3 months of SICU, good or bad?

[aimedicine]

Surgery intern going into anesthesia, i'm doing 3 months of ICU per my intern schedule, good or bad??? should i try to argue for schedule change...

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[TaoistDoc]

It depends on the hours and caseload. If you're working less than 60 hours a week and your ICU only have 10-15 patients, then that would be a pretty good rotation.

 

[deleted444089]

Agree with the post above; also keep in mind that the ABA has a certain requirement for number of ICU months during residency - you may be able to have one fewer during your actual residency if I'm not mistaken?

Also, SICU experience is way more valuable IMHO than doing scut work running a general surgery floor.

 

[G-Man82]

For me only 2 months of ICU from intern year could count; any more was counted as a floor month. It was fine by me though; I preferred the ICU to the medicine floors intern year anyway. Guess that's why I'm where I am.

 

[Planktonmd]

You should be very happy about getting ICU exposure instead of wasting your time on the surgical floor or holding retractors in the OR

 

[scudrunner]

Being an ICU intern sucks, but sucks less than being a floor intern, and certainly more like useful.

 

[IkeBoy18]

intern year sucks all together... especially when youre on a general surgery rotation..and youre more hardworking and knowledgeable than then gen surg interns..... smh

 

[OB1🤙]

I think SICU is the best possible place for an anesthesia intern, assuming a reasonably-run unit. I did 3 months as an intern and loved it. Well, I hated it least is probably a better way to put it. I definitely got the most out of it, compared with other medicine rotations.

So much of ward medicine is working on dispo. Trying to shuck patients out of the hospital, get them to a SNF, etc. You can almost always dispo an ICU patient- to anywhere else in the hospital but the ICU. So you don't waste time doing this case management crap in the ICU to anywhere near the extent you have to on the floors.

It'll be intimidating at first, but once you realize that plenty of interns worse than you made it through and survived, you'll do fine. Once you get it wired, there's nowhere else (other than the OR of course) that you'll want to be.

 

[Guillemot]

general medicine wards were the worst months of intern year. icu was stressful, long hours, but more focused on medical care and thus more worth while.

 

[bkell101]

Surgery intern going into anesthesia, i'm doing 3 months of ICU per my intern schedule, good or bad??? should i try to argue for schedule change...

As an intern we had mandatory 4 month micu/sicu....I traded two of my medicine floor months for two more micu months. Best thing I did during intern year. The skills gained and exposure translates nicely to the OR. I felt ahead of the curve because of this. You should thank your program for give you three months and ask for more.

 

[Random Anesthesiologist]

Resuscitation is a key component of anesthesia. You'll learn a lot in SICU. I did a surg intern year but no set SICU rotation as those patients were just part of my daily rounding census. I did a pulm Ccm month to have an official Ccm month on the books, but with all the exposure you should get proficient at lines, resuscitation and care for various maladies and learn the equipment, eg vent, pumps, crrt, etc.

It can be long days but come CA1 you'll be thankful for the training. You also might get to do some cool bedside procedures!

 

[DoctorDude]

my program has us doing at least 3 months of ICU during intern year. Was just browsing the ABA certification requirements and stumbled across this: "The clinical base year should also include rotations in critical care and emergency medicine, with at least one month, but no more than two months, devoted to each."

 

[deleted171991]

my program has us doing at least 3 months of ICU during intern year. Was just browsing the ABA certification requirements and stumbled across this: "The clinical base year should also include rotations in critical care and emergency medicine, with at least one month, but no more than two months, devoted to each."

Meaning that only 2 months of PGY-1 ICU count against the required residency total.

 

[aimedicine]

Ya ive already done 3 central lines during my 1st month, i can get reasonably proficient with another 2 months. Placed tons of I.V, a lot of which were difficult sticks. Plus the knowledge of managing acute patients, so im actually not all that displeased...its just the hours were insane...im feeling burned out already

 

[Random Anesthesiologist]

Ya ive already done 3 central lines during my 1st month, i can get reasonably proficient with another 2 months. Placed tons of I.V, a lot of which were difficult sticks. Plus the knowledge of managing acute patients, so im actually not all that displeased...its just the hours were insane...im feeling burned out already

3 lines is a very low number. Are you academic or community program?

 

[aimedicine]

maybe it is...but im at level 1 trauma center, academic. There is multiple interns so procedures are spread.

 

[Urzuz]

3 lines is a very low number. Are you academic or community program?

I wholeheartedly disagree, and believe that doing any lines as an intern is icing on the cake, as interns are at the bottom of the totem pole in terms of priority.

When you become a resident you will become proficient at any and every procedure, assuming your training program is reasonably good. They are "cool" to do as interns, but just because you did five more than the next guy doesn't mean anything in the long run.

Sit down for this one: as an intern I did ONE central line, probably less than three arterial lines, and maybe a handful of intubations. Despite that, I'm not drilling my needle through the patients' lungs whenever I place a central line in practice on my own.

Don't stress at all OP -- keep doing your thing and learning the medicine. That should be your focus as an intern.

 

[pgg]

I think it's more common than not for interns to have single digit lines for the YEAR these days. These aren't House Of God days when med students could get proficient with lines, or even 15 years ago when most interns could. For better or worse, mostly worse, everything has shifted to the right.

 

[pjl]

Understanding all the weird diseases and the hospital/discharge management of them was far more valuable to me long term than the placement of a few lines during my intern year. I did 6 months of ICU during my intern year which I felt was valuable. It was cleverly disguised as other rotations though, PICU, NICU, MICU, Cardiac ICU (1/2 month), SICU, Neuro ICU (1/2 month), and another MICU. Not certain that all the requirements would still allow this, but it was better than the medicine floor and ED.

 

[ether123]

Surgery intern going into anesthesia, i'm doing 3 months of ICU per my intern schedule, good or bad??? should i try to argue for schedule change...

it depends on what they have u do. I would recmmend doing as many a-line, central lines and learning about the vent as possible. dont waste time going too far into TPN. also, learn suturing.

 

[vector2]

I think it's more common than not for interns to have single digit lines for the YEAR these days. These aren't House Of God days when med students could get proficient with lines, or even 15 years ago when most interns could. For better or worse, mostly worse, everything has shifted to the right.

One of my co-residents on night float recently had to supervise a PGY3 medicine resident (who was the upper level covering MICU) because he hadn't done enough solo central lines (5) to be checked off at our institution. This is not because not enough procedures are available but mostly because the med folks are lazy and/or scared. Just recently the MICU intern came down to pacu to admit a patient...pacu anesthesia resident offers to supervise a-line and central line. Guess who ended up doing them....

 

[Random Anesthesiologist]

I wholeheartedly disagree, and believe that doing any lines as an intern is icing on the cake, as interns are at the bottom of the totem pole in terms of priority.

When you become a resident you will become proficient at any and every procedure, assuming your training program is reasonably good. They are "cool" to do as interns, but just because you did five more than the next guy doesn't mean anything in the long run.

Sit down for this one: as an intern I did ONE central line, probably less than three arterial lines, and maybe a handful of intubations. Despite that, I'm not drilling my needle through the patients' lungs whenever I place a central line in practice on my own.

Don't stress at all OP -- keep doing your thing and learning the medicine. That should be your focus as an intern.

Well then I'm glad for the experience I had. No one had to hold my hand to learn how to do it come CA1. I think it's an opportunity that's missed if you do that few. It's easy to ask for them in the unit, and a few months after July the seniors get bored with them.

I'm not going to get involved in a flame war about lines. I just think intern year is the time to really learn these things, that's all.

 

[pgg]

No flame war. I think it's unfortunate that a mixture of liability worries (leading to ever-shorter leashes on trainees) and work hour restrictions have so cut back on learning opportunities for med students and junior house staff.

 

[Urzuz]

Well then I'm glad for the experience I had. No one had to hold my hand to learn how to do it come CA1. I think it's an opportunity that's missed if you do that few. It's easy to ask for them in the unit, and a few months after July the seniors get bored with them.

I'm not going to get involved in a flame war about lines. I just think intern year is the time to really learn these things, that's all.

No problem. It is a great time to learn them during intern year, but I want to assure the OP that he shouldn't stress or freak out at the fact that he isn't getting a chance to do them. He will become proficient at them during his residency. And I'll add to it that many attendings will treat every resident like they know nothing at the beginning of CA-1 year regardless of how much experience someone may have had!

 

[G-Man82]

I did a medical intern year with 2 months of MICU/Ccu and a month of EM. I came out "certified" (5 each) to do IJ and SC lines, but the ones we placed were little triple lumen catheters. In residency though, I rarely placed TLCs outside the ICU. And even in the unit it was rare because a lot of surgical patients came with lines in place any way.

That being said, you get real good at lines in the OR. But in the OR we're also placing bigger lines: introducers. So attendings may get a little antsy with a new CA-1 placing those lines despite coming out of intern year "certified."

Intern year is good for a lot of things, but I would still prioritize medical knowledge and treatment of medical problems over technical skills. You'll get the technical skills in the OR, but you'll pretty much never be faced with bread and butter diagnostic medicine (as in see patient from start, take history/physical, and come up with differential diagnosis and plan) ever again in general anesthesiology practice.