Anesthesia Rotation: How can I be useful?

[Josh1]

Hey all,

Starting my Anesthesia rotation soon...just have a question: what can I do to be useful for the attendings and residents? What is the busy work that I can look up to make your lives easier and hopefully my letter of recommendation better? e.g. in surgery I would find the follow up appointments, fill out the surgery note etc. I obviously could only hold retractors and close sometimes so they appreciated that I did what I could do. What can I do on anesthesia?

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[OB1🤙]

Unlike in most other fields, there's really nothing you can do to facilitate the workflow for the residents and attendings.

I give students who will be in my room the following advice:

1) Know the patient. Know their comorbidities, and how they came to need the surgery they will be getting.

2) Know what the procedure will be. You don't need to be able to recite the steps of a Whipple, but have a general idea of what the surgical problem is and what the fix will entail.

If you know these things, I can teach you how we will tailor the anesthetic to this specific patient having this specific procedure.

For those intending to match into anesthesia, I add 3) do some reading from a basic text, Baby Miller or the like, regarding the anesthesia for the procedure being done, and be prepared for some good-natured pimping.

So to be useful, you need to just be aware of what's going on around you, participate when you're asked to, stand out of the way when you're asked to, and come to the OR with an intelligent list of topics to discuss. There's nothing substantial you can physically do to help out, unfortunately.

 

[Lightwand]

Arrive early enough to help your resident set up the room. Even if you can only draw up two sticks of propofol in the time it takes them to get the rest of the room set up, it's a help and shows that you are interested. Few things bother me more than when a med student/off-service resident rolls up right when we're preoxygenating and thinks I'm going to let them have the airway.

Learn to help put monitors on, you can do this while someone else preoxygenates.

You can help to set up for the next case during the prior case- make syringes, get ETT styletted and cuff tested, check laryngoscope blades, make IV start kits.

Help to make sure there's an O2 tank on the bed for transport to the PACU.

Run to the pharmacy to pick up extra drugs.

Help to move the patient to the OR table and then back to the stretcher.

Most importantly, be observant and realize when you can be involved and when you need to step back. I once had a med student pimping me on the difference between a mac and a miller blade in the middle of an unanticipated difficult intubation. Clearly, not the best time/situation to be asking questions.

Be interested, be involved, be willing to learn and accept feedback and you will do fine.

Most of us are pretty easy to get along with 😉

 

[kazuma]

I agree with the post above. There are a few little things you can do to help out. Know where you can find supplies like bags of NS or LR, blankets, tubing, etc. If you see that the fluids are running low and the resident is busy, you can offer to change them out. When the pt is rolled back to the PACU, you can make yourself useful and grab a warm blanket for the pt, or help the nurses connect the monitors to the pt. After a day or two you will get a feel of what your role will be and the key is to be as helpful as possible, but not get in the way.

 

[El Dooderino]

honestly just act interested and get as much face time with one attending as possible so you can get a good letter. Have some baseline knowledge from reading secrets or something before the rotation. Changing some resident's LR bag isn't that important

 

[OB1🤙]

You can help to set up for the next case during the prior case- make syringes, get ETT styletted and cuff tested, check laryngoscope blades, make IV start kits.

This may be my own pathology more than anything else, but I would never let or ask the med student to draw up meds. It's too important and too easily f'ed up. Except for maybe propofol. But then I'd think they somehow managed to draw up intralipid... (No, no I wouldn't. At least, probably not.).

Same goes for checking the blade- I'll just want to check it again myself. And rebend the ETT the way I like it.

There are probably little ditzel things here and there you can help with, but has been emphasized by all posters- be interested and come prepared.

 

[amyl]

i agree, label the syringes but don't draw anything up.... no offense is meant by it guys -- but i want to draw up the drugs, check the machine and blade... its my a-- on the line, you will understand some day 🙂

 

[Doctor4Life1769]

yeah, agree with amyl. although, while rotating thru the program, some residents did have me do the machine check... man did i hope i didn't eff it up.

 

[deleted245139]

Had one rotation in anesthesia in Aug and LOVED it -
-From my experience, the more interested I was, and the more willing I was to step out of my comfort zone, the more my attending let me do. I started with easy intubations on older individuals with upper/lower dentures and just observing. By the end, I had floated 6 Swan-Ganz catheters myself, started numerous IV's , and intubated nearly 80 people, among other many procedures.
-Ask questions, but ask pertinent and intelligent questions - don't ask something for the sake of opening your mouth.
-Ask if you can help, and be understanding when someone says no.
-Silence is ok... no need to talk constantly.
-be willing to ask for help.
-be willing to say "i don't know" ...and ALWAYS follow that up with the drive to look up what you didn't know later on..
-be interested!

Like I said, just one rotation, but I loved every moment of it and it is the only rotation I have missed so far. I don't know if these are all universal things, but doing this resulted in two really amazing letters of Rec. GL on the rotation!

 

[Lightwand]

Fair enough. I usually pull out all the vials of drugs I need to draw up from my cassette and then hand the student the propofol vial, and the prelabeled syringe. In the time it takes them to draw up the one or two vials of propofol, I've done a majority of the setup.
I always check my own blades, but it's a good habit for everyone to get into. If you think you're going to take a try at the airway, you should check the blade.
I always do my own machine check.

 

[PMPMD]

I would volunteer to do the (paper) charting when I was a med student. Not sure how many progs still use this though.

 

[loveumms]

Leave when told, "you can go home". Take a break when told, "you can go get coffee ... have a nice long break". Sometimes as a primary, you just need to breath and think - alone.

 

[Josh1]

Thanks for the feedback. Well my first day the resident layed out the syringes by the vials and told me to draw up the drugs which I thought was good practice, you'd have to be quite the student to mess up drawing a syringe that's right next to a bottle, the West Coast has always been known to be a little more freewheeling and looks like our residents are too!

 

[kazuma]

Leave when told, "you can go home". Take a break when told, "you can go get coffee ... have a nice long break". Sometimes as a primary, you just need to breath and think - alone.

This is a good point. You don't want to wear out your welcome.

 

[Frank Rizzo]

Leave when told, "you can go home". Take a break when told, "you can go get coffee ... have a nice long break". Sometimes as a primary, you just need to breath and think - alone.

This is very true, at least in my group... large community hospital group ACT model. We do not have any residents, but do get a couple of medstudents a month. If I tell you that you can go home, or go to lunch, I mean it. ITS NOT A TEST.