Advice for CA-0

[Superdork]

---

Members do not see this ad.

I saw the other thread and liked the idea so I figured I'd take the corresponding PGY-1 thread for a spin.

The powers that be have deemed it necessary for anestesiology residents to complete a PGY-1 year that is mostly not anesthesia (medicine+icu+ or -surgery). For current anesthesiology residents, what do you advise a rising PGY-1 matched into anesthesia try to take from this fun year? What are the most important things to learn, skills to master?

 

[imfrankie]

I saw the other thread and liked the idea so I figured I'd take the corresponding PGY-1 thread for a spin.

The powers that be have deemed it necessary for anestesiology residents to complete a PGY-1 year that is mostly not anesthesia (medicine+icu+ or -surgery). For current anesthesiology residents, what do you advise a rising PGY-1 matched into anesthesia try to take from this fun year? What are the most important things to learn, skills to master?

I did a transitional year that I found helpful because it exposed to OB, ER, Medicine, ICU, Surgery, some elective time, blah. I did mine at the poor man's hospital which is kinda nice because you do stuff and it's bread/butter healthcare. Plus it helped chop the year down into modules so it wasn't such a long internal medicine or surgery grind.

It's not gonna matter that much. Lots of good anesthesiologists did tons of different things. Just read a little every night and try to keep your eye on what a privilege it is to be able to care for people (cause you aint gonna feel like that all the time)

 

[urge]

Anything but surgery. Whatever you learn, if any, will have no bearing in the room when you already have a fully trained surgeon. Learn some medicine, peds... so you can be useful.

 

[Idiopathic]

get good at showing up early, staying late, listening and presenting...all will be valuable to you later on. work on efficiency. for intern year, what you are doing doesnt matter so much as how you are doing it

 

[GoodmanBrown]

I saw the other thread and liked the idea so I figured I'd take the corresponding PGY-1 thread for a spin.

The powers that be have deemed it necessary for anestesiology residents to complete a PGY-1 year that is mostly not anesthesia (medicine+icu+ or -surgery). For current anesthesiology residents, what do you advise a rising PGY-1 matched into anesthesia try to take from this fun year? What are the most important things to learn, skills to master?

lfesiam started a quality post on the same topic. Hopefully you'll find some pointers there as well.

 

[PamIsHorny]

Do a bunch of a-lines, central lines, and IVs. Get your upper-level residents to teach you early on. No one expects an intern in July to be great at these procedures, so it's the perfect time to learn and to fumble. You don't want to show up CA1 year struggling more than your classmates.

 

[BeddingfieldMD]

I feel like that can be hard to do as an intern, unfortunately. IV's are easy, and a-lines are relatively easy. But in medicine, at least, it seems there's always a more senior resident who wants/needs practice with central lines and takes those procedures. And of course when I'm on ward or consult months, we're not putting central lines in anyone unless they're code patients. I've been able to get a few central lines this year, but a "bunch" hasn't happened.

Do a bunch of a-lines, central lines, and IVs. Get your upper-level residents to teach you early on. No one expects an intern in July to be great at these procedures, so it's the perfect time to learn and to fumble. You don't want to show up CA1 year struggling more than your classmates.

 

[WholeLottaGame7]

I feel like that can be hard to do as an intern, unfortunately. IV's are easy, and a-lines are relatively easy. But in medicine, at least, it seems there's always a more senior resident who wants/needs practice with central lines and takes those procedures. And of course when I'm on ward or consult months, we're not putting central lines in anyone unless they're code patients. I've been able to get a few central lines this year, but a "bunch" hasn't happened.

Ditto.

 

[fakin' the funk]

Important rotations are:
Cardiology.
Medical ICU.
Cardiac ICU.
Medical wards.
EM.

In that order.

 

[nycitygas]

In June before you start, read up for your AKTs in July. Smoking them will go a long way in establishing your rep for the next three years

 

[Doctor4Life1769]

.

 

[PamIsHorny]

I feel like that can be hard to do as an intern, unfortunately. IV's are easy, and a-lines are relatively easy. But in medicine, at least, it seems there's always a more senior resident who wants/needs practice with central lines and takes those procedures. And of course when I'm on ward or consult months, we're not putting central lines in anyone unless they're code patients. I've been able to get a few central lines this year, but a "bunch" hasn't happened.

That's too bad that there aren't more procedures for you guys. Perhaps I have a skewed idea of internship since I did a transitional year with several months of ICU. Most of my upper level residents (especially during surgery months) were happy to lighten up their workload by having interns do the central lines. I always heard..."oh you're anesthesia, go line up the patient."

I guess my suggestion is somewhat suckie for you guys. Sorry. I just remember seeing interns that got intimidated by procedures and tried to get out of them. I thought that was crazy. Wanted to warn against that.

 

[jennyboo]

Don't worry about central lines. Why learn from a senior medical resident who's done 10 when you will later learn from the experts who've done hundreds? Any unsafe habits you gain during your internship will likely have to be unlearned later.

Learn to place SUBCLAVIAN central lines if you have an expert who can teach you. (Again, do not bother with IJs, because you as an anesthesiologist will get better at those than anyone.)

Learn to be fast.

Learn the management of acute MI, CHF, COPD, basic arrhythmias such as Afib/SVT. When you finish internship, you should know how to manage these conditions as though you were an attending.

Do as many chest tubes, paracenteses and thoracenteses you can. You won't do many of these procedures later, but you never know when (especially) a chest tube will come in handy.

Learn to present a patient. You wouldn't believe how many anesthesia residents have lost this skill.

 

[Consigliere]

Here's my advice: don't go into anesthesia - it sucks. Don't believe me? Save this post and refer to it 10 years from now.

 

[ComfortableWolf]

Would you care to elaborate?

Most seem to be quite content in Anesthesia...

 

[beavis]

...

Learn the management of acute MI, CHF, COPD, basic arrhythmias such as Afib/SVT.

...

This. Also, being able to assess volume status of a patient by clinical exam (although not always perfect) is key.

Also, try to get a feel for who is "sick."

IVs, art lines, central lines...doing a couple per month isn't going to make you slick. You gotta do multiple per day consistently for a period to achieve this. As said above, you will have better teachers in anesthesia for this.

I can't speak for what I'll think in 10 years, but I'm quite happy I chose anesthesia over all the other specialties.

 

[pgg]

In June before you start, read up for your AKTs in July. Smoking them will go a long way in establishing your rep for the next three years

Agreed, content outline here. Some people here will argue that it's stupid to prepare for these tests. Maybe they had kinder or more disinterested attendings. Whatever, you'll never regret a high score on a test.

There are no cardiopulmonary bypass questions on the AKT 0/1. Read up on the cardiac physiology, pulmonary physiology, anesthesia drugs (the muscle relaxants have their own section on the AKT 0/1), "boring" stuff like equipment. Your peers won't know what a line isolation monitor is or what microshock thresholds are. Things like knowing how many liters are in a full O2 tank are things that you can't reason out on the test. But if you know the facts, they're easy points.

nycitygas is correct ... if you smoke the AKT 1 and 6 you will be treated differently. When you've got a 95 on the AKTs and ITEs and screw something up, it'll be perceived as an off day. When you've got a 25, the same mistake will be perceived as just another stupid thing a stupid resident did.

I got a 20-something %-ile on my AKT1. The next 6 months of my residency were rough. I didn't do anything really stupid, and I think I was a pretty good CA1, but I got hazed a lot. I got a 99 on the AKT6 and overnight the atmosphere changed. Residency is hard enough, try not to stack bad test scores against yourself too ... if that means prepping for and gaming the AKT, so be it.

 

[Doctor4Life1769]

Agreed, content outline here. Some people here will argue that it's stupid to prepare for these tests. Maybe they had kinder or more disinterested attendings. Whatever, you'll never regret a high score on a test.

There are no cardiopulmonary bypass questions on the AKT 0/1. Read up on the cardiac physiology, pulmonary physiology, anesthesia drugs (the muscle relaxants have their own section on the AKT 0/1), "boring" stuff like equipment. Your peers won't know what a line isolation monitor is or what microshock thresholds are. Things like knowing how many liters are in a full O2 tank are things that you can't reason out on the test. But if you know the facts, they're easy points.

Is there a book that covers most of the above topics necessary for AKT-0/1? Baby Miller vs. M/M vs. something else?

 

[psychbender]

Is there a book that covers most of the above topics necessary for AKT-0/1? Baby Miller vs. M/M vs. something else?

Either of those should prove sufficient to do well on the AKT 0/1. I only read the pharmacology chapters in M&M in the last weeks of intern year, and scored above 95th percentile on both of those (the 1 is the exact same test as the 0). Basic pharmacology and machine facts make up the bulk of the exam.

 

[jennyboo]

Is there a book that covers most of the above topics necessary for AKT-0/1? Baby Miller vs. M/M vs. something else?

Any of the following (pick one and stick with it, reading it periodically throughout your residency and making sure you cover every topic a couple of times):

Baby Miller

Lange (M&M)

Faust

Big Blue

Baby Miller and Lange are both textbook-like and pretty wordy, but the figures in Baby Miller especially are very good for exams. I personally found the outline format of Big Blue to be fast to read and fairly comprehensive, but some people are annoyed by the style. Faust is easy to read in small chunks throughout residency, but it may be a little annoying to study from for the written boards.

For questions, many people also use Hall & Chantigian. These questions are difficult and not like the format of the real questions, but if you go through all the topics in the book you will cover all your bases. For people who want to read something else and then practice truer exam-like questions, you can simply go online to the ABA website and download the (free) released in-training exams.

 

[sunnyINphilly]

Here's my advice: don't go into anesthesia - it sucks. Don't believe me? Save this post and refer to it 10 years from now.

I understand your concern, but this is not the thread for it. I'm wondering how I am going to survive my internship year; I've already crossed the bridge of making my decision to go into this field and there is no looking back.

BTW, regarding the general pessimism about where the field is going, please consider the fact that you are talking to the future leaders in anesthesiology. We have worked our asses off to become game-changers in this field and we will not let it slip from under our grip.

So my advice? YOU can save THIS post and refer to it 10 years from now.

 

[OB1🤙]

I understand your concern, but this is not the thread for it. I'm wondering how I am going to survive my internship year; I've already crossed the bridge of making my decision to go into this field and there is no looking back.

BTW, regarding the general pessimism about where the field is going, please consider the fact that you are talking to the future leaders in anesthesiology. We have worked our asses off to become game-changers in this field and we will not let it slip from under our grip.

So my advice? YOU can save THIS post and refer to it 10 years from now.

Well played.

 

[Gimlet]

I understand your concern, but this is not the thread for it. I'm wondering how I am going to survive my internship year; I've already crossed the bridge of making my decision to go into this field and there is no looking back.

BTW, regarding the general pessimism about where the field is going, please consider the fact that you are talking to the future leaders in anesthesiology. We have worked our asses off to become game-changers in this field and we will not let it slip from under our grip.

So my advice? YOU can save THIS post and refer to it 10 years from now.

Great post, love your attitude. 👍

I would advocate for CA-0's to become intimately familiar with the political challenges of the specialty, and make sure to donate to the ASAPAC. Learn to be the best physician you can be so you represent the specialty well within the hospital as a perioperative specialist and expert in caring for critically ill patients.

 

[Doctor4Life1769]

I understand your concern, but this is not the thread for it. I'm wondering how I am going to survive my internship year; I've already crossed the bridge of making my decision to go into this field and there is no looking back.

BTW, regarding the general pessimism about where the field is going, please consider the fact that you are talking to the future leaders in anesthesiology. We have worked our asses off to become game-changers in this field and we will not let it slip from under our grip.

So my advice? YOU can save THIS post and refer to it 10 years from now.

👍👍

 

[Doctor4Life1769]

Any of the following (pick one and stick with it, reading it periodically throughout your residency and making sure you cover every topic a couple of times):

Baby Miller

Lange (M&M)

Faust

Big Blue

Baby Miller and Lange are both textbook-like and pretty wordy, but the figures in Baby Miller especially are very good for exams. I personally found the outline format of Big Blue to be fast to read and fairly comprehensive, but some people are annoyed by the style. Faust is easy to read in small chunks throughout residency, but it may be a little annoying to study from for the written boards.

For questions, many people also use Hall & Chantigian. These questions are difficult and not like the format of the real questions, but if you go through all the topics in the book you will cover all your bases. For people who want to read something else and then practice truer exam-like questions, you can simply go online to the ABA website and download the (free) released in-training exams.

Very helpful post, both you and psychbender. 👍👍

 

[Narcotized]

Some people here will argue that it's stupid to prepare for these tests.

My point isn't that it is stupid to prepare for these tests, but that if you make a dedicated effort to learn anesthesia by way of a legitimate text over the course of time between tests (ie, not big crap blue crammed a few weeks before the test), then you have prepared and will do well without any last minute shortcuts and gimmicks, and what you will have learned will stay with you longer than 5 minutes after the test is finished.

When you've got a 95 on the AKTs and ITEs and screw something up, it'll be perceived as an off day. When you've got a 25, the same mistake will be perceived as just another stupid thing a stupid resident did.

Very true; except beware the jerk attending that finds his way into every hospital at every program. This is the guy who up to one day before your 95th percentile result is back is saying "you aren't reading enough," and then one day after the test results are back is saying "those tests don't mean anything anyway."

I got a 20-something %-ile on my AKT1. I got a 99 on the AKT6.

That is some serious improvement.

 

[Consigliere]

I understand your concern, but this is not the thread for it. I'm wondering how I am going to survive my internship year; I've already crossed the bridge of making my decision to go into this field and there is no looking back.

BTW, regarding the general pessimism about where the field is going, please consider the fact that you are talking to the future leaders in anesthesiology. We have worked our asses off to become game-changers in this field and we will not let it slip from under our grip.

So my advice? YOU can save THIS post and refer to it 10 years from now.

Yeah, ok I will. When you are working for some mega AMC or for a CRNA, I'll laugh at your idealism.