Returning to OR after CCM fellowship

[mikey1982]

i'm finishing up a CCM fellowship next week and starting my job soon. Im nervous since its my first time as an attending haven't been in the OR literally for a year and don't want to look bad in front of my new employers. Hoping it all comes back to me quickly in terms of flow in the OR, blocks, preop/postop.
Any advice on preparing in the two weeks prior to returning to the OR
thank you

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[IkeBoy18]

Sorry I obviously cant answer your question, but I had a question if you dont mind. Why did you decide to go back to the OR vs CCM or CCM/OR? I know it can be hard to find CCM/OR.

 

[G-Man82]

I think he means it will be his first time back in an OR since the start of his fellowship. When we do CCM, and I'm assuming a Pain Fellowship, unless we get the opportunity to moonlight, it is a non-operative year. No OR time at all.

I will be in the same boat. Although, I'm going to try and moonlight during one my of elective months next month.

 

[nycitygas]

Your first case will be kinda of mess. and you will make some CA-1 mistakes.

After your first day, you'll be back up to speed. Congrats on finishing fellowship!

 

[yancantcook]

I'm finishing a pain fellowship but will be doing an academic anesthesia/acute pain job and will be in the same boat as you guys. Having not been in the OR for a while, I hope it comes back soon.

 

[CodeBlu]

Your first case will be kinda of mess. and you will make some CA-1 mistakes.

After your first day, you'll be back up to speed. Congrats on finishing fellowship!

Just out of curiosity... any examples?

 

[fakin' the funk]

Neostigmine alone, when given for reversal of NMB, is not a great rate control agent for someone in rapid A-fib.

Or, stated another way, it's too good of a rate control agent.

 

[PracManCA]

i'm finishing up a CCM fellowship next week and starting my job soon. Im nervous since its my first time as an attending haven't been in the OR literally for a year and don't want to look bad in front of my new employers. Hoping it all comes back to me quickly in terms of flow in the OR, blocks, preop/postop.
Any advice on preparing in the two weeks prior to returning to the OR
thank you

If you are in PP and starting at a new facility are you going to be proctored on your first +/- 10 cases? If so I would just let your proctor know where you've been ect. and I'm sure he would understand. We've had similar situations with new/nervous attendings and we always pair them with our seasoned, patient, respectful attendings.

 

[seinfeld]

Sounds silly but asked to be paired up with some of the best CRNAs in the practice. Take their lead and watch how they do things and what customary practices are. For the CRNA haters out there, the CRNAs that have been at a practice for a long time and are respected by nursing can teach you much about the customary practices that go on. I am not saying allow anyone to provide substandard care.

I was a bit of a mess, especially in OB (literally had not done a spinal in 2 years) and cardiac where the dance was more complicated to remember. It doesnt take long to get back up to speed.

 

[Arch Guillotti]

Sounds silly but asked to be paired up with some of the best CRNAs in the practice. Take their lead and watch how they do things and what customary practices are.

Sometimes the most experienced ones are the ones that do the stupidest stuff.

 

[seinfeld]

I choose my words carefully. "Best" not "most experienced". We all know which CNRA in our practice we would want all others to be like, I use them as mentors.

 

[risnwb]

On principle, I would never want a CRNA to be the one "showing me the ropes". Nope. Not saying it's necessarily a bad idea, but even the thought of it leaves a bad taste in my mouth.

 

[vector2]

Speaking as a current CA-2, the only ones at my institution who could show you the ropes are far as actually setting up an OR, finding equipment, or correctly following case workflow from pre-op to PACU are upper level residents, staff who have been out for less than than 5-10 years, and the CRNAs. I would venture that anyone who says they never learned some useful logistics from an experienced CRNA at some point in their career (especially when starting a new job) is either in an MD only practice or full of it.

 

[Ignatius J]

Keep it simple and don't try and reinvent the wheel and you'll be just fine.

 

[Ignatius J]

Neostigmine alone, when given for reversal of NMB, is not a great rate control agent for someone in rapid A-fib.

Or, stated another way, it's too good of a rate control agent.

Made this mistake when their was a switcheroo for neostigmine and it was 5mg/10ml. Forgot that and thought it was my glyco mixed in. The patient code-browned. It was bad.

 

[kazuma]

Made this mistake when their was a switcheroo for neostigmine and it was 5mg/10ml. Forgot that and thought it was my glyco mixed in. The patient code-browned. It was bad.

A trauma/Ccm fellow reportedly gave neo without glyco to a post-op patient that wasn't reversed in the OR and the patient coded and died. I'm not sure how much they gave or what the other problems the patient had.

 

[caligas]

i'm finishing up a CCM fellowship next week and starting my job soon. Im nervous since its my first time as an attending haven't been in the OR literally for a year and don't want to look bad in front of my new employers. Hoping it all comes back to me quickly in terms of flow in the OR, blocks, preop/postop.
Any advice on preparing in the two weeks prior to returning to the OR
thank you

Jeez, cant they let the CCM fellows do a few cases in the o.r. from time to time? Maybe an "anesthesia elective month" or something?

 

[IkeBoy18]

Jeez, cant they let the CCM fellows do a few cases in the o.r. from time to time? Maybe an "anesthesia elective month" or something?

Some fellowships require an OR month. Others let you take one as an elective.

Good to know for future reference. Choose a program that values some OR time.

 

[G-Man82]

I don't think that's true. I'm pretty sure that the acgme states it's a non-operative year that consists of 9 months of ICU training. The other 3 though are at your disposal. A lot of programs add in a month of echo, others some other electives too. If you want a month in the OR that's up to you. Some allow moonlighting, like mine, at another hospital in the system with a different Medicare number. But for the most part, it's a non-operative year.

As far as allowing a month during fellowship, what good would it do? In an accredited fellowship, you cannot be fellow and attending at the same time in the same hospital. After completing residency, do you really want to do an extra month of essentially residency just because you can't be credentialed as an attending? I'm done with that and listening to some oldies (some of whom are great, but some are awful) dictate my anesthetic. If I have a question, I'd rather run it by them and do the case myself. If you want OR time and you're in CCM or Chronic Pain, you should find a moonlighting gig as an attending.