Another chances thread (yeah yeah, I know)

[Temeraire]

Been a lurker forever. My last post was probably something asinine I wrote as a premed or MS1. I'm MS3 now. Found out that I did not honor my IM rotation, and now it keeps me up at night.

My school has H/S grading, and each rotation typically awards honors to the top 30%. So far, I've honored surg and psych. My only other S was in family med. No grades from obgyn or peds yet. I'm at an Ivy League med school, and my Step 1 score was >260. I have 2 basic science publications and a stupid amount of poster presentations because I really love research.

My goal is to match to a west coast gas program for family reasons. How much did I screw myself over at top-tier/bay area places by not honoring IM? I'm asking this because IM is treated as if it's a huge deal at my school, so I can only assume it's ?true for other places. I don't know how anesthesiology residencies view the IM rotation.

I know I'm going to be told I need to take a chill pill-- but I just need an outside perspective. I'd appreciate any Real Talk. Thanks, everyone.



Please don't tell me to go into derm, god I can't make myself care about rashes.

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[IkeBoy18]

Been a lurker forever. My last post was probably something asinine I wrote as a premed or MS1. I'm MS3 now. Found out that I did not honor my IM rotation, and now it keeps me up at night.

My school has H/S grading, and each rotation typically awards honors to the top 30%. So far, I've honored surg and psych. My only other S was in family med. No grades from obgyn or peds yet. I'm at an Ivy League med school, and my Step 1 score was >260. I have 2 basic science publications and a stupid amount of poster presentations because I really love research.

My goal is to match to a west coast gas program for family reasons. How much did I screw myself over at top-tier/bay area places by not honoring IM? I'm asking this because IM is treated as if it's a huge deal at my school, so I can only assume it's ?true for other places. I don't know how anesthesiology residencies view the IM rotation.

I know I'm going to be told I need to take a chill pill-- but I just need an outside perspective. I'd appreciate any Real Talk. Thanks, everyone.



Please don't tell me to go into derm, god I can't make myself care about rashes.

you will be fine for any program.. even if you didnt honor anything at all.. im pretty sure with step 1 >260.. most wont care that much..

 

[Sirach38]

Been a lurker forever. My last post was probably something asinine I wrote as a premed or MS1. I'm MS3 now. Found out that I did not honor my IM rotation, and now it keeps me up at night.

My school has H/S grading, and each rotation typically awards honors to the top 30%. So far, I've honored surg and psych. My only other S was in family med. No grades from obgyn or peds yet. I'm at an Ivy League med school, and my Step 1 score was >260. I have 2 basic science publications and a stupid amount of poster presentations because I really love research.

My goal is to match to a west coast gas program for family reasons. How much did I screw myself over at top-tier/bay area places by not honoring IM? I'm asking this because IM is treated as if it's a huge deal at my school, so I can only assume it's ?true for other places. I don't know how anesthesiology residencies view the IM rotation.

I know I'm going to be told I need to take a chill pill-- but I just need an outside perspective. I'd appreciate any Real Talk. Thanks, everyone.



Please don't tell me to go into derm, god I can't make myself care about rashes.

Go out and have a drink with your friends, find some sexy babes (assuming you're male, or handsome guys if you're female), talk to them, and have a great night. You got a 260 on step 1. No one in the world will give a darn about your IM grade. Please go out and enjoy your life and stop thinking about this silly nonsense.

 

[Temeraire]

Already found myself a sexy dude who puts up with my silly nonsense and enables the upregulation of my liver enzymes.

Still waiting for folks in residency and beyond to weigh in, though they might just be rolling their eyes at my post. Alas.

 

[DrZzZz]

>260 from an Ivy League med school. Unless you fail a rotation or have some horrific things written about you in an evaluation, no one is going to care you didn't honor a rotation.

 

[mustang1]

Current anesthesia resident at top 10 program. You will look back at this post in a few years and realize it was just as "asinine" as some of the things you may have posted as a pre-med. A little common sense is in order here - please utilize it. You are from an ivy. I am sure you can figure this one out.

 

[IlDestriero]

I think you lose points for honoring IM.

 

[Temeraire]

Thanks, guys. I needed to hear this. It's easy to get dragged into the ivory tower hysteria and unwarranted self-doubt that's rampant at my school, where people fear that being average is tantamount to being a poor residency candidate. Guilty.

Gotta keep my head out of the neuroses.

 

[deleted171991]

Temeraire, you are probably still better on paper than 95% of the applicants. Why are you fretting? Are you "téméraire" or aren't you?

 

[deleted171991]

I think you lose points for honoring IM.

Allow me t0 disagree, professor. Former internists are among the most well-rounded anesthesiologists I know. IM knowledge is one of those things that makes the difference between a CRNA and a physician. A big part of what we call "anesthesia for coexisting disease" is IM. Heck, one of the two current editors of the famous Stoelting textbook is a former internist.

Now I agree that one doesn't need much IM for peds, and pediatricians tend to downright hate all those old sick adult patients.

 

[Temeraire]

Former internists are among the most well-rounded anesthesiologists I know. IM knowledge is one of those things that makes the difference between a CRNA and a physician.

I believe this 100%. This is why I started doubting my candidacy at top-tier places. Honestly, now my goal is to bust my chops on my critical care sub-I, so I can demonstrate I know how to handle really sick people.

Temeraire, you are probably still better on paper than 95% of the applicants. Why are you fretting? Are you "téméraire" or aren't you?

Touché.

Thanks again, everyone, for slapping some sense into me. Now back to my holiday libations...

 

[murdoc9]

Allow me t0 disagree, professor. Former internists are among the most well-rounded anesthesiologists I know. IM knowledge is one of those things that makes the difference between a CRNA and a physician. A big part of what we call "anesthesia for coexisting disease" is IM.

Now I agree that one doesn't need much IM for peds, and pediatricians tend to downright hate all those old sick adult patients.

How much does having extra "IM" training beyond critical care make one a well rounded anesthesiologist? And what exactly is meant by " well rounded" anesthesiologist? It makes sense from the standpoint of working as an Intensivist, but anesthesioloist intensivists are a rare breed it seems. Unless the job description of anesthesiologist changes in this country, I'm unconvinced about the whole IM thing

 

[CardiacIntensivist]

I am doing residency at what most consider a top 10 program. Your application is fine. Go out, have a drink, socialize. If you show this level of anxiety during your interview, that will be your ultimate downfall. The fact that you have publications and did a bunch of research is _REALLY_ going to help.

I echo what others have said about looking back and realize how stupid all this is. My program accepts people from very broad backgrounds. Some of my co-residents have admitted to me that they had average or slightly below average Step scores. What did they offer? Research, publications, life experience, a great personality. There really is more to this than what your scores are.

Just don't fail anything....seriously

 

[Sirach38]

How much does having extra "IM" training beyond critical care make one a well rounded anesthesiologist? And what exactly is meant by " well rounded" anesthesiologist? It makes sense from the standpoint of working as an Intensivist, but anesthesioloist intensivists are a rare breed it seems. Unless the job description of anesthesiologist changes in this country, I'm unconvinced about the whole IM thing

IM is the foundation for everything in medicine. If you don't understand and appreciate IM it's hard to be a doctor. Well, except maybe an orthopod...

 

[deleted171991]

Unless the job description of anesthesiologist changes in this country, I'm unconvinced about the whole IM thing

The ASA 3 and higher patients all have significant coexisting medical diseases. A big part of what we call anesthesia for coexisting disease is actually IM applied to anesthesia. I am not talking about intensive care; I am talking about understanding the medical conditions of our patients. Unless one wants to be just a knee-jerk anesthesiologist (basically just another CRNA). Just my 2 cents.

Typical example: I cancelled a patient yesterday before even having left home for his cataract surgery. He had a syncope on Saturday, woke up in the ambulance with a HR of over 200 that resolved before the ER. Did not really bump his troponins (about 0.03-0.04), but there was concern about possible VTach vs Afib with RVR in an otherwise ASA 4 patient. This was his second syncope; the first one had been attributed to a completely blocked carotid. He needs a Holter before any anesthesia. Is understanding all these anesthesia, or IM, or both? I don't know, but it's definitely not intensive care.

Sirach38 said it much better.

 

[murdoc9]

The ASA 3 and higher patients all have significant coexisting medical diseases. A big part of what we call anesthesia for coexisting disease is actually IM applied to anesthesia. I am not talking about intensive care; I am talking about understanding the medical conditions of our patients. Unless one wants to be just a knee-jerk anesthesiologist (basically just another CRNA). Just my 2 cents.

Sirach38 said it much better.

Yeah, I mean I undestand that. I'm doing plenty of IM right now. But the way that anesthesiogist treat patients with these diseases in the OR is related to critical care, not treating an intraoperative cellulitis

 

[deleted171991]

Yeah, I mean I undestand that. I'm doing plenty of IM right now. But the way that anesthesiogist treat patients with these diseases in the OR is related to critical care, not treating an intraoperative cellulitis

Sure. But one of the reasons our patients keep receiving the wrong antibiotics for their type of surgery is also the lack of our (and the surgeon's) infectious disease knowledge, for example. Of course, one could just consult the guidelines for something so simple.

Obviously, a big part of IM is not really relevant for anesthesia, but a big part is, far beyond just critical care. Just my 2 cents.

 

[Sirach38]

This is exactly what differentiates MDs from nurses (among other things). It's this deep knowledge of MEDICINE that keeps our patients safe from the dangers of advance practice nurses.

 

[deleted171991]

This is exactly what differentiates MDs from nurses (among other things). It's this deep knowledge of MEDICINE that keeps our patients safe from the dangers of advance practice nurses.

I don't believe that APRNs are more dangerous than MDs, on average. The truly dangerous people are the ones who don't know the limits of their knowledge, regardless of their pompous titles.

Unfortunately, most laypeople go by the title, hence a "professor" or a division "head" will be more sought after, while those are generally the physicians one should stay away from.

 

[murdoc9]

This is exactly what differentiates MDs from nurses (among other things). It's this deep knowledge of MEDICINE that keeps our patients safe from the dangers of advance practice nurses.

Again maybe I'm just arguing semantics here. But I don't believe that extra internal medicine training makes any difference in safety for what anesthesiologists do. Better training in the critical care OTOH I believe would make a difference.

 

[murdoc9]

Again maybe I'm just arguing semantics here. But I don't believe that extra internal medicine training makes any difference in safety for what anesthesiologists do. Better training in the critical care OTOH I believe would make a difference.

Obviously knowledge in the relevant systems of "internal medicine" is important in both anesthesia and CC. I just don't buy I to the whole extra IM training thing. Maybe the whole PSH takes off. Maybe one day CC certification will become part of Residency. But I still think cc months are much more valuable , in terms of real time medical decision making

 

[deleted171991]

Obviously knowledge in the relevant systems of "internal medicine" is important in both anesthesia and CC. I just don't buy I to the whole extra IM training thing. Maybe the whole PSH takes off. Maybe one day CC certification will become part of Residency. But I still think cc months are much more valuable , in terms of real time medical decision making

What I personally found the most applicable to anesthesia was not critical care, but cross-coverage on the floors during the evening/night, as a medical intern. The latter exposes one to many fast-paced decisions about previously unknown patients. One has minutes to learn about a patient and decide what to do, before the crazy pager buzzes again. And then one has to defend all those many decisions during the morning report.

CCM taught me a systematic approach to patients, but by far what I apply the most in anesthesia is the acute care/firefighter knowledge from cross-coverage night float weeks.

 

[murdoc9]

What I personally found the most applicable to anesthesia was not critical care, but cross-coverage on the floors during the evening/night, as a medical intern. The latter exposes one to many fast-paced decisions about previously unknown patients. One has minutes to learn about a patient and decide what to do, before the crazy pager buzzes again. And then one has to defend all those many decisions during the morning report.

CCM taught me a systematic approach to patients, but by far what I apply the most in anesthesia is the acute care/firefighter knowledge from cross-coverage night float weeks.

Interesting. I guess that makes sense

 

[IlDestriero]

Allow me t0 disagree, professor. Former internists are among the most well-rounded anesthesiologists I know. IM knowledge is one of those things that makes the difference between a CRNA and a physician. A big part of what we call "anesthesia for coexisting disease" is IM. Heck, one of the two current editors of the famous Stoelting textbook is a former internist.

Now I agree that one doesn't need much IM for peds, and pediatricians tend to downright hate all those old sick adult patients.

I was being sarcastic. I didn't think anyone would misread the sarcasm as it would not make sense to lose points on your application for having honors level evaluations.
OP- don't sweat it. You will be fine. (No sarcasm)

 

[deleted171991]

I was being sarcastic. I didn't think anyone would misread the sarcasm as it would not make sense to lose points on your application for having honors level evaluations.

In my experience, there are actually anesthesiologists who dislike anybody who even remotely smells like IM, even some big names. They had surgical internships or even residencies, and see internists as eternal debaters who get nothing done. So I can see how having honors in IM can be a minus in their eyes. Seriously.