Anesthesia not what I expected..

[preDoGuy24]

---

Members don't see this ad.

Long time lurker first time posting, I am a 3rd year student on my 1st anesthesia rotation and it...blows. This pisses me off. I really enjoy physiology, pharmacology and procedures so I thought anesthesia would be a good fit. I am at a smaller branch hospital of a big health system (my rotation at the academic center was dropped) anesthesia is done by all crnas,with 3-4 total anesthesiologists supervising (usually 1-2 here a day). There is a crna program here so most of the time the docs spend teaching them, they get intubations, ivs, etc..I do a pretty solid job observing though! I follow the docs mostly which is sometimes nice when they teach, but a lot of it has been more along the lines of explaining stuff to me that I have had down since 1st year and or telling me I'm too early in third year to get anything out of an anesthesia rotation, I've been given an anesthesia basics book with reading assignments to complete before the rotation ends so I guess I have that going for me.
Now here are my questions..

Is this really how anesthesia is in the community? "Supervising" 4 rooms of crnas? I realize this hospitals acuity is low, but I think I would rather kill myself then work a job like that, especially with how the crnas treat me as a med student, I don't see most of them respecting the difference In training.

Should I do another rotation in anesthesia? This was supposed to be my elective that showed me if it was for me (ive had ortho, and radiology is coming up) needless to say it is doing a ****(y job in showing if anesthesia is for me. I love the OR, enjoyed Ortho, did not like gen surg/vascular and from shadowing anesthesia thought I would enjoy it as well..

Any suggestions for getting more out of this rotation?

I am frustrated because I have loved reading this forum, probably my favorite on SDN, it sucks to be so disappointed in a field I thought would be awesome going into this rotation. I think I would be a competitive guy to match well in anesthesia (249 step 1) I am just very disheartenned about even doing another rotation in it at this point. It's frustrating as a third year you have to make big career decisions based on your narrow clinical experiences.


sorry that was a bible length post, thanks for the advice

 

[countingdays]

Long time lurker first time posting, I am a 3rd year student on my 1st anesthesia rotation and it...blows. This pisses me off. I really enjoy physiology, pharmacology and procedures so I thought anesthesia would be a good fit. I am at a smaller branch hospital of a big health system (my rotation at the academic center was dropped) anesthesia is done by all crnas,with 3-4 total anesthesiologists supervising (usually 1-2 here a day). There is a crna program here so most of the time the docs spend teaching them, they get intubations, ivs, etc..I do a pretty solid job observing though! I follow the docs mostly which is sometimes nice when they teach, but a lot of it has been more along the lines of explaining stuff to me that I have had down since 1st year and or telling me I'm too early in third year to get anything out of an anesthesia rotation, I've been given an anesthesia basics book with reading assignments to complete before the rotation ends so I guess I have that going for me.
Now here are my questions..

Is this really how anesthesia is in the community? "Supervising" 4 rooms of crnas? I realize this hospitals acuity is low, but I think I would rather kill myself then work a job like that, especially with how the crnas treat me as a med student, I don't see most of them respecting the difference In training.

Should I do another rotation in anesthesia? This was supposed to be my elective that showed me if it was for me (ive had ortho, and radiology is coming up) needless to say it is doing a ****(y job in showing if anesthesia is for me. I love the OR, enjoyed Ortho, did not like gen surg/vascular and from shadowing anesthesia thought I would enjoy it as well..

Any suggestions for getting more out of this rotation?

I am frustrated because I have loved reading this forum, probably my favorite on SDN, it sucks to be so disappointed in a field I thought would be awesome going into this rotation. I think I would be a competitive guy to match well in anesthesia (249 step 1) I am just very disheartenned about even doing another rotation in it at this point. It's frustrating as a third year you have to make big career decisions based on your narrow clinical experiences.


sorry that was a bible length post, thanks for the advice

Sounds like you are making the right decision for the wrong reason, but you've still landed on the right decision- not to do anesthesia, so just go with it.

 

[AnesDiva]

Long time lurker first time posting, I am a 3rd year student on my 1st anesthesia rotation and it...blows. This pisses me off. I really enjoy physiology, pharmacology and procedures so I thought anesthesia would be a good fit. I am at a smaller branch hospital of a big health system (my rotation at the academic center was dropped) anesthesia is done by all crnas,with 3-4 total anesthesiologists supervising (usually 1-2 here a day). There is a crna program here so most of the time the docs spend teaching them, they get intubations, ivs, etc..I do a pretty solid job observing though! I follow the docs mostly which is sometimes nice when they teach, but a lot of it has been more along the lines of explaining stuff to me that I have had down since 1st year and or telling me I'm too early in third year to get anything out of an anesthesia rotation, I've been given an anesthesia basics book with reading assignments to complete before the rotation ends so I guess I have that going for me.
Now here are my questions..

Is this really how anesthesia is in the community? "Supervising" 4 rooms of crnas? I realize this hospitals acuity is low, but I think I would rather kill myself then work a job like that, especially with how the crnas treat me as a med student, I don't see most of them respecting the difference In training.

Should I do another rotation in anesthesia? This was supposed to be my elective that showed me if it was for me (ive had ortho, and radiology is coming up) needless to say it is doing a ****(y job in showing if anesthesia is for me. I love the OR, enjoyed Ortho, did not like gen surg/vascular and from shadowing anesthesia thought I would enjoy it as well..

Any suggestions for getting more out of this rotation?

I am frustrated because I have loved reading this forum, probably my favorite on SDN, it sucks to be so disappointed in a field I thought would be awesome going into this rotation. I think I would be a competitive guy to match well in anesthesia (249 step 1) I am just very disheartenned about even doing another rotation in it at this point. It's frustrating as a third year you have to make big career decisions based on your narrow clinical experiences.


sorry that was a bible length post, thanks for the advice

[Disclosure: I'm just an M4]

Like many fields, anesthesia is practiced in many ways. Just as not all pediatricians do well-child checks all day, not all anesthesiologists supervise multiple rooms with bread and butter surgeries all day. Some orthopods do outpatient hands 5 days a week for 20+ years. Some general orthopods out there do it all! Some neurosurgeons dont operate on the brain. Some radiologists only read mammo... you get the picture.

I was at a conference recently and attended a session with 20 attending anesthesiologists, some academic and some not. Each has an incredibly different practice! One pedi/critical care/pedi heart surgery anesthesiologist (obvs super academic), one person that just does outpatient dental anesthesia (he flies 100% solo at this facility... so sounds "easier" but he had some horror stories .... back up for him = think harder....it's just him!), one doc who does mostly hearts at a small community hospital, a few that mostly supervise CRNAs, a few intensivists, and more.

I am going into anesthesiology and I am an adrenaline junkie/control freak. I like how anesthesia requires both earnest preparation/forethought and comfort with extemporaneous/impromptu critical medicine on critical patients. The aspects of periop medicine that I'm attracted to may be more concentrated in academia -- but that is a vast generalization I think. Critical care, surgical care of truly sick patients, complex surgeries (hearts, transplant etc), pedi anesthesia, and regional anesthesia all offer challenges that you may find enjoyable.

So I would not rule out anesthesia yet. You've just seen one flavor. Is there a way for you to get a different type of experience?

 

[Idiopathic]

this sounds like an unfortunate setup for a medical student to do an anesthesia rotation. the MD/DOs are likely too busy to engage in the kind of teaching that you want, and there is probably a premium on throughput. even with supervision and what you perceive as a "lack of respect" (remember it doesn't come with the letters, it has to be earned), it can be a rewarding and challenging job that many people enjoy.

 

[Surfer]

That's what you get at DO school. Sorry. Yes, it's different at a real school. You're way too early in your rotations to be doing electives. Sounds like this point in your third year that's all you've done? That's bad education my friend.

Long time lurker first time posting, I am a 3rd year student on my 1st anesthesia rotation and it...blows. This pisses me off. I really enjoy physiology, pharmacology and procedures so I thought anesthesia would be a good fit. I am at a smaller branch hospital of a big health system (my rotation at the academic center was dropped) anesthesia is done by all crnas,with 3-4 total anesthesiologists supervising (usually 1-2 here a day). There is a crna program here so most of the time the docs spend teaching them, they get intubations, ivs, etc..I do a pretty solid job observing though! I follow the docs mostly which is sometimes nice when they teach, but a lot of it has been more along the lines of explaining stuff to me that I have had down since 1st year and or telling me I'm too early in third year to get anything out of an anesthesia rotation, I've been given an anesthesia basics book with reading assignments to complete before the rotation ends so I guess I have that going for me.
Now here are my questions..

Is this really how anesthesia is in the community? "Supervising" 4 rooms of crnas? I realize this hospitals acuity is low, but I think I would rather kill myself then work a job like that, especially with how the crnas treat me as a med student, I don't see most of them respecting the difference In training.

Should I do another rotation in anesthesia? This was supposed to be my elective that showed me if it was for me (ive had ortho, and radiology is coming up) needless to say it is doing a ****(y job in showing if anesthesia is for me. I love the OR, enjoyed Ortho, did not like gen surg/vascular and from shadowing anesthesia thought I would enjoy it as well..

Any suggestions for getting more out of this rotation?

I am frustrated because I have loved reading this forum, probably my favorite on SDN, it sucks to be so disappointed in a field I thought would be awesome going into this rotation. I think I would be a competitive guy to match well in anesthesia (249 step 1) I am just very disheartenned about even doing another rotation in it at this point. It's frustrating as a third year you have to make big career decisions based on your narrow clinical experiences.


sorry that was a bible length post, thanks for the advice

 

[preDoGuy24]

That's what you get at DO school. Sorry. Yes, it's different at a real school. You're way too early in your rotations to be doing electives. Sounds like this point in your third year that's all you've done? That's bad education my friend.

I wouldn't say it was the fault of my (fake?) school (except for the fact DO schools aren't at large academic centers) I got hosed on a rotation I had set up at a bigger center months in advance, I as a third year have three months of surgery (2general + 1 ortho) and family medicine going into this rotation, so I would say I am as or more familiar with the OR as any other 3rd year BUT I have not done IM, gyn, peds etc...which sucks in some ways. Yes I do agree having front loaded electives as a third year really screws you, but these aren't the things you know to look Into as an applicant.

 

[preDoGuy24]

[Disclosure: I'm just an M4]

Like many fields, anesthesia is practiced in many ways. Just as not all pediatricians do well-child checks all day, not all anesthesiologists supervise multiple rooms with bread and butter surgeries all day. Some orthopods do outpatient hands 5 days a week for 20+ years. Some general orthopods out there do it all! Some neurosurgeons dont operate on the brain. Some radiologists only read mammo... you get the picture.

I was at a conference recently and attended a session with 20 attending anesthesiologists, some academic and some not. Each has an incredibly different practice! One pedi/critical care/pedi heart surgery anesthesiologist (obvs super academic), one person that just does outpatient dental anesthesia (he flies 100% solo at this facility... so sounds "easier" but he had some horror stories .... back up for him = think harder....it's just him!), one doc who does mostly hearts at a small community hospital, a few that mostly supervise CRNAs, a few intensivists, and more.

I am going into anesthesiology and I am an adrenaline junkie/control freak. I like how anesthesia requires both earnest preparation/forethought and comfort with extemporaneous/impromptu critical medicine on critical patients. The aspects of periop medicine that I'm attracted to may be more concentrated in academia -- but that is a vast generalization I think. Critical care, surgical care of truly sick patients, complex surgeries (hearts, transplant etc), pedi anesthesia, and regional anesthesia all offer challenges that you may find enjoyable.

So I would not rule out anesthesia yet. You've just seen one flavor. Is there a way for you to get a different type of experience?

Solid post, thank you. You are talking about all the things that had me interested in the field, unfortunately I don't think I'll be able to do any other rotations until 4th year, so definitely have some big decisions to make.

 

[Consigliere]

I'm glad you got this exposure. Most jobs currently are supervising. In the very near future (5-10 years) that's all there will be. AND you'll be an employee of the hospital or an AMC. Anesthesiology sucks and it's getting worse. Consider yourself lucky that you are seeing this before it's too late. Pick another speciality - you won't regret it.

 

[Biochemist21]

I wouldn't say it was the fault of my (fake?) school (except for the fact DO schools aren't at large academic centers) I got hosed on a rotation I had set up at a bigger center months in advance, I as a third year have three months of surgery (2general + 1 ortho) and family medicine going into this rotation, so I would say I am as or more familiar with the OR as any other 3rd year BUT I have not done IM, gyn, peds etc...which sucks in some ways. Yes I do agree having front loaded electives as a third year really screws you, but these aren't the things you know to look Into as an applicant.

I agree AnesDiva's advice. Medicine is a gigantic field; so big you can barely grasp its depth or complexity as a medical student (I'm an M4). Even amongst anesthesiologists there is a huge variety of practice, and subspecialization will only become more common in the future. I applaud your effort to jump feet-first into your interests as an M3, but as you mention above, you've barely scraped the surface of third year. What's done is done with your rotation schedule. At this juncture your number one priority should be to see and do the most that you possibly can during your third year in every rotation.

Long time lurker first time posting, I am a 3rd year student on my 1st anesthesia rotation and it...blows. This pisses me off. I really enjoy physiology, pharmacology and procedures so I thought anesthesia would be a good fit. I am at a smaller branch hospital of a big health system (my rotation at the academic center was dropped) anesthesia is done by all crnas,with 3-4 total anesthesiologists supervising (usually 1-2 here a day).

Should I do another rotation in anesthesia? I love the OR, enjoyed Ortho, did not like gen surg/vascular and from shadowing anesthesia thought I would enjoy it as well..

Any suggestions for getting more out of this rotation?

it sucks to be so disappointed in a field I thought would be awesome going into this rotation. I am just very disheartenned about even doing another rotation in it at this point. It's frustrating as a third year you have to make big career decisions based on your narrow clinical experiences.

(I paraphrased your initial post)
I'm sorry that you've had such a poor experience, made worse by your high expectations entering into the rotation. Again, I think you should take some solace in AnesDiva's post (as well as posts from the Anesthesia attendings on here), knowing that your experience is by no means the rule. You can get the maximum out of this rotation by being as involved as possible, making yourself visible at all times (without getting in the way), and always be willing to stay late if it means a chance for one-on-one time with an attending. I think it's fair to revisit Anesthesia and do another rotation your fourth year, just plan things early so you can get a spot at a large academic center.

SIDENOTE: you say that you're a first-time poster (not sure where your other 200+ posts came from), so just a word of caution about your language. Obscenities don't bother me in the slightest, but keep in mind that people, particularly those who don't know you, might take you more seriously if you avoided them.

 

[foodle]

Your experience sounds like the exact opposite of my anesthesia elective. I lost count of the number of IVs put in, lines started, and intubations . Tons of hands-on work (obviously under supervised conditions). This was in a large hospital system, end of 3rd year, MD school.

It sounds like you're hampered in part by location, and in part by this being the start of your 3rd year, and they probably don't trust you to do very much, since you haven't been through your core rotations.

Also remember that you can use anesthesiology as a stepping stone to positions in critical care or other sub-specialties.

As for salary, CRNAs, and the future of anesthesiology, you have to decide for yourself what things about your future career will matter most to you.

 

[preDoGuy24]

I agree AnesDiva's advice. Medicine is a gigantic field; so big you can barely grasp its depth or complexity as a medical student (I'm an M4). Even amongst anesthesiologists there is a huge variety of practice, and subspecialization will only become more common in the future. I applaud your effort to jump feet-first into your interests as an M3, but as you mention above, you've barely scraped the surface of third year. What's done is done with your rotation schedule. At this juncture your number one priority should be to see and do the most that you possibly can during your third year in every rotation.



(I paraphrased your initial post)
I'm sorry that you've had such a poor experience, made worse by your high expectations entering into the rotation. Again, I think you should take some solace in AnesDiva's post (as well as posts from the Anesthesia attendings on here), knowing that your experience is by no means the rule. You can get the maximum out of this rotation by being as involved as possible, making yourself visible at all times (without getting in the way), and always be willing to stay late if it means a chance for one-on-one time with an attending. I think it's fair to revisit Anesthesia and do another rotation your fourth year, just plan things early so you can get a spot at a large academic center.

SIDENOTE: you say that you're a first-time poster (not sure where your other 200+ posts came from), so just a word of caution about your language. Obscenities don't bother me in the slightest, but keep in mind that people, particularly those who don't know you, might take you more seriously if you avoided them.

Thanks for the post, solid advice. Yeah I only meant it was my first time posting a thread on this forum. I mostly lurk and read about the awesome clinical threads on here. I've spent the last three months doing surgery, so my language is probably a little more locker room then classroom right now.

I think overall I just ended up in a worst possible rotation for someone interested in anesthesia, crna training program so most of them ignore me as a med student and teach there own students, while the attendings are too busy/advise me not to go into anesthesia. Hopefully I can make a better experience for myself-staying later won't really work, I leave when the last case is done everyday and quite a while after all the crnas/srnas have left for the night, frustrating when you tell multiple attendings you're interested, you try to be engaged and ask questions and nothing really changes.

 

[preDoGuy24]

Your experience sounds like the exact opposite of my anesthesia elective. I lost count of the number of IVs put in, lines started, and intubations . Tons of hands-on work (obviously under supervised conditions). This was in a large hospital system, end of 3rd year, MD school.

It sounds like you're hampered in part by location, and in part by this being the start of your 3rd year, and they probably don't trust you to do very much, since you haven't been through your core rotations.

Also remember that you can use anesthesiology as a stepping stone to positions in critical care or other sub-specialties.

As for salary, CRNAs, and the future of anesthesiology, you have to decide for yourself what things about your future career will matter most to you.

The size of the system isn't really the issue, the hospital system is one of the largest in the state, it's just the way the practice is run, I think it's kind of silly not to trust me for procedures based on not having done ob,peds,IM-students dont typically intubate/do lines on those services. I think at a minimum I know now that Anesthesia isn't for me if it entails a practice like the one I'm currently at-i know there are lots of different interesting fields and subspecialtys, I have shadowed some awesome anesthesiologists that got me interested in the field, it just sucks to rotate and have the experience I am having.

 

[IlDestriero]

Anesthesia's not for everyone.
There are all kinds of practices, from 4:1 supervising at low acuity or ambulatory centers to high acuity specialty hospitals to doing your own cardiac cases. If you like the field look further, if not then focus on other things.
It's a long time till you retire, so find something you love.

 

[WholeLottaGame7]

The size of the system isn't really the issue, the hospital system is one of the largest in the state, it's just the way the practice is run, I think it's kind of silly not to trust me for procedures based on not having done ob,peds,IM-students dont typically intubate/do lines on those services. I think at a minimum I know now that Anesthesia isn't for me if it entails a practice like the one I'm currently at-i know there are lots of different interesting fields and subspecialtys, I have shadowed some awesome anesthesiologists that got me interested in the field, it just sucks to rotate and have the experience I am having.

It sounds like you have an issue with the specific environment you are in and not the field in general. It sounds like that if you were with attendings that let you do stuff and taught you things and you weren't farmed out to CRNAs, you would be loving it.

 

[Mman]

Sorry you had a bad experience on your rotation, but that sounds like it had far more to do with the location of the rotation than anything about anesthesia in particular.

And don't knock supervising rooms. I get to run around putting in epidurals, spinals, central lines, arterial lines, and peripheral nerve blocks all day long for 4 rooms all while also trying to come up with ways to keep really sick people alive during big procedures. Do I have time to teach much to a med student that would be following me? Not really. But I'm also doing a lot more than somebody doing their own cases.


To each their own. Some people like to be hands on with 1 case at a time from start to finish. For me, I enjoy the constant action of always being on the move and not having down time. Makes time fly.


As for your career choices, try to envision what life would be like to actually be the attending in various jobs and not what you see as a "lowly" med student getting crapped on by people.

 

[scudrunner]

Your rotation sucks. Do a good one before you decide. Anesthesia ROCKS.

 

[Consigliere]

Sorry you had a bad experience on your rotation, but that sounds like it had far more to do with the location of the rotation than anything about anesthesia in particular.

And don't knock supervising rooms. I get to run around putting in epidurals, spinals, central lines, arterial lines, and peripheral nerve blocks all day long for 4 rooms all while also trying to come up with ways to keep really sick people alive during big procedures. Do I have time to teach much to a med student that would be following me? Not really. But I'm also doing a lot more than somebody doing their own cases.


To each their own. Some people like to be hands on with 1 case at a time from start to finish. For me, I enjoy the constant action of always being on the move and not having down time. Makes time fly.


As for your career choices, try to envision what life would be like to actually be the attending in various jobs and not what you see as a "lowly" med student getting crapped on by people.

It saddens me that you have died and gone to hell. Nice knowing ya'....

 

[chocomorsel]

It saddens me that you have died and gone to hell. Nice knowing ya'....

Hilarious. Cracked me up.

 

[Mman]

It saddens me that you have died and gone to hell. Nice knowing ya'....

I'm pretty sure I have more fun at work than 99.99% of the US population. Doesn't get any better. I get to be a rockstar several times each hour every day I'm at work and nearly 12 weeks off each year keeps me sane.

 

[pgg]

It saddens me that you have died and gone to hell. Nice knowing ya'....

Funny, but different people want different things out of work. What Mman does sounds pretty enjoyable to me, and he's probably making a killing doing it. (Though who knows if that'll be true in 10 or 15 years.)

 

[Mman]

Funny, but different people want different things out of work. What Mman does sounds pretty enjoyable to me, and he's probably making a killing doing it. (Though who knows if that'll be true in 10 or 15 years.)

Different strokes for different folks. I'd probably claw my eyeballs out turning the vaporizer up or down a click in the middle of the 3rd lap chole of the day or spiking another bag of fluid for that 4-6 hour whipple.

 

[norwood]

OP has a point - if you're supervising, you normally won't be intubating unless you're demonstrating something, handling a bizarre airway with an awake fiberoptic, or bailing out a CRNA. IVs are often done before you get there, and your average pt in the community hospital won't need a central line or an A-line. Of course, there's higher acuity work, which entails more procedures, and there are individual places where there's more for you to do as the anesthesiologist.

But IMHO, if your primary goal is to be working with your hands, you should be considering either surgery or a procedure-oriented specialty (GI, interventional cards, IR, etc). Those guys spend way more time during the average work day working with their hands than we do.

 

[kazuma]

That's what you get at DO school. Sorry. Yes, it's different at a real school. You're way too early in your rotations to be doing electives. Sounds like this point in your third year that's all you've done? That's bad education my friend.

Funny you say this as I hadn't ever met an SRNA until I did a rotation at an MD program vs running my own cases as a 3rd year medical student under the watch of my attending at my DO program. In hindsight I'd never trade my DO clinical rotations for those at my current allopathic institution. I quite frequently feel bad for the students here. Sometimes I'll take the poor OB or surgery student under my wing and teach him/her something before they resume their post in the OR corner looking at the backs of surgical gowns. Unfortunately the experiences people have can vary wildly. And I agree, that sucks they put the OP in that type of situation.

I'd do another rotation if you can, anesthesiology is a pretty cool field and I can't imagine myself doing anything else.

 

[BobBarker]

Funny you say this as I hadn't ever met an SRNA until I did a rotation at an MD program vs running my own cases as a 3rd year medical student under the watch of my attending at my DO program. In hindsight I'd never trade my DO clinical rotations for those at my current allopathic institution. I quite frequently feel bad for the students here. Sometimes I'll take the poor OB or surgery student under my wing and teach him/her something before they resume their post in the OR corner looking at the backs of surgical gowns. Unfortunately the experiences people have can vary wildly. And I agree, that sucks they put the OP in that type of situation.

I'd do another rotation if you can, anesthesiology is a pretty cool field and I can't imagine myself doing anything else.

I concur with you completely. Our experiences have been very similar. I learned how to be an anesthesiologist from my DO preceptor as a 3rd year student, not in my residency.

 

[countingdays]

OP has a point - if you're supervising, you normally won't be intubating unless you're demonstrating something, handling a bizarre airway with an awake fiberoptic, or bailing out a CRNA. IVs are often done before you get there, and your average pt in the community hospital won't need a central line or an A-line. Of course, there's higher acuity work, which entails more procedures, and there are individual places where there's more for you to do as the anesthesiologist.

But IMHO, if your primary goal is to be working with your hands, you should be considering either surgery or a procedure-oriented specialty (GI, interventional cards, IR, etc). Those guys spend way more time during the average work day working with their hands than we do.

What the OP doesn't realize is that once you've mastered the skills, you won't care about doing iv's, lines, blocks, etc. As a student that stuff is exciting. As an attending it is just work. I'm perfectly happy doing ivs the nurses can't get or tubes the crnas miss, but it's not like it's exciting.

 

[kazuma]

I concur with you completely. Our experiences have been very similar. I learned how to be an anesthesiologist from my DO preceptor as a 3rd year student, not in my residency.

Right? I still remember tips and tricks of the trade that were taught to me by my DO and MD preceptors during 3rd year. Perhaps that's why I it didn't seem so scary when my attendings cut me loose a few days into July CA-1 year.