Could you please tell us a little more about the specifics? What are your day to day responsibilities in your first year? Are you managing just floor patients or unit patients also? What is your operative experience like? I can't imagine them letting you do all that much in the OR cause they have surgical residents that need the experience too, right? Would love all the details that you could give as you are one of the trailblazers in the field so please give us all the info you can. Thanks
Sorry for the delayed response SBJesus--
As you know, the first year is the advanced preliminary year and this is very program dependent. I feel that the ABS/ACGME-RRC Surgery have made the req'ts very open to give program directors a lot of latitude for the curriculum. My year consists of three months SICU, one month MICU, one month Neuro CC, four months General Surgery/Trauma Surgery, one month Hepatobiliary surgery and two months night float. The second year will be the formal Surgical Critical Care fellowship.
A typical morning begins at 645 am with checkout from the team that is post call re: admissions and anything that happened in the ICU overnight. The program is a small one (2 categoricals/yr and 4 prelims) so we do brief walk rounds in the ICU (as all teams have patients in the ICU) and then split off to round on floor patients or operate. The program ensures you have at least 2-3 operative days a week even as a prelim so your upper level or attending will round on patients by themselves while you are in the OR (how is that for non-malignant?). We usually are done by 430 pm and checkout to the call team anything that needs to be followed up on. We have every other weekend off.
Since we are a Level 1 trauma center in a small program, we do not have dedicated trauma teams that rotate every three days. Instead, two residents are paired together to be the call team for that day. Typically prelims do 2 calls/week. During call we respond to all traumas, all in-house cardiac arrests, and see all surgical consults.
The operative experience is actually fun. I requested not to do many laparoscopic cases which the categoricals are happy to take. Instead, I scrub amputations, mediports (great way to get subclavian sticks), trachs, and interesting vascular cases (usually go uncovered). It is usually just you and an attending. On Hepatobiliary you are the only resident on service along with a fellow so they let me do parts of the liver resection, bowel resections, perform the abdominal closures, etc. On trauma call it is all hands on deck so I have been able to do a few trauma ex-laps where I make the incision, pack liver, run bowel, etc with the attending guiding me.
This is certainly a unique program as all the surgery residents and attendings are great people to work with. The program director used to co-own a local EM group in town and two of the attendings trained with EM-CC fellows so they are very EM friendly. I am never made to feel as though I am an "outsider".
When it comes to bedside procedures like chest tubes, central lines, and intubations I am treated as an EM attending and perform them independently or supervise other residents. Once again, the small size is a benefit as we have the volume of procedures you see in a Level 1 trauma center, therefore, I have been able to perform or supervise >25 chest tubes this year. I have also been able to perform a cric and resuscitative thoracotomy which obviously would not normally be a junior resident procedure.
The ICU itself is staffed with a combination of surgical residents and NPs. It is a brand new ED/ICU that opened up in August.
