Test

Anesthesiology for exams is quite different than anesthesiology for everyday cases. On the day-to-day basis, most cases proceed smoothly, as expected, routinely. On tests, every case probes a specific disease, disorder, malfunction, injury, complication, calculation, etc. In real life, patients have common medical problems: hypertension, diabetes, arthritis, coronary artery disease. On tests, there is a preponderance of systemic lupus erythematosus, anticardiolipin antibody, diabetic ketoacidosis, and tracheo-esophageal fistulas. Each day in the OR, I concentrate on practical issues: improving turnaround time, preparing following cases, getting my lines untangled. Tests address none of these but instead ask mechanisms of action of drugs, interpretation of statistical calculations, and obscure medications we no longer use.

In taking our yearly in-training exam, I realized anesthesiologists have to know other fields of medicine pretty well: I have to be able to calculate GCS in trauma, Apgar scores in newborns, and Child-Pugh classes in cirrhotics. I have to understand the process of labor and complications of delivery, changes in physiology after gastric bypass, vital signs of small children, anatomy of nerve plexi, interactions of psychiatric medications with anesthetics, ventilator settings in the ICU. This is really hard; some of these subjects I haven't contemplated in over a year. But even more than just medicine, we also have to know physics, engineering, biochemistry, pharmacology, statistics, and ethics.

Taking the test is a humbling experience and reminds me that though I may feel comfortable managing the anesthetic for a straightforward simple case, I have a great deal more to learn to fully master anesthesia.