Intern year advice with electives and Step 3 timing

[BW15]

Hi everyone,

I will be doing my TY intern year and advanced Anesthesiology residency at different institutions. I had a couple of questions since I have to make some decisions very soon.

1. When to take Step 3
My Anesthesia program is signing us up for the ITE during intern year for Feb 2016. I've been searching the forums to see when people are taking Step 3 and I'm getting conflicting advice. Some say take it as soon as possible, others say that your intern year will really help so take it toward the end. I'm doing a transitional year with a good mix of IM, Surgery, ER, ICU, + electives. No peds or OB required.

When do you guys feel is best time to take Step 3, without it being too close to the ITE?

2. Electives
I have 4 electives to choose from. 2 general electives and 2 surgical electives. So far I have came up with.

1 general elective -> ICU
2 general elective -> something easy so I can study, or something I can use?
3 Surgical elective -> Anesthesia for the peri-operative surgery aspect if they let, if not then what?
4 Surgical elective -> ?

What electives would you guys recommend I do for the open slots?

Thanks

---

Members don't see this ad.

 

[deleted171991]

1. Since nobody will ever ask/care about your Step 3 score, the best time to take it is in the first 6 months of your intern year, once you feel relatively comfortable with the material.

2. Do 2 months of ICU and one month of emergency medicine. They will probably be easier during your internship and will count towards your anesthesia residency totals. For the last elective do something easy; your CA-1 year will be tougher than your internship.

 

[Ronin786]

1. Since nobody will ever ask/care about your Step 3 score, the best time to take it is in the first 6 months of your intern year, once you feel relatively comfortable with the material.

2. Do 2 months of ICU and one month of emergency medicine. They will probably be easier during your internship and will count towards your anesthesia residency totals. For the last elective do something easy; your CA-1 year will be tougher than your internship.

Do fellowships really not care about Step 3?

 

[deleted171991]

Do fellowships really not care about Step 3?

Since many people have just passing scores on Step 3, I don't think it carries much weight (beyond not failing it). It's much more important to do well on the ITEs.

 

[G-Man82]

I think up to 2 months of CCM can be done in intern year, and one month of EM must also be done. If you do more than 2 months, the overflow will count as a floor month, not a CCM month in your numbers, because you still have to do 2 months of CCM as a real Anesthesiology resident. The required one month of EM is more than enough to never want to set foot in the ED ever again. As for electives, I'd suggest lots of cardiology. Learn coronary anatomy, look at echo (both TTE and TEE), learn how to read an EKG, and learn how to manage Heart Failure in its various forms. Honestly, I'd minimize the surgical rotations and focus more on the medical ones; I may be biased, since I did a full Internal Medicine preliminary year, but there's no need for 2 surgeons in the OR.

I don't think Peds or OB is really necessary in Intern year, unless your experience in med school was sub-optimal. I wouldn't do those regardless. If PICU is an option, maybe I'd consider that, because there may be some overlap then with Pedi Anesthesia. But I doubt they'd let you do much, as their own residents don't do PICU anyway until PGY-2 year.

So yeah, focus on the IM. Floor medicine sucks, and it involves a lot of social work, especially if you're at an urban hospital, but you need to be exposed to the breadth of medical disease so that you're familiar with it later on. Remember, the floors (including step-down) admit things like hypertensive urgencies, sepsis, other ID issues, oncologic cases (febrile neutropenia), SLE flares and all of those various complications, renal failure (also important to know when in the ICU), COPD exacerbations, plus you'll also see a lot of GI Bleeds and get exposed to their management.

Good luck with intern year! I personally enjoyed it and considered staying in IM for about a week before I realized what I was thinking. It is what you make of it. But also, welcome to the specialty of Anesthesiology.

p.s. None of my fellowship interviews cared about Step 3, just that it was submitted. They never mentioned my scores to me during my interview.

 

[psychbender]

Take Step 3 as soon as possible. I took it in December of my intern year, as my November was spent in IM clinic (read/did questions when patients no-showed), and December in the ED, with a flexible schedule. You only really need to pass it, and it's not that hard.

As for electives, agree with the above sentiments regarding doing two months in the ICU. I am horribly biased, and think that we should do more time in the ICU than required, but two months as an intern will give you a good foundation on which to base the rest of your training dealing with critical illness in the OR. As for other electives, that depends on your medical school exposure. Excellent choices would be Cardiology (especially if you can get some time in a CCU or heart failure clinic, or a week in the echo lab), Pulmonology (particularly inpatient consult or a week with an interventional Pulmonologist), or CT Surgery (even being the post-op orders bitch gives you exposure to how heart patients are managed perioperatively).

In my TY, Ortho was a required surgical rotation, and it was utterly worthless. The Ortho department demanded interns as fresh bodies to soak up the extra work from their large inpatient load, and there was no teaching involved, just lots of note writing on patients we didn't even see (the PGY2 Ortho resident would, but wouldn't write notes). One of my co-residents knew this, and was able to talk the PD into letting his switch to CT Surgery. So, while I was writing thirty notes on Ortho Trauma patients, he would round on the two or three CT inpatients, then talk to the surgeons about when/how to operate and manage patients with surgical CV disease. Bastard.

 

[BW15]

Thanks for the responses, I appreciate the advice.

 

[Biochemist21]

At my institution we have required rotations in CCU, Gen Cards, and Cards consults. I thought my time in the CCU was key to making me more comfortable working with end-stage HF and immediate post-MI patients. Even though I felt like I had a solid foundation in physiology/pathophys from med school, the CCU really forced me to think on a deeper level about CV phys (effects of each pressor, constrictive vs restrictive physiology, etc.). I can only speak for my institution, but compared to the other ICUs, the CCU is somewhat more chill as the patients there are generally more stable than the pts you're going to see in the MICU/SICU/CTICU, but still have the ability to crump on you quickly if you're not paying attention. I felt that Gen Cards was mostly just titrating Bumex drips and coordinating f/u appts with EP and far less learning. I can't say that you're going to have much free study time in the CCU, but I think it's all golden material for your future anesthesia yrs.

As for a surgery elective, what about ENT? I would have loved the ability to rotate with them for more surgical airway experience during intern year, and maybe you could finagle something like 2wks of OR and 2wks of clinic? The ENT docs I shadowed saw about 5-6 pts in the morning, then we went out for sushi for 2hrs, then back to clinic for another 5-8 pts, then home. Albeit my experience is probably not a realistic assessment of the average outpatient ENT clinic, but based on the fact that most TYs are in community programs, I don't think it would be too hard to find study time.

 

[JeffGarrett]

This is GREAT advice everyone. Thanks!!!