One week med student rotation

[johncunningham]

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Alright all you MS3's and MS4's. I am a young attending in a community setting that has recently found myself in the position of coordinating the medical student experience during their ONE WEEK of anesthesia as MS3's. I have the authority to to whatever I would like, and would love to know what you would want to do if you only had one week to experience anesthesia during your MS3 surgery block. I will be giving lectures as well as placing people into ORs. So, aside from the standard stuff, this is what we do, these are the drugs we use, this is how we evaluate pts preop, this is basic airway management, IVs.... What would you want to be able to learn/do?

Residents and staff should feel free to chime in as well.

Thanks

John

 

[fakin' the funk]

Fairly time-intensive, but...

On the last day you could do a 30-45 minute case or "mock oral" session with them. Have them do the pertinent H&P preop, design the anesthetic, pimp them on their reasoning, have something common happen intra-op (pulse-ox malfunction, BP cuff unreadable, problems with tidal volumes during lap case on a fatty). In short, teach them how anesthesiologists think - the same way surgeons do on the surgery clerkship.

That's stuff you won't find in a book, a Powerpoint, or from just watching cases.

 

[Gimlet]

Alright all you MS3's and MS4's. I am a young attending in a community setting that has recently found myself in the position of coordinating the medical student experience during their ONE WEEK of anesthesia as MS3's. I have the authority to to whatever I would like, and would love to know what you would want to do if you only had one week to experience anesthesia during your MS3 surgery block. I will be giving lectures as well as placing people into ORs. So, aside from the standard stuff, this is what we do, these are the drugs we use, this is how we evaluate pts preop, this is basic airway management, IVs.... What would you want to be able to learn/do?

Residents and staff should feel free to chime in as well.

Thanks

John

Wow, one week sure isn't much to work with....hopefully you will be able to do something to pique the interest of a few students who wouldn't have considered anesthesia as a career before the rotation, as well as educate people about what anesthesiologists do so they have an understanding of the profession and how it interacts with their chosen specialty.

I think the most useful thing to learn on an M3 anesthesia rotation - especially for people who aren't destined for anesthesiology - is how to properly mask-ventilate a patient. They should also get some shots at intubating patients, which is a really exhilirating experience for med students.

I would try to minimize the amount of lecture aside from the basics of what they need to know about induction, intubation, maintenance, etc. and focus on getting them into the OR with charismatic anesthesiologists who will be comfortable letting the student take the head of the bed during induction while they talk them through the process and push all the drugs.

Getting the students into rooms that have relatively short operations so they can be involved in a number of cases without getting bored in between would be good. I think it's important for students to not "procedure hop" between rooms, but sitting them in a heart room for long cases would waste too much of the week. Another thing to stress to your colleagues is to make sure to talk through their decision making process and the rationale behind all of their actions during the case...it's frustrating and boring to see the anesthesiologist adjust the gas flows or give a drug without hearing their reason for doing so. They should also make sure to discuss the pharmacology and physiology of all the drugs they're using.

I would try to work in a half-day or so of a regional anesthesia experience, too.

 

[Bertelman]

Fairly time-intensive, but...

On the last day you could do a 30-45 minute case or "mock oral" session with them. Have them do the pertinent H&P preop, design the anesthetic, pimp them on their reasoning, have something common happen intra-op (pulse-ox malfunction, BP cuff unreadable, problems with tidal volumes during lap case on a fatty). In short, teach them how anesthesiologists think - the same way surgeons do on the surgery clerkship.

That's stuff you won't find in a book, a Powerpoint, or from just watching cases.

I'm not so sure anyone can learn this in a week. An MS4 interested in Anesthesia might find this interesting, but the average MS3 would have no clue. Don't pimp them on their "reasoning"- they don't possess any reasoning about how the ventilator works, what a pulse ox measures besides "oxygen saturation", or how quickly profound hypotnesion can occur in the OR. Also, if this is a part of a surgery clerkship, most MS3s aren't even interested in anesthesia. They're interested in a free pass from their surgery clerkship for one week.

An anesthesia H&P is too specialized. I could give a rat's ass about their job, or what their parents died from, but this kind of crap is drilled into med studs from FP and IM rotations. Again, unless they are going into anesthesia, this exercise is lost.

I would say the goal of the clerkship is to show them what they're looking for. Lots of intubations, teaching in the OR about the gas machine, etc., and out the door by 3 p.m. Maybe one or two reading assignments during the week. A couple of LMA placements, maybe watch part of a cool case like a CABG with TEE.

A 5-day rotation is like summer camp. No one really learns anything other than how to blow a smoke ring. You kiss a girl or two, and look forward to next year's camp.

 

[jennyboo]

Our one-week third year medical students spend a day in ECT. Typically this is a morning of 15-odd patients, all of whom get masked with an ambu-bag when the patients get prop-or-brevital and sux-or-non-depolarizing. They start to "get" masking after the third or fourth patient -- works like a charm. Probably not as exciting as tubing in the OR, but a very useful and functional basic skill.

 

[fakin' the funk]

I'm not so sure anyone can learn this in a week. An MS4 interested in Anesthesia might find this interesting, but the average MS3 would have no clue. Don't pimp them on their "reasoning"- they don't possess any reasoning about how the ventilator works, what a pulse ox measures besides "oxygen saturation", or how quickly profound hypotnesion can occur in the OR. Also, if this is a part of a surgery clerkship, most MS3s aren't even interested in anesthesia. They're interested in a free pass from their surgery clerkship for one week.

...Again, unless they are going into anesthesia, this exercise is lost.

I would say the goal of the clerkship is to show them what they're looking for. Lots of intubations, teaching in the OR about the gas machine, etc., and out the door by 3 p.m. Maybe one or two reading assignments during the week. A couple of LMA placements, maybe watch part of a cool case like a CABG with TEE.

My feelings are, anesthesiology is not tubes and lines and it shouldn't be taught as such.

Of course you can't pimp people about how a pulse-ox works, but you can help them think through why the ventilator is in the OR in the first place, why we use this drug, why this technique is appropriate for this patient. To me that's how you learn and that's how you develop an appreciation for the field for the 93% of students who aren't gonna be anesthesiologists.

Let me draw a parallel. Every MS3 does a substantial surgery elective yet few go into surgical fields. Now, do the surgeons say "Go ahead and drive the camera and close the wound, I know that's the fun part and the only reason you're here." ? Of course not. You earn it. Surgical clerkships are valuable because they teach you how to think "like a surgeon," develop surgical ddx's, and think through surgical management. It would be like if your surgery clerkship involved learning how the insufflation and electrocautery works. They are tools involved in physician-delivered care, not the focus.

Since these MS3s are required to do a week of anesthesia, it should be treated as a core medical specialty based on medical knowledge and decision-making, and not "playtime."

 

[error404]

I come from a program that does 1 wk of anesthesia in our first clinical year, which is our entire required exposure.

I likely represent the sort of person you're trying to reach. I still appreciate how hard my course director worked to strike a balance of informative lectures, hands-on but safe experience with the toys, and time in the OR. We were allowed to choose which OR rooms to go to, so if we met a particularly good teacher or were interested in a particular area (like awake craniectomies) we could spend more time there.

I still remember our first day, where we did a few hour workshop with the mannequins and sim man before heading to the OR. Now I'm an MS4 matching in the field.

 

[Bertelman]

My feelings are, anesthesiology is not tubes and lines and it shouldn't be taught as such.

Of course you can't pimp people about how a pulse-ox works, but you can help them think through why the ventilator is in the OR in the first place, why we use this drug, why this technique is appropriate for this patient. To me that's how you learn and that's how you develop an appreciation for the field for the 93% of students who aren't gonna be anesthesiologists.

Let me draw a parallel. Every MS3 does a substantial surgery elective yet few go into surgical fields. Now, do the surgeons say "Go ahead and drive the camera and close the wound, I know that's the fun part and the only reason you're here." ? Of course not. You earn it. Surgical clerkships are valuable because they teach you how to think "like a surgeon," develop surgical ddx's, and think through surgical management. It would be like if your surgery clerkship involved learning how the insufflation and electrocautery works. They are tools involved in physician-delivered care, not the focus.

Since these MS3s are required to do a week of anesthesia, it should be treated as a core medical specialty based on medical knowledge and decision-making, and not "playtime."

Now I absolutely agree with your thoughts on what anesthesia is, as well as how it should be taught to interested students. But I don't see that happening in 4 days (you can't count the first day of a rotation). I certainly agree with your second paragraph above, but I don't believe a one week rotation in ANY field allows a student enough time and background to present a specialized H&P or survive a 45 minute oral board exam, as your original post suggested. Hell, I was 3 months into my residency before they sat me down for a mock oral. Believe me, the expectations were pretty low. Furthermore, I think you can and should cover the topics you suggested, but it should be done in the OR next to the ventilator or pulse ox. NOT during a mock oral.

Instead of comparing an 8-12 week surgery rotation to one week of anesthesia, try imagining what you might have learned doing 5 days of surgery. You certainly couldn't learn how to "think like a surgeon"in five days. Bottom line, a one week rotation is enough to give people a taste of what we do, and hopefully stoke some interest in the specialty overlooked by many students.

...and you can't assume they are all "required" to take this as a core clerkship. The fact that it is only one week, and occurs at a community hospital, sounds much like an elective. Expectations are different.

BTW, thanks for the grammatical lesson on anesthesia v. anesthesiology, douche. I've really never heard that before. I can only surmise you were corrected on the terminology during a clerkship lecture. It's the internets, dude. Take it easy. No one likes the grammar police. But if you're really interested, I can point you to some users that don't understand the difference between there and their, or misspell words in nearly every post. I notice those things, too, I'm just cool enough to keep it to myself.

 

[jetproppilot]

Alright all you MS3's and MS4's. I am a young attending in a community setting that has recently found myself in the position of coordinating the medical student experience during their ONE WEEK of anesthesia as MS3's. I have the authority to to whatever I would like, and would love to know what you would want to do if you only had one week to experience anesthesia during your MS3 surgery block. I will be giving lectures as well as placing people into ORs. So, aside from the standard stuff, this is what we do, these are the drugs we use, this is how we evaluate pts preop, this is basic airway management, IVs.... What would you want to be able to learn/do?

Residents and staff should feel free to chime in as well.

Thanks

John

Take'em out for a beer.

 

[jwk]

One thing I would do is make sure they can actually see and participate in some cases from start to finish. We had one med student years ago that literally ran from room to room to do an IV here, an a-line there, an intubation somewhere else. He never actually did a case with anyone from start to finish, even a short one. He learned and got some practice on a few procedures, but he learned very little about anesthesiology in a month.

 

[fakin' the funk]

BTW, thanks for the grammatical lesson on anesthesia v. anesthesiology, douche. I've really never heard that before. I can only surmise you were corrected on the terminology during a clerkship lecture. It's the internets, dude. Take it easy. No one likes the grammar police. But if you're really interested, I can point you to some users that don't understand the difference between there and their, or misspell words in nearly every post. I notice those things, too, I'm just cool enough to keep it to myself.

Yeesh. I think you misinterpreted my use of underlining. I wasn't grammar-policing.

I underlined "ology" to indicate a distinction: physician-delivered medical care of surgical patients vs. tubes and lines -- which we have established on this forum that "a monkey can do."

 

[Bertelman]

Yeesh. I think you misinterpreted my use of underlining. I wasn't grammar-policing.

I underlined "ology" to indicate a distinction: physician-delivered medical care of surgical patients vs. tubes and lines -- which we have established on this forum that "a monkey can do."

Fair enough. I was in a pissy mood last night.

 

[seinfeld]

My feelings are, anesthesiology is not tubes and lines and it shouldn't be taught as such.

Let me draw a parallel. Every MS3 does a substantial surgery elective yet few go into surgical fields. Now, do the surgeons say "Go ahead and drive the camera and close the wound, I know that's the fun part and the only reason you're here." ? Of course not. You earn it. Surgical clerkships are valuable because they teach you how to think "like a surgeon," develop surgical ddx's, and think through surgical management. It would be like if your surgery clerkship involved learning how the insufflation and electrocautery works. They are tools involved in physician-delivered care, not the focus.

Since these MS3s are required to do a week of anesthesia, it should be treated as a core medical specialty based on medical knowledge and decision-making, and not "playtime."

Totally agree....

My story of how i ended up in anesthesia stems from a week rotation, during my surgery clerkship. I wanted to be a surgeon up to that point. After a 3 days of putting tubes and ivs in and ohterwise being ignored and out by noon one attending took the time to pimp me about the hypotension we were seeing during a liver resection. " What is Blood pressure" he asked, then he went into the How Cardiac output is a combination of HR and SV and down the line. Then he asked how i wanted to treat it. Brought into the equation the depth of anesthesia as a confounder to hypotension. From that point on i had a true interst in anesthesia. Interesting that day i did not place a single iv or attempt a tube placement.

I had a med student in residency who kept asking what i was thinking during a case. So i preceeded to voice out all my thoughts. I did it for 5 minutes after which i was tired of talking and she commented how she never reliezed i was doing so much without looking like i was ever doing anything.

For med students (i did this only on ASA 1/2) after the propofol and NMB are in and i know i can mask, i set the mask down and make them uncomfortable with a non breathing patient, it usually helps them gain appreciation for our speciality especially after they have a hard time masking.

 

[Duane E]

Hmm, one week of anesthesia...a crashcourse is a possibility but I think it's too little time. If I were a young and ignorant MS3, I would like to see what a day in the life of an anesthesiologist consists of: Preparing yourself for the next day's cases, going over the anesthesia/complications, visiting with the family preop and reassuring them in their moment of terror (very important and overlooked job), then you can go over a few technical skills intra-op (bagging and securing the airway being the most important for all medstudents to know). A lot of people outside of anesthesia think it is boring and that we are not real doctors. Show them that there isn't anyone else in the room that can do what you can. When the popo hits the fan, you take on the mantel of authority!

 

[maceo]

None of those thirdyears have any interest in sticking around the OR on their week in anesthesia. LET THEM GO HOME EARLY. DOnt torture them. make them start a few IVS.. intubate a few times.. and thats your week I would make it mandatory that they have to be home before the price is right otherwise i would drop their letter grade a half. They would have to call me to confirm that they are home.

 

[dhb]

Try contacting BU. They've made a very good 30min video explaining the basics of anesthesia for med students: (i don't know if they have made it available to the public yet)

http://www.bmc.org/anesthesia/education/media.php

Contact Us

Susan Peterson
Administrator
Department of Anesthesiology
Boston Medical Center
88 East Newton Street
Boston, MA 02118

Tel: 617-638-6950
Fax: 617-638-6959
Email: [email protected]

 

[johncunningham]

Thanks for all the help. I think most of us are on the same page.

John

 

[cfdavid]

Alright all you MS3's and MS4's. I am a young attending in a community setting that has recently found myself in the position of coordinating the medical student experience during their ONE WEEK of anesthesia as MS3's. I have the authority to to whatever I would like, and would love to know what you would want to do if you only had one week to experience anesthesia during your MS3 surgery block. I will be giving lectures as well as placing people into ORs. So, aside from the standard stuff, this is what we do, these are the drugs we use, this is how we evaluate pts preop, this is basic airway management, IVs.... What would you want to be able to learn/do?

Residents and staff should feel free to chime in as well.

Thanks

John

So, I'm currently in an anes rotation as an MSIII. What I've found to be extremely helpful was being given a "topics" list at the start of the rotation. For us, it's serving 2 purposes; 1) it's a guideline of fair game topics for the end of rotation exam AND 2) it gives us "stuff" to talk to the residents about. It's basic stuff that most CA1's can easily answer, and it facilitates an academic discussion during cases. This has been a key component of my rotation thus far. (4 days in...lol)

Also, perhaps a brief reading requirement list would help the student focus his/her studying and better grasp some of the fundamentals.

Also, perhaps try to provide the students with a broad exposure to the field. Our school has a preop clinic, pain, and all the case loads of a large institution. So, rather than having the students sit in on lap chole after lap chole, some cardio, pain, neuro cases could be helpful if possible.

That being said, for 1 week, I feel it's more important to GROUND the students with a list of fundamental topics that will really help ORIENT them to the field.

Good luck!!!!

cf

 

[cfdavid]

None of those thirdyears have any interest in sticking around the OR on their week in anesthesia. LET THEM GO HOME EARLY. DOnt torture them. make them start a few IVS.. intubate a few times.. and thats your week I would make it mandatory that they have to be home before the price is right otherwise i would drop their letter grade a half. They would have to call me to confirm that they are home.

I disagree somewhat. I agree that hours for students shouldn't be unreasonable, but in order to appreciate anesthesia they need to BE THERE. Just yesterday, I experienced a nice teaching point (remember, hopefully those taking the rotation in the first place ARE interested in the field, at least somewhat).

It was the middle of the case. A simple lap hysterectomy, where we saw some desaturation that happened pretty acutely. So, the CA1 got a bit concerned (not gonna say what the sat level was.... it wasn't way down, but again, it happened quickly). The attending came in and explained how we almost certainly had the woman intubated too deep with the endotracheal tube, so when the patient went into reverse Trendelenberg and they re-insulflated to an increased pressure, the tracheal tube was likely RIGHT at the carina and upon insulflation and due to the patients position, the tube likely slid slightly down towards the right mainstem bronchi, thus causing a slight desaturation.

So, it was a pretty basic teaching point, but a practical one. But, I had to be there to learn from it.

Again, I agree on hours. We get to take off around 3 or whenever after that that we kind of want. It helps, because I'm not too tired to go home and read etc. Also, they DO give us flexibility to hop around a bit. HOWEVER, it facilitates cohesion when you start a case and stay with the resident, IMO. Just good form so to speak. Plenty of opportunities to open up Miller's Basics of Anesthesia and chat with the resident, and learn.

It also helps having residents that AREN'T OVERworked, and are with few exceptions good people and fun to work with.

 

[mstudent12345]

My school currently has a 1 week rotation and I can tell you what I thought was useful and not.

1) Teach the student basic procedures such as bagging and IV's and the why we do what we do. Ie there is a technique to an IV its not just shoving a needle, why do we push induction drugs in the order that we do? When do we use muscle relaxant and when not? How to we choose the paralytic we do use? Letting them get the chance to drop a tube or two is great but first they should learn the basics.

2) Try to give them a sense of what anesthesiologists do. One problem everyone states is that other MDs often don't recognize what we are experts at, so this is a chance to rectify that. Teach little physio or pharm, discuss why you are changing the settings you are or giving the drug you do, and some of the other thoughts that are regularly going through your head.

And yes let them go home early. The basic goal is to teach them skills every MD should have and give them a rough sense of what we do.

Just my $0.02