EM residency rotation in Anesthesiology

[MikeMerk-MtS]

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I am in the works of putting together a curriculum for EM residents who rotate in our department. Does anyone have experience in this (specifically with EM residents)? If so, please PM me if you wouldn't mind chatting a little about it... any advice/direction is much appreciated. Thanks in advance!

 

[dchz]

Tell them they are the master of the airway.

 

[deleted162650]

Tell them they are the master of the airway.

Don’t you think he should take this opportunity to teach them something they don’t already know??

 

[chessknt]

My suggestion would be to emphasize safe sedation techniques, how to use a capnograph waveform, and how to approach a difficult airway. Controlled airways aren't as useful to their education as learning how to properly run a conscious sedation case without having to worry about doing a procedure at the same time.

 

[woopedazz]

Not curriculum-related, but please make sure you put them on high turn-over sedation lists with supervisors that will do the charting for them.

Chatting to the ED guys; one told me the absolute best list he had was a gynae D&C lists with 10-20 patients under Hudson mask and intermittent propofol bolus (no syringe drivers/LMAs allowed). They become completely immersed and you can spend all day challenging them in a non-confrontational manner. They seem to really enjoy it and learn a lot.

Whenever I have a D&C list I'll go grab the rotating ED doc from whatever list they're in and spend the day with them. Letting them make their own mistakes and learning via trial and error; with a bit more handholding/explanation given to the really green ones.

 

[DrZzZz]

My suggestion would be to emphasize safe sedation techniques, how to use a capnograph waveform, and how to approach a difficult airway. Controlled airways aren't as useful to their education as learning how to properly run a conscious sedation case without having to worry about doing a procedure at the same time.

By "approach a difficult airway", I would hope you mean "recognize a difficult airway" so they can use a phone to call anesthesia before pushing 100 of Roc and knocking out some teeth.

 

[chessknt]

By "approach a difficult already", I would hope you mean "recognize a difficult airway" so they can use a phone to call anesthesia before pushing 100 of Roc and knocking out some teeth.

To be fair some of these people will work in critical access hospitals that may not have any other person who can do airways, or at night when there is nobody else available, or the patient may be in extremis on arrival and they dont have time to make phone calls. All kinds of scenarios they could be in where knowing a regimented approach could help remove some of the inevitable panic and provide a working framework.

 

[teacher2md]

Well, if we treat them the same way I was treated as an intern in the ED, then you’ll send them to the pre-op clinic for a month.

 

[DrZzZz]

To be fair some of these people will work in critical access hospitals that may not have any other person who can do airways, or at night when there is nobody else available, or the patient may be in extremis on arrival and they dont have time to make phone calls. All kinds of scenarios they could be in where knowing a regimented approach could help remove some of the inevitable panic and provide a working framework.

Totally fair, I'm just bitter from previous experiences. Thankfully, the ED at my current gig doesn't seem to have that problem. They actually call us for some rather straightforward airways occasionally, but I've yet to be called for a disaster they created, as I was frequently at my previous job.

 

[Southpaw]

as much as I respect our ED colleagues and bemoan the fall of their field due to flooding the market with new grads and a CMG (contract management group) problem that towers ours, i seriously doubt any sort of rotation you construct will change hard wired attitudes toward sedation and airways with goals that'll never align with ours. but if it helps you sleep at night, do your best.

 

[2Fast2Des]

Not curriculum-related, but please make sure you put them on high turn-over sedation lists with supervisors that will do the charting for them.

Chatting to the ED guys; one told me the absolute best list he had was a gynae D&C lists with 10-20 patients under Hudson mask and intermittent propofol bolus (no syringe drivers/LMAs allowed). They become completely immersed and you can spend all day challenging them in a non-confrontational manner. They seem to really enjoy it and learn a lot.

Whenever I have a D&C list I'll go grab the rotating ED doc from whatever list they're in and spend the day with them. Letting them make their own mistakes and learning via trial and error; with a bit more handholding/explanation given to the really green ones.

Your surgeon is okay with EM resident mucking around at the head of the bed??

 

[nimbus]

Your surgeon is okay with EM resident mucking around at the head of the bed??

Maybe they’re busy watching their own resident mucking in the pelvis. FWIW, we were often forced to mask cysto lineups during residency, no LMAs allowed.

 

[anbuitachi]

Maybe they’re busy watching their own resident mucking in the pelvis. FWIW, we were often forced to mask cysto lineups during residency, no LMAs allowed.

no tubes allowed?

 

[deleted162650]

Maybe they’re busy watching their own resident mucking in the pelvis. FWIW, we were often forced to mask cysto lineups during residency, no LMAs allowed.

That game is even more fun when you combine it with “No IV meds allowed”.

 

[nimbus]

That game is even more fun when you combine it with “No IV meds allowed”.

Old skool!

 

[nimbus]

no tubes allowed?

No, just mask, oral airway if needed and straps. And we had these black rubber masks that you couldn’t see fog.

 

[GassYous]

No, just mask, oral airway if needed and straps. And we had these black rubber masks that you couldn’t see fog.

That's gangsta. I have a partner who frequently masks cases. I just toss in an lma and call it a day.

 

[nimbus]

That's gangsta. I have a partner who frequently masks cases. I just toss in an lma and call it a day.

They must be old😉

 

[chocomorsel]

Your surgeon is okay with EM resident mucking around at the head of the bed??

Why not? How’s this any different than fresh CA1s mucking around? They gotta learn somewhere.

 

[2Fast2Des]

Why not? How’s this any different than fresh CA1s mucking around? They gotta learn somewhere.

But they're not going to be practicing the specialty of anesthesia. They'll be doing half assed sedation on full stomach in the ED. Not sure why we have to be responsible to teach them

 

[chocomorsel]

But they're not going to be practicing the specialty of anesthesia. They'll be doing half assed sedation on full stomach in the ED. Not sure why we have to be responsible to teach them

Come on, they are EM residents. They intubate a lot. Who better to learn from? And what’s best for the patients? Just let them keep fumbling around, or help them learn? You could be their patient one day, or your parent, or your spouse, or your kids. Let’s not denigrate them. Why? Aren’t you still in training? And this is how you think of helping your colleagues learn?
And some of y’all complaining about this are teaching CRNAs. Come on.

 

[anbuitachi]

from my experience since we get EM pgy1 rotators, i teach them airway stuff. they are eager to learn. i let them intubate and place LMAs. decent residents. unfortunately, after they go back to EM, i think their attendings teach them differently, and the stuff they learn on anesthesia is often lost.

 

[kidthor]

Most of the EM residents I've had in my OR seem fairly enthusiastic. Then some others show up conveniently right as you've pushed induction meds and say "I'm here for the tube" without any prior engagement.

I am very happy to work with the enthusiastic bunch. I think they like to learn about the whole perioperative mentality and patient physiology, aside from the procedural stuff. Luckily this is most of them.

The "I'm here for the tube" folks I just turn away.

PS Where's the anesthesia rotation for "I'm just here some chest tubes" in the ED?

 

[chocomorsel]

from my experience since we get EM pgy1 rotators, i teach them airway stuff. they are eager to learn. i let them intubate and place LMAs. decent residents. unfortunately, after they go back to EM, i think their attendings teach them differently, and the stuff they learn on anesthesia is often lost.

All you can do is try when they are with you. Not write them off as some people are doing on here.

 

[chocomorsel]

Most of the EM residents I've had in my OR seem fairly enthusiastic. Then some others show up conveniently right as you've pushed induction meds and say "I'm here for the tube" without any prior engagement.

I am very happy to work with the enthusiastic bunch. I think they like to learn about the whole perioperative mentality and patient physiology, aside from the procedural stuff. Luckily this is most of them.

The "I'm here for the tube" folks I just turn away.

PS Where's the anesthesia rotation for "I'm just here some chest tubes" in the ED?

I know right. We clearly missed that rotation. Haha.

 

[secretasianman]

I still remember the bias against anesthesia by the pulm/crit care docs during our ICU rotations in residency. I was actually treated better and given more independence as a prelim medicine intern at a different institution. Even more recently the CC docs had something against my previous group and would write us up. Funny that they still call us to help with the airway when they’re not comfortable though. Ash holes.

 

[2Fast2Des]

Yeah I don't know what it is about other specialty that like to crap on us but then sing our praises when we bail them out of sticky situations

 

[chocomorsel]

I still remember the bias against anesthesia by the pulm/crit care docs during our ICU rotations in residency. I was actually treated better and given more independence as a prelim medicine intern at a different institution. Even more recently the CC docs had something against my previous group and would write us up. Funny that they still call us to help with the airway when they’re not comfortable though. Ash holes.

Ash holes is right. So many of them really think they are so much better than everyone else.

 

[chessknt]

The ****ting on other specialties doesn't look nice, really derailed op's thread too.

 

[kidthor]

Yeah I don't know what it is about other specialty that like to crap on us but then sing our praises when we bail them out of sticky situations

Remember how everyone talked crap about psych, and then everyone realized that they're actually living in the promised land.

Sadly the promised land anesthesia ain't.

 

[dhb]

Sadly the promised land anesthesia ain't.

You didn't read the fine print on the agreement of sale

 

[deleted162650]

You didn't read the fine print on the agreement of sale

Ah, the large print giveth, and the fine print taketh away.

 

[We'llBeDoneIn15Minutes]

By "approach a difficult airway", I would hope you mean "recognize a difficult airway" so they can use a phone to call anesthesia before pushing 100 of Roc and knocking out some teeth.

Many hospitals, most smaller ones, don't have anesthesia in house and rely on the ER doc to run all codes and airways. I know, I was one....
And I learned after switching specialties being a really good ER airway specialist is not a really good Anesthesiologist airway specialist. Same for "sedationist."

So to repeat the others here, as much teaching and experience with airways and sedation would be a good top priority.