Developing confidence as a 4th yr

[aimedicine]

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So ive noticed my confidence growing steadily over last few weeks...i attribute it to 2 things...1) taking trauma night calls voluntarily 2)staying after 5pm (for whatever reason shyt seems to hit the fan after 5pm)...my a-line, iv line, and airway skills have all improved significantly because ive had to perform those skills under press usually with the attending breathing down my neck. And im starting to get to the point of knowing my drug dosing cold.

As a 4th yr med student hoping to go into anesthesia, this rotation has actually altered my perspective on what i should really be looking for in a program...which is great pathology and a program that pushes you to wrk hard....im not a resident but im starting to sense and agree with those on this forum that stresses the importance of wrking your butt off during residency #stayafter5pm

 

[Mman]

So ive noticed my confidence growing steadily over last few weeks...i attribute it to 2 things...1) taking trauma night calls voluntarily 2)staying after 5pm (for whatever reason shyt seems to hit the fan after 5pm)...my a-line, iv line, and airway skills have all improved significantly because ive had to perform those skills under press usually with the attending breathing down my neck. And im starting to get to the point of knowing my drug dosing cold.

As a 4th yr med student hoping to go into anesthesia, this rotation has actually altered my perspective on what i should really be looking for in a program...which is great pathology and a program that pushes you to wrk hard....im not a resident but im starting to sense and agree with those on this forum that stresses the importance of wrking your butt off during residency #stayafter5pm

Hard work definitely helps you learn things. Now I'm definitely not saying I'd go looking for the residency program that makes you work the longest hours, but I'd be wary of one that promises that you'll be getting out early (say by 3 PM) every day to have reading time. You gotta actually do the cases to learn. And overnight and on weekends is when you tend to have more freedom to do stuff yourself because there are fewer people around.

Residency isn't supposed to be easy. But when you are finished with it you should be confident to safely take care of any case that rolls in the OR, whether that's a 6 month old with a foreign body in their airway or a 97 year old with critical aortic stenosis and an open femur fracture or anything in between.

 

[aimedicine]

Hard work definitely helps you learn things. Now I'm definitely not saying I'd go looking for the residency program that makes you work the longest hours, but I'd be wary of one that promises that you'll be getting out early (say by 3 PM) every day to have reading time. You gotta actually do the cases to learn. And overnight and on weekends is when you tend to have more freedom to do stuff yourself because there are fewer people around.

Residency isn't supposed to be easy. But when you are finished with it you should be confident to safely take care of any case that rolls in the OR, whether that's a 6 month old with a foreign body in their airway or a 97 year old with critical aortic stenosis and an open femur fracture or anything in between.

Just out of curiosity, what will be your anesthetic plan for a 6 month old with a FB in airway??

 

[Mman]

Just out of curiosity, what will be your anesthetic plan for a 6 month old with a FB in airway??

Depends on how the surgeon plans to get it out. They will end up getting mask induction even if they have IV to have me avoid pushing the FB down further with positive pressure. Get them deep, keep them breathing, and probably rigid bronch to snag it although I'll have to switch over to TIVA if they take too long as you can't give anesthetic gas via the jet vent port on a rigid bronch. If it's too distal they'll likely end up getting an ETT and a fiberoptic bronch to try to go fish it out.

 

[IkeBoy18]

off topic.. but im on MICU right now..and i hate life

 

[aimedicine]

off topic.. but im on MICU right now..and i hate life

ya MICU sucked especially this time of the year where you suppose to be cruise control....im doing ambulatory (easy!!)

 

[Biochemist21]

off topic.. but im on MICU right now..and i hate life

Sure the hours are subpar, but get as much as you can out of your MICU rotation, because soon enough the training wheels come off and you're going to be the intern tasked with managing those patients on your own.

 

[MikeMerk-MtS]

I'm jealous of your train of thought 😛

 

[deleted171991]

It beats me how somebody can hate ICU as a student and think about anesthesia. I don't know why people think that gas is cushier or less stressful. Yes, I get the part about inefficient rounds and endless useless theories, but the science and skills overlap a lot.

 

[unchockey21]

So ive noticed my confidence growing steadily over last few weeks...i attribute it to 2 things...1) taking trauma night calls voluntarily 2)staying after 5pm (for whatever reason shyt seems to hit the fan after 5pm)...my a-line, iv line, and airway skills have all improved significantly because ive had to perform those skills under press usually with the attending breathing down my neck. And im starting to get to the point of knowing my drug dosing cold.

As a 4th yr med student hoping to go into anesthesia, this rotation has actually altered my perspective on what i should really be looking for in a program...which is great pathology and a program that pushes you to wrk hard....im not a resident but im starting to sense and agree with those on this forum that stresses the importance of wrking your butt off during residency #stayafter5pm

Agree on challenging pathology and a program that pushes you being important. Just make sure you're getting quality and not just quantity. A few months into CA-1 year and that 11 pm emergent lap chole that took 3 hours and had to go open because it was the 'worst gallbladder ever' (just like the other 3 that day) tends to lose its luster. Having a bad surgical department isn't necessarily a bad thing during residency though. You'll be a pro at dealing with any complication that might come up.

 

[IkeBoy18]

It beats me how somebody can hate ICU as a student and think about anesthesia. I don't know why people think that gas is cushier or less stressful. Yes, I get the part about inefficient rounds and endless useless theories, but the science and skills overlap a lot.

Personally Im not looking for cushy. I am just not a fan of endless rounds and social work. I dont mind the medicine, its very interesting frankly, and I love the procedures (I try to get as many as I can get.) Its not the stress, its the 14 hour days 6 days a week that I am doing (again, too much note writing, rounding, social work, wasting time, etc), when clearly we can be more efficient and leave some more time for life. I dont mind 14hrs in the OR, its much different than this, at least from my nieve perspective.

 

[deleted171991]

Holy crap! What kind of crazy place keeps students in the ICU for 80 hours/week?

 

[unchockey21]

Holy crap! What kind of crazy place keeps students in the ICU for 80 hours/week?

My wife had a family med rotation that was 80 hrs/wk with 24 hour calls. Her schedule was worse than mine as an intern at the time. No duty hour restrictions on med students. Needless to say she did not apply there.

 

[deleted171991]

My wife had a family med rotation that was 80 hrs/wk with 24 hour calls. Her schedule was worse than mine as an intern at the time. No duty hour restrictions on med students. Needless to say she did not apply there.

Perhaps you guys should "advertise" these malignant places. If they abuse their students, they might also abuse the residents and the fellows. Nothing produces good changes as fast as bad PR.

 

[Mman]

Holy crap! What kind of crazy place keeps students in the ICU for 80 hours/week?

The good ones? I probably averaged 100 hrs/week as a 4th year student in the ICU. Q3 call, long days, staying for lectures in the afternoon postcall. Basically got 2 days off every 3 weeks. It was nice with work hour limits coming up that as an intern/resident they were able to limit my time to only 80 hours a week on average.

 

[aimedicine]

i remember my IM rotation was the worst....started rounds at 530 am at one hospital...then its off to another hospital, then a nursing home, then we end up at the office...usually get out around 7pm...office closed at 6pm but we usually spend another hour on documentation and other admin bull****...that killed any interest i might have had in IM....

 

[deleted171991]

Nothing good about 50+ hours weekly for students. A student doesn't have the knowledge base to understand most of what he sees in the ICU anyway. Most important is building up that knowledge base first. Rounds and lectures, and then reading up on a couple of cases/day to be discussed the following day should be more than enough. Calls? What for?

Let's not speak about the opposite idiocy, the anesthesia AKA smartphone "rotation". The place I trained at had one; 75% were just lazy brown-nosing useless mediocrities, who didn't even know Step 1 level physiology. No educational value in that either, especially not for the amount of money they pay for it.

 

[aimedicine]

Nothing good about 50+ hours weekly for students. A student doesn't have the knowledge base to understand most of what he sees in the ICU anyway. Most important is building up that knowledge base first. Rounds and lectures, and then reading up on a couple of cases/day to be discussed the following day should be more than enough. Calls? What for?

I agree with this sentiment wholeheartedly....if a resident is consider dangerous with little sleep, can you imagine the danger a sleep-deprive med student poses!!! lol....i remember this one time, i was so tired i forgot to give vancomycin on a slow drip (basically bolused it) and the patient became very hypotensive...now its not because i didn't know not to do that but i was too sleep deprive to think straight....luckily it was just vanco!

 

[aimedicine]

i shouldn't say very hypotensive, but the patient sys BP did drop to the 80's...

 

[deleted171991]

Where I trained, med school was a pretty intense six years, but I never had more than 50 hours/week. Sometimes even those seemed too much (for stuff I knew I would never have to do).

The current American model was great when we were training mostly primary docs. Nowadays, half one learns in med school, especially on the clinical side, is unneeded, especially when followed by at least 3 years of residency, and some more of fellowship. Med school is becoming a luxuriously expensive waste of time, more and more.

 

[aimedicine]

6 years???

 

[deleted171991]

6 years???

Yep, right after high school, about 2.5 years basic and 3.5 clinical sciences. Six years is typical for most of the world.

No college, no premed, no interviews, no waste of time and money, just a crazy competitive entrance exam. And, as a student, one was treated like a younger colleague, not the one where the scut work stops. We were almost never under the care of other trainees. Many times I got to learn stuff firsthand even from top-notch university professors, and almost always from faculty members.

You guys are paying a lot of bennies for your education; make sure they don't go wasted.

 

[aimedicine]

Did u school here im the states and how long ago was this? Wish it was like that today....i woulda had my medical degree at 22!!!! Lol

 

[Mman]

.i remember this one time, i was so tired i forgot to give vancomycin on a slow drip (basically bolused it) and the patient became very hypotensive..

On what planet can a student administer a med to a patient? None I've yet visited. Hell an anesthesiologist is probably the only physician that is even allowed to administer an IV antibiotic to a patient. Every other part of the hospital it's ordered by a doc and given by a nurse.

 

[courtnes]

On what planet can a student administer a med to a patient? None I've yet visited. Hell an anesthesiologist is probably the only physician that is even allowed to administer an IV antibiotic to a patient. Every other part of the hospital it's ordered by a doc and given by a nurse.

I've started antibiotics pre-op on anesthesia rotations - but never in the ICU or on the floor.

 

[aimedicine]

It was abroad. And medicla school is still 6 years in most of the world.

Now don't get me started on the college system, on not having anything remotely as useless as liberal arts there. 😀

Haha

 

[Mman]

I've started antibiotics pre-op on anesthesia rotations - but never in the ICU or on the floor.

So you've opened the drip on the antibiotic ordered by the surgeon, checked by the pharmacist, hung by the nurse, and OK'd by the anesthesiologist and/or resident for you to do so.

 

[courtnes]

So you've opened the drip on the antibiotic ordered by the surgeon, checked by the pharmacist, hung by the nurse, and OK'd by the anesthesiologist and/or resident for you to do so.

No, I've discussed with the surgeon and anesthesiologist, ordered and had it co-signed by the resident, retrieved it and hung it myself. Depends on the hospital and attendings involved, but this was my experience half the time.

 

[aimedicine]

so when the nurse hands the 2 or 1 gram of cefazolin or vancomycin to the anesthesia residents....i just ask the resident( or attending) if its ok for me to start the antibiotics and they usually say "sure go for it!!!"....of course the first time you do it they watch u to see if u know what u doing and after that they just let u do it, no problem. I mean u just mix the darn thing with normal saline, its not rocket science!!!

 

[aimedicine]

On what planet can a student administer a med to a patient? None I've yet visited. Hell an anesthesiologist is probably the only physician that is even allowed to administer an IV antibiotic to a patient. Every other part of the hospital it's ordered by a doc and given by a nurse.

I don't order the antibiotics, they hand it to the anesthesia resident before the case, he/she then hand it to me, i mix it up and either bolus it (cefazolin) or mix it up/spike it/get the air bubble out/hang it/connect to IV port/slow drip it (vancomyin)....no big deal. One less thing for the resident to wrry about.

Thinking bout it now, i do a lot things on my rotation as a med student....preop, set up the anesthesia room, machine check, bring pt back, put monitors on, mask vent, intubate, put in iv or aline if needed, (one attending even let me do a central line), tape the eye, put temp probe, og or ng tube if needed, bis monitor, bair hugger, etc...the only thing i dont get to do is push the induction agent (but i did that once on a esophageal dilatation case, short quick procedure....of couse with attending permission and encouragement)....to me once i show the residents amd attending my work ethic and genuine passion for anesthesia, most of them actually want to teach me and they push me to do things....and of course it helps to show them u know what u doing and so u build the trust.

 

[Biochemist21]

Personally Im not looking for cushy. I am just not a fan of endless rounds and social work. I dont mind the medicine, its very interesting frankly, and I love the procedures (I try to get as many as I can get.) Its not the stress, its the 14 hour days 6 days a week that I am doing (again, too much note writing, rounding, social work, wasting time, etc), when clearly we can be more efficient and leave some more time for life. I dont mind 14hrs in the OR, its much different than this, at least from my nieve perspective.

Holy crap! What kind of crazy place keeps students in the ICU for 80 hours/week?

My wife had a family med rotation that was 80 hrs/wk with 24 hour calls. Her schedule was worse than mine as an intern at the time. No duty hour restrictions on med students. Needless to say she did not apply there.

I had several rotations where I was over 80hrs a week. On my surgery rotation alone I routinely had to come in 1-2hrs before the Chief and stay usually about an hour later, always averaging around 90-95hrs a week. I was told explicitly by two clerkship directors, "Duty hours are for residents, not medical students, so the rules don't apply to you." Am I complaining? No. Was it a deeply formative experience that will shape the way I practice academic medicine in the future? Absolutely. Do I think that anything is gained by having 3/4th yr med students in the hospital for >60hrs a week? Probably not, but I wouldn't advocate for putting a hard cap on hours at 60.