MICU Early vs. Late intern year

[ewokka]

I'll be one of the NOOBs come July and my PD just asked my class for our off-service rotations timing preferences this week. I'm leaning toward knocking MICU out relatively early in the year Oct/Nov. I'd like to hear some thoughts on early vs. late in the year from those who have some experience. My thoughts are that after MICU i'll feel much more comfortable with critical patients in the ED and just in general vs. doing it later i'll have grown into my skin a little more so MICU will be a more pleasant experience? Thanks

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[gutonc]

I'm in IM not EM so take whatever I say with a pound of salt. But I started in the MICU and it very positively changed my outlook on the rest of the year, including my EM month. I did feel much more prepared to handle critical cases later on by virtue of getting thrown into the deep end in July. I still had a ton to learn of course (and my next month was at a VA SNF so I kind of went a little overboard that month) but it was definitely a good place to start.

 

[link2swim06]

We do MICU twice intern year. I can say I learn different things from each rotation.

It doesn't matter when you do it. You will get a lot of experience from the rotation regardless.

 

[exsanguination]

EM PGY1 here (hopefully gonna be a PGY2 provided I don't get fired in the next 6 weeks)

My very first rotation as an intern was in our MICU with a hard@ss attending and unforgiving nurses. Truly a trial by fire experience, no doubt. However, I totally credit it for making me a stellar intern for the remainder of the year. You'll learn so much in that 1 month if you work hard, and let me tell you, it'll be an excellent base to build upon. Good luck.

 

[TooMuchResearch]

Anytime is fine, really.

 

[namethatsmell]

PROs to having it early in the year: you're energized to power through it well, you can learn a bunch about vents/pressors/fluids which will be helpful in the ED. you have a better idea of what it means when you send a patient to the MICU and how much you want to package your patients going there in the future.

PROs to having it later in the year: if your ED sees a decent amount of sick patients/codes you'll look competent and likely get to do more procedures in the unit, you will be in a better place to be helpful as the "EM guy" who knows ultrasound and how to handle things epistaxis etc, you'll have a greater appreciation for the finer points of vents/pressors/fluids.

It really doesn't matter.

 

[deleted109597]

Make your schedule around when you need your time off (family trips, etc). You'll learn regardless of when it is, but you probably can't take vacation on MICU.

 

[Angry Birds]

Personally, I would've been fired as an intern had I done MICU first.

 

[sonofva]

if you do it early, and you can really step up your game super hard, you'll finish the month and feel really like you can take any challenge for the rest of the year...but theres a chance you'll krump...you'll also probably learn less actual medicine if you do it early, because you'll be too distracted trying to get your feet on the ground...

if you do it late in the year, you'll probably do more solid learning, but then you'll have to do a micu rotation late in the year

 

[Droperidol]

You'll learn from the rotation no matter when you do it but I would say the biggest bang for your buck is between the second to fourth months of intern year. Ideally you want to make sure you gotten a few patients under your belt and gotten the yips out of the system before dealing with the sickest patients. If it is your first rotation you'll likely be more aware of trying not to screw up than to learn but make sure you take the time to listen and learn despite any fears. If you know you have it early make sure to look up manny rivers sepsis paper and the new surviving sepsis campaign. You'll invariably be asked about oxygen delivery (DO2 = [1.39 x Hb x SaO2 + (0.003 x PaO2)] x Q) to tissues and different ways pathological processes effect this. You'll also be asked to interpret abg values. I'm not saying spend a ton of time of this but it may help to be familiar of it and bring direct questions on rounds to discuss the intricacies of the decision making.


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[VentJockey]

I don't think it matters a whole heck of a lot, but preferably you wouldn't do it your first block because you won't know the EMR very well at that time and will struggle with that rather than the things you should be struggling with. I agree that you're better off doing it earlier rather than later, because what you learn there will be put to good use caring for critical patients in the ER. The ICU is a fantastic place to learn. Make sure you always correlate what is going on with the basic physiology, because in my experience ICU is all about the physiology.

 

[herewego]

I had it first rotation of intern year. Even though I was a student at the institution I matched at so I was familiar with the computer system etc, I feel like I missed out on alot of learning. I wasn't comfortable as a doctor, putting in orders, giving instructions to nurses etc..and so most of what I did was just try to stay afloat. I think if I had it during the middle of the year, I'd be more comfortable taking care of patients in general, and have enough experience with sick people to appreciate the ICU medicine, instead of constantly checking if the AM labs were ordered correctly..or getting all the correct orders to transfuse someone.

 

[swamprat]

I had it first block of intern year as well.. I feel like I learned a lot. I don't think there is any way your first block will not be scary, confusing and well..new. It's not the only month of ICU you will do so I don't think it matters. If you were in the ER the first block you'd still have to get used to the system, telling nurses what to do, what attendings like what etc. there is no avoiding this which is a lot of why I think the beginning of intern year sucks. GL.