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CA3 in academic programs - do you feel competent and comfortable??

E'01

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    I just came back from an impressive community-based program interview yesterday. Practically all of the CA3 go into private practice but some do fellowships (esp peds at boston children's hospital). Because there are no fellows at this program and the program itself is very small (8 incoming PGY1/year) , the residents state that they get to do the hearts, transplants, etc and feel extremely comfortable with their skills and are ready to practice by the end of second year.

    I'm just curious as to whether the seniors on here at academic programs feel the same way or do they feel like they have to fight for complex cases. I'd really appreciate all input. Thanks!
     

    DRTHOR

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      I am at an acedemic program in Florida. I can tell you that I feel very comfortable doing any big case, liver, heart, peds, trauma,, neuro..you name it. As far as the smaller programs go, be careful that you don't get too much experience. Livers, hearts. etc. are nice to know how to do well, but they can also be very stressfull and labor intensive, in other words you don't want to do those every day. Somedays, you want bread and butter cases that you can read during.
       

      E'01

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        DRTHOR said:
        I am at an acedemic program in Florida. I can tell you that I feel very comfortable doing any big case, liver, heart, peds, trauma,, neuro..you name it. As far as the smaller programs go, be careful that you don't get too much experience. Livers, hearts. etc. are nice to know how to do well, but they can also be very stressfull and labor intensive, in other words you don't want to do those every day. Somedays, you want bread and butter cases that you can read during.

        That's reassuring to hear. Thanks so much for your input! Anyone else care to share their experience?
         
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        Smokenchoke

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          I'm at MUSC in Charleston. Here, we have no fellows and no ER residents (WEll, actually we took 1 CT fellow this year, but only this year)...which means we get the good cases, and almost all the trauma intubations, so yes I feel confident....that being said, I agree with the above post--bread and butter is nice.
           

          JackPB

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            I'm a CA-3 in an academic center with multiple fellowships. There are plenty of interesting cases to go around, and I do not compete with fellows. In some super-duper cases, I've been posted to a room along with a fellow. In those rooms, there's plenty of excitement for all and I'm glad to be with a fellow.

            I think we should seek to do the most complex cases possible in the sickest patients possible. Don't short-change your education! We learn anesthesia by taking care of really sick people. ASA 1's are pretty hard to kill. After a while, those bread-and-butter cases are just work. Work is what a private practice anesthesiologist does. We're residents to get an edumacation.

            The baddest, most interesting patients often go to major academic centers. Once we know how to take care of that obese, pre-eclamptic, myasthenic trauma thoracotomy, a bread/butter lap chole seems pretty easy. I want to experience my "oh-crap" moments while a resident when someone else is responsible, not when my own license is on the line.

            Any resident who feels ready to practice by the end of the second year is overconfident. He/she simply hasn't seen enough dangerous cases or scary moments. Terrible, Unexpected Things happen in the OR. Make sure your residency can show you a few.

            JPB
             

            drfeelgood

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              E'01.... Did you interview at Caritas-St. Elizabeths in Boston? They do many of their complex cases offsite at Lahey Clinic. Maybe the CA-2 are confident because most of them were anesthesia attendings in their homeland...i.e. India. Eastern Block Be aware that you will spend more than one month each year in the pre-op clinic and many post call days in pre-op clinic. I know a friend there who is extremely upset.

              Best of luck
               

              Ahh...The Life

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                I'm surprised that the CA-2s feel well prepared. Most CA-3s are still getting their numbers there. I'm not sure how prepared people are if they haven't gotten the minimum ACGME numbers, but they may feel prepared.

                I like the programs where CA-2s are finished with their numbers by late second year and can focus/tailor their CA-3 year to their interests.
                 

                drfeelgood

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                  Ahh...The Life said:
                  I'm surprised that the CA-2s feel well prepared. Most CA-3s are still getting their numbers there. I'm not sure how prepared people are if they haven't gotten the minimum ACGME numbers, but they may feel prepared.

                  I like the programs where CA-2s are finished with their numbers by late second year and can focus/tailor their CA-3 year to their interests.

                  The ACGME numbers are set very low. They are designed so that you can have your numbers by CA-2. This shouldn't be a issue at most academic (university) programs. I don't know them off the top of my head, but i can find them if anyone wants them.
                   

                  E'01

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                    drfeelgood said:
                    E'01.... Did you interview at Caritas-St. Elizabeths in Boston? They do many of their complex cases offsite at Lahey Clinic. Maybe the CA-2 are confident because most of them were anesthesia attendings in their homeland...i.e. India. Eastern Block Be aware that you will spend more than one month each year in the pre-op clinic and many post call days in pre-op clinic. I know a friend there who is extremely upset.

                    Best of luck

                    No I didn't interview there. Good luck to you too


                    ** JackPB - Thanks so much for your response. It makes a lot of sense and I will keep what you said in mind. Anyway, what it boils down to is that I want a more community based prelim program and definitely an academic program for Anesthesiology.
                     
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