Expectations for a CA-1?

[Seagal]

Hey guys,

Almost 6 months into CA-1, wondering if I am 'on track'. Many of us are still doing cysto's, lap chole's, etc. When did you all start doing more advanced cases? Also, do you have a system/schedule for reading? I am just going by getting as much done on the weekends as possible. No rigid schedule or anything.

Thx!

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[gasattack3]

What I tell our CA1's who are getting a little restless is that after January, just start requesting more complex cases. Look ahead at the schedule and just request those cases to whomever is making the schedule for the following day.

Also, hang in there. There's a lot of "finesse" you can learn from those B&B cases. Get your timing and efficiency down. You'll need both of those when you're doing a more advanced case.

The natural progression during CA1 seems to be Survive-->get more comfortable-->hone finesse-->become "slick" at routine cases with smooth wakeups, good pain control, patients "moving themselves over to the bed" quick turn over, great timing etc. THEN, you start looking for challenges. But, it should be in that order.

CA2 year is busy and the challenges tend to come to you. Good luck and hang in there.

 

[caligas]

...and in about ten years you'll be looking to do more cystos, lap choles, etc. It all comes full circle.

 

[S@xplayer]

Don't know where you train, but after one month of CA-1 year, we do plenty of high acuity cases...adult hearts, awake craniotomies, bad vascular cases, etc...they don't waste anytime pushing us in at my program. This is not always a good thing, however we are excellent in our clinical training.

 

[gasattack3]

Don't know where you train, but after one month of CA-1 year, we do plenty of high acuity cases...adult hearts, awake craniotomies, bad vascular cases, etc...they don't waste anytime pushing us in at my program. This is not always a good thing, however we are excellent in our clinical training.

He's either joking, full of sh.t, or he means that he's doing those cases with a CA-2/3 in the room with him the whole time.

 

[WholeLottaGame7]

He's either joking, full of sh.t, or he means that he's doing those cases with a CA-2/3 in the room with him the whole time.

Maybe, maybe not. It sounds like there are some crazy programs out there based on stories from this forum.

That said, what's the point of doing hearts a month into your CA-1 year when you're still worried about getting the tube in and maybe trying for that 16g instead of the 18?

You don't pick up HALO for the first time ever and play it solo on Legendary. Same deal...

 

[urge]

Don't know where you train, but after one month of CA-1 year, we do plenty of high acuity cases...adult hearts, awake craniotomies, bad vascular cases, etc...they don't waste anytime pushing us in at my program. This is not always a good thing, however we are excellent in our clinical training.

Mental note: Do not have surgery in Iowa.

 

[Doctor4Life1769]

Don't know where you train, but after one month of CA-1 year, we do plenty of high acuity cases...adult hearts, awake craniotomies, bad vascular cases, etc...they don't waste anytime pushing us in at my program. This is not always a good thing, however we are excellent in our clinical training.

1 month in huh.

🙄

 

[BobBarker]

Double booked with a sr resident or one on one with an attending who does his own cases would be the only way that would be feasible.

 

[DannyB]

don't know where you train, but after one month of ca-1 year, we do plenty of high acuity cases...adult hearts, awake craniotomies, bad vascular cases, etc...they don't waste anytime pushing us in at my program. This is not always a good thing, however we are excellent in our clinical training.

lol

 

[S@xplayer]

Wow guys, none of you interviewed at Iowa eh? We do hard cases early on, not double booked with seniors what so ever. We aren't scheduled to do hearts as a month rotation until after 3-4 months, but it isn't uncommon to do hearts and the cases described above after 1-2 months if we are needed. I'm not even half way through CA2 year and I've more than met every case number to graduate..

 

[S@xplayer]

He's either joking, full of sh.t, or he means that he's doing those cases with a CA-2/3 in the room with him the whole time.

Don't know why I would waste my time posting if it weren't true.

 

[S@xplayer]

Mental note: Do not have surgery in Iowa.

Sorry Urge, I have to disagree. There isn't any sacrifice in care because of our set ups.

When we are in hearts, we are one on one with faculty, no matter what year we are. What good is a program if the faculty can't teach you, even if you are a CA 1 and not comfortable with the case yet? Sure, attendings work harder with the junior residents during these cases, but that doesn't mean safety is sacrificed. Our graduates are frequently complimented on our clinical skills in practice which is no coincidence, based on our training. Iowa has long had an excellent reputation in anesthesia, which is also not a coincidence.

 

[DannyB]

Sorry Urge, I have to disagree. There isn't any sacrifice in care because of our set ups.

When we are in hearts, we are one on one with faculty, no matter what year we are. What good is a program if the faculty can't teach you, even if you are a CA 1 and not comfortable with the case yet? Sure, attendings work harder with the junior residents during these cases, but that doesn't mean safety is sacrificed. Our graduates are frequently complimented on our clinical skills in practice which is no coincidence, based on our training. Iowa has long had an excellent reputation in anesthesia, which is also not a coincidence.

Second to none!

 

[pressor]

It's interesting to hear about being double-booked with senior residents, as that never happens over here...is that normal for big cases? I'm just starting out in a training program in Canada, and we sorta just get thrown into things first year here, where our first year is actually the equivalent of your intern year. 3 months into anesthesia and I've done mostly those types of cases as well, but have had actually quite a bit of time in peds rooms, and a couple vascular days, and whatever comes in on-call. It's been fun! We get put into heart rooms too. But as someone else pointed out, I wanna get somewhat slick at these bread and butter cases first too instead of the anxiety from the constant barrage of new operations to read up on and stress over frequently too. 😛

 

[IveGotTwins]

Also a CA-1 about 6 months in.

I have done cranis, but not awake.
I have done neurovascular but not open peripheral vascular.
I have done major Ortho (acetabulum, etc), free flaps, OMFS (nasal ETT) but this is probably fairly standard.
I have done pedi but only on call.
There are many of my fellow CA-1s who have done a whole month of pedi by this point.
One of my classmates did a liver the other day which shocked the hell out if me.
None of us have done CV. The first of us to do it are those of us that have expressed interest and it will begin in February.
No regional until CA-2.
No pain rotations until CA-2.

I've yet to be double booked with an upper level but I suppose it could happen.

 

[yasawa]

He's either joking, full of sh.t, or he means that he's doing those cases with a CA-2/3 in the room with him the whole time.

We start doing hearts as a CA1. 2/3 of our CA1s will do cardiac and the remaining 1/3 will do cardiac as a CA2. Obviously healthy CABGs go to the CA1s while sicker cases go to the CA2s/3s/fellows. I really wouldn't consider awake Crani's and AVM resections CA2/3 level cases. Our neuro anesthesia fellow mainly does a lot of EEG/SSEP/MEP readings since that's what the fellowship is really for(plus a lot of research). I guess at my program its a necessity that CA1s do big cases early in the year since CA1s on call are responsible for any case that comes in except for liver transplants and ruptured AAAs. Starting in May, CA1s will start to do hepatectomies, whipples and a few will get their first liver txp before CA2 year. If there are no liver txps, the CA2 sleeps at night while the two CA1s on call rotate all of the emergency cases with the CA3 acting as the attending.

 

[urge]

Who does the hysteroscopies nowadays? Medstudents? High school students?

 

[btbam]

I gave a CA-1 a break the other day and he had A-line tubing as an extension on a blood set, so the notion of one of them doing hearts scares me just a bit.

 

[Sonny Crocket]

Expectations? Show up, be prepared, be interested, read, and don't complain. People who don't complain are few and far between. But I have noticed that they tend to get a lot of respect and do very well in this field.

 

[Mman]

Sorry Urge, I have to disagree. There isn't any sacrifice in care because of our set ups.

When we are in hearts, we are one on one with faculty, no matter what year we are. What good is a program if the faculty can't teach you, even if you are a CA 1 and not comfortable with the case yet? Sure, attendings work harder with the junior residents during these cases, but that doesn't mean safety is sacrificed. Our graduates are frequently complimented on our clinical skills in practice which is no coincidence, based on our training. Iowa has long had an excellent reputation in anesthesia, which is also not a coincidence.

the problem early on is you can't appreciate the intricacies of the complicated cases because you have too much of the basics to learn. It's pointless putting a person in the 2nd month in a heart or other big complicated case when they are still getting used to how to handle an induction sequence. You certainly don't learn everything you would later on in the same case. (and I say this coming from a program where I also had all my case minimums before my CA2 year was finished)