Tess McClenahan '23 on anesthesiology residency in MA

Dr. Tess McClenahan, a recent graduate of UMHS, discusses her upcoming residency in anesthesiology at Baystate Medical Center in Springfield, Massachusetts. She explains that her interest in anesthesiology was influenced by her father, who was a nurse anesthetist. Dr. McClenahan describes a typical day for an anesthesiologist, which involves preparing the operating room, reviewing patient histories, administering medications, and monitoring patients during surgery. She emphasizes that anesthesiology is not just about putting patients to sleep, but also involves continuous monitoring and providing compassionate care. Dr. McClenahan believes that anesthesiology is a competitive field because of its autonomy, variety of procedures, and good work-life balance. She also mentions the importance of networking and achieving high step scores for success in the field. Dr. McClenahan chose UMHS because of the positive experiences shared by alumni, and she encourages current and prospective students to make the most of their time in medical school and to network. She plans to continue in anesthesiology after residency and is interested in practicing in a rural setting.

Dr. McClenahan also discusses the challenges faced by women in medicine and the need to break down stigmas and biases. She mentions the use of new technologies and medications in anesthesiology, such as video-assisted intubation and improved drugs for pain management. Finally, Dr. McClenahan expresses her gratitude to her mentors and highlights the importance of their support and guidance throughout her journey.

While a student at UMHS, Dr. McClenahan worked for the UMHS Marketing Department as a Media Ambassador, sharing student content on social media about St. Kitts and the UMHS experience. She is still active at UMHS even as she prepares to enter residency. On June 17, 2024, Dr. McClenahan was a panelist on the webinar UMHS Celebrates Pride: Insights and Advice from LGBTQ+ Physicians

UMHS Endeavour: Welcome today, Dr. McClenahan.

Dr. Tess McClenahan: Thank you so much for having me, Scott. Happy to participate in the interview. It's always nice to have a full-circle moment for graduation, so thanks for having me.

Tell us about your upcoming residency that you just matched into. Where will you be working?

I matched into a categorical four-year anesthesia program. It's one of the U Massachusetts campuses located in Springfield. I'll be at Baystate Medical Center, which I'm really excited about. It's pretty close to home, I guess, or at least my home base. And so yeah, I'll be spending the next four years there in northern New England and honestly really couldn't be happier.

What made you initially become interested in anesthesiology?

I love that question actually because I think anesthesia specifically is one of those specialties that you don't get a lot of exposure to. It's not part of the core rotation, so if you think that you might have an interest in it, it's something that you'll have to do as an elective after you complete your core rotations. I think I had a little bit of an advantage going into medical school. My dad was actually a nurse anesthetist, and so I had that exposure to anesthesia growing up from his stories and just his experiences. And so, in the back of my mind going into med school, I knew I would probably like anesthesia, but when I went into my third year, I tried to keep an open mind and went into every core rotation and every elective with [the idea}—"even if I don't end up liking this, I'm going to make the best out of it, and I'm going to try to learn as much as I can from each thing."

There were a couple of specialties that I had a little bit of interest in, but once I scheduled my elective anesthesia rotation, within the first week I was like, oh man, I was so happy that I found it, which was definitely a little bit of a relief because it was coming into my fourth year and the six core rotations that we do. Like I said, I liked certain aspects of each one, but it was never something that I saw myself going into each of those six. And so, when I got into anesthesia, it was like, oh man—finally, I found what I wanted to do and what I wanted to Match in.

And so yeah, I ended up applying for anesthesia. I think it's just one of those specialties where I'm going to be biased when I talk about it, but I think it has a lot of good things about it. It's very procedure-heavy. You get to quickly connect with patients. No ordinary day, really. So yeah, like I said, I really couldn't be happier that I found my home in anesthesia and found my residency spot.

It's interesting that you mentioned not an ordinary day, but could you describe what might be a typical day for an anesthesiologist, just for people who aren't really familiar with the specialty?

Sure. So there's a lot of different avenues within anesthesia that you can take, but let's say you're working in the hospital setting, in the intraoperative setting, your day would start, even some people might know this before some of the surgery residents or some of the surgery attendings come in because you're the person that's with that patient first. And so you need to prep the room. You need to go in and drop all your medications. You need to review the patient's history, make sure that there are no contraindications to any of the typical medicines that you would use in that intraoperative setting, make sure that they don't have any allergies to some of those medications, and just get everything set, ready, prepped. The saying in anesthesia is that you can never be more prepared. If you're preparing yourself the best, then the chances of there being trouble is less.

So prep, prep, prep, then you'd go and talk to the patient, and your day could vary from doing an orthopedic case from a knee replacement, to maybe an OB-GYN surgery with a hysterectomy, and then maybe there's an add-on appendectomy at the end of the day. And in between, you're doing regional blocks on that knee that you did - you're going to want to do a block on that person for some post-operative pain. So they go home as comfortable and as easygoing as they can, and then you can do blocks throughout the day. Like I said, you might be on the OB floor doing epidurals for delivering mothers. So, it just depends on the setting that you're in. But I think that's what drew me a little bit to anesthesia in the first place, that you're not just doing one type of case. You're not just doing gallbladders or you're just doing knee replacements. You're getting all of those all the time, so.

It runs the gamut, it sounds like. Why is anesthesiology such a competitive area of medicine?

I think I'm going to be biased again here, but I love the autonomy that you get. I love sort of the variation. Like I said, you're not just going to be doing the same surgeries that if you're a surgeon that specializes in this one area, you're not just doing those surgeries all day every day and you're with patients in a pretty, I don't want to say scary, but a very vulnerable time in their life, they're most likely scared. And for you to be that person that can just give them that reassurance and just say, "I am well-prepared for you, well for this, and I'm going to try to make this journey into your surgery the most happy and healthy for you."

You get a good work-life balance; you get that variation. I think more and more people are starting to figure that out and are well compensated, as well, for the time that you do. So it used to be that anesthesia was a hidden gem, but now more and more people are figuring out that you can have it all in anesthesia. I think that's why it's gotten a bit more competitive over the last few years especially.

Dr. Tess McClenahan when she was a med student at UMHS in St. Kitts. Photo: Courtesy of Dr. McClenahan.

That’s great to know. And whenever you applied to med schools, why did you choose UMHS over others?

Yeah, so I actually had first applied to some US MD and DO schools. And while I had some interviews through those avenues, I had a little bit of a non-traditional path into med school. And so I think that played a little bit of a role into—it just didn't work out. And I was at the point in my life where I knew for certain that med school was something that I wanted to do and I wasn't going to stop until I got to the end goal. And so when I applied to UMHS, I had gone to a couple of their prospective webinars and actually one of the student alumni speakers was Dr. Mikayla Troughton, who is a practicing anesthesiologist now. And so just listening to her experience and shed some light on UMHS, it was something that I just felt really strongly to apply to and I have no regrets. I applied a few months before I started and there was no waiting game with it, and I was like, like I said, this is what I wanted to do and I wanted to get started as soon as I could.

I know Dr. Troughton very well. She has done several webinars for us. She's really an amazing person. What would you say to a UMHS current or prospective student who is interested in going into anesthesiology?

I think that my advice for anesthesiology is probably pretty generic as far as the advice that I would give to anybody going into any specialty. There might be a couple of specific tidbits of advice that I would give for someone for anesthesia, but really, it's just soaking up as much as you can in your time in medical school, both in basic sciences and in clinical rotations. At the end of the day, I hate to say it, but Step scores really do matter as far as getting your foot in the door for interviews. And so, you're not going to learn everything that you need to know within your lectures and basic sciences, and you're not going to learn everything that you need to know in your day-to-day, clinical rotations in that short six-week or 12-week rotation, whatever it may be.

And so, it's really just being accountable and networking. Absolutely, networking is huge. You need to do well in your exams, and it's just really soaking up every opportunity that you can get to give yourself the best chance at being successful in anesthesia or any specialty that you apply for. I think those are the really two big things that would be networking and step scores, so.

Growing up in New Hampshire & Idaho

Where did you grow up and where did you do your undergrad?

I was extremely privileged to grow up in two amazing places. I spent half of my childhood in very northern New Hampshire, and then the other half of my childhood where I graduated high school was actually in a very rural town in Idaho, so I had both the northeast and then the mountain west. But I did return to the northern New England area for my undergrad and I went to a really small school, it's called Thomas College in Waterville, Maine. I actually graduated with a degree in criminal justice.

Oh, wow.

I had a little bit of a non-traditional path to medicine in the early stages, but I eventually came around.

That's so great to hear that you had a non-premed degree because I worked in admissions for eight years before I went over to marketing and I would get so many people who said, "What should I major in?" And the reality is as long as you take the prerequisites, you can major in English, you can major in Latin, there's all kinds of different, liberal arts.

Absolutely.

It’s really great to hear that you did something that's totally not pre-med and that you've been so successful. That's amazing. Did you always want to be a doctor?

No. So going back to my previous answer, both of my parents are in medicine. They're both retired now, but my father was a certified registered nurse anesthetist, and my mother actually was a family physician. And so I don't know if it was that late teenage rebellion in me that was like, "I don't want to do what my parents do." So like I said, I majored in criminal justice and it wasn't until my junior year that I actually did an internship with my state's medical examiner's office, doing autopsies and just getting really involved with the anatomy. And originally I went into it from the criminal justice standpoint and within a month of me being there, I had decided I just loved so much of the anatomy and the pathophysiology that I needed to go to med school.

So, my parents definitely were pleased, but I will give them all the brownie points in the world that they really didn't try to persuade me along the way. So no, I didn't always want to be a doctor, but I got there eventually in my path. And I think that just goes to show that like you said, there's no one way to get there. And I think that each experience that you have shapes you into the physician that I am and whoever else is going to be in your future. So I think, yeah, it's great that people have other majors and other interests outside of medicine because yeah, I think it gets you there eventually if that's what's meant to be.

I think that I've heard a lot of people say that it just makes some more diverse doctors that not everybody comes from a science and math background.

Absolutely.

Since you majored in criminal justice as an undergraduate, were you thinking you might become a lawyer?

I left that to my sister. She went to law school, which is perfect for her. I was thinking more of the law-enforcement homicide side of things. So in a way, I was still in that science background era. But yeah, I found the perfect fit for me eventually.

Let's segue a little bit to talk about an important issue in medicine. I think this has changed a lot because we have so many awesome female UMHS graduates, but when I was doing a little bit of research before our interview, I found a website from 2017 that said at the time, that three-quarters of anesthesiologists are men. I think those figures have definitely changed since then, because I know we have so many grads working in anesthesiology. But I remember you posting something about patients thinking that you're the nurse or whatever, and a lot of women that I talked to in alumni have had similar experiences. And I don't think medicine is as male-dominated anymore as it used to be. But do you think women in medicine still have to prove themselves more than men? Or is there still that bias toward women?

Yeah, that's an interesting question. I'm not sure that I would necessarily say that, and this is speaking from my experience and maybe other women who have been practicing for a little bit longer in respective fields would have a little bit of a difference in opinion. I'm not sure that I necessarily feel the need to prove myself, but it's more of continuously and actively breaking down the stigma of female physicians in medicine. There are plenty of studies out there now to show even in surgery that female surgeons have fewer complications post-op than their male counterparts, or even in the general practice world, that female physicians tend to spend “X” number of minutes more with each patient than their male counterparts.

I think all of that just goes to show that I don't feel the need to prove myself. I'm comfortable with my ability at my skill set and where I'm at, and I know that I can provide both compassionate and empathetic care to patients, but I think it's just breaking down those stigmas of what has been built for the last 50 plus years, and just constantly re-framing patient's mindsets of when a female walks in the room, it's not automatically assumed that she's a nurse or an aide or whatever it might be. So yeah, I hope that answers your question and I hope to add to breaking down those stigmas as I enter residency and hopefully as an attending in the future.

Just out of curiosity, and I know a lot of people don't know a lot about anesthesia, but what are some of the different kinds of drugs or medications that are used for general or even local, just in general, just for the people that aren't that familiar with your specialty?

Obviously, the drugs are going to vary a little bit or a lot, depending on what type of procedure or what environment you're in. So if you're intra-op, you're going to have a lot of the same, I want to call it the drug lineups of things like you are always usually going to have a steroid and an anti-emetic, an anti-nausea, depending if it's general anesthesia and you need the patient completely paralyzed, obviously you're going to need a paralytic, you're going to need something to reverse that paralytic. So I would say there's probably 10 to 15 drugs inter-operatively that are part of the lineup, I guess you could say, but obviously, those can change with certain contraindications that patients have or allergies or et cetera, et cetera.

So inter-operatively, I would say 10 to 15, and obviously, that can change with the course of the operation. And yeah, there's a bunch of different medications that you could use for blocks like Lidocaine, Benzocaine, and even from an epidural standpoint as well. And then for different avenues and pain medicines, different types of steroids, longer acting, shorter acting, the list goes on and on and on. But yeah, a lot, to answer your question.

Because of all the dosages in anesthesiology meds, does it require a lot of math skills or is that really not the case anymore to be an anesthesiologist?

I think much to my parents' dismay that they would always tell me that you're not always going to have a calculator, I'm glad that they were wrong about that and that I'll always have one near me. I don't know that you necessarily need to be great at math, but you need to be great at knowing the dosage equations. So it's like you might not need to be able to do those equations very quickly in your head as far as the math goes, but you need to know, okay, this drug, so many milligrams per kilogram, per millimeter of dosing or something. So yes and no, I think, to answer your question.

Dr. Tess McClenahan when she was a UMHS med student. Photo: Courtesy of Dr. McClenahan.

Facts & myths about anesthesiology

What are some facts that people often don't know about being an anesthesiologist? I know there's probably a lot of people that are familiar with it. What are some things that people don't know about being an anesthesiologist?

Yeah, I think that people just assume anesthesia is just putting people to sleep, which I mean that is true. That is a lot of what we do in our profession, but it goes so much beyond that. It's not just putting the patient to sleep and that's it. There's so much continuous monitoring that goes on in the current physiology of the patient throughout the surgery. Then like I had mentioned before, it's not just the intraoperative setting. You're going to be in the labor and delivery suite doing epidurals or if you go into pain medicine, you could be outside of the hospital completely and have your own clinic and doing different types of injections on different areas of the body, or even before you go into the operating room, you're doing regional blocks out in the pre-operative area. I think, yeah, just knowing that it's so much more than putting patients to sleep, I guess, is really the big thing that is the misconception in the field of anesthesia.

You might have already answered my next question, but I know the anesthesiologist's job during surgery is just as crucial as a surgeon's. I mean, I just know from experience whether it's a colonoscopy or something where you have to go under, the anesthesiologist really has to set the patient at ease because people are nervous, people are scared, they're going to be going under, they get very emotional. How would you say that the job is just as crucial as what the surgeon is doing? Does that make sense?

Absolutely. I think especially for more complex procedures that require general anesthesia in the operating room, those procedures don't start without the anesthesiologist. So it doesn't matter what the surgeon's skill level is or what they want to do, if the anesthesiologist is not there, the surgery doesn't go on. But I think to break down a little bit of the stigma is it always seems like it's portrayed that anesthesiologists and surgeons have this continuous battle with each other. And I think at the end of the day, what's important for myself, and also everybody who has a general misconception about anesthesia, is that at the end of the day, the surgeon and the anesthesiologist are both working towards the common goal of the health of the patient.

So, really, it should be this collective, supportive environment where you want the patient to have whatever procedure they want and need to be done, but you want it to be healthy and safe in the process. And so continuously monitoring the physiology of the patient during the surgery-the surgeon's not doing that, it's up to you to make sure that the patient stays healthy throughout the procedure.

Right, absolutely. And are there any new breakthroughs in technology or medicine in anesthesiology that you'd like to talk about? I just know I've had maybe two major surgeries in my life, and I know now the anesthesia they use is not like what they used a few years ago. I know in the old days, the anesthesia they gave would make you very sick and vomiting and everything, and I think they use different stuff now. But are there any breakthroughs in the medication or just the technology that you use?

I think technology specifically, I think that a lot of people are going more toward video-assisted intubation in contrast to direct visual intubation, which I think both think have their pros and cons. And I think that studies continuously are being conducted to evaluate the efficiency of both. But I think during residency, it's extremely important to dip your toes into each new technology or even the old ones, too, because you might be in a situation where you might not have the newest and latest technology and you have to rely on some of your, I don't know, older skillset to get you through and make sure that the patient is okay.

And as far as medications, without going super nerdy on you, and maybe for other people who are going to be reading this, there are always new medications. And I think that they just keep getting better and better and more efficient with, especially for the reversal of paralytics, which they've... Well, I shouldn't say... It's not necessarily a new drug, but it's more of a generic drug that's being more widely used and is a lot cheaper to use now. More hospital systems are able to use it, and so it's just a lot quicker and it just works faster so you can get the patient out of anesthesia faster and reduce the complications rate.

And then there's always going to be drugs that have certain contraindications and they're developing new drugs that don't have those contraindications. So maybe somebody that you want to give this drug to that might have a chronic renal failure that you couldn't give to, well, now there's a new drug that is great, you want to use it, and it doesn't have the contraindication for that so you can use it for the patient. So yeah, I think technology, yes, but medications for anesthesia are always up and coming and always being developed for new and more efficient ones, which is exciting.

Future plans

Do you see yourself continuing in anesthesiology after residency or are there other areas of medicine that you'd like to explore down the road like maybe a different fellowship?

I think it's hard to say right now. I feel like I'm going into my third year of med school again where it's like, I think I might be interested in this, but really, I have no idea. And maybe something that I thought I would like, I hated. So I want to finish my anesthesiology residency, and if there's something along the way that I really, really enjoy, great, maybe I'll do a fellowship. As of right now, I don't foresee myself doing that. I like the idea of getting back into private practice in a rural setting or as rural as I can be as an anesthesiologist. And I love the idea of traveling around to maybe some of those more rural areas that could really use an anesthesiologist. So to be continued, I suppose.

That's good to know. That's what we were mentioning. I believe Mikayla did. We did one... I actually did a brochure where I interviewed a bunch of people about rural medicine, and I know that, and actually some of our alumni, like our alumni president, she's actually in Oklahoma in a small town, and we have another gentleman who's a psychiatrist, who is head of a hospital in a rural part of Utah. What people don't realize is that you can do very well in a rural setting because they so desperately need doctors.

Absolutely.

And the compensation is just incredible because not everybody can work in New York or LA. That's if you're willing to go work in a smaller city.

No, and I absolutely can't. I am a small-town person through and through. So if I can be in that setting and be compensated well, that's such a win-win for me, so.

Oh, that's awesome. Okay, finally, is there anything that you'd like to say about your UMHS experience? I know that you did really amazing work for us as a media ambassador. Anybody that you'd like to thank, whether it be professors or somebody in clinicals or academic affairs, anybody that helped you along the way that you'd like to give a shout-out to?

Oh, my gosh, probably so many people. But I would just say that it truly takes a village and it takes these little tidbits from each professor or each attending, each preceptor that you have along the way. A few people are coming to mind for me specifically. I would love to give a shout-out to Mary Abel. She was my clinical coordinator at McLaren. She made my transition into clinicals and scheduling a thousand times easier and smoother. Without her I don't honestly know, I might still be in rotations at this point. She's an angel.

She is such a sweet lady, yeah.

I know. She really would do anything for anybody, too. So yeah, shout out to Mary. And then I had mentioned her previously in the interview, but Dr. Mikayla Troughton, and then actually Dr. Shane O'Toole, who is a practicing anesthesiologist within the McLaren system. And he recently graduated from his anesthesiology residency this past July. The two of them have been just amazing mentors to me and advice, and I worked in the OR with Shane. And just having him as that person who really encouraged me and wrote a letter of recommendation for me just really was super sweet along the way. And it takes those types of people who have already gone through things to help you and just give a little bit of encouragement like, "I made it, you're going to be fine. You're made to do this."

He’s amazing, too—Dr. O'Toole. I know he was valedictorian one year at graduation. So yeah, you've really had some awesome mentors from alumni.

And he's like the humblest person that you'll ever meet. You would never know that he was valedictorian because he would never tell you that. So yeah, he's awesome.

Is there anything else that you'd like to add that we haven't covered, whether it's about your specialty anesthesiology or about UMHS, anything else?

Just really making the most of your time and your experience is going to be your own. Nobody is going to give anything to you. I hate to say it, but especially at a Caribbean school, you have to work a little bit harder and you just have to accept that and take that almost as a challenge - that it doesn't matter what school you go to, if you want something, you're going to work your hardest toward it.

Dr. Tess McClenahan wrapped in a Pride flag with her partner. Dr. McClenahan was one of the panelists on the webinar UMHS Celebrates Pride: Insights and Advice from LGBTQ+ Physicians   Photo: Courtesy of Dr. McClenahan.

Email Dr. Tess McClenahan at mcclenahan.tess@gmail.com

(Top photo) Dr. Tess McClenahan. Photo: Courtesy of Dr. McClenahan.