I'm wondering if anyone has advice for someone taking a neonatology sub-I as a 4th year (preparation etc). I have absolutely no experience in neonatology (or at this hospital) and was hoping for a peds wards sub-I, but hey, you take what you can get! THANKS!
4th year neonatology sub-i
- Thread starter aziz
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Got married during the end of June, honeymoon, then started my Neo sub-i.
First, read a chapter from any 'ol handbook on neonatology. SHouldn't take too long.
Does your dept have a handbook for the NICU? Ours did and it was quite helpful. I suspect that each NICU does things a little bit different, and so reading the handbook from your particular institution is quite appropos.
If there are any students currently on the rotation, make a plan to meet them in the NICU "after hours". By the end of the month, they should be able to intro you to the notes, nutrition, vents, where things are, schedules, etc. It also gives them a chance to see just how far they've come; I rare treat it is to actually teach in the NICU!
It's pefectly normal to be a little weary (or downright terrified) of getting your first kid. I thought my first kid as an MS4 would be an over-Mg'd 38 weeker. No no, a pretty sick 27 weeker!
Start off by giving yourself an HOUR per patient for pre-rounds!!! My first notes were two and a half pages long. Silly when I look back, but I'm not sure there is anything actually wrong with over-documenting in the NICU. You'll get much quicker, I promise, and it helps only have 2-3 kids to start with.
Bring a calculator, and double check everything.
I guess I would also recommend reading up on HyperAl/TPN, but make sure it's for neonates. The principles are the same, but almost everything else is different when writing TPN. (We just had a great lecture on TPN at the end of our MS4 year, but a couple of us started comparing adult values to neonate values...we had a good laugh.)
My story: I loved the NICU, but for a couple of reasons elected to go into anesthesiology. Still, I'd give my left earlobe for a chance to do NICU again as an intern, such a gratifying rotation it was. Taking care of babies is great, the people you work with are awesome...
Enjoy and let me know if you have any other questions. Lots of great resources on this site for those interested in the NICU!
First, read a chapter from any 'ol handbook on neonatology. SHouldn't take too long.
Does your dept have a handbook for the NICU? Ours did and it was quite helpful. I suspect that each NICU does things a little bit different, and so reading the handbook from your particular institution is quite appropos.
If there are any students currently on the rotation, make a plan to meet them in the NICU "after hours". By the end of the month, they should be able to intro you to the notes, nutrition, vents, where things are, schedules, etc. It also gives them a chance to see just how far they've come; I rare treat it is to actually teach in the NICU!
It's pefectly normal to be a little weary (or downright terrified) of getting your first kid. I thought my first kid as an MS4 would be an over-Mg'd 38 weeker. No no, a pretty sick 27 weeker!
Start off by giving yourself an HOUR per patient for pre-rounds!!! My first notes were two and a half pages long. Silly when I look back, but I'm not sure there is anything actually wrong with over-documenting in the NICU. You'll get much quicker, I promise, and it helps only have 2-3 kids to start with.
Bring a calculator, and double check everything.
I guess I would also recommend reading up on HyperAl/TPN, but make sure it's for neonates. The principles are the same, but almost everything else is different when writing TPN. (We just had a great lecture on TPN at the end of our MS4 year, but a couple of us started comparing adult values to neonate values...we had a good laugh.)
My story: I loved the NICU, but for a couple of reasons elected to go into anesthesiology. Still, I'd give my left earlobe for a chance to do NICU again as an intern, such a gratifying rotation it was. Taking care of babies is great, the people you work with are awesome...
Enjoy and let me know if you have any other questions. Lots of great resources on this site for those interested in the NICU!
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aziz said:
Be careful. I decided on neo as a career after my sub-I in neo.
I know of no field that requires more respect for nurses, RT's, etc than neo - go into your rotation with a huge sense of humility and respect for these folks and they'll tell you what to do.
Regards
OBP
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Realize that neonatologists are a different breed than general pediatricians, in general. They are intensivists, and act like intensivists.
What OBP said is very trueabout the nurses. They are very very protective of their babies and deserve a lot of respect.
My NICU month was way too stressfull for me. There is no way I will go into it. God bless you all who do!
What OBP said is very trueabout the nurses. They are very very protective of their babies and deserve a lot of respect.
My NICU month was way too stressfull for me. There is no way I will go into it. God bless you all who do!
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OBP,
What level are you at in your training for neonatology?
I have heard that neonatology has group practices that give you the ability to have decent hours. Is this true?
I am studying for the OSCE on Monday. The physical exam is so important but I feel all I do is memorize a protocol and do not obtain any skills in the art form. This has nothing to do with neonates but just thought I would throw it in.
What level are you at in your training for neonatology?
I have heard that neonatology has group practices that give you the ability to have decent hours. Is this true?
I am studying for the OSCE on Monday. The physical exam is so important but I feel all I do is memorize a protocol and do not obtain any skills in the art form. This has nothing to do with neonates but just thought I would throw it in.
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makesomerheum said:
I am currently a PL >20. Hours are highly variable - but most neonatologists will continue to work at nights throughout their career. Some neos do shift work, others work a certain number of days consecutively and then have time off. In academics, more traditional "months on service" where you work Mon-Fri and some weekends certain months and do research or other tasks other months are most common.
Regards
OBP
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kristing said:
I haven't done my NICU sub-I yet but from my limited experience in the NICU during my peds clerkship and from the advice from my fiance, who is a NICU nurse, I can comment a bit on this.
NICU nurses hate certain things. Some of these things are unavoidable for a busy NICU team, but others are a little bit easier to pay attention to, especially if you are a student with a bit more time and humility than the docs.
-a fussy baby has finally gotten to sleep and the doc comes to examine the kid, waking them up, and leaving the baby fussy and inconsolable...if possible, try to wait when the baby needs to be awakened for their feedings..in our NICU, the feeding times are posted on a sign at the bedside
-try and get the babies back to the condition they were in when you found them...if you unwrap them, wrap them back up...temp regulation is difficult for these kids so do not leave then uncovered if they were covered when you find them
-if you find a dirty diaper, change it...nurses HATE when the resident finds a dirty diaper and looks at the nurse and says "can you change this please?"...this one resident at my school, when he/she finds a dirty diaper, he/she just leaves the diaper open for the nurse to find it upon returning...it
is like this resident thinks he/she is doing the nurse a favor by making it easier for the nurse to find the poop
-when i was on my peds clerkship, i would offer to feed the babies if i had time...it was a good experience for me to learn how to feed, observe the baby's coordination with their suck and swallow, and i thought it was fun to have a little bonding with my patient, especially if it is a baby who doesn't get a lot of love because their parents do not come to visit...plus nurses love the break from the monotony of feeding the babies over and over
If you keep these things in mind, the nurses will love you, and they will be more likely to teach you things from their wealth of knowledge. Plus, they tend to be pretty friendly with the residents and probably will comment on your behavior. I have had attendings (not in peds) who have asked the nurses about students' behavior. They only remember if you're really nice or a jerk.
Everyone's advice is great!! Unfortunately for me, the NICU I am working at is also at an unfamiliar hospital. If anyone has any specifics on OHSU, that's where I am going to be.
Yes, if I have learned nothing else during 3rd year, it is that nurses can be your very best friend (and most useful periferal brain!).
Anyone know of any specific books for TPN OR vents! I know nothing about the latter as I have had very little time in the unit.
Thanks again to all!!!!!!!
Yes, if I have learned nothing else during 3rd year, it is that nurses can be your very best friend (and most useful periferal brain!).
Anyone know of any specific books for TPN OR vents! I know nothing about the latter as I have had very little time in the unit.
Thanks again to all!!!!!!!
scholes said:
that is awesome, all this advice is helping!!
if this is the second post (b/c i tried this and failed, i think) then ignore this
but i must say, that if I have learned nothing else during 3rd year, it is that nurses can be your very best friend!!
also, my sub-i is at OHSU, if anyone has any specifics, they would be greatly appreciated!
Does anyone know of any good books for TPN, vents etc. in the neonate??
Thanks to all again!!!
if this is the second post (b/c i tried this and failed, i think) then ignore this
but i must say, that if I have learned nothing else during 3rd year, it is that nurses can be your very best friend!!
also, my sub-i is at OHSU, if anyone has any specifics, they would be greatly appreciated!
Does anyone know of any good books for TPN, vents etc. in the neonate??
Thanks to all again!!!
scholes said:
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aziz said:
Neonatology : Management, Procedures, On-Call Problems, Diseases, Drugs (LANGE Clinical Science) by Tricia Lacy Gomella, M. Douglas Cunningham
is my personal favorite for a neo text for trainees.
Best way to learn TPN is to have a sit-down talk with the dietitian in the NICU. Again, like the nurses, treat them with respect and they'll teach you a lot that will be useful beyond neonatology.
Regards
OBP
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Any advice for a new intern whose first month is in the NICU? I didn't spend any time there as a med student.
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fourthyearmed said:
Well now, I'm a bit biased, but I think NICU is a good way to start residency
- really - it'll get you into the swing of things and you won't always be "dreading" the first month of neo.The only advice beyond what has already been given is to be aggressive about procedures. Make sure you get chances to do LPs, intubations and umbilical lines. Even if they won't turn some of them over to you, put on gloves and help. Also, talk to RT's about the ventilators and blood gasses. Ask them the questions about those that you don't want to ask on rounds for fear of sounding dumb (e.g. what is synchronized mode, when do you oscillate, etc). These are things they know and usually they like teaching interns if the interns treat them with respect.
Also, try to learn a little nutrition - it'll help you elsewhere - learn about the uses of transitional formulas, vitamins for babies, etc. Sometimes NICU is the best place to get that info.
Tomorrow I meet our new interns during NRP training.....
Regards
OBP
