Excelling in Clinical Rotations: Your Complete Anesthesiology Guide

Understanding Your Anesthesiology Rotation: Goals, Culture, and Expectations

An anesthesiology rotation can be one of the most rewarding—and one of the most misunderstood—experiences of third year. Unlike other clerkships, you won’t “carry” a list of patients or write long daily notes. Instead, you’ll be immersed in short, intense episodes of care, seeing patients through some of the most vulnerable minutes of their lives.

Before you can excel, it helps to understand:

What Anesthesiology Rotations Are Really About

Most anesthesiology clerkships focus on:

• Preoperative assessment and risk stratification
• Airway evaluation and management
• Pharmacology and physiology of anesthetic drugs
• Hemodynamic and respiratory monitoring and management
• Postoperative care, pain control, and complication recognition

From the perspective of faculty and residents, the primary goals for a student are:

• Build a strong foundation in perioperative medicine
• Demonstrate reliability, curiosity, and teachability
• Learn to function safely and professionally in the operating room (OR)
• Gain exposure to what life and workflow look like in anesthesiology
• Show residency potential if you’re interested in the specialty

Even if you’re not planning on an anesthesiology residency, these skills will help you in surgery, emergency medicine, critical care, internal medicine, and beyond. For many, this is also a decisive period for the anesthesia match—evaluators are quietly asking, “Would I want to work with this person at 3 a.m. in a crashing case?”

How Anesthesiology Culture Differs from Other Rotations

The culture of anesthesiology is shaped by:

• Safety and precision: Small mistakes can have immediate consequences. Attention to detail is non-negotiable.
• Calm in crisis: Much of anesthesia is routine—until it suddenly isn’t. Teams value students who remain composed.
• Team-based workflow: You will interact constantly with surgeons, nurses, techs, and recovery staff.
• Punctuality and preparation: OR schedules are tight. Being late disrupts the entire team.

You’ll be judged less on how many facts you can recite and more on how you perform in real time: Are you prepared? Do you anticipate needs? Are you safe?

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Preparing Before Day One: Setting Yourself Up for Success

Preparation for clinical rotations in anesthesiology starts before you ever step into the OR. Strategic prep can transform your rotation from “shadowing” to high-yield learning.

Core Concepts to Review

You don’t need to be an expert. You do need a solid grasp of basics. Focus your pre-rotation studying on:

1. Airway Anatomy and Management

• Oral and nasal airway anatomy: tongue, soft palate, vallecula, epiglottis, vocal cords, trachea
• Mallampati classification and other airway predictors (neck mobility, thyromental distance, mouth opening)
• Basics of:
  • Bag-mask ventilation (BMV)
  • Oropharyngeal and nasopharyngeal airways
  • Laryngoscopy and endotracheal intubation (conceptual, not yet procedural)
  • Supraglottic devices (e.g., LMAs)

2. Cardiovascular and Respiratory Physiology

• Frank-Starling relationship, preload/afterload, contractility, and systemic vascular resistance
• Oxygen delivery: hemoglobin, saturation (SpO₂), cardiac output
• Ventilation vs oxygenation, dead space vs shunt
• Basic ventilator modes: volume control vs pressure control, PEEP concept

3. Common Anesthetic Agents

Be able to name, categorize, and briefly describe:

• Induction agents: propofol, etomidate, ketamine
• Opioids: fentanyl, hydromorphone, morphine
• Volatile agents: sevoflurane, isoflurane, desflurane
• Neuromuscular blockers: succinylcholine, rocuronium, vecuronium
• Reversal agents: neostigmine, sugammadex, naloxone, flumazenil

Know their major effects on blood pressure, heart rate, and respiration at a basic level—not every receptor, just clinical implications.

4. Risk Stratification and Pre-op Evaluation

• ASA physical status classification
• When elective surgery is risky: unstable angina, recent MI, decompensated heart failure, significant arrhythmias, severe aortic stenosis, poorly controlled asthma/COPD
• Simple EKG and CXR interpretation basics

A weekend of focused studying using a short anesthesia primer or clerkship handbook is usually enough to give you a strong foundation.

Logistics and Professionalism: Easy Wins

A surprising amount of clerkship success comes from predictable professionalism:

• Know where to be and when:
  • Ask the coordinator or chief resident: “What time should I arrive? Where can I find the board with OR assignments?”
• Dress and gear:
  • Hospital scrubs, comfortable closed-toe shoes (you will be standing a lot)
  • Pen, small notebook, and/or index cards
  • Light jacket if your ORs are cold
• Introductions:
  • Have a 10-second intro ready: “Hi, I’m [Name], a third-year medical student on my anesthesiology rotation. I’m really interested in learning more about perioperative care and airway management.”

Showing up early, presentable, and clearly prepared will make a strong first impression—critical for clerkship success.

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Day-to-Day in the OR: How to Be an Outstanding Student

Once your rotation starts, excellence in anesthesiology residency or student rotations is less about brilliance and more about reliable daily habits. This is where your performance can strongly influence your future anesthesia match prospects if you choose this path.

Arrive Early and Own the Pre-op

Aim to arrive 30–45 minutes before your first scheduled case. Your pre-op tasks might include:

1. Reviewing the Chart

Look up:

• Surgical procedure and indication
• Past medical history, especially:
  • Cardiac disease, arrhythmias, prior MI
  • Pulmonary disease, OSA, smoking history
  • Renal and liver dysfunction
  • Diabetes, anticoagulation
• Medications and allergies
• Prior anesthesia records: difficult airway, complications, PONV

Keep a brief, structured summary in your notebook. For example:

65M for elective laparoscopic cholecystectomy
PMH: HTN, CAD s/p stent 5 yrs ago, well-controlled DM2
Meds: aspirin, beta-blocker, metformin, ACEi
Allergies: NKDA
Airway: Mallampati II, good mouth opening, full neck ROM

2. Participating in the Preoperative Interview

Let the resident/attending lead initially, but with time, ask if you can perform parts of the pre-op:

• Focused history: NPO status, anesthesia history, family history of anesthesia complications, bleeding history
• Focused exam: airway, heart, lungs, relevant system for case (e.g., neuro status for spine surgery)

Offer a concise presentation:

“Mr. X is a 65-year-old male scheduled for laparoscopic cholecystectomy. He’s ASA 3 due to CAD and DM2. He is NPO since midnight, Mallampati II, no prior difficulty with anesthesia documented, and denies personal or family issues with anesthesia.”

Faculty will remember students who can summarize patients clearly and succinctly.

Learning the Setup: OR and Anesthesia Machine

Every morning is an opportunity to show initiative:

• Ask your resident: “Can I help with the setup?”
• Learn how to:
  • Check the anesthesia machine and circuits under supervision
  • Prime IV tubing, label syringes correctly, and prepare basic drugs
  • Help place monitors: blood pressure cuff, pulse oximeter, ECG leads

Do this consistently and carefully; never draw up or label medications independently without direct supervision. Safety is paramount.

Performing During Induction, Maintenance, and Emergence

Your visibility is highest at three moments: induction, critical intra-op periods, and emergence.

Induction: Controlled, Focused Participation

You may be invited to:

• Apply cricoid pressure (if indicated and properly taught)
• Assist with bag-mask ventilation
• Handle simple tasks like passing the laryngoscope or securing the ET tube

Your priorities:

• Know your role clearly: Ask before starting: “What would you like me to do during induction?”
• Avoid clutter: Stand where you’re asked, keep hands controlled and movements deliberate.
• Narrate what you see (to yourself and quietly to your resident if appropriate): “BP dropped from 140/80 to 100/60 after induction; HR is stable.” This shows that you’re learning to read the room.

Maintenance: Turn Dead Time into Learning Time

During the operation, when things are stable:

• Ask targeted questions:
  • “Why did we choose sevoflurane over TIVA for this case?”
  • “What are we watching for on the arterial line waveform?”
  • “Could you walk me through your thought process in managing this blood pressure?”
• Volunteer simple tasks:
  • Document vitals (if appropriate)
  • Help adjust ventilator settings when instructed
  • Assist with positioning and padding

Avoid constant chatter. Learn to sense when your team is tightly focused and hold questions for calmer moments.

Emergence and Post-op Handoff

Emergence is another high-value learning moment. Watch or assist with:

• Timing of turning off volatile agents
• Reversal of neuromuscular blockade
• Extubation criteria: spontaneous ventilation, adequate tidal volumes, following commands, protective airway reflexes
• Handoff to PACU staff: brief summary of case, intraoperative events, pain management plan

Ask: “Can I give the PACU handoff under your supervision?” Practicing concise handoffs is crucial for your overall clerkship and for future anesthesiology residency performance.

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Clinical Rotations Tips: How to Stand Out (Without Overdoing It)

Many students worry about how to stand out during third year rotations without being perceived as overzealous. In anesthesiology, the most valued traits are reliability, teachability, and situational awareness.

1. Be Predictably Reliable

• Show up early every day, not just at the beginning of the rotation.
• Follow through on what you say you’ll do (reading topics, checking labs, following up on a PACU patient).
• Keep a short to-do list each day and review it.

Faculty often comment: “I could trust [student] to be there and be on top of things.” That’s a residency-level compliment.

2. Demonstrate Active, Not Passive, Learning

Some practical strategies:

• Micro-reading: Pick one case-related topic per day (e.g., local anesthetics for nerve blocks, PONV prophylaxis, management of OSA in the perioperative period). Read 10–15 focused minutes that evening.
• The next day, say: “I read about PONV risk factors after our case yesterday. Could I quickly run something by you?” Then share 2–3 high-yield points.
• Keep a running list of “Things I want to understand better” in your notebook—then close the loop by revisiting those questions.

3. Communicate Like a Junior Colleague

High-yield communication habits:

• Always introduce yourself to new team members: “Hi, I’m [Name], MS3 on anesthesia.”
• Before stepping away (even briefly), ask: “Is it okay if I step out for 5 minutes to use the restroom?”
• When uncertain: “I’m not comfortable doing that independently yet—could you walk me through it?” This shows insight and maturity.

4. Show Situational Awareness

Anesthesiology teams prize students who show they’re paying attention:

• Glance at the monitors frequently. Note changes in BP, HR, SpO₂, ETCO₂, and communicate concerning trends.
• Notice the surgical field: large blood loss, surgeon requesting blood products, sudden changes in positioning.
• Anticipate needs: prepare tape for securing an ETT, move cords out of the way, have a suction ready.

This ability to “read the room” is one of the clearest signals that a student will excel in an anesthesiology residency and in the broader anesthesia match process.

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Aligning Your Rotation With Future Anesthesiology Residency Goals

If you are considering anesthesiology as a career, your rotation is more than just exposure—it’s an audition. The impressions you create now can translate into letters of recommendation, networking, and early mentorship that directly impact your anesthesia match prospects.

Clarify and Communicate Your Interest

You don’t need to declare your life plan on Day 1, but if you’re genuinely interested in anesthesiology:

• Within the first few days, tell your attending or rotation director:

  “I’m very interested in anesthesiology and considering it as a career. I’d really appreciate feedback on how I can grow and what I should focus on during this rotation.”

• This simple statement changes how people teach you. They will:
  • Offer more responsibility (within safety limits)
  • Give more detailed feedback
  • Point you toward reading or cases that are high-yield for the specialty

Seek and Use Feedback Intentionally

Mid-rotation and end-of-rotation are key checkpoints:

• Ask 1–2 attendings: “Could you give me one or two concrete things I can improve on in the OR?”
• Common feedback themes:
  • Speak louder/more clearly during presentations
  • Enhance pre-op assessment structure
  • Improve situational awareness around the monitors
  • Read more on a specific topic (e.g., cardiopulmonary physiology)

Write feedback down and check back in: “You mentioned I should work on presentations; I’ve been practicing being more concise—could you let me know if you see improvement?” This demonstrates growth mindset—a big plus for any residency.

Position Yourself for Strong Letters

A strong anesthesiology letter of recommendation typically comments on:

• Clinical performance and professionalism on the rotation
• Work ethic, punctuality, and reliability
• Communication and teamwork
• Potential to thrive in an anesthesiology residency

To make this easier:

• Seek longitudinal contact: Try to work with at least one or two attendings multiple times during the rotation.
• At the end, if things went well, ask:

  “I’m planning to apply to anesthesiology. Would you feel comfortable writing a strong letter of recommendation for me based on my performance on this rotation?”

• Provide them with your CV, a short paragraph about your interest in anesthesiology, and any relevant projects or research.

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Integrating Anesthesia Into Your Broader Third Year Rotations

Even if you ultimately choose another specialty, excelling in anesthesiology adds a powerful dimension to your third year rotations skillset.

How Anesthesia Skills Translate

• Surgery:

  • Better understanding of perioperative risk, fluid management, and pain control
  • Improved communication with anesthesia colleagues when you’re on the surgical side

• Internal Medicine:

  • Deeper insight into pre-op clearance, cardiac risk, and medication management around procedures
  • Ability to better interpret hemodynamic instability in hospitalized patients

• Emergency Medicine/Critical Care:

  • Confidence with airway concepts, sedation, and ventilator basics
  • Appreciation of rapid hemodynamic shifts and resuscitation principles

Mentioning your anesthesia experiences in future rotation evaluations and your MSPE can highlight your versatility and clinical maturity.

Using Anesthesiology as a Model of Clinical Reasoning

Anesthesiologists are experts at anticipatory thinking:

• Before induction: “What could go wrong? How will I respond?”
• During surgery: “How might surgical events affect hemodynamics and ventilation?”
• In recovery: “What complications do I need to watch for next?”

Adopting this style of thinking can transform your performance across clerkships. When you present patients, try framing your assessment and plan with:

• Most likely problems
• Most dangerous (even if less likely) problems
• Immediate and contingency plans

This is gold for clerkship success in any field.

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FAQs About Excelling in Anesthesiology Clinical Rotations

How can I impress my attendings if I’m not allowed to do many procedures?

Focus on what is fully within your control:

• Be early, prepared, and engaged every day.
• Take ownership of pre-op assessments and concise patient presentations.
• Know your patient’s details cold: PMH, meds, prior anesthesia history, risks.
• Show growth: read nightly on topics related to your cases and reference that learning the next day.
• Develop strong OR etiquette: situational awareness, good communication, and respect for all team members.

Procedures are a bonus; professionalism and preparation are what truly stand out.

What should I read or study during the rotation?

A practical approach:

• Use a short anesthesiology clerkship handbook or introductory text (many departments provide PDFs).
• Pair each day’s cases with a focused topic:
  • Spine surgery → prone positioning, blood loss management
  • C-section → neuraxial anesthesia basics, hypotension management
  • ENT airway cases → difficult airway approach, rapid sequence induction
• Supplement with quick resources (department protocols, online anesthesiology societies) for guidelines on PONV, DVT prophylaxis, perioperative cardiac risk, etc.

Aim for consistency: 20–30 minutes of targeted reading per day beats occasional marathon sessions.

Do I need an anesthesiology rotation to match into an anesthesiology residency?

It is strongly recommended. For a competitive anesthesia match, programs value:

• At least one dedicated anesthesiology rotation (home or away), with a strong letter of recommendation.
• Demonstrated interest in perioperative medicine, ICU, or related experiences.

If your school doesn’t offer a formal rotation early, consider:

• Anesthesiology elective later in third or early fourth year
• ICU or pain medicine rotations as complementary experiences
• Away rotations at institutions where you might want to match

What if I decide I don’t like anesthesiology during the rotation?

That’s still a success. One purpose of clinical rotations in anesthesiology is to help you figure out what you don’t want as well as what you do:

• Reflect on what you liked/disliked: pace, patient interaction style, workflow.
• Use the skills you gained—airway knowledge, perioperative thinking, procedural exposure—in whatever specialty you choose.
• Be honest but professional in evaluations and future discussions; you can still ask for a letter if your performance was strong and you built good relationships, even if you apply in another specialty.

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Excelling in your anesthesiology rotation is less about dazzling with obscure knowledge and more about consistent professionalism, thoughtful preparation, and active engagement. Whether you’re exploring the field or already committed to an anesthesiology residency, the habits you build in the OR—attention to detail, calm under pressure, and team-based thinking—will serve you throughout your career.