Boston Medical Center has two Pavilions. The East Newton Pavilion has a total of 13 operating theaters: 10 in the main Operating Room and 3 in the Ambulatory Surgery Center. These operating rooms are used to perform a wide variety of cases ranging from simple "same day surgery" procedures to complex and specialized operations.

Our institution is the Regional Spinal Cord Injury Center for the New England area. We anesthetize many patients with cervical column injury making us airway management experts for patients with severe neck trauma and its neurological consequences. There is ample opportunity for our staff and trainees to master the use of fiberoptic instruments and multiple airway management adjuncts. There are 400 neurosurgical cases a year including brain tumor resections, aneurysm clipping, stereotactic brain biopsies and other cases rarely seen outside tertiary care referral centers.

Elective cardiac and thoracic surgery is performed in the East Newton Pavilion. Two operating rooms are exclusively used for open-heart surgery on a daily basis. The yearly load of this surgical specialty is approximately 800 cases. Multiple heart valve repairs, coronary artery bypass grafting with radial artery harvesting, cardiac re-operations, port-access procedures, mediastinoscopies and thoracotomies are all commonplace in our operating suites. A cardiac and thoracic anesthesia team with extensive trans- esophageal echocardiography (TEE) experience is dedicated to caring for these patients. TEE is routinely performed during our cardiac procedures and we have direct video connections with the cardiology echo lab for "live" interaction. According to the available data, the outcome of our cardiac surgery patients is the best in Massachusetts and among the best in the world. (See the Department of Cardiothoracic Surgery Web site for more details.)

While most of the trauma arrives at the Harrison Avenue Pavilion, a large number of elective complex orthopedic procedures are performed on our Campus. There are over a thousand orthopedic procedures done yearly providing our residents excellent opportunities for developing expertise in regional anesthesia and analgesia techniques.

General surgeons do over a thousand cases a year. The remaining of the surgical patients are taken care of by busy Ophthalmology, Urology, Maxillo-facial, ENT, Plastic, Gynecology and Vascular services. The postoperative and acute pain service is managed by our Department, and chronic pain by a multidisciplinary approach. All clinical areas at Boston Medical Center operate in modern physical plants. The operating rooms are well equipped and the monitoring instruments are state of the art. The surgical intensive care unit, cardiac catheterization laboratory and the post anesthesia care unit (PACU) are contiguous to the operating room. This is a convenient and practical arrangement facilitating the transfer and transport and care of patients by our staff and residents. There is Internet and literature search access from all these locations.

The Harrison Avenue Pavilion (formerly Boston City Hospital) is renowned as an outstanding Level 1 trauma center. Its Emergency Department is the busiest in Massachusetts with over a hundred thousand patient visits per year. Many of these patients require urgent surgery, providing an excellent opportunity for anesthesiology residents to receive training in this field. The Department of Anesthesiology at HAP conducts research and collaborates with the various surgical services in developing research projects and trauma related protocols. HAP offers its residents obstetric and pediatric anesthesia rotations. There are approximately eighteen hundred deliveries per year. The Departments of Obstetrics and Anesthesiology maintain a collaborative relationship. This greatly benefits each service and most importantly, the patients they serve. Our residents work with a high-risk obstetric population and develop skills in managing difficult and routine cases. The Director of Obstetric Anesthesia is fellowship-trained and has extensive experience in all aspects of obstetric anesthesia care. There is a strong didactic program, and residents and staff usually interact on a one-to-one basis.

HAP's pain service offers residents the opportunity to treat acute and chronic pain patients. Acute pain patients are followed on a daily basis with epidural analgesia, patient-controlled analgesia and other pain treatment modalities. Chronic pain patients are treated 2 days a week. Residents actively participate in the pain clinic and receive hands-on training in performing nerve blocks.

Our Department greatly benefits from the general and oral surgery residents rotating in anesthesiology for periods of two to three months. Anesthesiology is a popular rotation among third and fourth year medical students. These individuals provide the anesthesiology resident with the opportunity to teach and train others, thus gaining a better understanding of their own specialty. Additionally, there are paramedics and nurse anesthetist students rotating through to learn specific tasks, such as airway management.

We provide multiple services that while benefiting the hospital add to the residents' overall experience. The preoperative clinic evaluates patients prior to the surgical procedure. This prepares the patient, allows the anesthesiologist to develop a rapport with the patient, and can be important in detecting and correcting problems that could cause delays or cancellations.

These services in combination with the experience provided at East Newton campus, make Boston Medical Center an excellent institution to train in anesthesiology.