MSIVs: Peds Sub-I Inpatient vs. PICU/NICU???

[medready2005]

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Hello All!!!

Wondering what you all thought some advantages/disadvantages of either one for an MSIV Sub-I??? Thanks!!!!

 

[J-Rad]

Most of it will come down to preferences. PICU will teach lots of relevant physiology to general peds and will be a good intro into "sick vs. well" in all pediatric age groups from term neonate to young adult. Vent management is more straightforward in my PICU (for conventional kids are virtually always on PRVC mode and occasionally an oscillator gets run) and is always good physiology to learn. NICU will give you the sick vs. well introduction in the preemie and term neonate (as well as relevant physiology to those age groups. "Rat" physiology is often in-applicable to older kids) and an intro to the many ventillatory strategies employed with babies (none of which have any evidence of being more effective than the other...it usually comes down to what the (neonatologist) is more experienced at using). It also depends on whether you like playing with the preemies or the older kids.
A more practical answer revolves around whether you're plan is to do a peds residency (thus your reason for the sub-I): most residencies have at least 1-2 NICU months in intern year as well as well newborn service time. Doing a Sub in NICU may very well help take the edge off of the learning curve during your stressful intern year (especially if they employ a NICU EMR, some of which can be difficult to learn). A lot of residencies will have you doing PICU in 2nd & 3rd year and your intern year will function as a primer for that (making PICU lower yield). If you're a future a FP trying to get more Peds experience, time in the NICU resussitating babies is probably higher yield (lots of FP residencies do NICU time). And if you're just doing it to do something interesting, just pick which one will be more fun (I vote PICU)

 

[RockfordWF]

Hello All!!!

Wondering what you all thought some advantages/disadvantages of either one for an MSIV Sub-I??? Thanks!!!!

It's an easy choice.

Inpatient = paperwork & rounds

ICU = procedures

What do you prefer?

 

[DoctorFunk]

It's an easy choice.

Inpatient = paperwork & rounds

ICU = procedures

What do you prefer?

Not necessarily that easy. ICU still involves paperwork and rounds (my longest rounds of the year were in the PICU) and you'll probably only get to do procedures if the interns are already signed off on them, which is unlikely in July, August, or September when you would prefer your sub-I.

Another thing to consider is the attending schedule. At our hospital the PICU and step-down ICU staff rotate about every 5 days, while floor attendings rotate monthly. In that situation I would much rather take the inpatient assignment to give myself a better chance to get a strong LOR out of the sub-I.

 

[RockfordWF]

Not necessarily that easy. ICU still involves paperwork and rounds (my longest rounds of the year were in the PICU) and you'll probably only get to do procedures if the interns are already signed off on them, which is unlikely in July, August, or September when you would prefer your sub-I.

Another thing to consider is the attending schedule. At our hospital the PICU and step-down ICU staff rotate about every 5 days, while floor attendings rotate monthly. In that situation I would much rather take the inpatient assignment to give myself a better chance to get a strong LOR out of the sub-I.

If you are there to audition for residency, you want to see as many attendings as possible. Do ICU.

If you are there to get a letter for somewhere else and don't mind never seeing anything exciting, Do Floor.

Interns are only a problem if you are a timid medical student. I've stolen plenty of procedures from interns, including intubating a 10-month old last week.

 

[J-Rad]

Sorry, I (semi-dyslexically) read PICU vs. NICU and not your ward vs. PICU/NICU. Any of the above will give opportunity to impress for letters, but I'm inclined to say the ICU's will be more fun.