I know you cannot wait to complete your training and start working as an anesthetist.  You are counting down the days until graduation, if you are like most anesthetists in training.    But, you have a relatively short period of time to learn everything you can before you will be working in the real world.   There is a deadline that is looming ahead of you within six months of your graduation.

What happens six months out of your training?

There will be a major event that will happen in your career six months out of training.

Any idea what it is?

Give up?

Within six months of graduation from your anesthesia training program, you will encounter a life threatening event.  How you handle that event may determine the patient outcome and potentially the trajectory of your career.

What will your life threatening event be?

I don’t know … and neither do you.  There is no way to predict it.  It could be a failed airway, or a “high spinal” anesthetic, or an allergic reaction, or a laryngospasm.  There are so many different possible scenarios that you won’t know for certain what it will be.

So how do you train to be prepared for your event?

Take a page from a Navy Seal training manual to make the most out of your training.  These  5 principles are used in “The Teams” to train their elite warriors.  You can use to help you prepare for that life threatening event and become a better anesthetist.

The 5 Principles You Can Use to Make the Most of Your training.

1.  Be About the Business of being an Anesthetist Trainee

In The Warrior Elite: The Forging of SEAL Class 228, Dick Couch (author) noted that some of the BUD/S students did’t seem to be fully engaged.  They seemed to just be coasting by.  They were going through the motions “Just to get through”.   We have all had times in our lives when we just wanted to survive.   It might have been in school or in a job.

Don’t let this be part of your anesthesia training.

While you are a student of anesthesia, learn all that you can.  One day, you will be caring for patients as a practitioner.  They are depending on you to be a professional and take your training seriously.

Learn the Why

Technicians learn the “how”, practitioners learn the “why”.  Take the time to learn the “why”.  When you learn the “why” you understand the concepts, so that when you are out of training, you can apply them.

Starting arterial lines is a great example.  There is some good data that you will improve your chances of a successful a-line start when you sit down. Its not being lazy, it will improve your chances.  Take every opportunity to “why” so that you develop into a practitioner.

2.  Learn Your Equipment and How to Make Simple Adjustments

Anesthesiology involves using equipment that others either do not use, or they do not use it regularly.  Our anesthesia machine comes to mind first.  It is our ventilator, our anesthesia delivery system, and has our monitoring capabilities attached to it.  You are the only person in the OR who will know how it operates.

We also have airway equipment like videolaryngoscopes, fiberoptics, and even standard laryngoscopes.

You may be taking care of patients at night, or in offsite locations, where you will not have the availability of anesthesia technicians/technologists to help you.  The ICU might call upon you for help with an airway.  You will be surrounded by people who want to help you, but they will not know how.

If you know your equipment well and can make small adjustments, then you are more self sufficient.  Couple that with learning the “why” and you will be able to complete your task safely.

Learn how your anesthesia machine works.  Most of the basic books will walk you though the concepts of how the anesthesia machine works.  I learned how the anesthesia machine worked, by going through machine questions in the Hall question book.

If you really want to obtain a higher level of education, then you can check out A Practical Approach to Airway Equipment.

3.  Have a Back Up Plan

It is great when you anesthesia plan works.  You might be tasked with an elective cesarean section (C-section) under an epidural anesthesia.  The epidural you placed hours ago for labor pain and it has been working well since.  You now bring the patient to the operating room and dose up the epidural.  The epidural is working great and you are able to provide a great anesthetic to your patient.

What happen if the epidural doesn’t work?  Or it gets pulled out while moving the patient to the OR table?  Or the epidural is working “too well” and you get a high spinal?

In anesthesia, you need to be thinking several steps ahead.  You should expect something to go wrong.

Common complications are predictable, because they are common.  Build back up plans in your mind so that you will be able to manage complications when they surface.

4.  “Slow is Smooth, Smooth is Fast”

Everyone wants to be fast at procedures.  We all want to be able to intubate quickly, get the IV in the first stick, and thread that A-line like a champ.  Many new anesthesia trainees focus on speed.  They see more seasoned anesthetists move very quickly to get a task done.  The problem with wanting to move fast is that you tend to get sloppy and lose finesse.

Navy SEALS have a saying when talking about firearms training “Slow is smooth, smooth is fast.”

When you slow down, just a little, to get the right mechanics, then you will get better.  With smoother mechanics, you will actually get fast at the procure, because you are using finesse.  I know it sounds counter intuitive, but it works.

Next time you are intubating, slow down enough to really work on the technique.  When you get good, you will become smoother, which will end up making you perform the procedure faster.

5.  Be Comfortable in Your Environment

For most of your training, you will be spending time in the operating room (OR).  You will become very comfortable with the equipment and the space in which you will work.  The OR will become your second home.  If you are given the opportunity to work in an “off site” location, do it.

Off site locations are MRI, Cath lab, GI lab,  Interventional Radiology, or radiation oncology.  Working in these out of the OR locations can be a challenging experience.  The equipment may be different, the patients are usually sicker, and you are further away from help.  Some of these locations also have the added personal risk of exposure to radiation or a strong magnet.

It is far better for you to work in these locations during your training, then when you are assigned there when you first get out of training.

When you are in off site locations, remember that you still follow the same requirements that you would in the OR.  Becoming comfortable working in this environment will help you when you work in the environment when you graduate.


You have a short period of time to be in training.  By utilizing these 5 principles of Navy SEAL training, you will get more out of your training, and become a better anesthetist.

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