ICU rotations - how much?

[LovingItAll]

I'm about half-way through my interviews and I'm intrigued by the variability among programs with regard to the number of ICU months. I know generally that ICU is valuable because its the sickest patients and they provide the most opportunity for procedures.

Some programs count their trauma months as SICU months. Some programs have SICU months in addition to trauma months. Some programs dont have PICU months. Some programs have only 1 MICU month...others have 3.

I was hoping some of the residents and attendings could give their opinion regarding the relative value of ICU rotations. Did some of you feel like you had too much ICU? Not enough?

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[USAF MD '05]

I was really looking forward to my ICU rotations. I had dreams on lines and tubes floating in my mind. Actually I ended up staffing my seniors in medicine on their lines that they needed to graduate and the tubes were all consulted out to the anesthesiologists. Turns out they have been miserable months plagued by q3 call, interminable rounding and all around scut. Hate them. I am on the PICU right now and it is more of the same. Wheeeee. Go for the fewest ICU months and the max ED months. Just my Indian headed wooden nickle... Steve

 

[Hawkeye Kid]

I'd say that the above post is a perfect example of comparing pretty much everything in the application process--you can't just look at # of months doing x rotation to know what the value will be; it really depends on how the rotations are structured and what the residents actually get out of them.

We do five ICU months and two trauma months. On ICU, we work directly with faculty and get first crack at all procedures--there are no senior residents to take procedures from us. Trauma is more team-oriented, so it does depend on who you work with to an extent, but we get--at least--our share of procedures there as well. I've done one month of ICU and trauma, and thought that both were valuable in terms of procedures and taking care of sick folk.

So...don't just compare program A's curriculum with program B's, but ask residents how the rotations work and how worthwhile they are. Most residents I've met will be pretty candid with you about this.

 

[David Brosnahan]

EM residents at MCG do Trauma/STICU and Cards/CCU as a PGY1 and Trauma/STICU, PICU, MICU months as a PGY2. Call is q4. There is no call on Trauma/STICU because there is a night float team that covers overnight. Also, EM residents only cover STICU patients when on service. However, on cards/CCU, EM resident do cover both CCU and tele patients. I think the amount of ICU time here is just right. You can't do enough procedures and manage too many critical patients. I also think PICU is a must. I personally, would not consider a program that didn't have a PICU month.

 

[Painter1]

my firs icu month was similar to the disappointing experience of the person who replied earlier. i was too busy breaking down the I's&Os, writing down vent settings in a dozen or so patients in between rounding that i did not learn much. intubations as well were reserved for anesthesiology. there is so much that in the end i was just 'doing' without a real understanding of why i was doing certain things: jevity versus glucerona, etc etc. but yes, i would imagine it's hosptial dependant and what year in training you are . as an intern, it was scut-galore.

 

[GRchief]

No matter where you go, you're going to have to take the bad (I&Os, caloric requirements, albumin debates) with the good (tubes, lines, codes), but it's worth it.

Here as interns on MICU we mostly work directly with the attendings who are excellent instructors, and let us do the procedures. There is also a PA run MICU service (due to the volume), and they will let us do procedures on many of their patients as well.

We do two months on SICU as 2nd years, and are mostly on call by ourselves, sometimes with a surgery intern. Again this gives us a good opportunity to do and teach procedures.

We do PICU in our third year for more exposure to critically ill kids. The attendings and PICU nurses tend to be a bit more protective of these patients which results in some missed procedures, but probably a worthwhile experience.

I think wherever you go you'll get good exposure to critically ill patients in the ICU. But more importantly you'll get the exposure to critically ill patients in the ED where you don't have the benefit of knowing medical history, fluid status, recent medications, etc. It's a much more controlled environment in the ICU. The best place to learn to manage a critically ill patient in the ED...is in the ED.

 

[GRchief]

And we don't have an anesthesiology residency to compete with for airways.

 

[southerndoc]

Our six months of critical care (2 CCU, 2 MICU, 1 SICU, 1 PICU) are more about learning how to manage sick patients and not about procedures. Our residents get plenty of procedures in the ED. We do not count our 2 trauma months as ICU time, although 1 of the 2 trauma months involved some SICU experience.

I think critical care experience is an invaluable experience that should be emphasized in an emergency medicine training program. Of course that's just my two cents.

I chose a program that had a lot of ICU time and I do not regret that one single bit. None of my co-residents regret it.

 

[paramed2premed]

Drexel took over an ICU from the IM residents, and so it's staffed by EM-1's, 2's, and 3's - no medicine people! Additionally, they don't have a medicine floor month.

 

[roja]

The RRC requires 2 months of ICU. The amount of ICU being appropriate will depend on what you see in the ED as well. We did MICU and CCU- one month each. Both were great rotations and both were definately enough.

However, our hospital sees 170K a year, and in the ED we see and manage tons of really sick patients. So, for us, 2 months of floor unit is ample because we see a huge volume of sick patients in the ED. In a lower census ED, you probably need more ICU months because the overall # of sick patients that each resident will manage in the ED will be less.

Some of the variability also comes from the strength/position of your department in the hospital. GME meetings involve negotiations and often times you are on multiple services because those services need bodies and not so much because its vital for your training to be there (that said, you can always learn *something*). The RRC says 2 months for a reason. Everything else is 'gravy'. And you have to decide if you like gravy.

For me, I wanted to be an EMP. So I wanted to see lots and lots of patients in the ED.