ICU experiences

[Jefe]

I'm a MS-4 and took a clinical anesthesiology rotation a few months back and enjoyed the experience. However, in scheduling my fourth year rotations I did not sign-up for ICU and have not ever taken care of ICU patients. Just wanted to know what people think of ICU, is it really as horrible and exhausting as people have described it to be? I think that sometimes medical students do one month of clinical anesthesiology and they think that it's great (the job, the lifestyle, the money, the vacation time,...etc) and they don't do ICU and once they get into residency it's a whole different world. How many months of ICU do anesthesiology residents usually do? What about Categorical Internal medicine resident, how many months ICU do they have to do? Just wanted some insight into the whole picture about anesthesiolgy before I jump in full force.

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[UTSouthwestern]

ICU is not a horrible experience at all and it is definitely something you have to be comfortable doing if you are going to be an anesthesiologist as much of what you learn in the ICU is readily transferrable to the OR. In effect, the OR is a mini-ICU. Every major surgical procedure performed will kill the patient without someone there to attenuate the somatic and visceral stimulation, replete lost fluids, and support the cardiovascular system. Sounds an awful lot like what you need to do in the ICU.

Although you are taking care of a number of sick patients, remember that you are for the most part, in charge of treating only the major systemic insults that have placed your patient in the ICU. Ancillary comorbidities are left to the floor teams to deal with upon discharge from the ICU. On the many months I rotated through ICU's, I was never totally beaten down except for maybe the first month (which was the first month of my internship wherein I was also on call the first night of my internship). The ICU helps you to organize your thinking by systems and gives you the ability to analyze critical situations quickly and efficiently.

An anesthesiology resident will typically do 4-7 months throughout their residency (PGY-1 through 4). A minimum number is being discussed at this time and it appears that 6 months will be required of any anesthesiology resident in the future. Categorical IM residents do 1-3 on average. I have heard of some having to do 5 or 6, but that is usually an exception, not the rule.

I would highly recommend you do an ICU rotation as a medical student to get your feet wet and begin to organize your thought processes for the types of scenarios you will encounter in an ICU setting.

 

[sandman1]

I absolutely agree with UTSouthwestern.

ICU knowledge is paramount in becoming a responsible OR clinician. This is truly problem-based learning at its greatest. My former institution was a Level-1 Trauma Center so I had to take care of a large number of very sick folks. Just one exemplification: Massive trauma = massive blood tranfusions = ARDS. You master skills in areas such as 'jet' and inverse-ratio ventilation in ways that other docs are never challenged. It's a great experience that you should embrace rather than face with trepidation.

The first ICU was designed by an anesthesiologist - This is not a coincidence!

ICU is not a horrible experience at all and it is definitely something you have to be comfortable doing if you are going to be an anesthesiologist as much of what you learn in the ICU is readily transferrable to the OR. In effect, the OR is a mini-ICU. Every major surgical procedure performed will kill the patient without someone there to attenuate the somatic and visceral stimulation, replete lost fluids, and support the cardiovascular system. Sounds an awful lot like what you need to do in the ICU.

Although you are taking care of a number of sick patients, remember that you are for the most part, in charge of treating only the major systemic insults that have placed your patient in the ICU. Ancillary comorbidities are left to the floor teams to deal with upon discharge from the ICU. On the many months I rotated through ICU's, I was never totally beaten down except for maybe the first month (which was the first month of my internship wherein I was also on call the first night of my internship). The ICU helps you to organize your thinking by systems and gives you the ability to analyze critical situations quickly and efficiently.

An anesthesiology resident will typically do 4-7 months throughout their residency (PGY-1 through 4). A minimum number is being discussed at this time and it appears that 6 months will be required of any anesthesiology resident in the future. Categorical IM residents do 1-3 on average. I have heard of some having to do 5 or 6, but that is usually an exception, not the rule.

I would highly recommend you do an ICU rotation as a medical student to get your feet wet and begin to organize your thought processes for the types of scenarios you will encounter in an ICU setting.

 

[Wahoowa]

ICU is not a horrible experience at all and it is definitely something you have to be comfortable doing if you are going to be an anesthesiologist as much of what you learn in the ICU is readily transferrable to the OR. In effect, the OR is a mini-ICU. Every major surgical procedure performed will kill the patient without someone there to attenuate the somatic and visceral stimulation, replete lost fluids, and support the cardiovascular system. Sounds an awful lot like what you need to do in the ICU.

Although you are taking care of a number of sick patients, remember that you are for the most part, in charge of treating only the major systemic insults that have placed your patient in the ICU. Ancillary comorbidities are left to the floor teams to deal with upon discharge from the ICU. On the many months I rotated through ICU's, I was never totally beaten down except for maybe the first month (which was the first month of my internship wherein I was also on call the first night of my internship). The ICU helps you to organize your thinking by systems and gives you the ability to analyze critical situations quickly and efficiently.

An anesthesiology resident will typically do 4-7 months throughout their residency (PGY-1 through 4). A minimum number is being discussed at this time and it appears that 6 months will be required of any anesthesiology resident in the future. Categorical IM residents do 1-3 on average. I have heard of some having to do 5 or 6, but that is usually an exception, not the rule.

I would highly recommend you do an ICU rotation as a medical student to get your feet wet and begin to organize your thought processes for the types of scenarios you will encounter in an ICU setting.

I fully concur with UTSouthwestern. I just started my PGY1 year and my first rotation was SICU at the University of Mississippi Medical Center. This is the only level one trauma hospital in the state. Let me tell you that in the first week of the rotation, I was scared on more than one occasion. My first on-call night as a "doctor" came after a long day of residency orientation--my first day as an intern--which ended just in time for call to start. I had had no ICU experience whatsoever. That was one of the most stressful nights of my life. Over the course of my SICU experience, I grew up quickly making the transistion from medical student to intern. I have a long way to go, but experiences like this one are good every once in a while. Just remember, if you are thrown into the fire, you will learn how to NOT burn your feet quickly. My confidence in the clinical setting and doing procedures has increased ten-fold. I still have 2 or 3 ICU rotations to complete this year. It is a great experience.