Senior residents and attendings: any electives that are useful in retrospect?

[furosesonerolaquinox]

I'm a MS4 currently applying in anesthesiology. If I had to guess today, I suspect I'm going to be interested in a cardiac fellowship, but that's very malleable depending on what happens over the next few years. By this point I've obviously already done the electives needed to figure out if I want to do anesthesiology and get letters for applications.

I'm currently planning my schedule for the last few blocks of medical school, and the prelim programs I've interviewed at have made sure to emphasize the amount of elective time they provide. I'm largely following the advice I've heard to take things easy with this flexible time... but at the same time, I don't want to miss doing something potentially useful during my last chances to do electives basically anywhere in a hospital.

For those with some experience in anesthesiology: are there any electives you did as a MS4 or resident that now stand out as useful? Anything you didn't do but wish you did?

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[Mman]

I still find the 4 week elective I did in Chest Radiology to be quite useful. A CXR is a good thing to know how to read well.

 

[psychbender]

Any additional time you can spend in an ICU is time well-spent. A Cardiology rotation may also be good, depending on how it is set up (inpatient vs outpatient, time spent working with an interventionalist or electrophysiologist, etc), and picking up the finer points of ECG reading, and getting a basic primer on echo can prove invaluable, if you want to do CT later in life.

All that being said, be sure to take some relaxing rotations, as well. I did a Sports Medicine elective with the team physicians at my local university (and alma mater). Doing basic primary care on a bunch of student athletes, going to practices and the weight room before/after, doing OMM on the women's volleyball team were all good experiences. I had a blast spending a month in the Belizean jungle, doing a Wilderness/Remote Medicine elective (even did trachs on living pigs on make-shift OR tables).

 

[pgg]

I did a month of cardiology as a MS4 and the most useful part of it was the week I spent attached to an EP cardiologist, reading so many abnormal ECGs.

I can't remember much of what else I did as a MS4, apart from a 2 month sub-I block of ICU/anesthesia.

 

[lord_jeebus]

Most anesthesia residents have no shortage of ICU time in their training (between prelim year and anesthesia residency I had 6 months), so I would suggest something else for MS4 electives. Cards and Pulm are useful. Although not particularly useful in the daily practice of anesthesiology, as a physician I wish I had done a month of ophtho to fill that gap in my knowledge base.

An international elective is worthwhile if you are able to set that up. I spent a month at Keio University in Tokyo and it was pretty interesting. Officially I was doing a pathology rotation, but they let me spend some time in other departments.

 

[BuzzPhreed]

Disagree. ICU. You can't get too much.

'Nuff said.

 

[Mman]

Disagree. ICU. You can't get too much.

'Nuff said.

Perhaps. But 4th year is your last chance to actually get exposed to things you won't do during residency. Nobody graduates from an anesthesia residency feeling like they wish they had done 1 more month of ICU.

 

[BuzzPhreed]

Perhaps I'm a bit more utilitarian than the average dude but I believe you should get as much exposure as you can to what you're going to actually regularly use.

 

[stargirl50]

I did two weeks of transfusion medicine in the blood bank. It's very eye-opening: learned about separation of blood into components, amount of work involved when your type & screen comes back positive... things we deal with pretty regularly.

 

[Mman]

Perhaps I'm a bit more utilitarian than the average dude but I believe you should get as much exposure as you can to what you're going to actually regularly use.

Nah. Like I was told the first day of residency, it doesn't matter what you know now because at the end you will be a competent anesthesiologist. An extra month in medical school of what you will do for a living won't make a bit of difference in how you perform as a resident or attending.

 

[deleted547339]

picking up the finer points of ECG reading,

lol. med students picking up 'finer points' of EKGs.....

 

[BuzzPhreed]

Nah. Like I was told the first day of residency, it doesn't matter what you know now because at the end you will be a competent anesthesiologist. An extra month in medical school of what you will do for a living won't make a bit of difference in how you perform as a resident or attending.

Cool. He should probably just take the last six months of MS4 off then.

 

[psychbender]

lol. med students picking up 'finer points' of EKGs.....

Ok, so maybe learning more than just the basics. Not all med students are from the same background. I was a paramedic for several years, and already had the basics of ECGs down before starting med school. Some sit down time with an EP going over some more advanced topics, and getting a lot of repetition, can be beneficial for some students.

 

[Mman]

Cool. He should probably just take the last six months of MS4 off then.

why? As I said earlier, it's the last chance to get exposure to or learn things you won't learn in residency. Tuition costs a lot. I'd make the best use of it I could.

 

[Random Anesthesiologist]

I spent the last 4 months of med school doing a rural FM rotation. It was required, but I enjoyed it. I don't necessarily love clinic day in and day out but my preceptor was incredible and I learned a lot about "doctoring" during those months. My favorite quote from him that still stays with me is "yeah, but what are you going to DO about it" when I would rattle off a bunch of hpi and lab stuff.

It was a great experience, and I would do it again in a heartbeat if I were a med student.

 

[risnwb]

I agree with the those suggesting something related to eP or cards. I did a month in the cardiac icu (medical not surgical) and although some on here seem skeptical, I continue to use what I learned that month about reading an EKG on a daily basis. That being said I put a ton of effort into the month so I got a lot out of it.

 

[urge]

I would recommend an ekg elective also. You will not get any more training in it, yet you will look at them for the rest of your career.

Pulmonary is a waste. ICU or anesthesia is redundant.

The cxr rotation does not sound like a bad idea, but in reality the important stuff is hard to miss. The subtleties can usually wait.

 

[BuzzPhreed]

why? As I said earlier, it's the last chance to get exposure to or learn things you won't learn in residency. Tuition costs a lot. I'd make the best use of it I could.

I'm a utilitarian. I don't waste my time with stuff that isn't relevant. I did a 3-week optho rotation in med school. Complete waste of time. Tuition NOT well spent. All I needed to know about optho I learned in residency doing cases.

I did a lot of ICU. Still wish I'd done more. This is valuable stuff. Especially if just for learning how poorly some of the fleas manage their patients and how it falls on us to fix them in a short timeframe. I have a lot of stories...

 

[lunaire]

Did 4 months of ICU my 4th year. It was time well spent. I agree that ICU is the most bang for the bucks you can get 4th year wise. My 3rd & 4th were acting internships with attendings I worked with before, and I carried my own patients, reported directly to the attendings (like the actual interns) -- invaluable for the CA 0 year.

Also did floor cards and learned to read EKGs, but agree that EP rotation would've been better.

In retrospect I would've looked for more training in ultrasound use (for procedures or for diagnostic stuff like TTE, FAST, FATE); emergency rotation probably is the best bet for that. Knowing ultrasound physics/fundamentals and getting some muscle memory primer would've been a huge boost.

 

[vector2]

I probably read and learned more in my MS4 SICU and MICU rotations than I did in all my other med school rotations combined. Not to mention I got to do a-lines, central lines, intubations, thoracenteses and a couple bronchs. ICU principles such as fluid and blood product management, airway and vent management, pain control, pressors and antiarrhythmics, invasive lines etc are things you will use day in and day out throughout your anesthesia residency especially when taking care of sick patients in the operating room.

Also can't argue with learning as much as you can about CXRs and EKGs. These are things that you will never stop interpreting. And as the above poster said, play around with the ultrasound as much as possible as a med student and intern. When you're an intern and some difficult stick goober on the floor loses his IV, don't be that guy who tries to pawn it off to some other resident or the flight care RNs. Go find an ultrasound and teach yourself how to do a U/S guided A/C, cephalic, basilic, or saphenous PIV insertion.

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