Do we start on Saturday July 1st?
Started by E'01
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E'01 said:
Programs start on different schedules and will depend on orientation also. If you havent heard from your intern program Id give them a call so you can plan on things.
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My hospital starts a new month on the first weekday of the month. For example, even though today is April 1st, I am still on my March rotation until Monday. Not sure if this is the way it is everywhere, but they may start you out on Monday when everyone else changes rotations. I will slap you five on my way out the door July 3rd (end of intern year) on your way in.
nah dude
for the most part orientations for intern year start in the last week fo June. There's usu the stuff like ACLS and BLS, etc. then depending on ur residency you gotta do physicals sometime mid-june, etc.
for the most part orientations for intern year start in the last week fo June. There's usu the stuff like ACLS and BLS, etc. then depending on ur residency you gotta do physicals sometime mid-june, etc.
Daredevil said:
Aren't the hospitals a lot more chill on the weekends? I used to love working on Saturdays when I was a patient transporter because it involved sitting on my ass a whole bunch. Maybe it's different when you're actually responsible for patients, though!
nitecap said:
Another inflammatory nurse statement. Do you really believe that patients are less safe the month of july? That is just BS. Surgical interns rarely get in the OR to do anything other than retract and tell someone an update on a floor patient. Brand new CA1s are directly supervised.
So how are patients less safe in July? Why would you post that in this thread asking about start dates? You always like to point the finger at others saying you are just responding. Not true at all. You are the biggest instigator on this thread. Im sure you have something positive to contribute. Why cant you just stick with that unless you are actually called out?
It turns out this has been studied a bit:usnavdoc said:
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1525-1497.2003.20605.x
Journal of General Internal Medicine
Volume 18 Page 639 - August 2003
doi:10.1046/j.1525-1497.2003.20605.x
Is There a July Phenomenon?
The Effect of July Admission on Intensive Care Mortality and LOS in Teaching Hospitals
William A. Barry, MD, Gary E. Rosenthal, MD
BACKGROUND:It has been suggested that inexperience of new housestaff early in an academic year may worsen patient outcomes. Yet, few studies have evaluated the "July Phenomenon," and no studies have investigated its effect in intensive care patients, a group that may be particularly susceptible to deficiencies in management stemming from housestaff inexperience.
OBJECTIVE:Compare hospital mortality and length of stay (LOS) in intensive care unit (ICU) admissions from July to September to admissions during other months, and compare that relationship in teaching and nonteaching hospitals, and in surgical and nonsurgical patients.
DESIGN, SETTING, AND PATIENTS:Retrospective cohort analysis of 156,136 consecutive eligible patients admitted to 38 ICUs in 28 hospitals in Northeast Ohio from 1991 to 1997.
RESULTS:Adjusting for admission severity of illness using the APACHE III methodology, the odds of death was similar for admissions from July through September, relative to the mean for all months, in major (odds ratio [OR], 0.96; 95% confidence interval [95% CI], 0.91 to 1.02; P = .18), minor (OR, 1.02; 95% CI, 0.93 to 1.10; P = .66), and nonteaching hospitals (OR, 0.96; 95% CI, 0.91 to 1.01; P = .09). The adjusted difference in ICU LOS was similar for admissions from July through September in major (0.3%; 95% CI, −0.7% to 1.2%; P = .61) and minor (0.2%; 95% CI, −0.9% to 1.4%; P = .69) teaching hospitals, but was somewhat shorter in nonteaching hospitals (−0.8%; 95% CI, −1.4% to −0.1%; P = .03). Results were similar when individual months and academic years were examined separately, and in stratified analyses of surgical and nonsurgical patients.
CONCLUSIONS:We found no evidence to support the existence of a July phenomenon in ICU patients. Future studies should examine organizational factors that allow hospitals and residency programs to compensate for inexperience of new housestaff early in the academic year.
http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200405000-00012.htm;jsessionid=E3ax1h9NF62SpinKE2Vla2PiL3wBBpk0GBnf2OhWgHIL52MRtGlx!-2044578995!-949856145!9001!-1
Mortality rate and length of stay of patients admitted to the intensive care unit in July*.
Critical Care Medicine. 32(5):1161-1165, May 2004.
Finkielman, Javier D. MD; Morales, Ian J. MD; Peters, Steve G. MD; Keegan, Mark T. MB, MRCPI; Ensminger, S. Allen MD; Lymp, James F. PhD; Afessa, Bekele MD
Abstract:
Objective: At the beginning of each academic year in July, inexperienced residents and fellows begin to care for patients. This inexperience can lead to poor patient outcome, especially in patients admitted to the intensive care unit (ICU). The objective of this study was to determine the impact of July ICU admission on patient outcome.
Design: Retrospective, cohort study.
Setting: Academic, tertiary medical center.
Patients: Patients admitted to the ICU from October 1994 through September 2002.
Interventions: None.
Measurements and Main Results: Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) III score and predicted mortality, admission source, admission date, intensity of treatment, ICU length of stay (LOS), and hospital mortality of 29,084 patients were obtained. The actual and predicted weighted ICU LOS and their ratio were calculated. Logistic regression analysis was used to compare the hospital mortality rate of patients admitted to the ICU in July with those admitted during the rest of the year, with adjustment for potentially confounding variables. The patients' mean age was 62.3 +/- 17.6 yrs; 57.3% were male and 95.5% white. Both the customized predicted and observed hospital mortality rates of the entire cohort were 8.2%. The majority (76.7%) of the patients were discharged home, and 15.1% were discharged to other facilities. When adjusted for potentially confounding variables, ICU admission in July was not associated with higher hospital mortality rate compared with any other month. There were no significant differences in the discharge location of patients between July and any one of the other months. There were no statistically significant differences in the weighted ICU LOS ratio between July and any of the other months.
Conclusions: ICU admission in July is not associated with increased hospital mortality rate or ICU length of stay.
pseudoknot said:
Thank you, you just solidified my point to Nitecap.
usnavdoc said:
Im not just refering to new residents beginning rotations in July, we do as well. Really in July you have new faces, in new places, many inexperienced, or maybe just inexperienced to that particular area, maybe they have been at other facilities and now rotating thru a new one ect. Its just a joke and a comment I frequently here from the mouths of anesthesiologist attendings, CRNA faculty, surgery attendings. Why you ask? Because there are new CA-1's, new SRNA's all starting in the OR at the same time. All the new students despite doing many simulator sessions are a little green including myself. I have seen that give a few months and everyone is more comfortable more confident and things start running smoother. At the beginning you are struggling with tasks and things the experienced resident and SRNA are great at.
The comment is really just a repeat of what I have heard many attending joke about.
And yes the 1st yr Surgical residents are not doing much in the OR but the 2nd years go from just "retracting" as you stated to doing more. Hey I train in a huge academic facility and all are learning from surgeons, anesthesia residents to lab techs. Not to state that it is less safe in July b/c the same attendings are running the show but face it the CA-1, younger surg residents or SRNA that is just really starting in the OR is shakey. Does this make things less safe who knows?
I know what it does do however. Things are a little more hectic and less organized. You have new residents and other students that are new to the area, unfamiliar with all the equipment, unfamiliar with OR, Holding or PACU policies, procedures, protocols, databases, documentation systems ect. Knowing these things is essential to perioperative efficiency and productivity. All these things just take time to learn thats it. You have new residents/students that are new at doing procedures. This many times translates into longer times. Eg The new clinician who has inserted a handful of A-linees or central lines may take longer than the CA-3 holding up the Pt in holding or delaying start time. The new surgical resident that takes 3 hrs to do a lap appy or chole when the attending can do 3 in the same time.
SO maybe additional adverse event dont happen. Thanks for the study. However productivity and efficiency is without a doubt effected translating in to longer times, translating into higher healthcare costs. Also the more things are unorganized and delayed and the more attendings and faculy are pushing students and residents the more likely an adverse event of some sort will occur.
Perfect example block resident told to do ax block pre op for post op analgesia but pt going to sleep as well for repair of a open fracture of a radius. Surgery whining b/c he is ready and anesthesia isnt. Anesthesia attending getting on residents a$$ to get things going. Resident blcks the wrong arm. Surgery cancelled till tommorrow and everyone is pissed at everyone. Adverse event happended not b/c resident was incapable but because they were new, hurried, and stressed.
Really you shouldnt take things so harshly and get your panties in a wedgy. I have heard numerous attendings in numreous fields at numerous facilities say this comment in a joking manner so chill man. I dont care what study you show me or how much you cry I have seen first hand the disorganization ect of new clinicians or even experienced residents/SRNA that are new to the area on a different rotation struggle at the beginning.
And yes brand new residents/SRNA's are supervised but I can assure you they are left in the room alone the first week. I have been there done that and seen and experienced first hand believe me so dont hate, congratulate.
usnavdoc said:
You havent even started in the OR man, so what do you know? Typical, a anesthesia resident to be speaking out on a topic they have no clue what so ever about and gonna tell me I am wrong. I forgot you guys know it all, my bad.
nitecap said:
What does being a CA1 have to do with this topic? Nothing at all. For your info I have been a practicing physician in the Navy for the past 4 years. I think I have a bit of understanding as to what goes on in a hospital.
Again you have just turned another thread into a CRNA vs MD thread. For no reason other to hear yourself talk.
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nitecap said:
Since the original post was this:
And since you are most definitely not an intern or even going to be an intern (takes too much time and dedication to become an actual physician for you as you posted before) why do you even bother posting in physician specific threads?
Bah. Don't answer. We all know the answer anyway 🙄
Oddly enough, usnavdoc, who has had more "true" patient responsibility than you will ever have even before he will be in the OR, has an excellent point.
You have no data and you have no support for your inflammatory off-the-cuff comments but you post them anyways in a physician/physician-to-be forum?
Dude, there are many useful CRNA's and SRNA's that visit this site and seem to be able to get along fine--unfortunately you and a few other jokers seem to ruin it for everyone. Why are you even still here other than to annoy physicians and possibly sour many future anesthesiologists/CRNA working relationships with your crap is the big mystery.
Well here we go, another post that gets to be destroyed by Nitecap--SRNA extraordinaire. Strong work.
This thread blows chunks.
holy - I just asked a simple question. 😳 Well thanks for the responses for everyone who answered the original question. I'm still not sure when we start, but I'll just assume that it'll be saturday. Our orientation is june 20-23 with two early June days for ACLS (my med school offers BLS).
Are any of you planning to do ACLS before graduation? The early June days kind of kill my travelling plans.
Are any of you planning to do ACLS before graduation? The early June days kind of kill my travelling plans.
Nitecap seems to be that little chihuahua that's always trying to hump your leg.
I'm sure you heard DOCTORS talking about "don't be a patient in July," But they, unlike you my outspoken friend, have paid their dues in med school, and residency. I know you'll prolly give the retort "I've been a HEALTHCARE PROFESSIONAL for a thousand years, and have seen residents come and go that don't know half of what I know" spiel, but your experience will never be a substitute for going to med school, and through residency.
It gets annoying when the DOCTORS are chatting about a seemingly benign conversation, and the chihuahua starts humping our legs. (throws a milkbone into the horizon, aka stupid intern writes an ORDER for the omnipotent nurse to follow)
I'm sure you heard DOCTORS talking about "don't be a patient in July," But they, unlike you my outspoken friend, have paid their dues in med school, and residency. I know you'll prolly give the retort "I've been a HEALTHCARE PROFESSIONAL for a thousand years, and have seen residents come and go that don't know half of what I know" spiel, but your experience will never be a substitute for going to med school, and through residency.
It gets annoying when the DOCTORS are chatting about a seemingly benign conversation, and the chihuahua starts humping our legs. (throws a milkbone into the horizon, aka stupid intern writes an ORDER for the omnipotent nurse to follow)
L
leopold stotch
nitecap said:
who cares what some retrospective study from northeast ohio in a journal with an impact factor less than 3 says? i personally believe in the july phenomenon, because i know i made more mistakes in july than now. and upper levels retracted from the wards INSTANTLY.
but you could have studied and passed step 3 in the time it took to write this dude.
edit: just saw the second study in the above post, much more convincing.
you know lvspro...it's been a while since we've agreed on something. but this i agree with.lvspro said:
but instead of the chihuahua, i think he's the squirel in your avatar
ThinkFast007 said:but instead of the chihuahua, i think he's the squirel in your avatar
👍
lvspro said:
Cracks me up how resident/SRNA are always mentioned together in Chihuahua's posts as if they are synonymous.
leopold stotch said:
He can't study for step 3. He is a nurse anesthesia student.
toughlife said:
The reason resident and SRNA were mentioned in the above post was to refer that both were starting in the OR in July almost the same week. Both will not know their head from their a$$.
It was not a comparison or claim of equality so dont put words in my mouth toughfag.
A Chihuahua is a little biatchh dog, more on the likes of you guys and how you complain about everything, bark at anything that moves toward you, and whine when you have greater than 4 classes per block, and are so damn paranoid that if anyone even mentions the word nurse you get flush, start whinning (barking) and talk about your new breed of Anesthesiologists. So you admit the old breed is week or something? what is the new bread and teacup poodle, chihuahua mix. Tough maybe you are a little tougher but thinkfag007 is for sure a miniture yorkie with his tail b/t his legs that loves to lick the balls of the attendings b/f they sqaut to take a crap.
I prefer my comparision to a black lab/Blue pitbull mix on weekly equipoise injections. Smart as hell but mean as faq when provoked, ya heard me.
L
leopold stotch
nitecap said:
I like to think of myself as a golden retriever.
nitecap said:
Thank you for the compliment. I think of myself more like a homeless, hungry canine.
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yo my vote is still on him being that squirrel in Lvspro's avatartoughlife said:
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