ICU rotation

[nykka3]

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I have been looking at the apgo dB, but I haven't found what I am looking for. Are there any residency programs that offer a one month rotation in the SICU or other ICU equivalent? I know there are many that offer a medicine or an ER month. I am doing an ICU elective right now. I am an MS4 and i am finding out just how impt. it is to know how to manage a post surgical or critically ill patient....and I have seen many gyn patients here also. Just wondering. Thanks!

 

[Wednesday]

UCI has a SICU month, just started last year. It was very helpful.

 

[nykka3]

Wow great. I wonder if I am accepted to a residency prgm without an ICU month would I get some sort of didactic teaching or just try to learn it on my own?😕

 

[deucerp]

South Alabama has SICU

 

[Happy2BOB]

Brown has MICU.

 

[nykka3]

thanks i am finding more programs now with an icu rotation. i wished more programs had one.

 

[Flea girl]

Baystate/Tufts has a SICU rotation

 

[nykka3]

i wonder what programs w/o and ICU rotation do to make up for it.? i don't think a medicine or ER rotation gives you the same experience.

 

[tiredmom]

Most programs without an ICU rotation will say you get your experience with critically ill patients on your gyn-onc rotations. I took a SICU rotation towards the end of my 4th year to feel better about it. In reality, most ob/gyns are getting help if they have a patient in the ICU anyways, but it's good to know the info. My program only does outpatient medicine, which I actually like, because it's much more useful to me in the long run. I need to know how to take care of chronic hypertension, DM, etc... that's going to be more in my realm than the ventilated, deathly ill post-esophagectomy. Plus, now that I'm into residency, I'm really looking forward to the vacation that the family medicine rotation affords!

 

[nykka3]

ok i see so it is all relative then. so tiredmom how is residency treating ya?

 

[bro]

UT Memphis does a month of SICU.

 

[tiredmom]

It's going pretty good so far. It's overwhelming but it usually is when I start something new. The people are really nice which makes a huge difference. Probably the scariest part was the first day on call, when the ED calls and they expect you to know what the heck you are doing! But, with good upper levels, I'm learning a ton and starting to feel more comfortable.

 

[nebin]

wash u

 

[boyob]

So you are telling me you want a more difficult residency than you already will have! Doing a SICU month as a R1 is really not all that helpful. Remember that as an ob you are not going to be dropping lines in patients or running vents. Even if you do manage to learn it your first year you won't be practicing it by the time you are an R4 and you would be crazy to do it as an attending. The liability is just too much. If you are going to do onc then that is built into the fellowship.

Don't try to make your residency more difficult if you can help it.

 

[nykka3]

So you are telling me you want a more difficult residency than you already will have! Doing a SICU month as a R1 is really not all that helpful. Remember that as an ob you are not going to be dropping lines in patients or running vents. Even if you do manage to learn it your first year you won't be practicing it by the time you are an R4 and you would be crazy to do it as an attending. The liability is just too much. If you are going to do onc then that is built into the fellowship.

Don't try to make your residency more difficult if you can help it.

Never thought of it like that, but there must be a role for it since there are resideny prgms that include it. I noticed on my SICU rotation there were at times disagreements on how to manage a critical ob or general surgery patient. For instance, one of the ob patients had a history of ASD repair, MV replacement and an ICD and on coumadin for 6 months with a high INR b/4 she knew she was pregnant. Well there was a leak around the MVR and this lead to really bad PHTN and the pt. decompensated. Well the baby was delivered at 33 weeks by c/s. However, the mom still needed to be anticoag. despite her partially opened c/s wound. She came in with a high INR and we held a few doses of coumadin and put her on heparin. I found it very educational b/c the MFM's didnt want her c/s wound to bleed and not heal well but the ICU team and CT surgery didnt want her throw a embolism either. It was a very valuable experience. We also had a few gyn onc patients and management was interesting. I figured that even though the ICU team is more skilled in managing critical patients, the surgeon/ob doc can still learn a lot from this type of exposure. Surgery residents usually do ICU months why not OB/gyn's?

 

[boyob]

Never thought of it like that, but there must be a role for it since there are resideny prgms that include it. I noticed on my SICU rotation there were at times disagreements on how to manage a critical ob or general surgery patient. For instance, one of the ob patients had a history of ASD repair, MV replacement and an ICD and on coumadin for 6 months with a high INR b/4 she knew she was pregnant. Well there was a leak around the MVR and this lead to really bad PHTN and the pt. decompensated. Well the baby was delivered at 33 weeks by c/s. However, the mom still needed to be anticoag. despite her partially opened c/s wound. She came in with a high INR and we held a few doses of coumadin and put her on heparin. I found it very educational b/c the MFM's didnt want her c/s wound to bleed and not heal well but the ICU team and CT surgery didnt want her throw a embolism either. It was a very valuable experience. We also had a few gyn onc patients and management was interesting. I figured that even though the ICU team is more skilled in managing critical patients, the surgeon/ob doc can still learn a lot from this type of exposure. Surgery residents usually do ICU months why not OB/gyn's?

Ok ok ok......doing a SICU rotation will probably be fine. But I guess I look at it on the other side of the coin...a majority of programs do not include it. You will be better served doing medicine or er than a sicu rotation IMHO. And your example just tells me what I am trying to say. Yes there are complex situations that come up. Yes, we will have pts in the MICU and SICU. But there is often a give and take between teams MFM sicu team etc. And you will have many interactions with them, but doing a month really won't make you a SICU star. You still won't manage your ob pts in the icu nor very complex onc pts. Would you know a little more by doing it...well sure it can't hurt your knowledge base...... But ultimately you will not use those skills in a general practice so why do q4 sicu call unless you have to????? I guess if it that important to you go for those programs....but when you are a chief resident let me know if you still remember how to run a vent 😛