CA-1 year stress

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MAC10

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Im a Catergorical PGY-1 at my 4yr program and while I am close to all the other PGY1s I dont really know the upper levels that well. So I was waiting for the elevator yesterday and briefly chattting with one of the CA-1s. I was telling him how much this year blows (not in those words..) and how much I couldnt wait for June/July when we transition into Anesthesia. He then starts telling me that it only gets MORE stressful being a CA-1.. :confused: This is not the first time a CA-1 has told me this..Ive also heard..yeah your hours will be less but you will be in the OR all that time :confused: .. isnt that a good thing? I mean it cant be worse than rounding on medicine all day? can it? I didnt want to pin him down in the elevator but Im curious.. What exactly makes CA-1 so stressful? Is it being slow at lines, intubations etc and having staff, surgeons upset at you, is it getting used to being in OR all day???? Anyone....

Just want to be at least mentally prepared
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MAC10 said:
Im a Catergorical PGY-1 at my 4yr program and while I am close to all the other PGY1s I dont really know the upper levels that well. So I was waiting for the elevator yesterday and briefly chattting with one of the CA-1s. I was telling him how much this year blows (not in those words..) and how much I couldnt wait for June/July when we transition into Anesthesia. He then starts telling me that it only gets MORE stressful being a CA-1.. :confused: This is not the first time a CA-1 has told me this..Ive also heard..yeah your hours will be less but you will be in the OR all that time :confused: .. isnt that a good thing? I mean it cant be worse than rounding on medicine all day? can it? I didnt want to pin him down in the elevator but Im curious.. What exactly makes CA-1 so stressful? Is it being slow at lines, intubations etc and having staff, surgeons upset at you, is it getting used to being in OR all day???? Anyone....

Just want to be at least mentally prepared
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Dude you're in for a rude awakening. CA-1 is so much harder than the MED SCHOOL anesthesia rotations. I remember those days when I used to go from room to room like an intubating machine with no worries in the world. Then you step into the OR as a CA-1 and you see the production pressures of a super busy academic OR. You're accountable for everything and by the second month, you're in the room by yourself 90% of the time. Unlike the newbie surgery resident who always has an attending standing by, you have to deal with the surgeon and the nurses all on your own. I met a CA-1 last week ,who dropped out of a Harvard Gen. Surgery residency after 3 years, who told me that he thought anesthesia was going to be easy. But, in fact, anesthesia was much more difficult for him to learn to adjust to.

It gets better CA-2 though.

For those of you who played or tried out for high school football. Remember HELL WEEK in early summer? Well... you'll have HELL WEEK times twenty come JULY. :smuggrin: :smuggrin:
 
drfeelgood said:
It gets better CA-2 though.
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i sure hope so. i'm in the 4th month of my ca-1 and it's been so stressful and exhausting. one often feels like a chicken with its head cut off. everything is rushed and hurried. it never feels like there is enough time to set up the room, do the h+p/consent, get drugs between cases. when there are delays, anesthesia seems to always get the blame.

however, i do enjoy it more than the other fields of medicine that i have done residencies in.

on another topic, some of the more senior residents and i were discussing the fallacy of aneshthesia being a "lifestyle field". i'm not sure where that perception come from, but the attendings in my program work really hard and take quite a bit of overnight call.
 
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Pinky said:
i sure hope so. i'm in the 4th month of my ca-1 and it's been so stressful and exhausting. one often feels like a chicken with its head cut off. everything is rushed and hurried. it never feels like there is enough time to set up the room, do the h+p/consent, get drugs between cases. when there are delays, anesthesia seems to always get the blame.

however, i do enjoy it more than the other fields of medicine that i have done residencies in.

on another topic, some of the more senior residents and i were discussing the fallacy of aneshthesia being a "lifestyle field". i'm not sure where that perception come from, but the attendings in my program work really hard and take quite a bit of overnight call.
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Attendings....that is academic not private, thus the difference,,,,duh :laugh: :eek: :smuggrin:
 
drfeelgood said:
Then you step into the OR as a CA-1 and you see the production pressures of a super busy academic OR. You're accountable for everything and by the second month, you're in the room by yourself 90% of the time...
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Wow! You mean your attending has this much confidence in you this early on?
 
Its not about confidence as it is about getting the work done. Residency is about work and thats the end of it. If anybody tells you otherwise, they are lying to you. I am ready to roll up my sleeves and get to work once July hits. Doing 3-4 cases a day all by yourself will definitely put some hair on your chest by the end of your CA1 year. It will give you a new appreciation for life (you know the same BS that academic centers keep feeding the residents/students that "it is good for you"). Sad truth is, each of us has different levels of comfort in doing cases and to make everyone go at the fastest speed possible will leave many of us disillusioned. Welcome to residency.

P.S. this is only temporary (atleast thats what I tell myself to cope with it). good things will come down the road after residency. Since you have waited this long, whats another 3 years of hell. Atleast you will be doing something that will help you towards your career in the future.
 
The CA-1's I talked to during my rotations at Sinai and NYU said their CA-1 year was tough, but way easier than intern year. I hope this is true at Columbia too. I've had a stressful past few days and this thread is NOT helping my attitude.
 
The stress of CA1 year is very real, but it definately gets better as you go. The beginning is a bit overwhelming as you struggle with everything being so new. New drugs you've never used, new OR's you've never worked in, new grouchy surgeons, new procedures you may have never done (well) and new clinical situations you've never had to manage. Also, just the mechanics of drawing drugs, setting up lines, infusion pumps, machine checks can lead to feeling like you're a squeaky MSIII again.

That being said, it gets better....takes some time, but you will feel more comfortable on your side of the curtain. The OR is a scarey place but I really think that you need to maintain a certain degree of fear in order to remain vigilant. You won't know everything and you're not expected to be able to manage everything alone. Just know when to call for help and have confidence that you can stave off disaster until some more people come cruising in.

For me, one of the more difficult things to adjust to as a CA1 is working alone so much. In the OR, the surgeons have their team, the nurses have their team and you stand alone representing anesthesia by yourself. Quite a big switch from MSIII, MSIV and PGY1 years where everything is team-based with some down time during the day to shoot the breeze about whatever. At times it can get a little lonely in the OR so it's important to touch base with your anesthesia colleagues frequently. Be social.

CA1 is a tough year, but I can't see myself doing anything else. We were all drawn to anesthesia for a reason and that's because it's sweet, so don't live in fear/dread of the start of CA1. We will all make it through and it's a pretty fun ride anyway.

:)
 
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Pinky said:
i sure hope so. i'm in the 4th month of my ca-1 and it's been so stressful and exhausting. one often feels like a chicken with its head cut off. everything is rushed and hurried. it never feels like there is enough time to set up the room, do the h+p/consent, get drugs between cases. when there are delays, anesthesia seems to always get the blame.

however, i do enjoy it more than the other fields of medicine that i have done residencies in.

on another topic, some of the more senior residents and i were discussing the fallacy of aneshthesia being a "lifestyle field". i'm not sure where that perception come from, but the attendings in my program work really hard and take quite a bit of overnight call.[/QUOT

Hi Pinky,

I sent you a personal message.

CambieMD
Click to expand...
 
As a Ca-1 I have been very happy so far! Yes there are days when you work hard but its a FAR FAR cry from the pains of a surgical intership. If you dont work hard in residency and learn all you can in residency you wont be a good anesthesiologist. People who did cush medical and transitional internships often find it harder as a CA-1 in terms of time demands and exhaustion.

life cant be perfect

the goal is : work hard and play hard!!!!!!!!!!!!!!
 
Is it better to be fired from Ca-1 Anesthesiology or quit. My daughter is going through a very very rough time in this residency. No one is born an anesthesiologist, but her program probably expected that. Everyone learns at their own speed but if the whole program makes up their mind that so and so is bad and incompetent and do not give her a chance to learn . It becomes a self fulfilling prophecy. She is being watched and being told how terrible she is. Can anyone learn in that environment? I also read something about Pygmalion on this board. This is happening to her. Please advice. There is a risk that she may--- . She is an extremely hard worker, very respectful ,punctual and a polite polite even to the janitors. She is being put under the microscope and daily briefings are being given about her to the PD. She has not done anything good at all and everything bad. They did fire another person of her faith last year. What are her options. Please advice.
 
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Not compaining. Asking for advice.
 
Was just a general advice statement not directed at you. Another piece of advice don't be so defensive.
 
Sorry ohman I wasn't referring to you didn't realize how old this post was. I was saying something about the original posters. Didn't even see your post about your daughter. My apologies
 
sit back, relax, and enjoy ca-1 year.

the learning curve is steep, yes. But it's not an impossible climb.

aknowledge the fact that you know very little and have a great deal of progress to make. it's ok to miss procedures or make mistakes. it's ok to look clumsy drawing up drugs. it's ok if everybody is waiting on your for your room to be ready. there are a MILLION little tasks and skills to learn as a ca-1. (don't worry though you could teach a monkey to do most of them). clumsiness, mistakes, slow room turnover...it's expected....early on at least.

honestly, i could write a book on all the stupid things my co-residents and I did as ca-1's. from putting on the bairhugger upside down, to letting prbc's go into the LR bag, to putting in an arrow aline without the catheter portion, to accidentally taking off my mask in the heart room, to spraying propofol all over myself trying to draw it up, to trying to find the femoral vein lateral to the artery, to putting on the ekg leads backwards....the stories i've heard and been a part of are endless.... open up to your fellow ca-1's and share your embarrassing stories or personal stress. nobody is perfect. you will be surprised to hear that they have all done things to look stupid and feel over stressed. learn from each other's mistakes and be open. it'll build comradarie.

the stupid mistakes will be overlooked if you......

ask a million questions. seek advice. read daily. show initiative. be humble. try to get better at one or two things every day. ask your seniors and attendings daily where you could have done better. be a hard worker and team player. go the extra mile.

most of the mundane workflow tasks, nursing skills, and advanced procedural techniques will just come with time and practice. if you fail, don't get down, just examine where things went wrong. think about your efficiency and technique and how you can improve. believe that you will get better.

most importantly, don't get wrapped up in all the small nursing skills, details of workflow, ect and miss the big picture of PERIOPERATIVE MEDICINE. know your patients comorbities and how they relate to the surgical procedure and how they shape your anesthetic plan. focus just as much on the medicine considerations as you do perfecting your aline skills. be a DOCTOR.

accept and embrace the challenge and your outlook will change and your stress level will decrease.
 
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Have her talk to her program director. Anesthesia probably isn't for her.... Ask them to help her obtain a spot in another specialty... My program did this for people all the time
 
vegas said:
Wow! You mean your attending has this much confidence in you this early on?
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I think this is an overlooked portion of the residency search. Some programs baby their residents so much that they're not on their own till a long ways down the line. There's a fine balance between too little supervision and negligence, but at my program I was left on my own starting in July and have already been extubating some patients on my own since last month.

It's always interesting to hear about these big name programs that can't trust their residents alone till they're finishing CA-1 year.


To the OP, CA-1 year is nothing like intern year. Intern year you have a ton of free time, no matter how busy you are. You can always get up and go to the bathroom or squeeze in a coffee break. There's a lot more production pressure on you as a CA-1 and the dynamics of the OR don't give you much time to take a breath. Hours might be less, but 24 hour call and rapid turnover can leave you physically exhausted.
 
ohman said:
Is it better to be fired from Ca-1 Anesthesiology or quit. My daughter is going through a very very rough time in this residency. No one is born an anesthesiologist, but her program probably expected that. Everyone learns at their own speed but if the whole program makes up their mind that so and so is bad and incompetent and do not give her a chance to learn . It becomes a self fulfilling prophecy. She is being watched and being told how terrible she is. Can anyone learn in that environment? I also read something about Pygmalion on this board. This is happening to her. Please advice. There is a risk that she may--- . She is an extremely hard worker, very respectful ,punctual and a polite polite even to the janitors. She is being put under the microscope and daily briefings are being given about her to the PD. She has not done anything good at all and everything bad. They did fire another person of her faith last year. What are her options. Please advice.
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First, don't necrobump 10 year old threads. Most of the replies are to people who haven't logged in to SDN in years. It's ok to start new threads.

There's a lot in your post:

1) It's your daughter's life and career, not yours. She needs to handle this.

2) Are you alleging or suspicious of religious discrimination? She needs to handle that, with a lawyer.

3) "There is a risk she may--" ... what? Hurt herself? Hurt someone else? I don't know what this means, but it sounds ominous. Someone outside this message board needs to handle that.

4) While you're being a good, positive, supporting parent, consider the possibility that she may in fact actually be failing. You're totally unqualified to judge the truth or falsehood of the criticisms she's received. Anesthesia is a tough field for some people, has nothing to do with intelligence or effort, they just struggle with the flow and multitasking and situational awareness needed in the OR. That doesn't mean they can't excel in another specialty.

5) Any direct involvement you attempt to have in her professional life will be harmful. There's a pattern to what happens when parents get personally involved in their adult child's professional lives, and it's universally bad.
 
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image.jpeg
pgg said:
5) Any direct involvement you attempt to have in her professional life will be harmful. There's a pattern to what happens when parents get personally involved in their adult child's professional lives, and it's universally bad.
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What you talking about?
 
ohman said:
Is it better to be fired from Ca-1 Anesthesiology or quit. My daughter is going through a very very rough time in this residency. No one is born an anesthesiologist, but her program probably expected that. Everyone learns at their own speed but if the whole program makes up their mind that so and so is bad and incompetent and do not give her a chance to learn . It becomes a self fulfilling prophecy. She is being watched and being told how terrible she is. Can anyone learn in that environment? I also read something about Pygmalion on this board. This is happening to her. Please advice. There is a risk that she may--- . She is an extremely hard worker, very respectful ,punctual and a polite polite even to the janitors. She is being put under the microscope and daily briefings are being given about her to the PD. She has not done anything good at all and everything bad. They did fire another person of her faith last year. What are her options. Please advice.
Click to expand...

Probably better to resign than be fired, though neither is good, obviously. You are right, it is a self-fulfilling prophecy in many ways, in that people who are struggling are put under the microscope, which can cause them to struggle even more.

BUT, it is still early in CA-1 year. We had several residents who got off to rocky starts who were able to turn it around. She needs to take the criticism she is receiving to heart and figure out what she can do to improve. A lot of times the criticism can be very superficial and stylistic, but I am sure there are good and important suggestions in there, as well. Part of being a successful resident is playing the game: learning the stupid stuff to keep the attending happy while also learning the important stuff to keep the patient safe.

That said, it could be that anesthesia is the wrong field. There is no shame in that. It is super hard to know if anesthesia is right for you after a month of medical school rotation, because it is not representative at all. And most people I know who left went on to successful careers in other fields (usually medicine).

As for the other stuf.... "There is a risk that she may--- ." Agree with pgg, don't know what this means but it sounds bad and probably needs to be addressed promptly by professionals. Also not sure what faith has to do with the equation unless you think she is being targeted, in which case that should also be addressed by professionals (lawyers, in this case).
 
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