Anesthesia Rotations advice for a med student

[Ron Mexico]

Hello everyone. I know this forum is for more experienced users but I couldn't find anything about this on the clinical rotation sub-forum. Anyway, I am interested in Anesthesiology and I have my elective next month...I was wondering what to expect and what resources I should look into. Thank you.

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[RussianJoo]

resources should be remembering physio and pharm and read parts of baby miller or usually they'll provide a packet for you to read.

as for the rotation it should be pretty chill, get there in the am, help residents set up their OR, go talk to the patient in holding, evaluate their airway, if they let you fill some forms out do it, once in the OR be proactive, help the patient to the table,move the stretcher out of the room, place the bp cuff, pulse ox, ekg leads on the pt, help draw up meds if they let you, pay attention to what the attending/residents are doing, watch the monitors, ask questions, ask to do procedures like starting IV's, intubating, maybe A-lines. You'll get the swing of things in the first couple of days, just be proactive and try to keep things moving, try not to wait for people to tell you what to do and just do them yourself (this is tough at first).. also relax and know that a lot of times attendings/residents just want to shoot the sht and tell the people that you're working with that you want to go into anesthesia.

and most importantly have fun!

 

[yasha83]

Personally, my preference was to read Morgan&Mikhail daily, and have pharm and physio texts handy for reference when need be. A pocket anesthesia resource is handy during the day when you don't want to lug around anything unwieldy, especially when a resident is busy during a case and then needs to spend a significant amount of time to catch up on charting, etc. I used Handbook of Anesthesiology, by Ezekiel. What RJ said above is pretty much the lay of the land. I would suggest game-planning your day. Pay attention to the main board, once you're familiar with residents and attendings a little, you will know which ones teach more. Certain types of cases lend themselves more to didactics and hands-on exposure for students, once you're aware of the complexities and intra-op flow of particular surgeries you will be able to pick out specific cases that allow more opportunities for serious didactics and other cases that are more conducive for you getting your hands dirty with tubes and lines (elective lap-whatevers on ASA 1 or 2 type-patients). Some places take the strategy out of it by assigning you cases that are beneficial for a student to see. Above all, being personable, respectful and enthusiastic and PREPARED for intra-op discussions will take you a long way.

GL and enjoy! Those rotations are a blast!

 

[cfdavid]

I never really liked baby Miller too much. Not detailed enough, even for a med student. I did like Anesthesia Secrets as I found it has a wealth of good info relative to my knowledge base at the time. M&M would be good, but you only have so much time.... Depends on how fast a reader you are.

Try to get a fair number of IV starts in. Usually there's at least one friendly nurse (or a couple) who's job it is to start IV's, and you may need to take initiative, as nobody will (generally) hold your hand to make sure you get some procedures in. You'll find that the residents are busy. Also, mid-morning may be a better time for that as things tend to settle down a bit by that time versus 6-7 a.m.

If you can, try to get an arterial line in, but a MICU rotation may be better for that given that the patients are often have altered mental status and/or are sedated etc. That was my experience anyway, but art lines are fun.

For intubations, confidence is KEY. (fake it if you're not...) Try on a simulator or "dummy" first and get used to the anatomy. Check out Youtube vids even. Remember, when you do the real deal, the attending and resident will be there (in July the CA1's will want to do that stuff so spend some time with more senior residents perhaps) and they need to feel at least semi-confident that you're not going to traumatize the patient.....

***The best way (IMHO) to get good at art lines is to FIRST do as many ABG draws as possible. Often, an ICU or general medicine rotation will provide ample opportunities for that as well, but again, you'll need to be proactive.

So, enough of the procedures. ****Don't be a "tube jockey". Stay with the residents from start to finish and ask questions when appropriate during the case. If you don't understand why they are giving a certain drug, simply ask (you know this). But, if you don't ask, you won't learn as much.


Ask how you can help. Some residents will delegate and others will want to really micromanage themselves. So, just be flexible.
Good luck, it'll be a good rotation.


cf

 

[pjl]

I think the biggest thing to remember is that you are going to be bored out of your mind. Watching somebody perform anesthesia is more boring than watching soccer. Performing anesthesia is a different matter entirely.
As far as being prepared goes, just try to pay attention and read a little bit. Asking questions is nice, see if you can find a resident who likes to talk, it will make the time go faster and you will learn a lot.

As far as what to read, I think the baby miller book would be a good start, just read a chapter a day, and discuss it the next. The secrets book is a different format if textbooks aren't your thing. Or. see what they are recommending for the CA1s that are new, and try to follow along.

Unfortunately, July is a hard month to get a lot of procedures because of all the new residents. After about a month or two I didnt care at all about a lines and intubations. After my cardiac rotation I dont feel a strong desire to do central lines either, so I would imagine there are other similar residents out there that are CA2/3s you could try to hook up with. The CA1s will likely all be too busy trying to figure out how to give an anesthetic without killing someone to be all that helpful for you. Just remember that if they seem less than helpful, or very stressed out. You may get involved with all of their introductory teaching which would be a great way to learn a lot in a short amount of time.

That was a lot of rambling, sorry.

 

[Voodoo]

The few students I interact with fill out evaluations. The ones that are successful AND indicate that they had a positive experience all share the following:

1) They all show up promptly, and have evaluated the patients prior to the resident and attending seeing the patient.

2) They all maintain the attitude that no job is too small for them. After demonstrating some degree of humility and affability, they will be given larger roles.

3) While that "boring charting" is being performed, use your time wisely. Ask questions at the appropriate times, read about cases the night before to help direct questions, and PREOP THE NEXT PATIENT. Just because the resident is stuck in the case doesn't mean that you have to be or that that resident won't apprectiate you bird dogging the next case.

4) Smile and have a positive attitude.

You will notice I didn't include particular names of text books. There are a vast array of texts, all of which have their strengths (and weaknesses). As a medical student, you will gain more for a proactive attitude than a wealth of knowledge (although the latter doesn't hurt).

Hope this helps.