The branch of anesthesiology in medicine involves the full scope of perioperative medicine. This is essentially the steps a patient needs to undergo before having surgery. This comprises a number of procedures, such as pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, post-operative recovery, intensive care medicine, and chronic and acute pain management. Anesthetists, thus, in Sacramento have to complete a pre-medical course, then a graduation degree in general medicine, and then a further specialization in anesthesiology that usually lasts four years, including a one year medical or surgical internship followed by three years of anesthesiology training. Thus, the training needed for this profession is extensive. Many anesthesiologists also choose to follow up these degrees with training in allied areas such as pain management, cardiothoracic anesthesiology, pediatric anesthesiology, neuro anesthesiology and critical care medicine. On the other hand, anesthetists are also from non-physician personnel in Sacramento. These are anesthetist nurses. For qualifying as a Certified Registered Nurse Anesthetist (CRNA), the nurse has to have graduate level education, a board certification in anesthsia, and a minimum of one year of full-time nursing experience in an acute care setting, such as medical intensive care unit or surgical intensive care unit. Many places also require them to be active participants in research, as well as have knowledge about methods of scientific inquiry and statistics.