First year attending woes

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dchz said:
Agree. I joined a practice that allowed me to do my own cases, tough cases. We will see how I come out the other side.

I'm also a first year attending. It was more humbling that I've ever thought: I had a two week stretch where I had a run of close calls and even had an MI on induction.

Last weekend call I literally had my first on table death. They tell me it gets easier dealing with bad outcomes. May be I'll be less emotionally invested each time but I'm sure I'll remember all those cases for the rest of my life.

Thanks y'all for all the good advice in this thread.
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Would be helpful if we had a thread on bad outcomesin the private forum.
 
BLADEMDA said:
The first year out is critical to polishing your skills. Those who join a practice where they can actually DO cases are in a much better situation than those who ONLY supervise from day 1. IMHO, the best supervisors are those anesthesiologists who have several thousand cases personally performed under their belts. I really think the number needed is round 3,000-5,000 cases to become truly proficient in the field with sufficient exposure to many of the things that can/do go wrong.

There simply is no substitute or shortcut for experience.
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Can't like this enough.
 
dchz said:
Agree. I joined a practice that allowed me to do my own cases, tough cases. We will see how I come out the other side.

I'm also a first year attending. It was more humbling that I've ever thought: I had a two week stretch where I had a run of close calls and even had an MI on induction.

Last weekend call I literally had my first on table death. They tell me it gets easier dealing with bad outcomes. May be I'll be less emotionally invested each time but I'm sure I'll remember all those cases for the rest of my life.

Thanks y'all for all the good advice in this thread.
Click to expand...

One of the best ways to deal with these kinds of tough cases is to share them. It can be cathartic for you and also educational for you and the people you share with.
 
vector2 said:
One of the best ways to deal with these kinds of tough cases is to share them. It can be cathartic for you and also educational for you and the people you share with.
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Agree. Even the close calls, I perseverate on for a few weeks discussing with colleagues with multiple years of experience to adjust my practice if needed in the future.
 
Justice4all said:
Agree. Even the close calls, I perseverate on for a few weeks discussing with colleagues with multiple years of experience to adjust my practice if needed in the future.
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Near misses are completely different from total losses.

Btw, young attendings should read M&M books. Springer has a couple. Best to learn from other people's mistakes.

Cursory search results:
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dchz said:
Agree. I joined a practice that allowed me to do my own cases, tough cases. We will see how I come out the other side.

I'm also a first year attending. It was more humbling that I've ever thought: I had a two week stretch where I had a run of close calls and even had an MI on induction.

Last weekend call I literally had my first on table death. They tell me it gets easier dealing with bad outcomes. May be I'll be less emotionally invested each time but I'm sure I'll remember all those cases for the rest of my life.

Thanks y'all for all the good advice in this thread.
Click to expand...
Was this a cardiac case? Honestly, I only say this because it’s something i seriously considered and I think residents should consider when deciding whether or not to go into cardiac. I liked the rotations and echo but I did not want the emotional burden for my career that comes with being exposed to cases like this on a routine basis. Much happier talking about sports all day and doing mostly ortho.
 
I was an attending for a year before going back to cardiac fellowship, and have continued to moonlight doing general anesthesia as an attending during fellowship. Unfortunately, I have had a few bad outcomes (including one death on the table) while moonlighting this year.

I think one of the biggest things I have gotten from cardiac fellowship is the confidence that comes with having been down the algorithm of a crashing patient so many times... knowing what’s the end of that algorithm looks like, who will and will not be a good candidate for mechanical support, what else to think about when a patient is circling the drain. of course the bad outcomes still suck, but I beat myself up a little less knowing that I did everything right and that every possible avenue (cath lab, ECMO, etc) was considered from an educated standpoint
 
Hork Bajir said:
I was an attending for a year before going back to cardiac fellowship, and have continued to moonlight doing general anesthesia as an attending during fellowship. Unfortunately, I have had a few bad outcomes (including one death on the table) while moonlighting this year.

I think one of the biggest things I have gotten from cardiac fellowship is the confidence that comes with having been down the algorithm of a crashing patient so many times... knowing what’s the end of that algorithm looks like, who will and will not be a good candidate for mechanical support, what else to think about when a patient is circling the drain. of course the bad outcomes still suck, but I beat myself up a little less knowing that I did everything right and that every possible avenue (cath lab, ECMO, etc) was considered from an educated standpoint
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Yes. We need to focus on our process. Sometimes the outcome is out of our control.

Many years ago during internship, I had a highly regarded cardiologist as a CCU attending. He was fond of saying...

“I’m just a physician, not a magician.”

and

“Tell that guy not to buy any long playing records.”
 
Hork Bajir said:
I was an attending for a year before going back to cardiac fellowship, and have continued to moonlight doing general anesthesia as an attending during fellowship. Unfortunately, I have had a few bad outcomes (including one death on the table) while moonlighting this year.

I think one of the biggest things I have gotten from cardiac fellowship is the confidence that comes with having been down the algorithm of a crashing patient so many times... knowing what’s the end of that algorithm looks like, who will and will not be a good candidate for mechanical support, what else to think about when a patient is circling the drain. of course the bad outcomes still suck, but I beat myself up a little less knowing that I did everything right and that every possible avenue (cath lab, ECMO, etc) was considered from an educated standpoint
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Always beats me why PDs are as dumb as to prioritize hiring fresh grads, instead of attendings, especially if already board-certified.

There is nothing nicer than working with a fellow who owns his patients, who knows exactly what he needs to learn, and doesn't need much hand-holding.
 

FFP said:
Always beats me why PDs are as dumb as to prioritize hiring fresh grads, instead of attendings, especially if already board-certified.

There is nothing nicer than working with a fellow who owns his patients, who knows exactly what he needs to learn, and doesn't need much hand-holding.
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Maybe less headaches, potential ego battles, or trying to remold a person who is set in their ways. Easier to train a new grad who will just be a pgy 5
 
anaesthetic said:
Seen this issue exactly. Overconfidence, inability to take criticism, frustration at being a trainee again, etc. Maybe wasn't an attending issue so much as a personality issue but certainly didn't help.
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There are definitely upsides AND downsides to taking a break and getting some attending experience between residency and fellowship. The upsides are fairly obvious in terms of skills, knowledge, confidence, and perspective.

The downside is that it really really sucks to be back in training after tasting that attending life (both in terms of finances, respect, and autonomy). I would be lying if I said that I didn’t have some ego clashes or moments of major frustration this year. All you can do is try to handle the dynamic with grace and focus on learning what you need to learn... But when I was corrected on how to tape the tube during my first day of fellowship (this actually happened - wish I was kidding)... Well, my poker face is only so good. “Thank you for this learning opportunity”.

Going back into training after a gap is an exercise in humility. YMMV
 
Hork Bajir said:
There are definitely upsides AND downsides to taking a break and getting some attending experience between residency and fellowship. The upsides are fairly obvious in terms of skills, knowledge, confidence, and perspective.

The downside is that it really really sucks to be back in training after tasting that attending life (both in terms of finances, respect, and autonomy). I would be lying if I said that I didn’t have some ego clashes or moments of major frustration this year. All you can do is try to handle the dynamic with grace and focus on learning what you need to learn... But when I was corrected on how to tape the tube during my first day of fellowship (this actually happened - wish I was kidding)... Well, my poker face is only so good. “Thank you for this learning opportunity”.

Going back into training after a gap is an exercise in humility. YMMV
Click to expand...
JFC some people do not know how to teach. I do have a question for you @Hork Bajir (love the name btw, I've been downloading all the old books to reread)...how much of fellowship was actually teaching vs using you as a body filler for rooms? Cause I'll be honest, at my current rotation, I am barely getting taught anything on my cardiac days, and am primarily being used as a body for places where they don't have a crna. That or they just don't know what to do with me, so they throw me wherever they can find a space. Admittedly, this isn't a cardiac fellowship, nor is it a specific cardiac rotation, so it's mildly understandable.
 
Hork Bajir said:
There are definitely upsides AND downsides to taking a break and getting some attending experience between residency and fellowship. The upsides are fairly obvious in terms of skills, knowledge, confidence, and perspective.

The downside is that it really really sucks to be back in training after tasting that attending life (both in terms of finances, respect, and autonomy). I would be lying if I said that I didn’t have some ego clashes or moments of major frustration this year. All you can do is try to handle the dynamic with grace and focus on learning what you need to learn... But when I was corrected on how to tape the tube during my first day of fellowship (this actually happened - wish I was kidding)... Well, my poker face is only so good. “Thank you for this learning opportunity”.

Going back into training after a gap is an exercise in humility. YMMV
Click to expand...
If my attendings saw how I do things or if I went back to residency and did things the way I do now (pace wise and not having literally everything drawn up or set on the machine, among others), I'm pretty sure they would probably pass out from the shock haha. I can't imagine holding it together if someone told me how to tape... Props to you guys who can pull off an extra year of 'yes sir' when you were the boss for however long
 
@MirrorTodd as you might imagine, it varies quite a bit by attending. Some ppl teach a lot and others not at all; some of that teaching is very high quality, and some of it is exceptionally poor. That being said, I am still learning a lot this year. I chose a fellowship where the primary selling point was that we are a busy service, where the fellows get preference for the educational cases, mostly do our own cases, and do a lot of them. The year is a grind, but the only way to get good (in my opinion) is to do the reps... Ya never know when something will go catastrophically wrong, and the only way to get those experiences under your belt is to do enough cases and be in the driver’s seat when the bad things happen.

Of course, I tend towards self directed learning. This style of fellowship probably wouldn’t work for everyone. It’s a case of “you get out of it what you put in”.

I feel your frustration as being a stool-warmer, though... it happens sometimes and it sucks. Service and learning need to be at least SOMEWHAT balanced. Just my 2 cents
 
anaesthetic said:
My fellowship experience was excellent. Many times now I've relied on some obscure experience in fellowship to guide my practice when complications or difficult situations arise. It's almost inexplicable how important those reps really are. I am also thankful for some of the surgeons I worked with during fellowship who pushed me to be a better anesthesiologist by offering their perspective and approach to the complex surgical patient. The whole experience was truly invaluable, as I brought some of that knowledge to my current practice and have helped the surgeons here navigate some very difficult situations. Absolutely no regrets personally.
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I'm curious, what kind of discussions did you have with surgeons where they valued input? Especially knowledge you felt made you better. And what knowledge do you provide them that helps them? This seems to be a different species of human beings you are referring
 
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