BACKGROUND The Internet is a potentially useful tool in medical education. The patterns of its usage and availability among anesthesia residents have not been surveyed. This survey, conducted in 2000, attempts to gain insight into and quantify its usage. METHODS After ethics committee approval, a postal questionnaire of attitudes and usage was sent to trainees in Anesthesiology in two training programs: the University of New Mexico, USA (UNM) and the North West Regional Health Authority, UK (NWR). A repeat questionnaire was sent to non-responders after four weeks. Telephone interviews were conducted with hospital administration to determine availability and cost of the Internet. RESULTS Response rates were 67% (82/122) from the NWR and 83% (25/31) from UNM. Compared to UNM, residents at UNM used the Internet longer for general (median 3 vs. 2 years, p<0.001) and medical (median 2 vs. 1.2 years, p<0.001) purposes. All (31/31) UNM trainees and 73 % (89/122) of NWR trainees had Internet access. More NWR trainees who had Internet access at work (98%; 60/61)) used it for medically related purposes than those work access (17/21, 81%) (p<0.001). More UNM trainees (76%; 19/25) accessed web sites other than those of official national organizations than NWR trainees (40/82, 49%) (p=0.046). Approximately 75% of all trainees access web sites of the Association of Anaesthetists and Royal College of Anaesthetists (in the NWR) the American Society of Anesthesiologists and American Board of Anesthesiology (in UNM) and on-line journals. The most favorite sites were GASNET (NWR) and ASA (UNM). Both UNM and NWR trainees perceived the Internet as supplying useful and accurate information. CONCLUSIONS If the reported survey results are representative of Internet use among anesthesia residents in the USA and UK, access at work is associated with greater Internet use for medical purposes perhaps in part because residents perceive it as a convenient and accurate resource.