Making a good impression during rotations.

[agent_purple]

Hey all.

Obviously it makes sense to have a balance of trying to be helpful without getting in the way or being a nuisance. But aside from the obvious (show up early, eager to learn, reading), anything in particular any residents or seniors would like to comment on how to be successful? Any pet peeves we may not be aware of?

Thanks.

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[LunchMD]

Hey all.

Obviously it makes sense to have a balance of trying to be helpful without getting in the way or being a nuisance. But aside from the obvious (show up early, eager to learn, reading), anything in particular any residents or seniors would like to comment on how to be successful? Any pet peeves we may not be aware of?

Thanks.

Ask questions periodically. Don't act like you know everything or more than your residents (even if you do), be proactive and willing to help out with the small daily tasks that aren't real medicine but have to get done. Read up on your patients and know the common pimp questions. Be present, it's very obvious when med students disappear. Clinical grades are 90% sucking up and playing "the game", 10% actual competence.

 

[McPoyle]

I can’t stress “knowing your patients” enough. I don’t expect you to know much (if anything) about conducting a general anesthetic, but you damn well better know the results of their stress test, echo, cath, etc. You absolutely should know why they are in the OR, like what was the natural history of their disease that landed them there (ie exertional pain leading to positive stress and then cath showing disease). What meds are they on, especially BP, anticoagulants and anti platelets, do they have lung disease and if so how is it treated and how bad is it.

The anesthesia you will learn, if you’re able to integrate some of their history and speculate on how it might impact their anesthetic then that’s awesome. But, I don’t expect you to know random pimp stuff about the meds etc.


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[ghastly75]

I can’t stress “knowing your patients” enough. I don’t expect you to know much (if anything) about conducting a general anesthetic, but you damn well better know the results of their stress test, echo, cath, etc. You absolutely should know why they are in the OR, like what was the natural history of their disease that landed them there (ie exertional pain leading to positive stress and then cath showing disease). What meds are they on, especially BP, anticoagulants and anti platelets, do they have lung disease and if so how is it treated and how bad is it.

The anesthesia you will learn, if you’re able to integrate some of their history and speculate on how it might impact their anesthetic then that’s awesome. But, I don’t expect you to know random pimp stuff about the meds etc.


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Agree with above. The worst thing is when a learner shows up at the last minute and they expect to intubate or place an IV...if they haven’t read about the patient , met the patient , discussed with me ahead of time their goals/expectations of the day, then you will be invisible to me.

 

[deleted171991]

Hey all.

Obviously it makes sense to have a balance of trying to be helpful without getting in the way or being a nuisance. But aside from the obvious (show up early, eager to learn, reading), anything in particular any residents or seniors would like to comment on how to be successful? Any pet peeves we may not be aware of?

Thanks.

You need to RESPECT people and SHOW INTEREST.

RESPECT for the patient (introduce yourself, ask for permission), for the resident (s/he is your boss for the day, be helpful without being in the way) and attending (keep your mouth shut unless talked to, ask for her permission, too). Show genuine interest in everything; YOU DON'T KNOW NOTHIN' and should be like a plant in the desert, eager for any drop of wisdom they share with you. Do what you're told. Don't ask for special treatment. Come early, leave late. Don't be a Millennial; be a soldier, be an apprentice.

This is what you are:



And this is what you should do: Bow Your Head

 

[deleted162650]

It would help if you’re not a tool.

 

[Psai]

Agree with above. The worst thing is when a learner shows up at the last minute and they expect to intubate or place an IV...if they haven’t read about the patient , met the patient , discussed with me ahead of time their goals/expectations of the day, then you will be invisible to me.

Man I had a guy come in telling me about how he's applying to EM and bragging about the 8 intubations he did. Didn't know **** about the patient but he did let me know that he had a doctor's appointment the day before and that he would need to go to another one that day, right after induction.

Then again when I was rotating through anesthesia, they didn't give half a **** about medical students. They didn't assign me a room or a resident in advance and would try to attach me to a resident as the patient was rolling into the OR. They also didn't tell me anything about when or where their conferences were or anything.

 

[2Fast2Des]

Man I had a guy come in telling me about how he's applying to EM and bragging about the 8 intubations he did. Didn't know **** about the patient but he did let me know that he had a doctor's appointment the day before and that he would need to go to another one that day, right after induction.

Then again when I was rotating through anesthesia, they didn't give half a **** about medical students. They didn't assign me a room or a resident in advance and would try to attach me to a resident as the patient was rolling into the OR. They also didn't tell me anything about when or where their conferences were or anything.

Sounds like a fantastic way to make the speciality more attractive

 

[Chip N Sawbones]

This wasn't enough to overcome my multiple red flags and get me into a residency, but I still think it's good advice:

From what I could tell nobody really expects a 4th year student doing an anesthesiology rotation to work hard. That means that when you actually do show up and work hard it makes you look really good. At the start of your first gas rotation, learn how to set up everything you can. The standard acronym is MS MAIDS - Machine, Suction, Monitors, Airway, IV, Drugs, Stuff (everything else). Find out what the residents set up before almost every case. Show up to the OR 15 minutes before they do and do as much as you can. Depending on how much equipment you have access to, that can include:
fresh towels on the machine and drug cart
run the machine check, check the backup gas cylinder levels, check to make sure there's an ambu-bag in the room
refill the sevo
put a new suction hose on
put a new ventilation circuit and face mask on
put the pulse-ox and EKG stickers on the leads
put the pillow on the table with the leads in place
assemble an ET tube/stylet/syringe
Get the laryngoscope and blade set up
Pull out the tongue depressors, eye stickers/tapes, BIS stickers, oral airway
Assemble and label syringes for propofol, versed, lidocaine, zofran, roc and fentanyl
Assemble an IV and a kit for starting IVs (16, 18, 22 gauge needles, tourniquet, alcohol wipes, flushes, gauze, tegederm, all neatly wrapped up with the tourniquet)
Assemble an art line kit if the case looks complicated enough to need one

Do the same to help the resident set up for each case throughout the day.

If you have even half of that done before the first case in the morning you'll look like a rock star. You can beat the resident to the OR in the morning, leave at the end of the last case and you'll still be working less than you did on surgery.

 

[Mman]

to make a good impression (although not be a total rockstar), it's pretty easy.

1) Show up. If you are early you are on time and if you are on time you are late. We start the day early. You will also go home early.
2) Be humble. You won't impress any of us with medical or anesthesia knowledge. Simply asking appropriate questions and putting thought to answers when we ask you goes a long ways.
3) Be interested in what is going on and ask questions accordingly about preop, intraop, and postop management.

That's about it. We will give you introductory teaching for the rest as it goes along. Bonus points if you have done some reading about things like airway assessment, fluid management, multi modal analgesia, etc. and can answer basic questions.