ICU elective

[Intensivist]

hi
l'm preparing to go to Montreal in less then a month to do a 4 weeks ICU rotation. I have been exposed ICU before, 8 weeks all together, been doing a lots of precedures, ET intubations, central lines, bronchs, and midlevel skills. Most of my ICU knowledge comes from Critical Care by Raoof, Marino's ICU and www. ccmtutorials.com
Can anyone give me some input on what to expect while there, duties and such stuff. I ask here because l would like to see what are residents and attendings expectations of a MS4 doing ICU not for the first time, if that matters at all.
Also what's with clothes issues, l want to simply go in srcubs, they recommend formal clothes.
I'm international student from Europe, final yr.

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[error404]

hi
l'm preparing to go to Montreal in less then a month to do a 4 weeks ICU rotation. I have been exposed ICU before, 8 weeks all together, been doing a lots of precedures, ET intubations, central lines, bronchs, and midlevel skills. Most of my ICU knowledge comes from Critical Care by Raoof, Marino's ICU and www. ccmtutorials.com
Can anyone give me some input on what to expect while there, duties and such stuff. I ask here because l would like to see what are residents and attendings expectations of a MS4 doing ICU not for the first time, if that matters at all.
Also what's with clothes issues, l want to simply go in srcubs, they recommend formal clothes.
I'm international student from Europe, final yr.

Even in the US, many medical ICUs don't wear scrubs except when on call. Definitely not my preference, but you should follow the house rules.

Don't know what to tell you about your upcoming experience-- they should orient you when you get there-- but if you're reading Marino you're on the right path.

 

[Intensivist]

considering clothes, what about common things like jeans or t shirts and stuff, l really am not used to wear suit on daily basis.

 

[Hernandez]

considering clothes, what about common things like jeans or t shirts and stuff, l really am not used to wear suit on daily basis.

Business causal or scrubs is the standard dress in places. There are a few hospitals that require suit/sports jackets, but those are rare these days. Jeans/t-shirts is probably a big no-no.

 

[proman]

What kind of ICU is this? Surgical, medical etc? That may dictate acceptable dress.

First day I would show up (assuming you're male), slacks, long sleeve shirt and tie with white coat. You can't go wrong. See what everyone else is wearing.

I see no place for a medical student to wear a suit, anywhere.

 

[Intensivist]

that's my point also, here we are obligated to wear lab coats, of course, sometimes scrubs, but never suits, it just silly if you ask me. pushing some tradition that is pointless and more important hard to follow, l really don't have 10 suits and 99.999% of time l wear jeans and shirts or something like that when in hospital, l agree one should look decent, but jeans and proper t shirt could be just that

 

[Intensivist]

What kind of ICU is this? Surgical, medical etc? That may dictate acceptable dress.

First day I would show up (assuming you're male), slacks, long sleeve shirt and tie with white coat. You can't go wrong. See what everyone else is wearing.

I see no place for a medical student to wear a suit, anywhere.

it's combined MICU/SICU 25 beds, 2 attendings at any time

 

[proman]

that's my point also, here we are obligated to wear lab coats, of course, sometimes scrubs, but never suits, it just silly if you ask me. pushing some tradition that is pointless and more important hard to follow, l really don't have 10 suits and 99.999% of time l wear jeans and shirts or something like that when in hospital, l agree one should look decent, but jeans and proper t shirt could be just that

I disagree. If you're seeing patients you should not be in jeans and a t-shirt, but that's our culture.

You'll probably spend the month in scrubs, just show up professionally dressed the first day.

 

[Bobblehead]

Can anyone give me some input on what to expect while there, duties and such stuff. I ask here because l would like to see what are residents and attendings expectations of a MS4 doing ICU not for the first time, if that matters at all.
Also what's with clothes issues, l want to simply go in srcubs, they recommend formal clothes.
I'm international student from Europe, final yr.

"Not for the first time, doesn't matter." Take it as an opportunity to learn. Trying to show off because it's not your first time through an ICU can be a good way to get on everyone's bad side in a very expeditious manner.

I would ask the attendings on service at that time what their expectations are of you on the first day that you arrive, then again half-way through the rotation. If they're not able to give it to you an answer in a very succinct fashion you can ask them, if functioning at the same level as an intern on the team is something they envision an MS4 doing.

I suggest you know something about every patient on your team even if you're assigned just one patient, and if there are no other students on service with you, in the entire ICU. At least the basics of age, sex, reason for admission, length of stay, general trend up/down/sideways, and any major interventions you hear about for that day.

This can be far more impressive than any procedural skills you may pick up along the way.

I read what you mentioned about jeans and T-shirts above, but if they recommend formal clothes, wear formal clothes. Period. Full stop. End of discussion. That's such clear feedback there's no need to waste any more of your time on it. By formal clothes it generally means slacks, long-sleeved (varies by region) dress shirt, tie and white coat. Most residents will wear scrubs if they're the overnight call team but unless you're on overnight call that day I wouldn't do the same.

 

[Intensivist]

ok, thank you all for replies, very helpful, just to add another comment, when l said t shirt and jeans, l did mean white coat on it
l just hope this thing is worth it, cause paperwork just to get there never ends...

 

[leviathan]

Physicians are supposed to demonstrate professionalism. How professional does one look showing up in jeans and a t-shirt, or scrubs for that matter? I agree though, it's much easier and more comfortable to show up in scrubs than to have to buy tons of dress clothes and iron them every night. Ugh...

 

[Hernandez]

Physicians are supposed to demonstrate professionalism. How professional does one look.........

I've always disagreed with this mentality. Professionalism is more so about how you act than what you wear. Frankly, I know many mechanics that are far more professional than some of the loud mouth braggarts that are dressed to a tee in medicine. Appearance without a doubt matters to some, but to me it's all fluff and now substance.

 

[leviathan]

I've always disagreed with this mentality. Professionalism is more so about how you act than what you wear. Frankly, I know many mechanics that are far more professional than some of the loud mouth braggarts that are dressed to a tee in medicine. Appearance without a doubt matters to some, but to me it's all fluff and now substance.

There's more to professionalism than appearance, but that doesn't mean you discredit appearance.

 

[Intensivist]

I've always disagreed with this mentality. Professionalism is more so about how you act than what you wear. Frankly, I know many mechanics that are far more professional than some of the loud mouth braggarts that are dressed to a tee in medicine. Appearance without a doubt matters to some, but to me it's all fluff and now substance.

Exactly! And since when is anything but suits unproper dressing for work? And chances of getting dirty aka bloody or for other bodily fluid aren't small, and to mess up a fancy suit on daily basis just isn't sustainable for some of us.

 

[howelljolly]

Exactly! And since when is anything but suits unproper dressing for work? And chances of getting dirty aka bloody or for other bodily fluid aren't small, and to mess up a fancy suit on daily basis just isn't sustainable for some of us.

Ive never heard of any hospital requiring one to wear a suit.

Depending on the hospital, scrubs may be allowed, or not. Some hospitals restrict scrubs to sterile areas like the OR.

In the US, and probably Canada as well, jeans and a t-shirt are very casual (not even business casual). They are not even allowed in some clubs and restaurants, let alone the hospital. Its almost as if you were to up to work in your pajamas.



You want to make a good impression, especially on a visiting rotation. As a visitor, you'll be judged on your initial appearance - like it or not.

Start off by wearing slacks, a shirt and tie, and your white coat. Later on you can find out if scrubs are acceptable. Where I rotated, they were only acceptable for night-call.

 

[Hernandez]

There's more to professionalism than appearance, but that doesn't mean you discredit appearance.

When I'm done, I'll be wearing dickies work shirts and cargo pants and a really really nice pair of boots to work.......

Exactly! And since when is anything but suits unproper dressing for work? And chances of getting dirty aka bloody or for other bodily fluid aren't small, and to mess up a fancy suit on daily basis just isn't sustainable for some of us.

Alas, however, you are the student, it's their hospital, you're to abide by their rules. wear what they said the first day or so and find out from the attendings if that's really their personal policy or if it's just the pencil pushers in the GME office policy.

Ive never heard of any hospital requiring one to wear a suit.

I had one attending who worked at Yale or some fancy place like that who said that was their requirement, but a quick google would seem to disagree, standford requires a watch with a second hand however.

 

[proman]

I think anyone working in an ICU should wear scrubs. I hardly even wore a white coat. Certainly anyone who is touching a patient should be in clean scrubs (not month old, worn home scrubs).

 

[Hernandez]

Certainly anyone who is touching a patient should be in clean scrubs (not month old, worn home scrubs).

you mean hospital washed scrubs vs home washed scrubs?

 

[Intensivist]

after all this complaining l'm starting to like the idea of wearing ties on daily basis, but l will ask about scrubs, combined with lab coat or not, it seems much easier.

 

[proman]

you mean hospital washed scrubs vs home washed scrubs?

I'm in a hospital that care a lot about wearing scrubs home (they hammer it for about a month then find something else to care a lot about). I don't wear my scrubs home. It's not that much effort to change, plus I like going directly from the hospital to eat etc.

As for the washing issue, neither OSHA nor CDC require hospitals to launder their scrubs, so I don't think that's a big issue (some nurses however think you are killing patients if you do it).

 

[Hernandez]

I'm in a hospital that care a lot about wearing scrubs home (they hammer it for about a month then find something else to care a lot about). I don't wear my scrubs home. It's not that much effort to change, plus I like going directly from the hospital to eat etc.

As for the washing issue, neither OSHA nor CDC require hospitals to launder their scrubs, so I don't think that's a big issue (some nurses however think you are killing patients if you do it).

It has been studied, and there is absolutely NO proven benefit of hospital laundered scrubs vs home laundered, granted most of these studies where directed at ORs and operating but on the converse medical side there is absolutely no studies which show clothing affects nosocomial infection rates. There is, however, a public perception survey by (I believe) an infection control nurse in the UK which states that the public believes wearing work scrubs outside of the hospital contributes to those infections

 

[Intensivist]

l have another question. What are the average "working" hours for med students when rotating in ICU, while not on call?

 

[leviathan]

When I'm done, I'll be wearing dickies work shirts and cargo pants and a really really nice pair of boots to work.......

That seems decent...I'll probably do the same.

 

[G-Man82]

l have another question. What are the average "working" hours for med students when rotating in ICU, while not on call?

That's highly dependent on the place at which you are rotating. For instance, I did my ICU rotation as my acting internship requirement for 4th year. With that, I was on call q4 days with my team. I had to arrive by 7 am as a student, though the real intern was there by 6:15ish and we stayed until about 4 pm. Those who chose to do our medical ICU elective as students arrived by 7 and stayed for rounds and left afterwards. In the Surgical ICU, run by trauma surgery, elective students were sub-interns and therefore on a q3 overnight call. Our CT ICU is small and only has 2 residents, 1 anesthesia and 1 surgery, in it, so Anesthesiology does not offer a med student elective yet. As you can see, highly variable.

 

[howelljolly]

l have another question. What are the average "working" hours for med students when rotating in ICU, while not on call?

When not on call, mine was 6:30 to about 4:30

 

[sunset823]

I'm shadowing in the ICU this year (I'm an M1), and the first day I wore slacks and a dressy shirt, and my attending was wearing jeans, sneakers, and a plaid shirt. I was both amused and pleased, cuz I hate dressing up. At least at the hospital I've been shadowing at, the ICU folks tend to be VERY laid back. Makes me love this field even more, besides the awesome stuff I've gotten to see.