answer

      "I would work with the child and his or her guardians in the room to try to calm the child. If unsuccessful, I would allow the guardian to come into the OR with the child and have the child fall asleep on a gas anesthetic."

  7. 7.

    Why do you want to pursue a career in anesthesiology?

      For this question, you need to discuss qualities that are unique to anesthesiology and why these qualities are important to you. It is not necessary to say you knew you wanted to pursue this field since a very young age.

      Ryan's Answer

      "There are two aspects of anesthesia that appeal to me. The first is the opportunity to work in an environment where vitals and organ functions, particularly the heart and lungs, are highly volatile and thus require anticipation of critical changes and careful titration of medications. This requires a deep understanding of cardiopulmonary pathophysiology as well as an ability to make decisions and act quickly. I find this academic component of anesthesiology exciting and congruent with my goals of working as a critical care provider of the OR. The second aspect is being able to explain to patients and their families about the anesthesia experience while instilling comfort and confidence in their care. I believe one of my biggest strengths is having these conversations as I would take the opportunity to have similar conversations during my ICU and anesthesia rotations."

  8. 8.

    The majority of people who are put to sleep during their surgery are kept asleep by gas anesthetics. How do gas anesthetics work?

      This is a common trick question. Even in the 21st century we don't understand how gas anesthetics work as their mechanism of action has not been identified. We do know how other anesthetics work. Local anesthetics act directly on the sodium channels of nerves and thus are injected directly adjacent to nerves. Most pain medications work on the opioid receptors. A notable exception is Ketamine which works with a wide variety of receptors. Propofol works on the GABA receptors.

      Ryan's Answer

      "While many anesthetics work on the GABA receptor or on the sodium channels of nerves, nobody knows how gas anesthetics work."

  9. 9.

    What kind of research opportunities exists in the anesthesia department?

      This is an interview question you can ask the interviewer. Aside from test scores, research is one of the few ways you can stand out from your colleagues when applying for fellowships. If research opportunities exist in the program, it is important to clarify which ones exist as getting authorship of a publication on prospective clinical studies or basic science research can take many years while getting one in a retrospective clinical study, particularly one that already has a database built, can be done relatively fast.

  10. 10.

    Are there any subspecialties of anesthesia that I will not have an opportunity to do a rotation in until my CA-3 year?

      This is an interview question you can ask the interviewer. This is an important question to ask interviewers as programs often do not reveal detailed information about residents' schedules. Many programs don't allow you to do a rotation in one or more subspecialties, most commonly regional anesthesia, until your CA-3 year. If you are considering going into a fellowship for a field that you will not get to see until your CA-3 year, you will be in a challenging position. Apply to the fellowship as a CA-2 without having seen the field or wait to become a CA-3 so that you can see the field before applying. If you chose the latter, there will be a one-year gap between the end of your residency and the start of your fellowship.

  11. 11.

    Is it customary for attendings or residents at this institution to call patients at home the day before surgery?

      This is an interview question you can ask the interviewer. While this is not the norm in many residency programs, it is important in private practice and doing so shows a commitment to your patient. If the program doesn't do this, you can sound like an all-star resident by suggesting that you would like to do so in order to get a complete history, provide instructions (e.g., NPO at midnight), and answer the patient's questions.

  12. 12.

    Your patient is excited for surgery right before you give them Versed; the patient begins slurring words and they no longer want surgery. You are certain he wants surgery and has already signed the consent forms. What do you do?

      Due to a character limit on our interview questions, we had to limit the above interview question. Here is the full interview question: 'You see your patient in preop for routine surgery. Your patient is excited for his surgery and has no reservations about surgery or anesthesia. After you give Versed, which produces an effect similar to inebriation, your patient begins to slur his words and says he no longer wants to go for surgery. He doesn't provide a reason. You are certain that he actually wants surgery and has already signed the consent forms for anesthesia and surgery. What do you do?'

      Although Versed's effects are similar to alcohol and it is likely that the patient truly wants to go forward with surgery, he has the right to revoke his consent at any time and this must be honored even if there is question about his mental status at the time of revocation.

      Ryan's Answer

      "I would tell the surgery team and my attending that I would like to delay the surgery for several hours until the effects of Versed wear off. Once the patient demonstrated competency, I would reconsent him."

  13. 13.

    Doctor, your patient was chewing gum in the preop area. He spit it out now and says he hasn’t eaten anything since midnight.

      Chewing gum causes increase salivation and thus the patient is not NPO since midnight. While some anesthesiologists will accept the increase risk of the patient aspirating gastric contents into the lungs during intubation, you are expected to follow standard guidelines unless otherwise instructed by your attending.

      Ryan's Answer

      "I would talk to the surgery team about postponing the case by 2-4 hours if it is not scheduled as an urgent or emergent case as chewing gum increases salivation which can fill the stomach, especially in diabetic patients who may have delayed gastric emptying."

  14. 14.

    What are you looking for in a residency program?

      This question is also asking 'Why do you want to come here?' It is important that you have researched the program and identify a few unique features of the program that are important to you when selecting a residency program.

      Ryan's Answer

      "I am looking for an academic program in an urban setting. I believe this will provide me with research and learning opportunities as well as the ability to work with diverse populations. I appreciate that your program is a level 1 trauma center because that will give me opportunities to work in the most emergent cases. I also appreciate that your program has a fellowship in obstetric anesthesia as I enjoy working with pregnant women and anticipating and dealing with challenges unique to this population such as the potential for significant hemorrhage and hemodynamic instability with caesarean section and swelling in the airway of pregnant women."

  15. 15.

    What will you bring to our residency?

      This question can be thought of as 'Why should we choose you?' It helps to approach this question by thinking of qualities that would be desired by anesthesia residency programs such as effective communication, diversity of experiences, and unique education (e.g., MBA).

      Ryan's Answer

      "Having worked extensively with pediatric patients and their families prior to medical school and during medical school, I believe my experiences will help me in providing comfort to patients of all ages as well as their families prior to surgery. This includes anticipating their concerns and often understanding unstated concerns in the preoperative area."

  16. 16.

    What do you want to call EBL? 10 cc?

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  17. 17.

    Suppose you catch one of your colleagues pocketing a bottle of fentanyl. What would you do?

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  18. 18.

    How would you counsel a patient about risks of anesthesia?

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  19. 19.

    What would you tell your adult patient who is scared of anesthesia?

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  20. 20.

    What qualities make a drug an anesthetic?

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