Advice for CA-1

[MrBrightside]

Hi Everyone:

Now that intern year is winding down. I would like to start thinking about how to be a good anesthesia resident and anesthesiologist. Since I haven't been in an OR since med school...I feel as though I don't remember any of this stuff. How do I impress attendings? Any advice would be helpful. I would like to get the most out of my residency and be a good anesthesiologist one day

Dr. BrightSide

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[PMPMD]

Show up on time. Read for your cases. Talk to your attending the day before. I don't expect a July CA1 to knkw much, but if they do the above, they will catch on fast.

 

[countingdays]

Show up on time. Read for your cases. Talk to your attending the day before. I don't expect a July CA1 to knkw much, but if they do the above, they will catch on fast.

Also, anytime the case isn't done as propofol, fentanyl, bag, roc, tube, des, chart (or whatever the typical anesthestic is where you are), find out why they changed whatever they changed. And don't knock out any teeth.

 

[Iluvpassingas]

Great thread!

Quick question:

With two months left before CA-1 year, what is the better choice from the experienced residents. The goal is to perform decently on the AKT-0, and knowing at least something on day 1.

1) Read Baby Miller pharmacology sections (section 2)

OR

2) Read M&M's Clinical Pharmacology section

I have both books, I feel like the baby miller pharm can be read like three times in the 2 months vs. M&M which is longer but seems to have better explanations.

 

[Direct Laryngoscopy]

I read the first 2 sections in baby miller towards the end of intern year, Most of M&M this year, and now I'm starting to read Barash. So far it's worked out pretty well.

For the start of CA1 learn a proper room setup (I use the pneumonic MOM SAID), learn the pharmacology and READ. You can't learn from osmosis and your learning is reinforced when you perform what you read and understand the consequences of your actions (or lack thereof). Good luck!

 

[PMPMD]

Our CA-1s read baby miller cover to cover in the first 2 months (they're supposed to, anyway). I think it's a solid intro text.

 

[rsgillmd]

Our CA-1s read baby miller cover to cover in the first 2 months (they're supposed to, anyway). I think it's a solid intro text.

During our residency program it wasn't required to do this, but I did something similar. My last month of intern year was an elective. I chose to do it as an anesthesia rotation at the place of my future residency. I started reading Baby Miller in May, and had basically finished it by June. By the end of June I was being assigned my own 1 on 1 covered room. I even got a little Peds exposure and a massive hemorrhage from a percreta in OB.

I found having read Baby Miller cover to cover was very helpful in not feeling totally lost. The first month will be overwhelming because of the amount of information you absorb, skills you learn/practice, people you meet, etc. However, if you are like me and learn best by doing you will probably have a very steep learning curve during that first month.

Partly echoing what others have said, in summary my advice would be:

1) Read Baby Miller cover to cover before starting
2) Read up on the cases you expect to be doing
3) Call your attending on the night before to discuss the cases (it could be very general or specific -- depends on you and the attending), and to pick a topic to discuss the next day.
4) Read up on the topic you pick so you can get the most out of your discussion.
5) Don't be afraid to ask questions/call for help. It's better to call your attending and not need him/her, than it is to call too late.

As PatDaddy said, not much will be expected of you in your first month. Obviously more will be expected at the end of the first month than on the first day. All that having been said, just relax, have fun, and enjoy your introduction to the anesthesiology fold. It's always easier to learn something when you enjoy what you are doing and are interested in the topic.

 

[Doctor4Life1769]

Great advice.

I know taking Step 3 early (I plan to take while on an outpt no-night float peds month) is a consensus.. should one start studying from Baby Miller after finishing Step 3?

 

[rsgillmd]

Great advice.

I know taking Step 3 early (I plan to take while on an outpt no-night float peds month) is a consensus.. should one start studying from Baby Miller after finishing Step 3?

I would leave Baby Miller to a month or two before you begin anesthesia. You are likely to forget most of the stuff if you don't use it. If you really want to split the field, read Stoelting's Anesthesia and Co-existing disease.

Until you are a month or two out, I would focus on the purpose of the clinical base year -- developing a solid clinical base which you will use to evaluate patients in the future.

 

[RussianJoo]

sorry if I am asking a stupid question but what do you guys exactly mean by "reading up on the case"? for example I would read up for cases during my surgery months in med school. I would go over the anatomy and complications of the procudre and the reason why we're doing the case and I would go over the pt's chart the morning of the case.

In a field where what you do can vary so greatly how can you prepare specifically for a case or if most cases are the generic "propofol, fentanyl, bag, roc, tube, des, chart" what specifically. Aside from the info specific to the durgs you'll be using. Would you go as far and prep for the possibility of doing an epidural or a block, but even then once you know it what else is there to read up on it?

Seems to me like I'll have a ton to learn the first week or so but once I know basics of the procedures and dozens of drugs that we use on a daily basis, the only thing that will be left will be to just read books cover to cover, read through monthly journals.

 

[Yo GabbaPentin]

When the surgeon demands that the table goes up, push the button with the up arrow. If you push up, and the patient goes down, then the table mode is in reverse. You must stop pushing up at this point. Knowing how to "airplane" a patient can be learned during CA2 year.

Hang in there for the first 6 months before making any career altering decisions. It gets much better. You'll know exactly what I'm talking about as a CA 1.5.

 

[Lightwand]

Seems to me like I'll have a ton to learn the first week or so but once I know basics of the procedures and dozens of drugs that we use on a daily basis, the only thing that will be left will be to just read books cover to cover, read through monthly journals.

Oh young grasshopper, you have much to learn.

In addition to reading up about your patient and their comorbid conditions, you will want to read about any pertinent surgical issues specific to the case. If the patient is otherwise healthy ASA 1 for a knee scope, this won't take long. However, I can count on one hand the number of ASA1s I've done in the last few months. Maybe your patient for a knee scope has Conn's syndrome or mitral regurg or a difficult airway, etc, etc, etc. Or maybe your patient is fairly healthy (ha, right), other than their esophageal cancer and they're having a minimally invasive esophagectomy. You're going to want to know what's going on in the surgical procedure that might impact you (ie: one lung ventilation, trocars near the aorta, airway management, etc). Learning about your patients and their procedures is how you start to develop your clinical judgement. Do you need another IV? Do you need an a-line? Is this surgeon going to take 5 hours to get the gallbladder out? Are you going to be hosed if you push a stick of Roc at the start of the lap appy? These are things that you learn by doing, but having a clue in advance about what to expect will help you to solidify your knowledge and anticipate what could happen. I tend to run over in my head what the worst case scenario would be and how I would handle it.

The first few MONTHS (not first week) of your anesthesia residency are going to feel like trying to drink out of a fire hydrant. There is a huge amount of material to learn, and it extends far beyond learning the basics of procedures and the pharmacology of a few drugs. If everything could be learned that quickly, there wouldn't be so many texts for you to read cover-to-cover.

Additionally, the entire point of residency is to learn as much as you can. So hopefully you are in a place that will discourage the 'prop,fent,mask,roc,tube,des,chart' routine and encourage you to explore alternative ways to run a case, manage an airway, and become comfortable with a variety of drugs.

 

[rsgillmd]

Oh young grasshopper, you have much to learn.

In addition to reading up about your patient and their comorbid conditions, you will want to read about any pertinent surgical issues specific to the case. If the patient is otherwise healthy ASA 1 for a knee scope, this won't take long. However, I can count on one hand the number of ASA1s I've done in the last few months. Maybe your patient for a knee scope has Conn's syndrome or mitral regurg or a difficult airway, etc, etc, etc. Or maybe your patient is fairly healthy (ha, right), other than their esophageal cancer and they're having a minimally invasive esophagectomy. You're going to want to know what's going on in the surgical procedure that might impact you (ie: one lung ventilation, trocars near the aorta, airway management, etc). Learning about your patients and their procedures is how you start to develop your clinical judgement. Do you need another IV? Do you need an a-line? Is this surgeon going to take 5 hours to get the gallbladder out? Are you going to be hosed if you push a stick of Roc at the start of the lap appy? These are things that you learn by doing, but having a clue in advance about what to expect will help you to solidify your knowledge and anticipate what could happen. I tend to run over in my head what the worst case scenario would be and how I would handle it.

The first few MONTHS (not first week) of your anesthesia residency are going to feel like trying to drink out of a fire hydrant. There is a huge amount of material to learn, and it extends far beyond learning the basics of procedures and the pharmacology of a few drugs. If everything could be learned that quickly, there wouldn't be so many texts for you to read cover-to-cover.

Additionally, the entire point of residency is to learn as much as you can. So hopefully you are in a place that will discourage the 'prop,fent,mask,roc,tube,des,chart' routine and encourage you to explore alternative ways to run a case, manage an airway, and become comfortable with a variety of drugs.

Well said.

 

[Narcotized]

If you push up, and the patient goes down, then the table mode is in reverse.

Actually, if you press up and the table goes down, it must be suspended up-side-down from the ceiling. Fortunately, we don't do many procedures in this position.

 

[countingdays]

er something

 

[Jay K]

I'll give you a piece of advice a senior gave me on entering CA-1 year:

Every class will have at least one resident who will visibly panic (even if it's on only one occasion) when **** hits the fan. Don't be that resident. It's a hard reputation to live down throughout your residency.

Always stay visibly calm. Keep that in mind and remind yourself, "I don't want to be THAT guy/gal." Take a breath. Assess. Do what needs to be done. Drop back to basics (ABC's of ACLS if you have to).

This advice also applies to future attendings.

 

[Yo GabbaPentin]

I'll give you a piece of advice a senior gave me on entering CA-1 year:

Every class will have at least one resident who will visibly panic (even if it's on only one occasion) when **** hits the fan. Don't be that resident. It's a hard reputation to live down throughout your residency.

Always stay visibly calm. Keep that in mind and remind yourself, "I don't want to be THAT guy/gal." Take a breath. Assess. Do what needs to be done. Drop back to basics (ABC's of ACLS if you have to).

This advice also applies to future attendings.

Every class will also have a LEAST one lazy pile of crap. That one resident that is an expert at getting Thursday calls and out of the ORs early on a routine basis. This resident will have more special circumstances keeping them from working weekends than you ever thought possible. Do NOT be that resident either.

 

[NotAMD]

Every class will also have a LEAST one lazy pile of crap. That one resident that is an expert at getting Thursday calls and out of the ORs early on a routine basis. This resident will have more special circumstances keeping them from working weekends than you ever thought possible. Do NOT be that resident either.

i agree with this, but the worst part about these particular residents is that they just get away with it and the more solid ones end up working more

 

[Doctor4Life1769]

i agree with this, but the worst part about these particular residents is that they just get away with it and the more solid ones end up working more

So.... why do the residents keep enabling this behavior? It's cool if it happens once or twice... or thrice maybe... but if it's persistent behavior, then why don't the other residents lay the smack down...

 

[Narcotized]

So.... why do the residents keep enabling this behavior? It's cool if it happens once or twice... or thrice maybe... but if it's persistent behavior, then why don't the other residents lay the smack down...

Because these people are expert manipulators. They have somehow gotten staff to think they work hard and that the ones picking up the slack and complaining are the lazy ones. You will grow to hate these people with every fiber of your existence.

 

[lord_jeebus]

Pick your battles. Even if a protest is justifiable, you may benefit more by maintaining a reputation for never complaining. And, if you ever have to "step up to the mic with micatin," your words will carry a lot more weight.

Read often, even if it seems your peers are not.

If your case has no learning value, change something up to make it a new experience for you.

 

[countingdays]

Pick your battles. Even if a protest is justifiable, you may benefit more by maintaining a reputation for never complaining. And, if you ever have to "step up to the mic with micatin," your words will carry a lot more weight.

Read often, even if it seems your peers are not.

If your case has no learning value, change something up to make it a new experience for you.

How you do things will change day to day with different attendings for each and every procedure or technique you learn. The supposed benefit is that you learn different ways of doing things. The negative is that is can be very annoying if it is more of an irrelevant personal preference than a significant difference.
Many anesthesiologists are extremely anal about every little thing from taping iv's or eyes a certain way, or how you label your syringes, etc etc etc (and also about some things where their preference actually matters). Just try to do it their way, even though it probably doesn't make any difference, without pointing out the absurdity of the situation or that Doctor Smith said to do it that way. It's hard when they are acting like you are doing something 'wrong', but passing-on a bunch of worthless personal preferences is about half of what you'll hear about from your attendings. You'll get your own personal preference at some point, but keep it bottled up until you graduate.

 

[jennyboo]

Hi Everyone:

Now that intern year is winding down. I would like to start thinking about how to be a good anesthesia resident and anesthesiologist. Since I haven't been in an OR since med school...I feel as though I don't remember any of this stuff. How do I impress attendings? Any advice would be helpful. I would like to get the most out of my residency and be a good anesthesiologist one day

Dr. BrightSide

Introduce yourself to the circulator and scrub tech each morning. Remember their names and when you need to ask for something, say their name.

Introduce yourself to the surgeon each morning.

Ask your attending in the OR every afternoon, "Is there anything you would have done differently for [case], that I could improve upon next time?" If this doesn't happen, email them the next day and ask, "Do you have any feedback from when we worked together yesterday?"

Read for 20 minutes a day.

Learn the names of the anesthesia techs and the PACU nurses.

Make a show of putting monitors on in the PACU. Usually this is just gesture but it goes a long way toward good will, and it will help get you outta there faster.

If you need to step away to get something before giving report to the PACU nurse, ask, "Is it ok if I step away to get [printed record, drugs, etc]?"

Get in the habit of watching the surgical field when you have nothing else to do. This will help you tremendously especially in cardiac and vascular cases, and you will become a much better clinician.