Dissapointing residency evals, advice for improving

[Iso4ane]

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So long as you are on track to graduate, who gives a fu(k? I had the occasional snarky comment in my evals as a resident, nobody but the program director sees it. When you graduate you just get a certificate that says you completed residency in good standing. Nobody at any job I applied for asked to see evaluation comments....

Not until you try to find a job and people just call people they know where you trained. No need for evaluation comments when you can get them from the source.

 

[dannyboy1]

Not until you try to find a job and people just call people they know where you trained. No need for evaluation comments when you can get them from the source.

Lol. Just work for the AMC. first question at the interview is “when can you start😉...

 

[Iso4ane]

Lol. Just work for the AMC. first question at the interview is “when can you start😉...

You know every time in training you said WTF happened at outside hospital? Yeah, that where those people go.

 

[dannyboy1]

You know every time in training you said WTF happened at outside hospital? Yeah, that where those people go.

Could be I’m a bit jaded because I’m in the northeast. Everyone works for an AMC. Ivy League graduates side by side with community hospital grads. Everyone quickly reaching the same level of mediocrity that inevitably arises when physicians are employed clock punchers.... yup.. I’m jaded.

 

[Status Sciaticus]

So long as you are on track to graduate, who gives a fu(k? I had the occasional snarky comment in my evals as a resident, nobody but the program director sees it. When you graduate you just get a certificate that says you completed residency in good standing. Nobody at any job I applied for asked to see evaluation comments....

Because your ITEs matter for fellowship placement? Because unconscious bias does work its way into your letters? Keep in mind that PDs/APDs/Chairs are not above the whole clique scene.

 

[ucladoc2b]

I got the highest ITE score in my program last year. I still got the occasional (sometimes inappropriate) snarky eval, as well (which left me wondering if the score actually led to increased snarkiness with some attendings).

So I feel your pain. It’s probably a universal experience.

 

[SingfrAbsoltion]

I got the highest ITE score in my program last year. I still got the occasional (sometimes inappropriate) snarky eval, as well (which left me wondering if the score actually led to increased snarkiness with some attendings).

So I feel your pain. It’s probably a universal experience.

I got yelled at by one of my co-residents for it. This is why people don't talk about their scores, it brings out the crazy.

 

[dchz]

Because your ITEs matter for fellowship placement? Because unconscious bias does work its way into your letters? Keep in mind that PDs/APDs/Chairs are not above the whole clique scene.

Totally agree with the unconscious bias, not sure I believe that ITE matters that much tbh.

Others who are involved on the other side of the process care to chime in?

 

[pgg]

From what I've seen and been told, most academic departments is like high school: you have your cliques, and people tend to gossip which includes your ITE scores and what they think of you.

Fair or not, residents should understand that attendings perceive and judge resident performance in the context of what they already think they know about them. If they know you put up a 10th percentile score on the ITE, that mistake you make in the OR is because you're dumb. If they know you got a 90th %ile score, then the mistake was because you were having an off day.

If I had it to do over again, I would've studied for the AKT-0 and AKT-1. Silly as that sounds. As it was, I was the dumb one until the AKT-6 scores came back, and from then on I could do no wrong. It's hard to overstate how much better I was treated literally the week after my PD shared the class's exam results at the department's clinical competency committee meeting.

Don't try to fight human nature, just smoke the exams as best you can. To an extent, they can be gamed with focused studying (especially the AKTs).

Besides, if the day comes you feel like applying for a competitive fellowship, you'll be glad to have those numbers.

 

[DM27]

I honestly don't even know if our faculty know our scores? It's never really talked about.

It probably varies between programs. My residency program loved gossiping about the higher ITE scores, and the people who scored in the “danger zone” definitely were put on a watch list and had some moonlighting privileges curtailed. I also def witnessed some biases regarding individuals that referenced their ITE scores.

I don’t personally think these scores matter much at all and generally only seem noted when you are a positive or negative outlier. When I was interviewing for fellowship I think only one program even referenced my test scores on the interview day.

 

[deleted697535]

I find a recurrent theme in my evaluations from year to year is that I seem to be behind my classmates in anesthesia knowledge/intraoperative care. This is usually only a few evaluations and the rest say positive things; however, I can't seem to pinpoint exactly where these gaps are. I wish the evals were more specific but they are also anonymous so I'm unable to ask for instances where I was lacking. I do ask attendings I work with for feedback at the end of the day and have yet to receive anything constructive, it's usually "you did great today!" Since my CA-1 year I have made a big effort to be very specific with my anesthetic plans and reasons for doing things a certain way and noting things I will look out for, and how to handle those situations. I'm not sure what else I can do to "prove" my knowledge to my attendings in the OR? If anyone has any advice or been through this before I would appreciate any words of wisdom. I do take these evals to heart and get disheartened despite the fact that I've really been trying.

1 asking for feedback might be part of the problem. Sorry dude but you gotta plow your own furrow

2 just snoop on your staffs preferences from their prior cases. Then repeat their insane mix

3 listen to verbal and non verbal cues. If your staff asks you a leading question about doing x y or z, just do it. Agree with them like they're demigods. Watch your approvals soar. Everyone likes ppl that agree with them. Always agree

4 the majority of or anesthesia is simple straightforward stuff. There's no duchennes or complex stuff coming. So that leads me to believe it's something personal in you that exudes this issue. Maybe you need to be more decisive. Don't bring problems, bring solutions and be concrete

Staff want to come in and sit back and do nothing all day. They want someone who thinks like them, acts like them, talks like them but crucially isn't them so they can relax and trust you and have a chill day. If you keep asking for feedback and advice they will tire of you quickly.

So enable your staff have a chill day

 

[surgndoc]

Staff want to come in and sit back and do nothing all day. They want someone who thinks like them, acts like them, talks like them but crucially isn't them so they can relax and trust you and have a chill day. If you keep asking for feedback and advice they will tire of you quickly.

So enable your staff have a chill day

maybe I’m getting lazy but this is pretty true for the most part. The trainees that are the most difficult are the ones that are highly unpredictable. Trying to put 8.0 ETT in 75yo women, giving esmolol boluses throughout a case for a HR of 101, focusing only on charting for brief but complex cases, the list goes on and on. Next thing you know you have an arytenoid dislocation or some other bizarre complication that of course will happen only with the trainee who always has their head in the clouds.

90% of anesthetics are almost identical, no need to reinvent the wheel on a daily basis.

 

[Zekchar]

Trigger warning: this post may contain strong language, AKA as THE TRUTH. Please do not read it outside of your safe space. Please make sure to put on your psychological safety belt, maybe gather together with other sensitive souls, to comfort each other and protect your feelings from getting hurt.

First of all, I am half sorry half not for the OP. I have walked in those shoes, maybe a different model, until the grapevine was so kind to tell me what one of the attendings had said about me. Nothing to be proud of. That was a wake up call.

While a resident, I used to hate working with a couple of attendings, including that one, because they were not nice to me. They were in your face, and told you (occasionally) exactly what they thought about you. Many years later, I mostly remember just what those people taught me.

Those who read this forum frequently know that I believe in tough love, especially in education. It's been proven again and again that memories are best formed when coupled with strong emotions. That's why the sergeant shouts at the fresh recruits in the military. I still have to see a good professional sports coach who doesn't occasionally raise his/her voice and make players feel bad. If one is comfortable, one is not learning.

The reason I was half not sorry for the OP was that one should know by the middle of the CA-2 (or CA-3?) year what one sucks at. It shouldn't be rocket science by now. If one doesn't have that kind of insight, it ain't good and won't end well. It's one thing not to be good at something; it's a different story not even knowing what one doesn't know. That's a royal lack of insight. And that was the part that pissed me off enough to kind of go off on a rant at some point.

By the way, that post was written while tired, hence my filters were not working well anymore (then, on top of that, I wasted 20+ minutes to give him advice, like any respectable sociopath). Still, some reactions to that post made me think QED. I couldn't have brought on the postmodernist whining better even if I had wanted to. Some people just couldn't help themselves and had to prove my point that one cannot tell the truth to some Y-ers and Z-ers without packaging it in a lot of lies, with a bow. It's not worth the effort, and it's not worth the consequences, and here's the proof. Also, it was symptomatic that the people who were so fast at being speech police did not contribute sh-t to the thread. If you disagree with what I said, at least do a better job than me, so I can admire the genius of your thoughts, the beauty of your minds. Don't just criticize me with the IQ of a mob, i.e. the reptilian brain, the limbic system. There is no cortex involved there.

As things stay, I am afraid for the future of this country and of the world. My only hope is that these generations will mature, as we all have. We have all been there. In the meanwhile, dear snowflakes, if you can't forgive my bluntness, please just Ignore me. It takes just a click, the same one I will use for ya.

Love, "Boomer". OK?

P.S. I've just re-read my previous post. THAT was sociopathic? Seriously? Holy cow, what babies! That post is almost civilized (as in yes, I would say all that to your faces, if I actually cared about your welfare). Please do yourselves a favor and grow up. You can start by reading "The Coddling Of The American Mind".

100% Correct and I applaud FFP for having the courage to say that which the rest of us think but are unwilling to say out loud. Sincere feedback is not only unwanted, but is often loathed. The few residents that come along and that are thoughful, interested, and truly interested in making themselves the best that they can be, I take notice and really pour myself into them. Everybody else, just shuffles along during the residency and you hope they dont do anything overly stupid on your watch. Such is the academic system that is in place.

 

[deleted697127]

maybe I’m getting lazy but this is pretty true for the most part. The trainees that are the most difficult are the ones that are highly unpredictable. Trying to put 8.0 ETT in 75yo women, giving esmolol boluses throughout a case for a HR of 101, focusing only on charting for brief but complex cases, the list goes on and on. Next thing you know you have an arytenoid dislocation or some other bizarre complication that of course will happen only with the trainee who always has their head in the clouds.

90% of anesthetics are almost identical, no need to reinvent the wheel on a daily basis.

Humor me. What’s wrong with esmolol?

 

[Status Sciaticus]

Humor me. What’s wrong with esmolol?

Short acting BB? Yo-yoing the HR? Maybe not dealing with the underlying issue causing the tachycardia?

 

[AdmiralChz]

Humor me. What’s wrong with esmolol?

In the average patient not with critical coronary or valvular disease, this is Usually well-tolerated and happens multiple times a day for people just walking around and doing daily activities.

Beyond that I think the point is treating a number like HR of 100 without thinking of WHY it has climbed over the past 2 hours is something to consider - did you not see the blood loss? Is it occult and not being seen? Is your patient light on anesthetic? Having some electrolyte problems or tons of urine output? Things to consider rather than reflexively giving esmolol to make your numbers look better - that’s what a SRNA does.

 

[2buckchuck]

As a resident, my view on evals changed once I saw certain staff do things that were very plainly wrong (misinterpreting ekg’s, misinterpreting ROTEMs, misinterpreting lab values). We know who writes our evals, and if it’s someone who I wouldn’t want taking care of me, I disregard them.

On the flip side, whenever I can work with someone who I really respect because they know their stuff and consistently make good decisions, I will hang on their every word.

 

[surgndoc]

Humor me. What’s wrong with esmolol?

It's only necessary in certain situations, tachycardia from intubation (rarely), light anesthesia in a patient with CAD or AS, really just as a temporizing measure until you've fixed whatever you should've noticed is causing the problem in the first place, blood loss, patient isn't deep enough for what the surgeon is doing, etc.

Since it's so short acting there isn't a huge downside to giving it, perhaps I wouldn't in a severe asthamtic, but Ive just rarely found much use for it. After finishing a residency and fellowship, I'd wager i've given esmolol perhaps 5 times, definitely less than 10. I'd be curious here to see how often the drug is used, especially outside of the cardiac realm by others on this board. Maybe I'm missing out on something.

At my new gig residents, mostly junior residents, seem to give it as a "treatment for tachycardia" - that has actually been said to me multiple times. They must be learning this from somewhere...

 

[MoMoGesiologist]

As a resident, my view on evals changed once I saw certain staff do things that were very plainly wrong (misinterpreting ekg’s, misinterpreting ROTEMs, misinterpreting lab values). We know who writes our evals, and if it’s someone who I wouldn’t want taking care of me, I disregard them.

On the flip side, whenever I can work with someone who I really respect because they know their stuff and consistently make good decisions, I will hang on their every word.

Agree with this one hundo. Find the ppl you wanna be like, and get their feedback and copy their styles. The ppl you think suck? Just learn what not to do, and smile and nod

 

[abolt18]

It's only necessary in certain situations, tachycardia from intubation (rarely), light anesthesia in a patient with CAD or AS, really just as a temporizing measure until you've fixed whatever you should've noticed is causing the problem in the first place, blood loss, patient isn't deep enough for what the surgeon is doing, etc.

Since it's so short acting there isn't a huge downside to giving it, perhaps I wouldn't in a severe asthamtic, but Ive just rarely found much use for it. After finishing a residency and fellowship, I'd wager i've given esmolol perhaps 5 times, definitely less than 10. I'd be curious here to see how often the drug is used, especially outside of the cardiac realm by others on this board. Maybe I'm missing out on something.

At my new gig residents, mostly junior residents, seem to give it as a "treatment for tachycardia" - that has actually been said to me multiple times. They must be learning this from somewhere...

I know Dr Wolpaw on ACCRAC podcast talks about giving it with induction to suppress the sympathetic response to DL instead of giving narcotic. I suppose that's a likely source as I know it is a regularly listened to podcast amongst residents.

 

[nimbus]

It's only necessary in certain situations, tachycardia from intubation (rarely), light anesthesia in a patient with CAD or AS, really just as a temporizing measure until you've fixed whatever you should've noticed is causing the problem in the first place, blood loss, patient isn't deep enough for what the surgeon is doing, etc.

Since it's so short acting there isn't a huge downside to giving it, perhaps I wouldn't in a severe asthamtic, but Ive just rarely found much use for it. After finishing a residency and fellowship, I'd wager i've given esmolol perhaps 5 times, definitely less than 10. I'd be curious here to see how often the drug is used, especially outside of the cardiac realm by others on this board. Maybe I'm missing out on something.

At my new gig residents, mostly junior residents, seem to give it as a "treatment for tachycardia" - that has actually been said to me multiple times. They must be learning this from somewhere...

I’ve used it as much as you. Somebody on the faculty must be teaching it.

As for 8.0 tubes, they fit fine. In residency we used 8s for all women and 9s for all men in the heart room.

 

[2buckchuck]

I know Dr Wolpaw on ACCRAC podcast talks about giving it with induction to suppress the sympathetic response to DL instead of giving narcotic. I suppose that's a likely source as I know it is a regularly listened to podcast amongst residents.

I’d throw it in the “more than one way to skin a cat” category.

 

[deleted697535]

What size dlt do ye stick in all women? Let me guess/tell you! 37fr. Can anyone do the match and convert French to id diameter?

I'm also sure no is the answer, so I'll tell you. A 37fr is same od as a 9 et id. So whoever has that opinion really doesn't know much about that particular subject.

But I digress. Another person posted about showing 'tough love'. Again that's just your opinion that that type of feedback works. I can tell you for damn sure it doesn't work for me and I hated it. Plus I'd probably break someone's jaw if they dug at me like that so it wouldn't work for them either...

 

[Arch Guillotti]

Plus I'd probably break someone's jaw if they dug at me like that so it wouldn't work for them either...

Talk is cheap on the internet. In the US you would be tossed out of residency and probably brought up on charges.

 

[deleted697127]

Reflexive

In the average patient not with critical coronary or valvular disease, this is Usually well-tolerated and happens multiple times a day for people just walking around and doing daily activities.

Beyond that I think the point is treating a number like HR of 100 without thinking of WHY it has climbed over the past 2 hours is something to consider - did you not see the blood loss? Is it occult and not being seen? Is your patient light on anesthetic? Having some electrolyte problems or tons of urine output? Things to consider rather than reflexively giving esmolol to make your numbers look better - that’s what a SRNA does.

Your point is well taken but we are talking about residents not SRNAs. Reflexively assuming your resident (or CRNA or SRNA) makes decisions without thinking also isn’t fair. If someone’s missing a major intraop event like blood loss, sure correct them. Consider asking why they are doing something if you don’t agree with it. There are plenty of sound reasons to give esmolol starting with the physiologically sound arguments of cardiac oxygen supply and demand. Regurgitating dogma that everyone’s heart rate goes up in every day life overlooks the fact that a lot of my patients are chain smoking couch potato diabetics. Esmolol has been shown repeatedly to decrease anesthetic requirements, opiate requirements, and PONV. Esmolol infusions have even been show to decrease post op pain. Why? Something to do with sympathetic modulation? I don’t know why but the data doesn’t look terrible to me.

Lastly, the reason we scaled back beta blocker use perioperatively was from a 2014 ACA/AHA recommendation. “These recommendations for perioperative beta blocker use were based on the results of the accompanied systematic review of 17 studies that found that "perioperative beta blockade started within one day or less before non-cardiac surgery prevents nonfatal myocardial infarction but increases risk of stroke, mortality, hypotension and bradycardia."

These studies involved starting and continuing beta blockers for several days if not indefinitely. This is different than temporarily using esmolol for short term hemodynamic management in the OR. I do believe that esmolol is an effective tool that can be used to optimize hemodynamics without long lasting consequences in certain patients. I have had cases where we checked troponins after and patients had troponin leaks likely due to demand ischemia. Could esmolol have decreased the heart rate, oxygen demand, and increased oxygen supply, and prevented demand ischemia had i timed it right? Not An unreasonable thought. I have no idea about cost, but google seems to suggest it ain’t cheap.

 

[deleted697535]

Talk is cheap on the internet. In the US you would be tossed out of residency and probably brought up on charges.

Ouch. Never claimed to be from the US big man. I did an actual residency not a 3 year plus change version

🙂


Re periop beta blockade, no it most certainly doesn't come from some acc aha guide. It's from the poise 1 trial

And esmolol could hardly be considered 'starting' beta blockade

 

[Arch Guillotti]

Ouch. Never claimed to be from the US big man. I did an actual residency not a 3 year plus change version

I know you are not from the US.

I did a residency also as well as a fellowship and have been board certified for 10+ years.

Academics at a “top 20” place as well as PP where we “turn and burn”.

Merry Christmas!

 

[deleted697127]

Ouch. Never claimed to be from the US big man. I did an actual residency not a 3 year plus change version

🙂


Re periop beta blockade, no it most certainly doesn't come from some acc aha guide. It's from the poise 1 trial

And esmolol could hardly be considered 'starting' beta blockade

We aren’t disagreeing. The statement I’m referencing is from the review of literature in response to the POISE-1 trial.


Perioperative Beta Blockade in Noncardiac Surgery: A Systematic Review for the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

https://ahajournals.org/doi/10.1161/CIR.0000000000000104

 

[MoMoGesiologist]

I’ve used it as much as you. Somebody on the faculty must be teaching it.

As for 8.0 tubes, they fit fine. In residency we used 8s for all women and 9s for all men in the heart room.

This is causing damage... why do this?

 

[nimbus]

This is causing damage... why do this?

It didn’t cause any damage as far as I know. It was standard practice in the 1990s when I trained. Rationale was that the patients were easier to bronch and suction in the icu postop.

 

[DrMDAware]

1. What kind of program are you at?
Like someone mentioned before an 'average' resident at a place that takes candidates with superb ITEs and extracurriculars could likely be #1 at another program.

2. Have you had a taste of humility and shame and used it to become better?
This goes back to what kind of program you are at. Some programs talk about sick patients and hypotheticals. However, they never expose residents to moments where they can really have a slice of humble piece. At other places you will see first hand opportunities for improvement and feel the real sense that you cannot be complacent. Humble pie is served up BID-QID.

3. Is it more important for you to score well on your ITE or be a clinical rockstar?
Someone could spend all their time reading and doing questions and kill the ITE. However, put them in a room and clinically they are mediocre. When it hits the fan - are you cool? do you communicate clearly? do you rely upon a strong foundation? do you know when to call back up? when to ask them to stop? Can you anticipate these scenarios and prevent them from happening? Can you tell me 3-5 things that could go wrong for this patient in particular and this surgery in particular and what your plan C D E F would be?

4. Can you work on your intelligence in your program?
Intelligence, to me, is a lot of different things. It is how quickly can we accumulate multiple streams of information, process it, and act upon it. It is being sent to a case with limited amount of time to preop and getting the most important information. It is the surgeon saying 'lets go lets go' and you finding out the key bits of information in pre-op instead sitting there for 20 mins asking about the name of their dog and favorite colour. It is being aware of how you make others around you feel - that means the pre-op nurses, the scrub techs, the people in the room. I

5. What are the expectations?
I laugh when places compare how many hours they worked to other programs. For example: Place 1 is a place where the patients are fine with anything, the room turn overs are slow, the surgeons don't expect much, you're expected to just provide anesthesia, the administrators run a loose ship, and you sleep throughout your shift. Place 2 is one where the patients don't expect not even a nick on their lip or else their lawyer will say something, the rooms are ready to rock the second you drop off the first patient in the PACU, the surgeons have high expectations, you're expected to publish/do research/get involved in committees, you're up a full 24 hours doing cases, and the admins count every single roll of eye tape you use. These are drastically different settings.

 

[dannyboy1]

I laugh when places compare how many hours they worked to other programs. For example: Place 1 is a place where the patients are fine with anything, the room turn overs are slow, the surgeons don't expect much, you're expected to just provide anesthesia, the administrators run a loose ship, and you sleep throughout your shift. Place 2 is one where the patients don't expect not even a nick on their lip or else their lawyer will say something, the rooms are ready to rock the second you drop off the first patient in the PACU, the surgeons have high expectations, you're expected to publish/do research/get involved in committees, you're up a full 24 hours doing cases, and the admins count every single roll of eye tape you use. These are drastically different settings.

Job 2 is a sh1ty job...

 

[Zekchar]

It is being aware of how you make others around you feel - that means the pre-op nurses, the scrub techs, the people in the room.

I have found this to be super important and a major influence on how an anesthesiologist's job satisfaction goes. Act overly important or dismissively and these people will ensure you have a crappy experience. Treating them well and with respect will allow for your work to become significantly easier, less contentious, and more pleasant.

 

[dchz]

I have found this to be super important and a major influence on how an anesthesiologist's job satisfaction goes. Act overly important or dismissively and these people will ensure you have a crappy experience. Treating them well and with respect will allow for your work to become significantly easier, less contentious, and more pleasant.

I came to this realization when I was a CA-2. None of the OR people care if you can do the toughest cases without a mistake and provided world class anesthesia. They wouldn't even know you did that. But if you say thank you and offer to make their job 1% easier. You're the best anesthesiologist ever...

 

[DrMDAware]

I have found this to be super important and a major influence on how an anesthesiologist's job satisfaction goes. Act overly important or dismissively and these people will ensure you have a crappy experience. Treating them well and with respect will allow for your work to become significantly easier, less contentious, and more pleasant.

I came to this realization when I was a CA-2. None of the OR people care if you can do the toughest cases without a mistake and provided world class anesthesia. They wouldn't even know you did that. But if you say thank you and offer to make their job 1% easier. You're the best anesthesiologist ever...

Exactly.

Write down people's names if you can't remember them.
Chat with them a bit and use their name.
Ask about their puppy, kids or upcoming vacation.
Know how to ask for things in a respectful way.
Tie the gown
Talk about the local sports team
Ask surgeons if the bed height is right.
Laugh at the surgeon's joke.
Change the music when pandora stops.
Throw in some tagalog words.
Say hi and bye to them when you leave the hospital

Of course knowing anesthesia cold and having a strong clinical foundation is important - but many people can do that.

 

[pgg]

Ouch. Never claimed to be from the US big man. I did an actual residency not a 3 year plus change version

🙂

Yeah, one of those 35 hour/week euroresidencies ... 🙂

 

[deleted697535]

Yeah, one of those 35 hour/week euroresidencies ... 🙂

Not me bud. I've earned my scars. 35 hour shifts more like(although that was only for 6 months) . No staff in house to go crying to either.

My last year there averaged 75 hours

 

[deleted162650]

Not me bud. I've earned my scars. 35 hour shifts more like(although that was only for 6 months) . No staff in house to go crying to either.

My last year there averaged 75 hours

It’s a shame it takes you guys so long to learn what we master in just 3 years.

 

[Status Sciaticus]

It’s a shame it takes you guys so long to learn what we master in just 3 years.

 

[deleted697535]

LOL thanks bud. How's that fight with those nurses going for ye?

 

[deleted162650]

LOL thanks bud. How's that fight with those nurses going for ye?

No CRNAs at my shop bud.

 

[Zekchar]

Exactly.

Write down people's names if you can't remember them.
Chat with them a bit and use their name.
Ask about their puppy, kids or upcoming vacation.
Know how to ask for things in a respectful way.
Tie the gown
Talk about the local sports team
Ask surgeons if the bed height is right.
Laugh at the surgeon's joke.
Change the music when pandora stops.
Throw in some tagalog words.
Say hi and bye to them when you leave the hospital

Of course knowing anesthesia cold and having a strong clinical foundation is important - but many people can do that.

This advice is solid gold. We spend way too much time focusing on the anesthesia itself. Once you have reached a certain level of anesthesia practice, the work is quite easy. What makes the difference is the intangibles. The sooner people realize that, the more power and influence they will wield.
Nobody gives a **** if it takes you 45 seconds as opposed to 2 minutes to place the epidural. Nobody cares that you kept the base excess at -1 as opposed to -3. You may think you just performed the slickest central line placement, but to the outside observer the central line merely went in. You may have performed the perfect anesthetic, but the staff only sees that the patient was returned to the ICU with the surgery completed. The interpersonal interactions you have are by far the greatest influence on how people perceive you, respond to you, treat you, and by extension how your job goes.
To any resident that is reading, you are not an all-star and not special. At least your anesthesia skills do not make you so. Once a certain threshold is reached, and you should reach this by late CA-2 or early CA-3, everything is roughly equal. My biggest advice is to read this book and to heed its recommendations. This book, more so than any Q-bank or test prep, will have the greatest influence on your work and life as a whole:

Dale Carnegie: How to Win Friends and Influence People

How to Win Friends and Influence People - Wikipedia

en.wikipedia.org

 

[pgg]

Exactly.

Write down people's names if you can't remember them.
Chat with them a bit and use their name.
Ask about their puppy, kids or upcoming vacation.
Know how to ask for things in a respectful way.
Tie the gown
Talk about the local sports team
Ask surgeons if the bed height is right.
Laugh at the surgeon's joke.
Change the music when pandora stops.
Throw in some tagalog words.
Say hi and bye to them when you leave the hospital

Of course knowing anesthesia cold and having a strong clinical foundation is important - but many people can do that.

All this stuff is what normal well-adjusted humans do. The only disagreement I have with your list is the "laugh at the surgeon's joke" bit. Laugh if it's funny. Nobody likes or respects sycophantic lapdogs.

Someone on SDN once talked about the need for us to be able, amicable, and available ...

I was a new CA-1 when Jet posted this.

 

[MoMoGesiologist]

Exactly.

Write down people's names if you can't remember them.
Chat with them a bit and use their name.
Ask about their puppy, kids or upcoming vacation.
Know how to ask for things in a respectful way.
Tie the gown
Talk about the local sports team
Ask surgeons if the bed height is right.
Laugh at the surgeon's joke.
Change the music when pandora stops.
Throw in some tagalog words.
Say hi and bye to them when you leave the hospital

Of course knowing anesthesia cold and having a strong clinical foundation is important - but many people can do that.

Meh, I don’t really care for this advice. I didn’t go into medicine so I can socialize and make friends and kiss butts. I just wanna get my job done, take good care of pts, and GTFO of the hospital. When people start talking about their personal lives or their kids, I make sure to look like I’m busy adjusting the anesthesia machine. That being said, I do try and learn names and say please and thank you. You can be good at your job and be respected and liked without having to be a social butterfly

 

[Status Sciaticus]

Exactly.

Write down people's names if you can't remember them. why? you know their title. Am I supposed to memorize all the nurses and residents name in my hospital? At the end of the day, they will still call you anesthesia...
Chat with them a bit and use their name. This point is fine. I usually chat with them about what antibiotics they are okay with and if theyre ready to start the case.
Ask about their puppy, kids or upcoming vacation. LMAO why....
Know how to ask for things in a respectful way. This is basic decorum
Tie the gown You mean I should walk away from the head of the table doing anesthesia things to the other side of the room when the circulator or the OR nurse can do it just as easily and is closer to the surgical team?
Talk about the local sports team This is fine, if theyre not busy focusing on the surgery
Ask surgeons if the bed height is right. Nah, theyll tell you when the want the bed adjusted. No need to bug them by asking this.
Laugh at the surgeon's joke. Sure, if theyre funny. But Im not going to be some brown noser and laugh at crappy jokes
Change the music when pandora stops. Am I doing residency to DJ the surgeon's playlist? Seriously?
Throw in some tagalog words. IDK what this even means.
Say hi and bye to them when you leave the hospital Again, basic decorum.

Of course knowing anesthesia cold and having a strong clinical foundation is important - but many people can do that.

IDK man. some of this stuff looks like b1tch work. See above.

 

[deleted697535]

Meh, I don’t really care for this advice. I didn’t go into medicine so I can socialize and make friends and kiss butts. I just wanna get my job done, take good care of pts, and GTFO of the hospital. When people start talking about their personal lives or their kids, I make sure to look like I’m busy adjusting the anesthesia machine. That being said, I do try and learn names and say please and thank you. You can be good at your job and be respected and liked without having to be a social butterfly

I dont care for it either for all the same reasons.

Faking that sh1t is easily found out, then your just known as a little b1tch.

Im nice overall but about 1x every couple months i think were all allowed a vent, so i think you should flip out occasionally. Keep ppl on their toes

 

[chocomorsel]

I don’t think he would talk like this to anyone in person. You could be direct without being this harsh. This just sounds bitter

Hilarious!!! Bitter? You must be new here and not familiar with @FFP.

 

[chocomorsel]

Not until you try to find a job and people just call people they know where you trained. No need for evaluation comments when you can get them from the source.

He or she said most of his/her evals are good. Just a few bad ones.
**** them. Can’t please everybody. Ask me how I know. And no I did not fail my orals or writtens, had high ITE scores last two years and never been fired.

I just don’t do well with brown nosing which seems to help a lot in residency.

And I stood my ground too much which was not a good thing. They want you to be a bit of a rug as they break you and exercise their power.

You literally have to fake so much to be a rock star resident. I clearly didn’t do that and suffered accordingly.

 

[chocomorsel]

I dont care for it either for all the same reasons.

Faking that sh1t is easily found out, then your just known as a little b1tch.

Im nice overall but about 1x every couple months i think were all allowed a vent, so i think you should flip out occasionally. Keep ppl on their toes

Nah. Not necessarily. You can fake it the entire time and everyone will love you. But there are some people who genuinely care about their colleagues puppies and **** and ask about that crap at work.

Some of us aren’t allowed the luxury of “flipping out” occasionally without potentially losing our residency slots.
Wrong sex, wrong race. That’s the reality.

 

[chocomorsel]

All this stuff is what normal well-adjusted humans do. The only disagreement I have with your list is the "laugh at the surgeon's joke" bit. Laugh if it's funny. Nobody likes or respects sycophantic lapdogs.

Someone on SDN once talked about the need for us to be able, amicable, and available ...

I was a new CA-1 when Jet posted this.

This list is exhausting. Why can’t we just go to work, say the hello how are you pleasantries and do our damn jobs?

I don’t care about anyone’s dogs so I am not good at pretending that I do. I sometimes find myself laughing inappropriately as I try to be amicable and then realize I’m how much I hate brown-nosing.

This crap is hard for some of us and doesn’t mean we aren’t good docs.

OP, at the end of the day, you need to learn to brown nose if you want higher marks or just say **** it and move on.
Good thing is once you are out, you can be yourself unless you are a total douche. But hell those people thrive in private practice too. You will be fine.