Decisions to make ...

[Doctor4Life1769]

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I have a pickle here ...

I am interested in Anesthesia and Surgery. However, with both I know I need good experience in the ICU/CCU. I know July-Dec. tends to be good months to do auditions; however, I have not had any experiences with the ICU/CCU yet on cores. Should I do an away rotation at a program that has ICU experience affiliated with Anesthesia or would I be better off doing Trauma/ICU at a hospital that is not affiliated with an Anesth residency program so that I can do another one to audition at a residency program and not look like a total idiot? I guess the question here is, should I burn a month for learning and lose a month to potentially audition at, or should I use all those months to audition?

 

[Boonu]

Wouldn't a formal rotation in either anaesthesia or surgery be a much better "audition" rotation for residency programs then an ICU rotation?

That being said, I would vote to burn a month for learning unless you have a huge desire to break into a certain geographical region and need all the away rotations you can muster.

 

[Doctor4Life1769]

I do plan on doing anesthesia rotations. However, certain programs also have SICU/pulm-CC rotations directed by the anesthesia staff that students may participate in. So, hence my question.

 

[Droopy Snoopy]

It's generally a good idea to get some ICU experience prior to starting residency, but what makes you think you need to do it as an away rotation? I'd recommend doing your away rotations in the fields you're interested in at the programs you're interested in, save your ICU block for the spring at your home institution.

Now if your dilemma is that your home institution doesn't have an ICU (which doesn't come through at all in your OP), then it all depends on how competitive your application will be and how many away rotations you think you'll need.

 

[SouthernSurgeon]

IMHO, having your first ICU experience be on an audition rotation seems dicey to me. There is a steep learning curve and you could come out looking less than your best (which is the whole point of doing aways - to show off).

Also, so many institutions vary in the way their ICUs are structured - you could sign up for a SICU month only to find out your attendings are largely anesthesia. Would hurt your chances of getting a letter in the specialty you want.

Edit: One more thing I forgot. On the surgery front, most of the time you won't have a true "chief" resident running the service (i.e. they often don't have upper levels assigned to the ICU as they put them on more OR-heavy rotations). It seemed like where I did my away and at my home school, the visiting students needed to have a chief who liked them and would report favorably to the program director.

 

[Doctor4Life1769]

In one of my core hospital sets, we have a level 1 trauma center. I haven't done Trauma yet, but I hear from classmates that while as a 3rd year you are not involved in the Unit, but as a 4th year you are and you get a lot of ICU/CCU experience, along with the usual trauma and floor duties. I figured it be best to rotate there from July to August to get the full breadth of knowledge since a lot of my IM will be 4 weeks office and 4 weeks inpatient on the floor. I also figured the Trauma experience prior to anesthesia would help in giving me the knowledge needed in terms of mechanical vent management, procedures, and some built-in aspects of cardio and pulm without actually going out and doing a cardio and/or pulm elective. I just wasn't sure if I should do one during that time frame or wait after I'm done doing auditions. I know of certain programs that have their SICUs ran by the anesthesia team and so I figured if I did an away at those programs, then it'd behoove me to have had this prior experience in a learning environment where I'm not being totally judged for when it comes to residency time. Thoughts?

 

[SouthernSurgeon]

In one of my core hospital sets, we have a level 1 trauma center. I haven't done Trauma yet, but I hear from classmates that while as a 3rd year you are not involved in the Unit, but as a 4th year you are and you get a lot of ICU/CCU experience, along with the usual trauma and floor duties. I figured it be best to rotate there from July to August to get the full breadth of knowledge since a lot of my IM will be 4 weeks office and 4 weeks inpatient on the floor. I also figured the Trauma experience prior to anesthesia would help in giving me the knowledge needed in terms of mechanical vent management, procedures, and some built-in aspects of cardio and pulm without actually going out and doing a cardio and/or pulm elective. I just wasn't sure if I should do one during that time frame or wait after I'm done doing auditions. I know of certain programs that have their SICUs ran by the anesthesia team and so I figured if I did an away at those programs, then it'd behoove me to have had this prior experience in a learning environment where I'm not being totally judged for when it comes to residency time. Thoughts?

I don't really know why you are so set on an ICU month as an away. IMHO one month in the trauma-ICU would be plenty of ICU experience for a fourth year, and I think that an SICU away rotation makes a less-than-ideal audition for either surgery or anesthesia:

-If you are going for anesthesia -> you may have anesthesia trained intensivists running the unit, but you won't have much exposure to the anesthesia residents (which is one of the most important reasons to do an away - see what the residents are like). You also won't have much exposure to the core anesthesia faculty, won't get to see how much experience/independence vs hand-holding the residents get in the OR, etc.

-If you are going for surgery -> you might not get enough attending exposure to even get a letter. You won't get into the OR, and therefore won't get to see how much autonomy the surgery residents are given (i.e. are they really "doing" the case, or are they bovie-ing between the attending's clamp).

 

[Doctor4Life1769]

Okay, sounds good. I'll just do that one then. Should I do it in July at the home institution or should I wait until the spring? Thanks for all your help!

 

[SouthernSurgeon]

Okay, sounds good. I'll just do that one then. Should I do it in July at the home institution or should I wait until the spring? Thanks for all your help!

Your first priority for 4th year needs to be figuring out anesthesia vs surgery. Take July and August for whatever rotations will best help you resolve that dilemma.

 

[Doctor4Life1769]

Thank you for your help!