anesthesiology away rotation

[sbp111]

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Hey,

I am a M3 interested in anesthesiology trying to set up my 4th year schedule. My school does not have an anesthesiology residency but we have an anesthesiology elective with the private practice group that services the hospital. I have already signed up for that rotation early in my 4th year. My question is do I need to do an away rotation at an institution that has a residency program? Or should I just do another anesthesiology rotation at a different local hospital? Another option would be to do a rotation at the local VA which does have a residency program. I appreciate the help

 

[mybubbles627]

I don't know for sure cause I am also a student, but I would assume a letter from a school with a residency program would be very helpful to be able to get a LOR from the PD or other faculty in the field to apply. Are you applying to MD or DO programs? I was under the impression all MD schools had a residency program but I guess that was an incorrect assumption.

 

[AGenericUserName]

Hey,

I am a M3 interested in anesthesiology trying to set up my 4th year schedule. My school does not have an anesthesiology residency but we have an anesthesiology elective with the private practice group that services the hospital. I have already signed up for that rotation early in my 4th year. My question is do I need to do an away rotation at an institution that has a residency program? Or should I just do another anesthesiology rotation at a different local hospital? Another option would be to do a rotation at the local VA which does have a residency program. I appreciate the help

I would do an away to get a letter or prove interest in a program you like. As long as you do some anesthesia rotation before apps go out you should be okay as it will show you have a reason to be interested in anesthesia. If you can get 2 good letters from your home institution rotation then you don't need an away but an away probably would help boost an average or less app. If you are a baller then whatever.

 

[Wolverines83]

Just be careful. If you are the kind of person that absolutely smokes rotations, then do it at a place you want to go....maybe. If you're not, I wouldn't risk it. Anesthesia is a specialty where it's hard to impress the attendings because it's different from the preclinical work. You're more likely to make an impression roughly equivalent to "oh yeah...I remember that student...he/she was fine I guess." If you have really good grades/boards/etc I especially wouldn't risk it by doing a potentially damaging rotation at the place you want to go.

I think the whole away rotation concept is overblown. The math doesn't work out...students can't rotate at all the programs they apply to yet a lot of the time they match way down there list at a place they didn't rotate.

Anyway, good luck with whatever you decide!

 

[sbp111]

I did above average compared to the anesthesiology average step 1 score but I didn't get a crazy high score or anything. My school is a MD program. I wouldn't say I absolutely smoke rotations...So should I do it at a place I don't care too much about going? Just to get a letter from academic faculty? Or would letters from PP guys be fine? Also I think most programs require 3 rec letters. How many should be anesthesia letters?

 

[kazuma]

PP letters are fine in most cases however, my PD mentioned that he thinks PP letter's are usually quite a bit more generous in their assessment so he thinks academic letters are more credible. My argument is that PP guys are working with you one on one the entire day and get to know you better than an academic attending who may see you in passing or for a few brief moments throughout the day such as induction and sometimes emergence.


I used 2PP anesthesiologist letters and a letter from a PP surgeon. My letter writers were able to get to know me really well since we worked together everyday for a month. One interviewer asked me of the surgeon was a relative of mine because the letter was apparently well written and more detailed than letters he usually read.

During this past interview season I usually just skimmed or skipped letters entirely if they from chairs/PD's and some academic attendings. Frequently letters from these folks were just a regurgitation of a CV with a few comments that were pulled from resident evaluations.

Usually the best letters are from people that know you well whether PP or Academic.

 

[MikeMerk-MtS]

All else considered, a letter from a PD will be worth more than a letter from a PP anesthesiologist. However, a great letter from a PP will go a long way. I would do an away at a program you are interested in. I disagree with the part that "it is hard to impress the attendings." If you go out of your way to help out during the case and are easy to talk to, you will do great!

 

[BIGphysician]

I'm almost done with my first year of anesthesia. I highly recommend NOT doing an away rotation/audition rotation unless you have gotten honors on every other rotation and your personality is your legit only ticket. Too much at risk if someone doesn't like you for some random reason, whether you spending too much time in their room and they find you annoying, or your hair cut looks too sloppy, or you answer some random question wrong, etc etc. best situation is to just let your board scores do the talking for you and skip out on audition rotations and do an election where you work 2 days a week instead and enjoy your time when you can.

 

[projectpat]

This is surprising to hear. I was under the impression that to increase chances of receiving an interview from a program that doesn't usually give your students interviews then you need to do an away rotation there.

I was planning on doing 2 away rotations at my current top two choices: first is in my home state and heavily favored by local students and second is an out of region program that is traditionally tough to break into

 

[DrMaximus]

This is surprising to hear. I was under the impression that to increase chances of receiving an interview from a program that doesn't usually give your students interviews then you need to do an away rotation there.
I was planning on doing 2 away rotations at my current top two choices: first is in my home state and heavily favored by local students and second is an out of region program that is traditionally tough to break into

This was my impression as well. Now I'm nervous about the two auditions I'm currently trying to set up...

 

[Nivens]

I am also firmly in the "no away" camp, for reasons mentioned above.

 

[projectpat]

I'm almost done with my first year of anesthesia. I highly recommend NOT doing an away rotation/audition rotation unless you have gotten honors on every other rotation and your personality is your legit only ticket. Too much at risk if someone doesn't like you for some random reason, whether you spending too much time in their room and they find you annoying, or your hair cut looks too sloppy, or you answer some random question wrong, etc etc. best situation is to just let your board scores do the talking for you and skip out on audition rotations and do an election where you work 2 days a week instead and enjoy your time when you can.

Are you saying this because you've personally witnessed prospective applicants blow their chances due to something that happened during an away rotation or have you just 'heard' about bad things happening?

There's a lot of 'noise' / stories regarding school, applications, residency, etc and I'm just wondering if you've seen something happen or if it's just something you've heard and felt inclined to warn others about.

 

[BIGphysician]

Are you saying this because you've personally witnessed prospective applicants blow their chances due to something that happened during an away rotation or have you just 'heard' about bad things happening?

There's a lot of 'noise' / stories regarding school, applications, residency, etc and I'm just wondering if you've seen something happen or if it's just something you've heard and felt inclined to warn others about.

Personally happened to me, luckily not at a top choice, and I've seen the other side of it as well. Never spend too much time in the same residents room. It's annoying. You guys steal all our airways and we can't just sit back and relax because we have you there. All it takes is one little misstep and people will start rumors about you. Some female resident might be jealous of another female if they are too flirty or attractive, or if the resident is trying to impress faculty for a letter and seems too much like a "know it all."

As far as rotations in your home state for an interview, it's not relevant, they'll see that on ERAS when they filter it all. If not, just email the program director when you submit your ERAS.

Big risk, stressful balancing act, and not really worth it. Especially the opportunity cost- you could be having a vacation month especially with something else super easy.

 

[Nivens]

I happened to a friend of mine this year. He was super solid on paper, great boards (240+), research, grades- did an away at a certain program in NorCal (his first choice/where he's from). Didn't even get an interview. He's a nice guy, but def rubs some people the wrong way occasionally. Very little doubt in my mind he would have gotten an interview had he not done the away. We have almost identical apps and I got an interview at that program.

I agree there is a ton of noise, but in my program we had 6 anesthesiology applications match into Ivys, 18/18 match into their first choice, and not one person did an away. That would suggest it simply isn't necessary.

 

[emememem]

N=1, but my fiance is anesthesiology with very average boards and grades, and we're at a mid-to-low tier MD school. He did an away at a pretty big name program, did his best to be enthusiastic and helpful, and they really really liked him. They wrote him a fantastic letter and he ended up interviewing at Brigham, MGH, Hopkins, Northwestern, U Chicago, Vandy, and several other places that we were not expecting to get. He ended up matching at the program where he rotated. Definitely not disagreeing with the other posters since he didn't know anyone else who did an away, but for him it was a high-risk high-reward situation and it paid off in spades.

 

[Nivens]

The truth is, as is often the case with things like med school admissions, Step prep, and residency applications, there are multiple paths to the same place. Always be leery of people telling you there is only way way to approach these things (this is what annoys me about many Crossfitters: yes it works, no it is not the only way to get fit). An objective evaluation of you and and your application by an adviser well-versed in your goals, personality and abilities will be able to give you much more personalized advice.

 

[scutdoc]

I'm simplifying, and generalizing, so it won't be applicable to everyone. But at a bare minimum I'd want to consider the candidate and their targeted program. For example, if you're a strong candidate on paper, and your targeted program is mid-tier or lower, then an away rotation won't help and could hurt, so probably not worth the risk. If you're a weak candidate on paper, and your targeted program is a reach, but you're an affable and hard-working person, then it could be worth the risk and help. Etc.

 

[BobBarker]

We are a mid tier program. We have many students for away rotations. If you are a normal, likeable person it will help you. We assign the student to the same resident for multiple days in a row, then move them to a new resident. So you will have 3-4 residents that will have enough time to give you an honest evaluation. I believe we interview everybody that does an away. Most of our away rotators are DO students trying to get letters from academic faculty or get their foot in the door. It pays off for some of them every year when we end up matching them. I was one of those students way back when. It was more about developing relationships with the residents than the faculty.

 

[kortneeluv]

I would love some advice! I'm a DO student, the top 10% of my class, 240+boards, research/publications from undergrad but no real extracurriculars to mention from med school. I have 4 away rotations set up. Is this a good idea? After reading these posts I'm second guessing doing that many aways. I'm looking at programs in the southeast. I want to increase my chances of getting into my top institution, but then again I don't want to "shoot myself in the foot," so to speak.

 

[deleted87051]

I would love some advice! I'm a DO student, the top 10% of my class, 240+boards, research/publications from undergrad but no real extracurriculars to mention from med school. I have 4 away rotations set up. Is this a good idea? After reading these posts I'm second guessing doing that many aways. I'm looking at programs in the southeast. I want to increase my chances of getting into my top institution, but then again I don't want to "shoot myself in the foot," so to speak.

It's a matter of having faith in yourself. I hope you do.

 

[Ronin786]

As long as you're a sane person that's not a douche, an away rotation is a good idea. Be nice and helpful and know your spot on the totem pole. I got two great letters from attendings I worked with for only a few days (granted one of those was one I took call with). It probably depends on the place you're rotating at, but I definitely encourage them as long as you have any sort of good personality.

 

[kortneeluv]

As long as you're a sane person that's not a douche, an away rotation is a good idea. Be nice and helpful and know your spot on the totem pole. I got two great letters from attendings I worked with for only a few days (granted one of those was one I took call with). It probably depends on the place you're rotating at, but I definitely encourage them as long as you have any sort of good personality.

Thanks for the advice! I'm a southern gal so I can have a conversation with a tree lol. I definitely feel like my personality will get me far during an away. Just hearing posts on here about residents/attendings finding any reason not to like you is scary.

 

[Ronin786]

I got a great letter from my away rotation and got honors - then it was one of my first rejection emails from eras. I'm telling you, not worth doing an away rotation. Too many variables.

Well it's only beneficial if you're a decent candidate for that program in the first place. Not saying you were or weren't, but too many medical students will schedule aways at places that are far above their reach thinking it's a guaranteed interview or that they can do well enough to make up for poor board scores. That's not going to happen.

 

[BIGphysician]

Well it's only beneficial if you're a decent candidate for that program in the first place. Not saying you were or weren't, but too many medical students will schedule aways at places that are far above their reach thinking it's a guaranteed interview or that they can do well enough to make up for poor board scores. That's not going to happen.

Was a safety for me

 

[kortneeluv]

Was a safety for me

Maybe they knew viewed them as your safety by your scores being well above their averages? That makes no sense that you got a great evaluation and letter from them but they denied your eras.

 

[Ronin786]

Was a safety for me

Seems weird to me. That said, I wouldn't say it was a bad idea. You still managed to get a good letter from them.

 

[sbp111]

On another note I was wondering how many programs I should apply to. Would I be able to apply to all categorical programs and successfully match or is that too risky? If not, how many prelim/transitional programs should I apply to? My step 1 is above the anesthesiology average.

 

[Nivens]

On another note I was wondering how many programs I should apply to. Would I be able to apply to all categorical programs and successfully match or is that too risky? If not, how many prelim/transitional programs should I apply to? My step 1 is above the anesthesiology average.

Please understand how difficult of a question this is to answer knowing only that your "step 1 is above the anesthesiology average". Two different people could respond to you, one claiming you'll be 100% fine applying to only categorical and the other telling you you'd be insane to narrow your options down so much, and they both equally would be right based on the information you provided. I'm not trying to blow you off, but before others weigh in with opinions you need to recognize what you'll read on here will not be a personalized answer for your specific situation; rather it will reflect the poster's global philosophy regarding how to apply.

That being said, I will offer you how I approached this problem: applications are cheap, the cost of overestimating your competitiveness is high. I wrote in another thread about how I view the relationship between scores and tiers: scores and grades move you vertically through the tiers, however you choose to define them, and the intangibles such as personality, extracurriculars, leadership potential, etc, move you horizontally across the tier, giving you options at the level of desirability of program your scores qualify you for. I see the advanced positions at great programs as a "half-tier" lower than the categorical positions, because history shows us that categorical spots are more desirable for the average applicant. Therefore, I believe it's possible to compete for a position in an anesthesiology training program that is "above your level" in terms of scores if you are willing to apply for an advanced position. This exact situation happened to a close friend of mine- for her first choice she ranked the categorical positions #1 and the advanced #2. Had she applied to only categorical she would not have matched at her first choice program. The program she matched at has roughly 14C and 12A spots- had she only applied to the categoricals she would have been making it twice as competitive.

So in summary: based on the little (read: zero) information we have about you, I would tell you that unless you KNOW (these people usually know who they are because PDs at their home institutions tell them) you are the cream of the crop on paper, spend the little extra money and apply to advanced positions to ensure you have the best chance to match as high on your list as possible.

 

[sbp111]

Please understand how difficult of a question this is to answer knowing only that your "step 1 is above the anesthesiology average". Two different people could respond to you, one claiming you'll be 100% fine applying to only categorical and the other telling you you'd be insane to narrow your options down so much, and they both equally would be right based on the information you provided. I'm not trying to blow you off, but before others weigh in with opinions you need to recognize what you'll read on here will not be a personalized answer for your specific situation; rather it will reflect the poster's global philosophy regarding how to apply.

That being said, I will offer you how I approached this problem: applications are cheap, the cost of overestimating your competitiveness is high. I wrote in another thread about how I view the relationship between scores and tiers: scores and grades move you vertically through the tiers, however you choose to define them, and the intangibles such as personality, extracurriculars, leadership potential, etc, move you horizontally across the tier, giving you options at the level of desirability of program your scores qualify you for. I see the advanced positions at great programs as a "half-tier" lower than the categorical positions, because history shows us that categorical spots are more desirable for the average applicant. Therefore, I believe it's possible to compete for a position in an anesthesiology training program that is "above your level" in terms of scores if you are willing to apply for an advanced position. This exact situation happened to a close friend of mine- for her first choice she ranked the categorical positions #1 and the advanced #2. Had she applied to only categorical she would not have matched at her first choice program. The program she matched at has roughly 14C and 12A spots- had she only applied to the categoricals she would have been making it twice as competitive.

So in summary: based on the little (read: zero) information we have about you, I would tell you that unless you KNOW (these people usually know who they are because PDs at their home institutions tell them) you are the cream of the crop on paper, spend the little extra money and apply to advanced positions to ensure you have the best chance to match as high on your list as possible.

Ok I will apply to advanced positions as well. The anesthesiology step 1 average is 230 and my score is right around 240. How many programs and prelims would you recommend I apply to? Any suggestions for reputable programs I would be competitive for? I'm not sure how to gauge my competitiveness for a particular program as I do not know their average step scores. I looking at programs on mostly the East Coast but would like to try out some West coast programs as well

 

[sbp111]

anyone?

 

[Nivens]

You are numerically eligible for consideration at most programs as far as I can tell. BLADE has posted multiple times on this board detailed info on step scores and match rates at various programs in various tiers. My guess is you may be hit or miss as far as getting an interview at the "top" places (MGH, Stanford, BWH, Duke, UCSF to name just a few), but overall you seem to be in a good spot. If you want more specific guidance than that you need to seek out mentors at your program that can evaluate everything you bring to the table. I know you want a formula from us: ((applications) x (applications/interviews)) + .57(step score/GPA+letters of rec index) = matching at #1 choice. When I was in your shoes I did too, but believe me if we had a concrete way to answers these questions it wouldn't just be a sticky, it would be the damn title of the board itself.

 

[Turtlez]

You are numerically eligible for consideration at most programs as far as I can tell. BLADE has posted multiple times on this board detailed info on step scores and match rates at various programs in various tiers. My guess is you may be hit or miss as far as getting an interview at the "top" places (MGH, Stanford, BWH, Duke, UCSF to name just a few), but overall you seem to be in a good spot. If you want more specific guidance than that you need to seek out mentors at your program that can evaluate everything you bring to the table. I know you want a formula from us: ((applications) x (applications/interviews)) + .57(step score/GPA+letters of rec index) = matching at #1 choice. When I was in your shoes I did too, but believe me if we had a concrete way to answers these questions it wouldn't just be a sticky, it would be the damn title of the board itself.

Where do I find the stuff blade posted?

 

[sbp111]

The only problem is there is no residency program at my home institution. The rotation here is with a private practice group and most of the physicians are not very knowledgeable about what scores would make you competitive for certain programs and how many programs to apply to. Would someone please point us in the direction of the posts made by blade? Also again if someone could give a rough estimate of how many programs I should apply to with how many of them being safety programs for my particular step score. Again just looking for rough estimates as I am feeling a bit lost right now. I can give more info through PM if it would help. I am not really sure what would be considered a safety program for my score range and am concerned I'm applying to too many reach programs and may get into trouble.

 

[Nivens]

This isn't based on much, but I kind of like the "5, 5 and 5" approach. Pick 5 'reaches'- these are the big name programs that are crapshoots no matter who you are, because with all of the top applicants competing you may be able to say with some certainty you'll match at this level, it's much harder to say for sure at a specific program. This is important: I interviewed at many "top" places but only saw myself fitting in at a few. Second 5 are solid programs that are not the marquee names nationally. I'm not gonna open the pandora's box that is naming specific programs, but I tend to think about these as programs with extremely solid regional reputations but for reasons that are difficult to identify do not have big national or global stature. These may be programs that excell at a few things rather than everything, and you can tailor your list to fit your career goals as you currently see them. Picking programs in the third level is a bit of an art: this is all about finding the diamonds that maybe other people dont see, solid programs in less desirable places to live, programs where you have connections, etc.

The overall goal is something like 7 interviews, which if you follow the above plan should be attainable with your scores.

 

[Fajardo04]

I really don't understand all the hate about doing away rotations. My program (at which I did an away rotation and matched) always viewed those who rotated through with them more favorably than those who did not, everything else considered equal. Everybody I knew of who did an away rotation at least got an interview. Personally, I did 2 away rotations at my top 2 choices, and matched at the second choice school. Another away student in my group at my first choice school matched there. I've never heard of it hurting your chances as long as you play by the rules and don't act like a gunner/idiot. In fact I also remember one of the other programs I interviewed with discussing during the interview that if I really liked the program, they suggested doing an away rotation there prior to the match. I didn't like that program.

 

[BIGphysician]

I really don't understand all the hate about doing away rotations. My program (at which I did an away rotation and matched) always viewed those who rotated through with them more favorably than those who did not, everything else considered equal. Everybody I knew of who did an away rotation at least got an interview. Personally, I did 2 away rotations at my top 2 choices, and matched at the second choice school. Another away student in my group at my first choice school matched there. I've never heard of it hurting your chances as long as you play by the rules and don't act like a gunner/idiot. In fact I also remember one of the other programs I interviewed with discussing during the interview that if I really liked the program, they suggested doing an away rotation there prior to the match. I didn't like that program.

If you have the grades and scores, you don't need the away rotation and it can only hurt you. It's like getting a 260 on step 1 and then taking step 2 before applications go out, it can only hurt you. Be my guest though, go on the 30 day interview.

 

[sbp111]

This isn't based on much, but I kind of like the "5, 5 and 5" approach. Pick 5 'reaches'- these are the big name programs that are crapshoots no matter who you are, because with all of the top applicants competing you may be able to say with some certainty you'll match at this level, it's much harder to say for sure at a specific program. This is important: I interviewed at many "top" places but only saw myself fitting in at a few. Second 5 are solid programs that are not the marquee names nationally. I'm not gonna open the pandora's box that is naming specific programs, but I tend to think about these as programs with extremely solid regional reputations but for reasons that are difficult to identify do not have big national or global stature. These may be programs that excell at a few things rather than everything, and you can tailor your list to fit your career goals as you currently see them. Picking programs in the third level is a bit of an art: this is all about finding the diamonds that maybe other people dont see, solid programs in less desirable places to live, programs where you have connections, etc.

The overall goal is something like 7 interviews, which if you follow the above plan should be attainable with your scores.

Thanks for the reply. As far as prelim programs go, do you have any suggestions for approximately how many to apply to?

 

[Fajardo04]

If you have the grades and scores, you don't need the away rotation and it can only hurt you. It's like getting a 260 on step 1 and then taking step 2 before applications go out, it can only hurt you. Be my guest though, go on the 30 day interview.

That's assuming you have a 260 on step 1. If you've already hit the ceiling, you obviously have nowhere else to go but down. For the other 99% of people, there is still room for improvement, and many times away rotations can help you in that.

 

[Docuronium]

Moral of the story? Be prepared to be on a 30 day interview---doesn't mean don't be yourself (it's hard to be anyone else)---but should certainly treat it seriously. I know at my program rotating students get good exposure to residents and attendings and overall seem to do great, whether they end up here or elsewhere.

 

[vector2]

If you have the grades and scores, you don't need the away rotation and it can only hurt you. It's like getting a 260 on step 1 and then taking step 2 before applications go out, it can only hurt you. Be my guest though, go on the 30 day interview.

This is absolutely true. We've had a quite a few M4's rotating at my shop this month cause one of the local schools has a ridiculous number of people in their class wanting to do gas and jesus, some of these kids are just terrible in the OR. There is a delicate balance between being helpful/interested and knowing when to stand in the corner and shut the hell up. Most of these applicants have decent board scores and are fairly personable, but a lot of them would've been better served by just showing up on interview day. There was one guy this month who was nice enough, but over the course of the last two days of the rotation he (in a non-rushed situation) stabbed through a saline bag when trying to access the nipple, made it evident to everyone that he still hadn't learned what a 10cc flush was, went on and on about his propofol rat research during critical parts of the procedure, and then somehow magically cut himself when trying to empty the foley. Which part of his rotation do you think everyone is going to remember when he shows up to interview?

 

[Psai]

This is absolutely true. We've had a quite a few M4's rotating at my shop this month cause one of the local schools has a ridiculous number of people in their class wanting to do gas and jesus, some of these kids are just terrible in the OR. There is a delicate balance between being helpful/interested and knowing when to stand in the corner and shut the hell up. Most of these applicants have decent board scores and are fairly personable, but a lot of them would've been better served by just showing up on interview day. There was one guy this month who was nice enough, but over the course of the last two days of the rotation he (in a non-rushed situation) stabbed through a saline bag when trying to access the nipple, made it evident to everyone that he still hadn't learned what a 10cc flush was, went on and on about his propofol rat research during critical parts of the procedure, and then somehow magically cut himself when trying to empty the foley. Which part of his rotation do you think everyone is going to remember when he shows up to interview?

okay maybe i'm not totally hopeless then

 

[FollowTheMoney]

This is absolutely true. We've had a quite a few M4's rotating at my shop this month cause one of the local schools has a ridiculous number of people in their class wanting to do gas and jesus, some of these kids are just terrible in the OR. There is a delicate balance between being helpful/interested and knowing when to stand in the corner and shut the hell up. Most of these applicants have decent board scores and are fairly personable, but a lot of them would've been better served by just showing up on interview day. There was one guy this month who was nice enough, but over the course of the last two days of the rotation he (in a non-rushed situation) stabbed through a saline bag when trying to access the nipple, made it evident to everyone that he still hadn't learned what a 10cc flush was, went on and on about his propofol rat research during critical parts of the procedure, and then somehow magically cut himself when trying to empty the foley. Which part of his rotation do you think everyone is going to remember when he shows up to interview?

LMAO. Thank you for that entertainment.

 

[Temeraire]

There was one guy this month who was nice enough, but over the course of the last two days of the rotation he (in a non-rushed situation) stabbed through a saline bag when trying to access the nipple, made it evident to everyone that he still hadn't learned what a 10cc flush was, went on and on about his propofol rat research during critical parts of the procedure, and then somehow magically cut himself when trying to empty the foley.

Good lord, I'm really thankful one of my attendings at my local institution told me, "I'm making you do this stupid **** [like spiking IVs and pushing drugs] so you don't look like a tool on your away rotation."

<<Still terrified of looking like a tool.>>

 

[vector2]

Things that will make you stand out as a rotating MS:

1. Knowing what case is scheduled, the basic anesthetic plan for said case, and a little PMH about the patient (yes, there are students who will show up in the room at 7am and be like 'hey dude, what's going on in here, can I put the tube in?'. These students don't fare well.

2. Familiarizing yourself with where basic equipment is in the room. It only takes a few minutes of your time to go through the cart, anesthesia machine, and the pyxis and learn where basic **** is. Once you have this down, try to help when turning over or setting up a room (MS-MAIDS- machine, suction, monitors, airway, IV, drugs, stuff etc). Basic things which residents will value because they are time saving include knowing how to do a machine check, making syringes and pulling up meds, making a hot line, making an IV start kit, knowing what I mean when I say flip off the vent and open the pop-off etc.

3. Knowing when to talk/ask questions and knowing when to shut up. It's obvious to staff and residents when a student has a bunch of prepared questions from anesthesia secrets to which they already know the answers, and when they have a legitimate question. Spend some time looking at stoelting, jaffe, baby miller, anesthesia secrets to answer the easy stuff you're wondering and put some thought into asking actually thought-provoking questions which can't easily be looked up in two seconds. That's not to say you should be looking for stumpers just for the hell of it, but every now and then it's refreshing to get an insightful 'the answer should be so simple I can't believe I haven't asked that myself-type" question from a student. With that in mind, all questions about the 'art' of anesthesia (minute to minute titration of anesthetics/vapor, wakeups, intubation technique, line placement) are welcome if asked during appropriate times. As far as shutting up, do not talk when the surgeon or attending anesthesiologist is talking or giving instructions to staff in the room. Do not talk if your resident has his brow furrowed and is intensely watching the monitor/patient because something looks fishy. Do not talk during induction and extubation if a staff is helping a junior resident perform these and you're just watching. And if you're in a cardiac room and are observing, for god sakes, move out of the way and stand in a corner during placement of lines, going on pump, and coming off pump.

4. Volunteer for procedures. Especially with more junior residents who may or may not have their numbers yet, you may not get to do them, but you might not be offered the opportunity unless you ask. You will likely get many opportunities to intubate, but don't pout if the resident steals the IV, a-line, central line, epidural etc.

5. If you are required to present a keyword or other presentation, don't half-ass it. We see so many of these that it's obvious when someone has half-assed it. Try and do an outstanding job- it will be noticed by the med student director and the PD will hear about it if they're not in attendance.

6. If the resident says take a break or get out of here for the day, IT IS NOT A TEST. It is because A. I would prefer to be alone so I can conduct my anesthetic in peace, or B. I'm being nice and you should be prepping for happy hour by now you lucky-ass MS4

7. Bring baked goods to the resident lounge. Yes, if you are as unfortunate as the aforementioned chap above you may be remembered as the guy who cut himself emptying the foley, but at least the people who didn't hear about that mess will also remember you as guy who brought donuts from that one really good bakery downtown.