No Residents, No Problem - Taking Ownership of Your Anesthesiology Rotation

by Sabina Kubayeva, MS3, SUNY Downstate College of Medicine & Sanjana Ahmed, MS1, SUNY Downstate College of Medicine

 
Medical student clerkship rotations are often shaped by residents and our interactions with them. They provide structure, guidance, and a buffer between us, the student, and the attending. But what happens when residents are no longer part of the equation?

Not all institutions have formal anesthesiology residency programs, and some medical students may find themselves working exclusively with attending anesthesiologists. While this structure offers unique opportunities for learning, it can also be intimidating, especially during a short one to two-week rotation where the time to make a good impression is limited. Without residents to set the tone, model expectations, and bridge the gap between students and attendings, we must navigate our role behind the drape independently. At the same time, attendings who do not routinely work with junior trainees may also be uncertain about how best to engage medical students, what level of autonomy is appropriate, or how much responsibility to offer during a brief rotation. This disconnect can foster an environment perturbed by mutual uncertainty, where both student and attending wait for the other to take the lead.

My personal anesthesiology rotation experience at a non-residency site illuminated the downsides of not working with residents directly. On my first day, I spent the entire morning sitting in the anesthesiology workroom waiting for an attending to invite me to a case and take me under their wing. I was unaware of the OR schedule, or even where to find it, and was hesitant to enter an ongoing surgery out of fear of being a distraction, or worse, contaminating the sterile field. Grown accustomed to the guidance of residents, I felt adrift without their help orienting myself and was unsure of my role. Ultimately, it made me feel discouraged about the rotation I had been most looking forward to in my third year.

Through my experience, I realized that in the absence of residents, the responsibility to create a memorable learning experience shifts to you, the student. If you find yourself in a similar environment, the first and most important step is to clarify logistics early. Start simple and ask where the OR schedule is located, how assignments are typically structured, and whether attendings prefer students to stay with one person or move between rooms. Even a basic question such as, “How can I best be helpful today?” can open the door to clearer expectations and signal initiative.

Being proactive becomes even more critical in this setting. I began asking for the OR schedule at the end of each day so I could read about the planned procedures, review patient charts, and try to formulate an anesthetic plan to discuss with the attendings the next day. I made sure to arrive earlier than the attendings, which gave me time to recheck the schedule, anticipate changes, and be physically present when attendings headed into the OR. Rather than waiting to be assigned, I chose an attending and followed them for the day, committing myself to learning their workflow and adapting to their expectations. Taking ownership of your placement within the OR removes ambiguity and demonstrates professionalism as well as initiative.

Equally as important is learning how to assert yourself respectfully. Without residents advocating for your involvement, you may need to volunteer for opportunities. When patients arrived in the morning, I offered to introduce myself, start IVs, and help with consent forms once the attending joined. With permission, I primed lines and drew up medications, gradually integrating myself into the anesthetic workflow. If you are unsure whether you can participate in a task, ask. Most attendings appreciate a student who is proactive but mindful of boundaries. Framing requests as learning opportunities, rather than expectations, helps maintain trust and allows for increased student autonomy.

Over time, what initially felt awkward began to feel natural. The attendings noticed my preparation, initiative, and genuine curiosity, and were more inclined to treat me as a junior member of the team who was eager to learn. In many ways, the lack of residents required both the attendings and me to adjust, ultimately paving the way for a more direct and intentional teaching relationship. It forced me to grow more quickly, to become comfortable with uncertainty, and to advocate for my education in ways I had not previously needed to.

In retrospect, the rotation taught me more than only anesthetic pharmacology or airway management. It gave me the opportunity to navigate unfamiliar clinical environments, learn how to read a room, and how to balance confidence with humility, skills that are essential in anesthesiology. An anesthesiology rotation without residents may initially feel isolating, but it offers a rare opportunity for individualized learning and mentorship. By showing up prepared, being willing to speak up, and embracing the initial discomfort of one-on-one learning, medical students can transform what feels like a disadvantage into one of the most formative experiences of their training