MICU rotation necessary?

[MDhopeful324]

Wondering what the consensus is about rotating through the MICU as a 4th year prior to starting an IM residency. I have the opportunity to do a subI in the MICU in March, but do not want to burn myself out with it. The alternative would be rotating through the wards a second time. Would MICU be worth it?

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[Crayola227]

Have you already had an ICU rotation? I did not before residency (just how my school requirements and schedule worked out) and it was one of my greatest regrets.

It is definitely good experience to have before you are actually responsible as an intern for ICU patients imho

 

[calivianya]

You should do it!

MICU is fun, plus it's good experience. I rotated through a SICU recently and all of the most interesting patients I had were MICU overflows. I should have just done MICU instead.

 

[ACSurgeon]

ICU rotations are a good way to learn who’s sick and who’s not. As an intern, that’s half the battle. I say do the MICU rotation.

 

[Matthew9Thirtyfive]

I did not want to do one, but it was highly recommended to me even by my obgyn mentors. So I scheduled one.

 

[ortnakas]

Necessary? No.
A very good idea? Yes.

 

[Bobblehead]

Wondering what the consensus is about rotating through the MICU as a 4th year prior to starting an IM residency. I have the opportunity to do a subI in the MICU in March, but do not want to burn myself out with it. The alternative would be rotating through the wards a second time. Would MICU be worth it?

You won't burn out as a medical student. You simply have to know more about your assigned patients medical history than anyone else on the service which shouldn't be hard because you'll have fewer patients assigned. This is especially valuable on the portion of the unit that has very high turnover (DKA, overdose, post-procedure, nursing requirements, bed availability) because none of the other people will want to necessarily deal with those people and you may be able to influence medical management on those individuals while understanding your job is to get them stabilized for floor care, not perform floor care.

If you want to stand out you should know something about every other patient in the ICU as well while making sure you're funneling that information through the assigned interns/residents. You may not hear about the consultants' recommendations first unless they happen to give them in person but that happens quite a bit in the ICU so if you're not hiding in the work room you'll find out.

And yes, the interns that have done MICU as med students tend not to be as deer-in-headlights as those that haven't.

 

[holdthemayo]

It is definitely worth it. I didn't do one 4th year, and I really wish I had. Doing one late 4th year when there is nothing on the line would have been a great learning experience. You'll almost certainly end up in an ICU setting at some point during residency. It helps to have some previous exposure when the stakes were low.

 

[Tangerine123]

I managed to do 4 ICU rotations (SICU, MICU, PICU, NICU) and it really helped me understand the "big picture" of a lot of things. Doing at least 1 of them should be a must.

Ended up in Psych, but ICUs were one of the best parts of med school

 

[Lawpy]

As someone who’s interested in critical care, this is a good thread

 

[Dral]

Necessary? No.
A very good idea? Yes.

This.

I crashed and burned my first day as an intern in the ICU when my upper level resident was off for the day. If I would have had the experience with Vent settings and other things more specific to the ICU, I would have been better off.

I turned it around right away, but it would have been better to not have had that bad day.

 

[longhaul3]

Highly recommend you do ICU. If you start residency never having seen a ventilator or arterial line or central line or pressers you will have missed an opportunity and I think you would regret it.

 

[NontradICUdoc]

The ICU is supposed to be one of the hardest and most stressful rotations there is. This is because the patients are there for a reason. The Intensivist wants to ensure that there is nothing missed and this means that the intern/resident needs to take ownership of the patient. When you do this, you learn a lot from that patient. Understanding not only the treatment but also the physiology and the derangements that they have. You should also learn, how to keep a floor patient OUT of the icu with appropriate follow up and management. Finally, ICU nurses tend to be very protective of their patients (if they are worth their degree) and will want to make sure that the patient is getting the appropriate treatment. Some of these icu nurses are well seasoned and will know more than you as an intern. They Have high expectations and will have little in the way of trust. These are things that you will find very hard to establish as an intern.

However, if you do a primer in ICU as a sub-I, you will really see what is involved and will be prepared for this during your intern year, as long as you pay Attention to what should and more importantly Should NOT be done in the ICU. It would certainly be to your advantage to do a rotation, but be warned that as a student you are expected to participate and not just watch. Don’t be afraid to ask to do something or say something.

 

[treatem-and-streetem]

I learned more medicine in 2 weeks of ICU during my third year than I did in almost any other rotation except maybe OBGYN

 

[RunsOnCaffeine]

As a counter to what some people are saying: I didn't do ICU during med school, matched into ortho (completely unrelated field), and had to do MICU as one of my intern rotations. I had to read a lot more than my medicine peers about some stuff, but ended up doing very well on the rotation because of how I prepped and showed up earlier than others. Don't feel like I missed out on a lot from not doing it as a med stud. That said, if your options are wards vs MICU, I think MICU is more interesting.

 

[Styrene]

I often reflect on my MICU rotation during MS3. It was my first ever clerkship experience. I learned a tremendous amount, and I will always remember it fondly despite the various stresses of it--especially a few patients who recovered from the brink of death and returned to their normal lives. I figure the learning would be even more valuable further along in medical school.

 

[Redpancreas]

Wondering what the consensus is about rotating through the MICU as a 4th year prior to starting an IM residency. I have the opportunity to do a subI in the MICU in March, but do not want to burn myself out with it. The alternative would be rotating through the wards a second time. Would MICU be worth it?

It's not a requirement but I'd strongly recommend it if you're headed to IM. . I didn't do one and compared to my IMG colleagues who'd done intern year and AMG peers who'd done ICU, I stood out despite my medical knowledge base being strong. You can't just pick up a ICU survival guide a few days prior and teach yourself. I tried and I still see interns trying and failing to do that. You need to see ventilators and recognize why patients are on them, understand lines, and see common ICU scenarios a few times. It's a completely different world. The management of a hypertensive patient on a ventilator for instance is completely different than it is on the floor or the clinic. I'm frankly shocked my school's schedule allowed me to go without it.

I admit I made some poor choices 4th year. If I were to go back, I would have done Nephro, ID, and MICU in preparation for IM residency. These three rotations will teach you the most about general medicine. Nephrology deals heavily with anemia, AKIs, dosing of medications, blood pressure management, and tons more. ID can really teach you how to collect a good history and also give you a frame work with how to deal with antibiotics to allow you to function more autonomously. The best thing you can learn to do before intern year is gain some knowledge/comfort/confidence in your plans. You get that by seeing and modeling off of what specialists do so take advantage of the academic nephrologists and infectious disease attendings at your school and learn some clinical pearls. Cards and GI are great fields to practice, but aside from ACS and GIBs, you're not getting exposed to a whole lot of general medicine. No one's going to be impressed that you know about Duolefoy lesions or some fancy cardiac procedure, but if you know how to manage antibiotics, anticoagulants, and manage anemias/akis, that's going to put you in the driver's seat to developing autonomy ahead of schedule in your intern year.

An even better explanation is very nicely laid out above by @NontradICUdoc . The ICU culture is just different and you'll do well to experience it even if you don't retain much medical knowledge. The nurses know more than you, the detail orientation/presentation style is different, etc.