This is the constant debate and the answer is different for everyone. Let me give you a few examples - clearly you will see I was a “sit the stool” type of fellow or as some call it a “CA-4” year.
1) Supervisory setup. When you start in July you are all in, along with go-getter CA-2s trying to impress for LORs. This crowd eats up all your teaching and you stick around a whole lot. But as the weeks go by the residents want more independence or you have the non-cardiac crowd who just wants to get through the day and doesn’t seem interested. Plus you need to finish your echo reports, work on that poster/book chapter and oral boards are looming. You probably haven’t intubated or placed an a-line or CVL in weeks. Maybe the attending staff isn’t comfortable with you directing care, especially early in your fellowship. It’s kinda crowded with 4 people behind the ether screen (you, resident, attending, maybe a med student). It’s pretty easy and attractive to just stroll in, help with the echo, and bounce. How many different echo findings are there for garden-variety AS anyways? By the end of the year you may stay for the pre-bypass echo and be on the beach or on the golf course by the time they are coming off. Or you are cramming for echo boards.
This has been a common refrain from many friends of mine - by the middle of the year their enthusiasm has really waned, and while they feel exceptionally proficient at echo, they wonder if they could be doing something more productive. A good friend of mine spent a year like this at a big name institution and her comment to me was - “what a waste of time.”
2) Sit the stool. Yes, setting your room up in the morning sucks. But you’re probably fresh out of residency and was doing it there anyway. You find yourself getting faster and faster at a-lines and CVLs, you probably have a competition with your co-fellows to see who can line up the quickest. You’re in the room with the surgeon, often they are internationally renowned (particularly at those fellowships) and you form a relationship with them. You start to get a feel, by doing it yourself everyday, what really works coming off pump - what pushes to use and when, what drips to have going, what echo findings you’ll probably see. Lots of this will become intuitive and almost like muscle memory. Since you’re in the room the entire time you see some rare, spur of the moment stuff like a kinked-off bypass graft, clotted ECMO circuit, real-time STEMI, air embolism. You’re halfway through treating it by the time your attending returns. Later that afternoon you care for the same patient who comes back with a postop bleed.
I can’t emphasize enough how the hands-on day-to-day experience positively impacted my anesthesia practice. Even though I’m mostly ACT, those skills prove helpful very frequently. It takes a devoted, constantly engaged fellow to get the most out of a supervisory year. We had a kid halfway through the year (I did a Type A dissection that morning!), and with orals/echo/moving I knew my attention would be divided. Anyways, I’ve been rambling for a while so I’ll sign off. YMMV!
