Why should internal medicine providers, let alone residents, be concerned about their knowledge of peri-operative medicine?  We asked Dr. Avital O’Glasser, program alumna, Associate Professor of Medicine, Medical Director of OHSU’s Pre-Operative Medicine Clinic (PMC), and Assistant Program Director. 

Dr. O’Glasser, after completing her residency training at OHSU, was offered a position as a hospitalist in OHSU’s Pre-Operative Medicine Clinic.  "I knew very little about the field at that time, though was certainly intrigued. However, other than some post-operative consults on cardiology rotations, I had very little exposure as a resident."

Dr. O’Glasser was constantly struck by how much she loved practicing peri-operative medicine.  "I am practicing some of the most broad, general internal medicine of my career.  In one day, I might have covered any or all organ systems ranging from cardiology to geriatrics with a keen eye on dynamic systems-based practice and interprofessional or patient communication."  With the U.S. patient population living longer with more comorbid conditions, internists are uniquely poised to be part of the multidisciplinary teams evaluating and helping prepare patients for surgery.

There is currently no national standard for pre-operative medicine curriculum for IM residents, though work is underway.  "I quickly realized that the clinic was set up to be an excellent educational venue for the Internal Medicine residents.  We know that a large percentage of internal medicine residency graduates are becoming hospitalists, though many report that their residency training did not prepare them for pre- and post-op consultations or co-management. Primary care physicians may be expected to write pre-op notes on their patients; however, peri-operative medicine extends past general medicine and into the subspecialties—how should a cardiologist manage chronic ischemic heart disease, how should a pulmonologist manage obesity hypoventilation syndrome, how should a nephrologist manage chronic dialysis all in the peri-operative setting?   "I love when residents emails me from a consult rotation and ask a peri-operative question relevant to that subspecialty--most recently, it was a question regarding management of immunosuppressants while on a rheumatology rotation."

Peri-operative learning opportunities for internal medicine residents at OHSU now include the primary care track, a second continuity site as part of the +1 week, and outpatient and inpatient electives.