how to make the best of intern year??

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hope2bnmd!

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hey guys...congrats to those starting their ca-1 year (although taking that in-service kinda sux). i was wondering if anyone knew how to make the best of their intern year. should we start reading a little bit about anesthesia? reason i ask is beacuse very few electives in my intern year are actually going to help me for my ca-1 year. for ex..right now im on the neuro service! strokes, strokes, and more strokes! not really helpful if you know what i mean. in a few months i have my ICU and CCU months, which will help a bit. unfortunately my intern year is not really geared up for anesthesia...will this hurt me as a ca-1? i set up my intern year to relax some, but now im thinkin i might of screwed myself. just curious if any of you actually started reviewing morgan and mikhail, or anything else during intern year--instead of reading for rotations like Neuro, or ER, or sports medicine or rhuematology (yes 2 of my electives!). take care.
 
hope2bnmd! said:
hey guys...congrats to those starting their ca-1 year (although taking that in-service kinda sux). i was wondering if anyone knew how to make the best of their intern year. should we start reading a little bit about anesthesia? reason i ask is beacuse very few electives in my intern year are actually going to help me for my ca-1 year. for ex..right now im on the neuro service! strokes, strokes, and more strokes! not really helpful if you know what i mean. in a few months i have my ICU and CCU months, which will help a bit. unfortunately my intern year is not really geared up for anesthesia...will this hurt me as a ca-1? i set up my intern year to relax some, but now im thinkin i might of screwed myself. just curious if any of you actually started reviewing morgan and mikhail, or anything else during intern year--instead of reading for rotations like Neuro, or ER, or sports medicine or rhuematology (yes 2 of my electives!). take care.

Neurology is a topic that readily applies to anesthesia. Cerebral perfusion, neurophysiology and understanding of pain mechanisms and pathways, understanding pathologic mental conditions (Parkinson, Alzheimer, etc.) and how certain medications affect them, etc. Almost everything you see on the neuro service you will see in anesthesia so don't think it is a useless service to be on. You will see more strokes in your day to day practice than you will know what to do with and you may even cause a stroke if you do not leave residency with at least a basic understanding of cerebral perfusion and mechanisms of cerebral ischemia.

Even rheumatology will have impact on your knowledge base for anesthesiology as you need to know what conditions predispose to critical physiologic weaknesses or tolerances that will affect your choice of anesthetics as well as what medications might worsen a patient's rheumatologic condition during anesthesia.

Every service you have listed will provide critical understanding and knowledge for your future as an anesthesiologist. Read for each rotation in depth and spend some time going through the correlating chapter in Morgan & Mikhail, Barash, or whichever anesthesiology text you have already purchased. In this way you can learn the rotation topics AND understand how they apply to anesthesiology. Most of all have fun. You might actually miss some aspects of general practice once you leave it for good.
 
Absolutely spot-on advice by UT.

Do not blow off any rotation thinking it won't apply to anesthesiology. Anesthesiology encompasses just about every medical field you can think of including psychiatry and radiology (other than maybe pathology).

Your goal as an intern should be to learn as much as you can. You want to be the best doctor that you can be so that way you can do good for your family, your community, and most of all your patients. The day you start blowing something off because you think it's not that relevant, well, then welcome to the world of mediocrity.

Finally, enjoy your intern year ... not because it's going to necessarily be fun or easy, but because there's a light at the end of the tunnel called anesthesia. And this is a light that none of the categorical IM residents ever really see. Cuz when they go to sleep, they're left wondering if in fact they are really just glorified secretaries or social workers. We, in anesthesia, thanks be to God, make a direct and potent difference on people's lives everyday.
 
Just echoing the advice already given from above posts. Try to make the most of each rotation you are on. Let's be honest, some months you are just going to try and get through it, but for the most part there are pearls in every area you rotate in.

Just finishing intern year, I echo what UT said in that if you want to read some anesthesia, read the correlating chapters in your text (M&M, baby, whatever) to your rotation. If your IM attendings (and they will) try to beat you down with unapplicable lectures every day, request a topic you feel relevant. Cardiology was a great rotation (learning EKG's, managing cardiac issues etc) however, they insisted on sitting me down for about 1-2 hours per day and talk about all of the literature on b-blockers etc which mainly pertained to clinic medicine. After a couple of days they asked if there was anything I wanted to talk about and I asked about 1. Eagle criteria and other pre-op considerations in the cardiac patient 2. EKG abnormalities for the house officer on call (really helpful) and just more EKG instruction. They were more than willing to talk about these things. One thing I have noticed, if you are professional and pay attention when they talk about clinic medicine and other moderately useful topics, they are much more willing to lecture for your area of interest. If you act like a douche, and let them see your disdain for their field b/c all you care about is anesthesia (or optho or rads or whatever) then rotation will be sub par.


Don't forget, we are doctors who specialize in anesthesia. We are valuable because of our breadth of knowledge. Learn all you can this first year. Me included, we don't really know what will be useful and what won't two years from now. Heed the advice of UT and other 'end of tunnelers' and learn all you can.

PS - UT was onto something else, as much as I love my CA-1 year so far and am stoked to be doing anesthesia now, the masochistic side of me sort of misses cruising the floor............Just kidding, but tell yourself that this year. :laugh:
 
hope2bnmd! said:
hey guys...congrats to those starting their ca-1 year (although taking that in-service kinda sux). i was wondering if anyone knew how to make the best of their intern year. should we start reading a little bit about anesthesia? reason i ask is beacuse very few electives in my intern year are actually going to help me for my ca-1 year. for ex..right now im on the neuro service! strokes, strokes, and more strokes! not really helpful if you know what i mean. in a few months i have my ICU and CCU months, which will help a bit. unfortunately my intern year is not really geared up for anesthesia...will this hurt me as a ca-1? i set up my intern year to relax some, but now im thinkin i might of screwed myself. just curious if any of you actually started reviewing morgan and mikhail, or anything else during intern year--instead of reading for rotations like Neuro, or ER, or sports medicine or rhuematology (yes 2 of my electives!). take care.

i'm just starting my ca-1 year so i don't yet know if what i did is right, but i immersed myself in my medicine preliminary year. i considered myself a medicine intern, not a preliminary person just jumping through the hoops to get to anesthesia. now, medicine was painful and i'm glad i'm not still doing h&p's, but i learned a lot and am glad i worked hard that year. i didn't read any anesthesia or do any anesthesia rotations--it was all medicine, including 3 micu months. i think we will have plenty of time to learn anesthesia, so i think taking advantage of the opportunity you have to learn as much medicine as possible is really key. i think being as knowledgable as possible about medicine is part of what makes one an anesthesiologist--a physician-- not just an anesthetist. further, many prominent leaders in anesthesia strongly believe the field is moving more and more toward emphasizing perioperative care, that is assessing and optimizing pts with complicated medical problems and managing critical care services. being able to adapt to these potential expanding/new roles i think makes a solid medicine background even more vital.
 
xjohns1 said:
i'm just starting my ca-1 year so i don't yet know if what i did is right, but i immersed myself in my medicine preliminary year. i considered myself a medicine intern, not a preliminary person just jumping through the hoops to get to anesthesia. now, medicine was painful and i'm glad i'm not still doing h&p's, but i learned a lot and am glad i worked hard that year. i didn't read any anesthesia or do any anesthesia rotations--it was all medicine, including 3 micu months. i think we will have plenty of time to learn anesthesia, so i think taking advantage of the opportunity you have to learn as much medicine as possible is really key. i think being as knowledgable as possible about medicine is part of what makes one an anesthesiologist--a physician-- not just an anesthetist. further, many prominent leaders in anesthesia strongly believe the field is moving more and more toward emphasizing perioperative care, that is assessing and optimizing pts with complicated medical problems and managing critical care services. being able to adapt to these potential expanding/new roles i think makes a solid medicine background even more vital.

This is my take on my prelim medicine year as well. I love learning internal medicine and I think it's absolutely crucial to practicing good anesthesiology. I also agree with whoever said anesthesiologists are physicians first. We as physicians shouldn't just limit our learning to what seems relevant to anesthesiology (at least, speaking for myself, I dont want to limit myself that way). EVERYTHING's relevant! As UTsouthwestern alluded to, anesthesiology is an extremely multi-disciplinary field. . .one of the many reasons i love it!! Actually someone mentioned pathology. . .i am doing a pathology elective right now, and yeah believe it or not, it's definitely relevant. Maybe less directly than say clinical pulm or cards, and we probably wont be sending off specimens for pathology, but to name one aspect as an example, pulmonary pathology is a huge discipline and understanding it at the cellular level contributes to overall understanding. . .same with GI path, cardiac path, definitely cytology (lots of BALs in the ICU!). I also am interested in keeping up with what's taking place on the other side of the curtain, and pathology (among other things) is definitely involved there. I dont know. . .maybe some of us here are just very curious and inquisitive people and want to know about as much as we can learn.

It's really funny to me when pathologists are surprised as to why on earth i'd want to do a path elective if i'm going into anesthesiology, or when medicine folk start trying to decide what would be relevant for me to know for anesthesiology, and just assume certain things wont be (when they in fact are VERY much so), and that i wouldn't be interested in knowing the "irrelevant" stuff. Actually, that makes me fume! 😡 😡 👎 👎 👎

Now that the OP mentions the inservice exam which happens 1 week into CA-1 year, however, i'm worried. . .do CA-1s actually have to pass that thing? Or is it just to compare one's performance from year to year? I guess i can try to cram M&M for 7 nights or so. . .
 
chicamedica said:
This is my take on my prelim medicine year as well. I love learning internal medicine and I think it's absolutely crucial to practicing good anesthesiology. I also agree with whoever said anesthesiologists are physicians first. We as physicians shouldn't just limit our learning to what seems relevant to anesthesiology (at least, speaking for myself, I dont want to limit myself that way). EVERYTHING's relevant! As UTsouthwestern alluded to, anesthesiology is an extremely multi-disciplinary field. . .one of the many reasons i love it!! Actually someone mentioned pathology. . .i am doing a pathology elective right now, and yeah believe it or not, it's definitely relevant. Maybe less directly than say clinical pulm or cards, and we probably wont be sending off specimens for pathology, but to name one aspect as an example, pulmonary pathology is a huge discipline and understanding it at the cellular level contributes to overall understanding. . .same with GI path, cardiac path, definitely cytology (lots of BALs in the ICU!). I also am interested in keeping up with what's taking place on the other side of the curtain, and pathology (among other things) is definitely involved there. I dont know. . .maybe some of us here are just very curious and inquisitive people and want to know about as much as we can learn.

It's really funny to me when pathologists are surprised as to why on earth i'd want to do a path elective if i'm going into anesthesiology, or when medicine folk start trying to decide what would be relevant for me to know for anesthesiology, and just assume certain things wont be (when they in fact are VERY much so), and that i wouldn't be interested in knowing the "irrelevant" stuff. Actually, that makes me fume! 😡 😡 👎 👎 👎

Now that the OP mentions the inservice exam which happens 1 week into CA-1 year, however, i'm worried. . .do CA-1s actually have to pass that thing? Or is it just to compare one's performance from year to year? I guess i can try to cram M&M for 7 nights or so. . .


I matched Categorical and chose the option of doing a Med/Peds Base year (more unit and less floor) which may be good or bad but it seemed to be a more comprehensive year as far as scope of practice. Don't have a weekly clinic, get a month of OR and a month of SICU that counts toward the ICU req's, no electives but not really much I would change about it. NICU, PICU C(ardiac)CU, SICU, two wards of Med and Ped each, Ped ER, Med ER and one ambulatory month (argh, this I would like to change).

I also had the pleasure of taking the In-Service today after 2 weeks of intern year. Some questions were familiar (and no I didn't study anything), others.....
 
For every patient that you encounter, imagine that they need emergency surgery and read about the anesthetic implications of their coexisting diseases and the medications that they take and then formulate an anesthetic plan for preop, intraop, and post op management of the patient. You will finish your intern year with a very good knowledge base and your score on the ITE will go way up. The exam is heavily weighted in internal medicine type content.
 
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