Any advice for incoming CA-1s?

hoosiergirl said:

Hello everyone. Internship is (finally!) coming to an end and I'm very excited to start anesthesiology on July 1. However, I'm also quite nervous about the transition. Does anyone have some advice to give all of us incoming CA-1s? Maybe some things that no one told you that you wish you would have known when you started? Thanks for any pearls you can provide!

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My last month of my medicine prelim year was an elective, and on the advice of a friend I used it to do a month of anesthesia at my institution. This way I was used to the system (where things were located, who to contact for different issues, etc.), before I had to start with more responsibility. By mid-month they were assigning me my own room. If you can arrange something like that, do it.

Since it is likely too late to arrange an elective, some general advice I would give would be:

read daily

don't be afraid to ask questions

share experiences/challenging cases with your colleagues so you can learn from each other

be as hands on as possible while realizing your limitations

always be vigilant

keep up a positive attitude -- it's infectious.

The answer to solving an intraop patient problem is usually to think about the ABCs of resuscitation and carry out the appropriate steps to the situation.

The rest of the details you'll learn as you go along.

Most of all, just go with the flow and you will have fun. I'm a CA-3 and I still enjoy going into work everyday.

The most important thing for you to do in the first 3 months is to learn from your senior residents. Of course, read and understand the basics from the book during your free time. Your learning curve is so steep the first few months that every little tidbit you get from the seniors is gold. Most CA-2s (the CA-3s may be past the point of caring) will be happy to help you out since they were just in your shoes.

There is little that you will retain from your attendings at this point, they are more interested in teaching you the Fick equation or the concentrating effect, which is important, but not as useful early on as figuring out how to draw an ABG from the art line without splashing blood everywhere.

Do not be afraid to ask your senior residents anything. The absolute worst thing you can do now is say you know how to do something and really not. Even worse is lying which got one of the residents in my program booted (...of course I reversed....). If you don't get every bit of the basics down now (how to connect a T-piece, how to do a machine check, how to order blood) you will catch sh** later on since you will be expected to know these things.

As far as procedures, nobody expects you to be perfect. Right now just focus on good technique and ask everyone how they would do it.

Good luck.

Advice?

Grab the Vaseline in the morning and apply liberally. Use Preparation H when you get home.

Not joking.

-copro

Buy the senior residents lunch. I know I'd appreciate our new CA-1's more if they did that.

Don't lie, cheat, steal, or cut corners- ever.

Never give the appearance of being unenthusiastic. Even if you got up at 5 am to come to work with minimal sleep. Even if that's been happening regularly for an entire month.

Always be demonstrably humble, particularly as a CA-1. No one likes teaching or working with a chirpy CA-1 who says "of course" "I know" and God forbid "MD aware" when they know not their own cluelessness.

Get good at basic technical skills as soon as possible. People will be quick to judge you on how smoothly you can place an IV, a-line, ETT, etc.

Don't cause delays. If it's a 7:30 am OR case, you should be the one pushing the nurses to let you take the patient in at 7:27. If that means coming in extra early to set up, or calling the patient the night before to have the pre-op interview, do it. Be aggressive and enthusiastic about getting the work done, and everyone will appreciate it.

Always be punctual. Be quick to relieve people on call. You would be surprised how soon word spreads that you are "slow". No one will give you credit for being 5 minutes early, but everyone will notice and hate you for being 5 minutes late.

Avoid assumptions. Don't assume that just because a tech set up your a-line pressure bag that he bothered to make sure all the connections are tight, and that the thing is connected to your monitor, and zeroed. If you didn't do something yourself, always verify. Avoid using other resident's drugs. Don't let someone else's mistake become your own.

Don't hide. If you're free and available, ask your supervisor if there's anything you can do.

Don't fight with nurses. It's never worth it.

Learn everyone's name. Techs, nurses, surgical colleagues, the janitor.

Read regularly.

Remember House of God, they can't hurt you forever. Residency sucks, but eventually it ends.

Doing these things well all the time is almost impossible, especially early on. These are the things that get noticed, however, and will form the basis for other's opinion of you. Do the best you can, and good things will eventually come your way.

Your avatar gives me seizures

Bougie said:

Your avatar gives me seizures

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HAHAHAHAHAHAHAHA

Me too!!!!

My 2 year old more than once has thought it was a real bug.

I've almost got to a point the other nite where I was gonna make a new thread pleading with Power to change that creepy avatar!

Instead I just adjust it off the screen. I cant watch it. Creeps me out.

jetproppilot said:

HAHAHAHAHAHAHAHA

Me too!!!!

My 2 year old more than once has thought it was a real bug.

I've almost got to a point the other nite where I was gonna make a new thread pleading with Power to change that creepy avatar!

Instead I just adjust it off the screen. I cant watch it. Creeps me out.

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FINALLY someone comments on that freakin' avatar!

Okay, I'll look into changing it. The first time I saw it, I really thought there was a bug on the screen.

Notice it crawls in an little infinity pattern. Very cool.

Looks like it crawls in a figure 8; make the bug crawl in a "sideways 8" pattern and ya got infinity. Regards, ----Zippy

powermd said:

Always be demonstrably humble, particularly as a CA-1. No one likes teaching or working with a chirpy CA-1 who says "of course" "I know" and God forbid "MD aware" when they know not their own cluelessness.

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AKA playing dumb: people don't like people that are smarter then them

Get good at basic technical skills as soon as possible. People will be quick to judge you on how smoothly you can place an IV, a-line, ETT, etc.

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Obviously a plus

Don't cause delays. If it's a 7:30 am OR case, you should be the one pushing the nurses to let you take the patient in at 7:27. If that means coming in extra early to set up, or calling the patient the night before to have the pre-op interview, do it. Be aggressive and enthusiastic about getting the work done, and everyone will appreciate it.

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Not the nurses that work on a fixed schedule and don' have incentives to move faster.

Always be punctual. Be quick to relieve people on call. You would be surprised how soon word spreads that you are "slow". No one will give you credit for being 5 minutes early, but everyone will notice and hate you for being 5 minutes late.

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Relieve on time only the ones that relieve you on time

Avoid assumptions. Don't assume that just because a tech set up your a-line pressure bag that he bothered to make sure all the connections are tight, and that the thing is connected to your monitor, and zeroed. If you didn't do something yourself, always verify. Avoid using other resident's drugs. Don't let someone else's mistake become your own.

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True

Don't hide. If you're free and available, ask your supervisor if there's anything you can do.

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Not true, if the anything is of educational value ok or else you'll end up being everybodies beotch

Don't fight with nurses. It's never worth it.

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True but your still owed so respect

If you have the type of attending-in-charge that is likely to scut you out, I can see why someone would have the desire to hide. However- when it comes time for evaluations, recommendations, PHONE CALLS from your prospective employer to his old buddy who runs your anesthesia program - you want him to say only the best things. Things like "always on time/available" "always ready" "quick learner" "great team player" "never had a problem with him/her".

As far as getting respect from nurses at an academic medical center go, good luck with that! Give them what they want without issue as along as it's reasonable. Draw a line when patient safety is at risk.

Don't start an open war with one over anything.

You'll quickly be up to your kneecaps in 5'1" Filipino women pecking you to death.

let me know if it helps

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enjoy!