Feb 18, 2010
26
0
0
Status
Hi,

I'm starting my anesthesiology sub-I next week and I was wondering if anyone can offer me any pointers on how to make a good impression? What do you feel is within the relm of a medical student? Also is there any book that might be good? I was debating buying the baby Miller off of a friend, but I wasn't sure how much it would help. Also is there any particular subject I should brush up on?

Thanks!
 

fakin' the funk

ASA Member
10+ Year Member
Aug 23, 2004
2,699
553
281
Status
Attending Physician
I'm starting my anesthesiology sub-I next week and I was wondering if anyone can offer me any pointers on how to make a good impression? What do you feel is within the relm of a medical student? Also is there any book that might be good? I was debating buying the baby Miller off of a friend, but I wasn't sure how much it would help. Also is there any particular subject I should brush up on?
Baby Miller would help...but so would Anesthesia Secrets and so would the CCS Handbook of Anesthesiology, which are cheaper, easier to read, and more likely to help you in a practical sense.

Plan to be proactive and energetic. Ideally, each afternoon/evening you're matched up with the resident for tomorrow, so you can read about the cases and page him/her to touch base.Get there just a little bit before him/her, help them set up the room, IV's, airway stuff, and meds in a supervised fashion.

As, or if, they get comfortable with you, you will get more responsibility and freedom with the morning setup. See the first patient first, do as complete an preoperative evaluation as you can in the time you have, and try to get the IV started.

Once in the room, ideally you are doing a lot, or most, of the monitors and airway setup prior to induction. This of course also depends greatly on the attending. Ideally you are mask-ventilating during induction and having the first DL, changing the fresh gas flows, and helping things get settled down before incision.

During the bulk of the case is teaching time for your resident to probe your knowledge base and teach you more setup stuff -- and to hopefully get face time with the attending to chat, learn, get pimped, etc. You should be actively helping the resident, or doing the majority of emergence/extubation activities. Rinse and repeat!

I had a great sub-I experience and, when paired with trusting and responsible CA-3's, was doing 95% of the actual manual activities during a bunch of cases, all the time discussing management and basic science. It's enough to get you hooked on anesthesiology!
 

paintstick

Paintstick
10+ Year Member
Mar 4, 2005
36
0
241
Status
Medical Student
here are some things that I found helpful....

Depending on how your sub-I is structured it is likely that you will be doing different "rotations" within your month (if your clerkship director is allowing you to shape your rotation this is something I highly recommend). When I did mine I started off doing general cases for 1 week, then moved on to Cardiac for 1 week, then split OB/Neuro for 1 week and finished on Peds. By doing things in "rotations" it allows you to really read on a subject and be more of a rockstar in the resident/attendings eyes for that one week.

For example, Take your "cardiac" week, it does not really matter if it is an LVAD, emergent dissection, or valve replacement if you read about the cardio physio/pharm/concepts of off-pump (you get the idea) you will have a strong foundation for that week. That is not the say these cases are the same and there not important differences to know about, but you at least gain a frame of reference for a short period of time allowing you to excel on your rotation.

My second piece of advice is just try to be useful. Offer to draw up drugs, pump the blood for transfusions, offer to run back to the supply/pharmacy to get whatever drug the resident needs, if it is time to check the urine output crawl under that table and go a fishing. These are the the little things that keep you involved in the case and help make you a good partner to the resident as opposed to just being a warm body in the room.

I agree with the above post, Miller is way too much and even with the best intentions you most likely will not get through enough to really help you out. I LOVED Secrets, it is a great book that is very easy to pick up great tips/concepts.

Finally, if possible do a small (and I do mean small) bit of reading for the surgeries themselves of what you will be covering. There are a ton of procedures out there and it is important to have a baseline idea of what is going on on the other side of the curtain. This is NOT to say memorize the anatomy and procedure itself, however having a general sense of what is going on for some of the neuro/cardiac/thoracic cases will help you understand why you need to place invasive monitor X, or pay special attention to parameter Y.

All in all, 1) show up early 2) Be friendly to EVERYONE 3) read what you can without going crazy 4) find ways to be "useful" 5) HAVE FUN. It is a great month, you are going to be surrounding by interesting, smart and nice people and taking care of a myriad of really sick people ENJOY!!!!
 

Jeep23Guy

Texan
7+ Year Member
Aug 10, 2009
51
0
141
Status
Resident [Any Field]
I agree with the above.

1) Always get there earlier than the person you are working with. It's nice to have the room pretty much set up when they arrive (and remember MS MAIDS). Also, stay late. Help out with other cases if you can.
2) Read a little. Know about the drugs you're going to use. Know the stuff on the monitors.
3) Be proactive. Ask if you can do the a-line or IJ. All they can do is say no. On a side note, know how to do the procedures. If you've never done them, read about it and know the steps. Doing the intubations is a given.
4) Help out when you can. My away sub-I I worked most closely with residents. They were the ones that told attendings how I was doing (only really saw attendings at induction, a couple times during the case, and at the end of the case for extubation). Offer to help out with preops. If they get to go home 30 minutes earlier because you helped them crank out their preops, they will like you even more. Offer to help in any way...take your abgs personally to get them done quicker.
5) Be yourself. In an anesthesia sub-I, you may have a bit of "down time". It's not exactly down time because you're caring for a patient, but you'll have a lot of time to interact with the resident/attending. It really helps your cause if you can carry on a conversation.

I know there are a lot more things that you can do, but I see these as most important. I think the theme for your rotation should be your willingness to work your butt off. Good luck!
 

RussianJoo

Useless Member
10+ Year Member
Jun 7, 2004
2,231
41
261
Rock City
Status
Fellow [Any Field]
in addition to all that I also found it helpful to be up on current literature. I had and still have a student ASA membership and get monthly anesthesiolgy journal deliveries. a lot of times they'll have articles in them about a technique or drug that you'll use in the OR, and you can always bring up that article if it's relevant and then maybe have a discussion about weather it was a good study or not. Also you don't need to know every drug in the book just the ones that you'll use in the OR, so take a look at the pre-printed labels or sneak a peak at the meds in the pyxis and read up on them, chances are they'll pimp you only on what they're using. be friendly introduce yourself to everyone ask if you can help or once you get to know the attending/residents a little just be proactice and things without being told what to do.

and most importantly don't forget to have fun! I loved my anesthesia months..