First day on Gas!

[newguy]

Today was my first day on gas, 4th year rotation! It was cool. I'll be excited to do a few procedures, but in due time.

I know this is what I want to do, but it feels a little like the "shadowing" we did early in our medical careers, and that's a little discouraging . I know it's day one, and I know this will change. How did you guys feel after your first rotation?

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[Breezee]

Your rotation will be what you make of it. If you show enthusiasm and initiative, you can get all the intubations and lines that you want. If someone asks if you want to give this a try, say "yes" and go for it. No one expects you to know much of anything at this point. This is your chance to learn. The more proactive you are about asking to intubate, asking for procedures-- the more receptive most people will be about giving you a shot at it.

 

[foodcoma]

Also, what you're feeling is COMPLETELY normal. i know the feeling of shadowing the attendings around...it's the most idiotic and annoying feeling that i have ever experienced as have you most likely. so you should understand that it's just your first day and it's the worst it can potentially be right now, and you have to sweat it out until you get more comfortable with your surroundings. or at least that's what i keep telling myself...

 

[pillowhead]

Today was my first day on gas, 4th year rotation! It was cool. I'll be excited to do a few procedures, but in due time.

I know this is what I want to do, but it feels a little like the "shadowing" we did early in our medical careers, and that's a little discouraging . I know it's day one, and I know this will change. How did you guys feel after your first rotation?

One attending that I hadn't worked with before was shocked when he saw me put in an A-line on the first try (I had done about 5 or 6 before). He came up to me and essentially said "make sure you tell the attending what you feel comfortable doing because we don't all know what skill level you're at and will assume you know nothing otherwise." So if you know how to do ANYTHING at all, (putting in an IV, charting, looking up lab values when someone asks, making small talk with a nervous patient), just do it. That last one--making small talk with a nervous patient--will impress some attendings incredibly. I remember this one 19 yr old who was super super nervous and they were having a hard time getting her epidural and I held her hand and distracted her for over half an hour. The chair of the dept afterwards came up and thanked me for doing that and talked a long time about how important it is to really know your patient in a short amount of time.

You can teach anyone to intubate and put in a line. You can't teach people to be empathetic and caring. (Sorry for the sappiness but it's true.)

 

[VolatileAgent]

You can teach anyone to intubate and put in a line. You can't teach people to be empathetic and caring. (Sorry for the sappiness but it's true.)

well said. come interview at our program... please! (PM me if you want details.)

 

[VentdependenT]

If you don't know then ask:

Whats this stopcock thingy do?

How do you get the bubbles out of the tubing or prime a drip?

How do you chart?

hows that knobby thing work that makes the bag harder/easier to squeeze?

When you see the opportunity to help do so:

Throw up the armboards and ASA monitors on the patient without needing prompting. Explain to the pt what and why you are putting sticky crap all over their body.

Preop the next patient and throw in the IV.

Ask what you can do to help.

Act interested.

If you do these things then any self-respecting resident should let you do/have a crack at most procedures.

This past month I had my students who were interested: intubate/DL & bag mask everyone, take over & understand the vent, understand the rgm/Airway Pressure monitors, understand basics of & then push meds, titrate the inh agent, throw in a-lines and all IV's, hang n' run blood/fluids, pimp me to no end, understand attractive things the applicant can do for his/her ERAS file.

Folks who were uninterested (only one) were encouraged to go on multiple breaks and lunches.

 

[VolatileAgent]

Folks who were uninterested (only one) were encouraged to go on multiple breaks and lunches.

 

[flashgordon]

At least you're not shadowing CRNAs all day long... I only see the anesthesiologist for 5 mins during the beginning of the case.

 

[blocks]

At least you're not shadowing CRNAs all day long... I only see the anesthesiologist for 5 mins during the beginning of the case.

Word of advice: don't even bother applying to that program.

 

[usnavdoc]

Word of advice: don't even bother applying to that program.

Come on theres nothing wrong with a med student shadowing a CRNA or PA. They have tons to teach you at that level. Even as a CA1 for the first 6 weeks we were paired with a PA or CRNA with progressively more autonomy until you are finally on your own with just an attending poping in and out. You learn to be an anesthetist first then you learn how to be an anesthesiologist.

 

[flashgordon]

.

 

[Lefty]

We had med students start with us this past week as well. I remember feeling lost and stupid when I started my first rotation. Now, as a resident I am trying to pay attention to a million things and don't do the best job paying attention the student, which I feel bad about sometimes.

Here are some tips I would offer:

Do as Vent suggested and ask questions about things you don't know or understand. BUT just use common sense and don't do it during busy times of the case.

Pay attention at the beginning of cases as to what's being done and help do it with every case (like Vent mentioned with putting on monitors--pulse ox, EKG leads, BP cuff, etc)

Learn the anatomical structures of the airway--this will take you 15-20 minutes looking in an anatomy book at most. With each laryngoscopy/intubation attempt you do be sure to communicate exactly what you are seeing as you do it. This will make you look good, put the resident and attending more at ease, and most importantly they will be less quick about jumping in and taking over.

After the pt is tubed and gas is on ask/offer to put in another IV. It'll be easier to start IVs due to venodilation, and pt will be asleep and not uncomfortable like in preop area.

Hope this info helps. Good luck on your rotation.

 

[aredoubleyou]

Come on theres nothing wrong with a med student shadowing a CRNA or PA. They have tons to teach you at that level. Even as a CA1 for the first 6 weeks we were paired with a PA or CRNA with progressively more autonomy until you are finally on your own with just an attending poping in and out. You learn to be an anesthetist first then you learn how to be an anesthesiologist.

I think its a total act of complete disregard and disrespect not to match you with residents, especially ca-2, and 3's as a student. You dont see the family med and internists pairing students with NPs! Coukd u imagine a med school that uses NPs to teach med students physical findings of disease, lab interpretation, incorporating radiologic findings to make a diagnosis? No one would stand for it. Why is it tolerated in anesthesia?