PICU attending here
1) PICU is certainly a tough rotation, but not so much in July compared to what you could be getting, say in January in terms of volume/acuity.
2) Any subI needs to do the basics well - know as much about your patients as you can, be eager to help, stay late if need be, make clear plans even if they're wrong, constantly be talking to your residents, try to be as efficient as possible.
3) No one expects you to be managing vents/pressors and dialysis on your first day/week, but you want to be a quick study of what people are teaching you. If I had students I would be most impressed by seeing them apply something I taught them 10 days ago with no follow up in between.
4) for matching purposes at that program, you need to impress the residents, not the attendings (unless by chance a PICU attending is one of the Program Directors/assistant program directors). Piss off the residents and it won't matter how great the PICU attending thinks you are. Most PICU attendings only do a week of service at one time, so you really will be stretching to get enough time for a LOR.
5) do not expect to get any procedures - if the place has fellows, in July, they are going to get first crack every time. If there aren't fellows, then it'll fall to the residents because it's early. This is especially true if it's a program where both PICU rotations are done in the 2nd year and so everyone will be trying to jockey for opportunities (as opposed to places where 1 rotation is done in 2nd year and 1 in third year which would give you a mix of senior level residents).
6)
Online Medical Education | OPENPediatrics is 100% the best resource you'll be able to find.
7) when making your plans, almost all PICU attendings will go with a systems based approach, so keep that in mind as you prepare your presentations. Additionally - INTERPRET your data when you present. I have lots of friends at academic centers (i'm in private practice) who absolute detest just getting hammered with data and no interpretation when students/residents present. So state the range of heart rates and that the patient is or isn't tachycardic (and bonus points if you can point to why - albuterol, a fever, symptomatic anemia, they're in un/compensated shock of whatever variety, etc).
8) PICU attendings are *not* the most cuddly of pediatricians, so keep that in mind as you prepare yourself for the rotation. Expect blunt feedback. Also realize that for most (if not all) PICU attendings, physiology is our love language. That's how we think, that is what we're trying to impact, so engage us on that level, and you'll get more out of the rotation. Starting a question with "can you explain the physiology of...?" will probably open you up to a 30 minute or more discussion.
9) all learners go through a phase where they think "if I can just see diagnosis XYZ I'll know how to treat it" but that's a fool's errand because even if you memorize the top 500 PICU diagnoses, you'll be sunk when #507 rolls through the door. Instead think of symptoms and tools you have to treat them. There are many final common pathways to hundreds of diseases, and for much of the PICU workload it really comes down to buying time so that either A) a subspecialist can give the definitive treatment plan, or B) the body heals itself.
