About the Program
The cornerstone of our department's academic mission is training high-quality consultants in anesthesiology. Our 50 staff anesthesiologists come from diverse backgrounds and are committed to resident education. The department is directly responsible for the anesthetic management of more than 28,000 cases annually. We pursue the ideal of anesthesiology as the practice of perioperative medicine and maintain a dominant presence in the areas of critical care medicine and pain management in addition to practicing a wide spectrum of OR anesthesia.
Clinical Base Year (CBY)
Our program introduces learners to the role of the anesthesiologist as a perioperative physician. The CBY curriculum for the upcoming academic year is composed of rotations in general internal medicine, cardiology, emergency medicine, general surgery, pediatrics, adult critical care medicine, blood banking, and palliative care. Interns work directly with our faculty during their clinical anesthesiology, perioperative medicine, ICU, CVCC, acute pain service and echocardiography rotations.
From high-turnover cases at the Outpatient Surgery Center to emergent, high-risk cases in the main OR, our residents are challenged throughout their training. Without competition from fellows, our residents have first priority for complex pediatric, cardiothoracic and obstetric cases. Our case mix index (a reflection of patient diversity, clinical complexity and needed resources) is among the highest in the country (top 5%). Residents easily satisfy RRC minimum case requirements, typically by the end of the CA-2 year. The routine use of the resident case log report, updated on a monthly basis and appended to the daily case assignment sheet, has helped ensure that all residents complete training with an appropriate balance of case types and procedural experience.
The department has an ongoing commitment to clinical and laboratory research. We encourage residents to participate actively in research projects; residents may choose to pursue The Clinical Scientist Tract and receive six months of protected research time. The department is able to provide opportunities for investigation in a wide variety of clinical areas, including masters-level preparation in outcomes research through The Dartmouth Institute for Health Policy and Clinical Practice (TDI).
Regional Block Program
The regional anesthesia program at Dartmouth has long been considered one of the best in the country with high volumes, internationally known faculty and a robust research activity. The block rotation is a required CA-2 rotation and most residents elect to purse an additional experience in their senior year. The resident on rotation is free from other OR duties and is expected to identify potential candidates, evaluate the patient, and perform the regional block under faculty supervision. Our residents average more than 150 peripheral nerve blocks over the course of their training.
We have an established perioperative echocardiography curriculum that covers both TTE and TEE and includes:
- a regularly scheduled Perioperative Echocardiography lecture series to establish foundational knowledge regarding ultrasound and echocardiography
- access to e-echocardiography.com, a comprehensive online echo resource
- a HeartWorks TTE/TEE echocardiography simulator system to develop a comfort level with obtaining the standard views and beginning to differentiate normal from pathologic
- the QPath Point-of-Care Ultrasound (POCUS) workflow management system that allows for logging and storage of all POCUS exams performed and facilitates expert feedback on those exams for our residents.
All residents (PGY1-4) rotate at least annually on the Perioperative Echo rotation which gives them a protected block of time to best utilize these resources. As evidence of the strength of this training, many CA-3s have successfully passed the Basic Perioperative TEE certification examination, achieving testamur status.
The use of simulator-based training plays a vital role in anesthesia resident training, teaching and reinforcing critical skills in a safe environment. The department sponsors on-site Anesthesia Crisis Resource Management (ACRM) training using the space and resources of the Patient Safety and Training Center (PSTC), an 8,000 sq. ft. simulation complex at DHMC. During the CA-1 year, the residents participate in ACRM1, a half-day course focusing on problem identification and call-outs for help of basic anesthesia situations using a computerized mannequin. ACRM2 for the CA-2 residents is a full day course that emphasizes crisis management and team building skills using the computerized mannequin in more complex anesthesia scenarios. ACRM3, a follow-up course for CA-3 residents, is intended to provide participants with the opportunity to review critical event management principles and practice their application in the simulated setting.
Transition to Practice
The Transition to Practice rotation is focused on preparing CA-3 residents for their shift to independent practice. Residents function as "pre-tendings" while supervising associate providers and junior residents in the OR. The senior residents are also responsible for making OR assignments and take on added responsibilities of supervision and triage while "running the board". This rotation consistently receives excellent feedback from our residents who appreciate the opportunity to experience the nuances of independent practice in a protected environment.
Combined Anesthesiology-Preventive Medicine Residency
The Department of Anesthesiology offers a unique opportunity for anesthesia residents to earn a master's degree in public health from The Dartmouth Institute for Health Policy and Clinical Practice (TDI) in a combined program with the Dartmouth-Hitchcock Leadership Preventive Medicine Residency.
A great place to live
Dartmouth-Hitchcock Medical Center is located in the scenic Upper Valley, an area of Northern New England that stretches along the Connecticut River and includes the foothills of New Hampshire's White Mountains and the Green Mountains of Vermont. With ready access to the outdoors and major metropolitan areas (Boston 2 hours, Montreal 3 hours), this area is consistently recognized as an extraordinary place to live and work:
- Best Small Town in America (Lebanon, Livability.com, 2015)
- Best Town finalist (Lebanon, Outdoor Magazine, 2015)
- Best College Town in America (Hanover, Movoto, 2014)
- Best Cities to Raise an Outdoor Kid (Lebanon, Backpacker.com, 2009)
- Best Places to Live (Hanover, Money Magazine, 2009, 2011)
A solid foundation
We remain committed to nurturing a dynamic environment that promotes the learning, teaching, and practice of all aspects of our specialty. Our trainees have enjoyed remarkable success in achieving certification from the American Board of Anesthesiology and have proven highly marketable following graduation. Given the extraordinary level of faculty commitment to resident education, our outstanding facilities, and increasingly diverse clinical caseload, our program will continue to be an innovator in the evolution of anesthesiology and perioperative medicine.
Benjamin D. Morley, MD
D-H Anesthesiology Residency