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If so, any advice, stories, 'what to dos', 'what not to dos', for a first year guy right out of residency is appreciated!
Any non-CT fellowship private guys do heart cases regularly?
- Thread starter Ignatius J
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I'm not in private practice, but also not in academics (govt job). I graduated from residency this past summer, am not CT-fellowship trained, and I do hearts about once a week.
If cardiac is going to be part of your expected case load at your new practice, then figure out how things are done when you first get there. I did hearts at three different hospital systems as a resident, and each had different criteria for who got SLICs vs PACs vs SvO2 PACs, different preferred pressor/inotrope combinations, ways to put in lines, etc. When I came here, I approached it as just another new rotation, where you have to learn the way that they like to do things, and be sure that you do them exactly that way, until the surgeons and other anesthesiologists are comfortable enough with you that you can start to modify techniques and patterns.
Don't be afraid to call for help if something isn't quite right. As a new attending, you are going to make some mistakes when you are first working on your own, even if you were a hot-shot senior resident that didn't need help from staff.
Don't be afraid to speak up. I've noted findings driving the echo that the Cardiologist undercalled, and the surgeons were not anticipating.
Stay calm. Surgeons and perfusionists smell fear.
If cardiac is going to be part of your expected case load at your new practice, then figure out how things are done when you first get there. I did hearts at three different hospital systems as a resident, and each had different criteria for who got SLICs vs PACs vs SvO2 PACs, different preferred pressor/inotrope combinations, ways to put in lines, etc. When I came here, I approached it as just another new rotation, where you have to learn the way that they like to do things, and be sure that you do them exactly that way, until the surgeons and other anesthesiologists are comfortable enough with you that you can start to modify techniques and patterns.
Don't be afraid to call for help if something isn't quite right. As a new attending, you are going to make some mistakes when you are first working on your own, even if you were a hot-shot senior resident that didn't need help from staff.
Don't be afraid to speak up. I've noted findings driving the echo that the Cardiologist undercalled, and the surgeons were not anticipating.
Stay calm. Surgeons and perfusionists smell fear.
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In PP and I am one of a handful in my group that do hearts. Somedays I do 3, somedays none. I did not do a fellowship and if I had, I that what Psychbender alluded to would piss me off. It's true that a system will be in place and you will simply fall into line. They don't want a hot shot or somebody to come in with guns a blazin changing things. Where I trained, things HAD to be done XYZ way. I'm sure a fellowship would have ingrained that further. The next place I went, things HAD to be done XYZ way (which was of coarse a different way
. Where I am now, you guessed it. These surgeon's are so rigid they apply the drapes the exact same way every time for every case, whether a CABG or MIMVR, etc. They even have a specific face shield they want under the drapes, each surgeon being different. They will have certain drips they are comfortable with and will "order". I did teach myself echo and became boarded, which allows me the satisfaction of finding unrecognized PFO's )))))) Otherwise, it's just another algorhythm that has been in place since long before you arrived so quiet assimilation should be pretty seamless.
. Where I am now, you guessed it. These surgeon's are so rigid they apply the drapes the exact same way every time for every case, whether a CABG or MIMVR, etc. They even have a specific face shield they want under the drapes, each surgeon being different. They will have certain drips they are comfortable with and will "order". I did teach myself echo and became boarded, which allows me the satisfaction of finding unrecognized PFO's )))))) Otherwise, it's just another algorhythm that has been in place since long before you arrived so quiet assimilation should be pretty seamless.
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Agreed. Find a local mentor. Learn the local customs. And do as the Romans do.....
You can change things up AFTER gaining the trust of the entire team.
You can change things up AFTER gaining the trust of the entire team.
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Thanks, guys. Very good information.
Sounds like I need to spend a day shadowing before going knee deep into my own cases.
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I concur with everyone else statements about doing it the way of them romans when in rome. I would apply this to pretty much all cases and surgeons. But never compromise a core principal, call a partner in first before arguing with a surgeon. Once they trust you and know who you are a what to expect then gradually make changes. We had a guy who was a cardiac guy with TEE at another hospital for 20 years, came to our place and started doing it his normal way, guess what? everyone heard about it.
Whether you need a fellowship is a matter of location and practice. My practice does not require a fellowship for hearts.
Whether you need a fellowship is a matter of location and practice. My practice does not require a fellowship for hearts.
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So to build off the aforementioned responses, how do you know how each institution does it? Do you ask partners? Do the surgeons and staff say "Well, this is how we usually do it" and you say okay? Is it trial and error? Do you get debriefed before ever going in?
Just curious about the typical "figuring" out of the first day bull****.
Reason I ask is because I will be getting credentialed at many hospitals and I know each one will do it differently.
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I am the only member of our 3-member cardiac team that is fellowship trained. I am echo certified and the other two are testamured.
The folks above pretty much covered it. Learn the local customs by asking the other anesthesiologists and master the customs before you try to change anything.
I highly recommend that you spend a couple of days shadowing one of the current cardiac guys before you have your own cases. In my practice, the Director of CT Anesthesia is responsible for ensuring that any new partner is proctored for his first week before going solo.
- pod
The folks above pretty much covered it. Learn the local customs by asking the other anesthesiologists and master the customs before you try to change anything.
I highly recommend that you spend a couple of days shadowing one of the current cardiac guys before you have your own cases. In my practice, the Director of CT Anesthesia is responsible for ensuring that any new partner is proctored for his first week before going solo.
- pod
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Shadowing is key. We took it a step further at our shop... although it's a money looser.
My wife and I currently make up 50% of our cardiac team. Although well trained, we were so grateful that our group put us in the CT OR one on one with another partner for 2 weeks. It was the easiest transition in the world. We induced, put in all the lines, did the echo, talked to our partner regarding the permutations of ea. surgeon and perfusionist algorithms, learned the CT OR dance, etc, etc. We also learned a different way of doing CT. We really felt protected with a senior cardiac anesthesiologist in the room. By the second week our CT anesthesiologist just hung out in the lounge or did epidurals on the OB floor. It was easy cheese with immediate backup if you needed it. We started taking call shortly afterward.
I can't think of a better way to do it.
My wife and I currently make up 50% of our cardiac team. Although well trained, we were so grateful that our group put us in the CT OR one on one with another partner for 2 weeks. It was the easiest transition in the world. We induced, put in all the lines, did the echo, talked to our partner regarding the permutations of ea. surgeon and perfusionist algorithms, learned the CT OR dance, etc, etc. We also learned a different way of doing CT. We really felt protected with a senior cardiac anesthesiologist in the room. By the second week our CT anesthesiologist just hung out in the lounge or did epidurals on the OB floor. It was easy cheese with immediate backup if you needed it. We started taking call shortly afterward.
I can't think of a better way to do it.
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Yep, it is a money loser. We have some mechanism in place for compensating the proctor out of group funds, but I haven't bothered to take advantage of it. For the first few cases, I am heavily involved with jumping in to take over echo etc, but by the end of the week I am in the lounge doing other nurses work.
Our group is really good about breaking me out when something comes up in the heart room on a day that I am not scheduled to be in there.
- pod
Our group is really good about breaking me out when something comes up in the heart room on a day that I am not scheduled to be in there.
- pod
