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Please help me think this through. 4th year in need of advice.

Discussion in 'Anesthesiology' started by medsend, Aug 2, 2011.

  1. medsend

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    I know, I'm the only one who can really answer that question of whether "is anesthesia for me?", but I obviously haven't done a great job at it since its August of my 4th year and I'm not 100% sure on this field. I would just very much appreciate some honest advice as the clock is ticking for me...

    Is this field for me? I'm not crazy about pharmacology, physics or basic physiology which are some of the foundations to the field. I more enjoy pathology/diagnosis and medicine-esque type situations. Maybe because I'm more comfortable with this and anesthesia concepts seem foreign right now.

    I enjoy being in the OR (but not as a surgeon), short/positive patient interactions, lack of paperwork/rounding (no long H&Ps), working with my hands, autonomy w/some teamwork. Compensation is not as important as having free time as I would rather spend more time with my family than anything...

    I have just started my first anesthesia rotation and plan to take several different electives in the field, but this would be after September 1st which worries me. My biggest concern is, will I be able to study anesthesia concepts/pass licensing during residency if I'm not interested by the topics of it now?? Is this a sign that I should seriously reconsider this field??

    THANK YOU TO ANY AND ALL RESPONSES.
     
    #1 medsend, Aug 2, 2011
    Last edited: Aug 8, 2011
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  3. epidural man

    epidural man ASA Member
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    Don't do it.

    Do radiation oncology. That sounds your speed.
     
  4. CambieMD

    CambieMD cambiemd
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    I do not think that anesthesia is the specialty for you. There must be an interest in the subject. You probably will not enjoy anesthesiology. Residency is too difficult for you to apply to a specialty that does not really interest you.
     
  5. pgg

    pgg Laugh at me, will they?
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    You'll be in a better position to answer your own questions when you've finished the rotation.

    But anesthesia is one of those specialties that can be hard to enjoy unless you're the one actually doing the case, making decisions, doing things. This can be difficult to appreciate as a student on a super short leash, which almost every first-time rotator is going to be. I liked anesthesia from the start, but didn't really start to love it until I'd been a rotator long enough to earn at least a small shred of trust and autonomy.


    Part of picking a specialty is making the leap of faith, extending what you experience as a student/resident to what you expect the practice and life of an attending to be. It's not easy ... so good luck with that. :D
     
  6. imfrankie

    imfrankie Anesthesiologist
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    Don't rush the decision. Do more elective stuff. Find what you really enjoy. Nobody says you have to decide at the "usual" time. Have you done any ER work? Nice procedures, good hours, important work, portable skill.
     
  7. medsend

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    Thank you for taking the time to reply! I do feel that there is an overwhelming rush to apply. I am actually considering applying to both fields so I can extend my time, keep options open, and experience the electives.

    There are many things I like about anesthesia and I haven't found an alternative that is better suited for me, but I cant say that I have fallen in love with the field and this is what's most concerning for me.
     
  8. codeb1ue

    codeb1ue ASA Member
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    I know many people who applied for both and had essentially an IM/anesthesia alternating rank list. And then there was me who already applied to Medicine, did my anesthesia rotation later in 4th year and ended up loving it. Now i'm in my second year of medicine, planning to change residency this upcoming year.
     
  9. medsend

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    A situation like this can be tricky when it comes to telling your LOR writers...do you ask for different letters from the same LOR writer, or do you just ask them to keep the letter general? but then would this change a great LOR into just a good LOR?
     
  10. cfdavid

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    This is so true. Honestly, it's VERY different (at least for me it sure was) from being a med student rotating through, to actually having responsibility as a resident. One of the things I'm enjoying most right now is the huge levels of responsibility you feel as a RESIDENT providing anesthesia to patients.

    But it's fun as hell to the extent that I often turn down breaks and have WANTED to finish cases even if it means staying late.... I think that's saying something. But, others might hate it......
     
  11. Unknown3234

    Unknown3234 Member
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    Very good question, because I am struggling with the same problem. Even from a personal statement stand point, I'm doing two, one for gas another for medicine.
     
  12. kazuma

    kazuma ASA Member
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    For LOR's, I had each writer make two copies of the letter. One was supposed to say something like "I recommend Kazuma to your residency program" and the other was supposed to say "I recommend Kazuma to your anesthesiology program." I was initially going to use the general letter for prelim programs but I didn't end up applying to any so I only used the anesthesiology-specific letters.

    I only applied to gas so I wrote one PS, but if you are applying to two different specialties, make sure you tailor each one to the specific field. And whatever you do, please don't give programs any notion that you are simultaneously applying to another specialty. According to one PD I talked to, this can show that you are not fully committed to the specialty. In fact, I could see the disappointment in one PD's face when a student in my audition rotation group told the PD he was also considering ER. Poor kid wasn't looked upon as serious candidate for the rest of the rotation. Obviously you shouldn't lie or be dishonest if specifically asked, but be careful what info you voluntarily give out about your application if you are applying to two specialties.


    edit: I also agree that it is difficult to get a real sense of what an anesthesiologist does from a student prospective. IMO, thats part of the reason why so many students think anesthesiology is boring. I was fortunate enough to do a 3rd year elective in a small community hospital where the attending literally allowed me to do my own cases under his direct supervision. Couldn't have had a greater learning experience as a student, in fact it was rather boring stepping down to a mostly observational role as a visiting student during audition. I'm looking forward to getting back in the saddle after intern year.
     
    #11 kazuma, Aug 5, 2011
    Last edited: Aug 5, 2011
  13. muhali3

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    Is an elective rotation even necessary then? What's the best way to know that anesthesia is the right fit without being able to do it?

    Is an inherent interest in pharmacology/physiology enough?
     
  14. amyl

    amyl ASA Member
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    interest in pharm and physio is a start... and if you don't like it I just don't know how you are going to appreciate anesthesiology. its so cool.... I tinker around and the numbers are perfect :), get to do fun procedures and feel like a badass when I get to codes and announce "anesthesia" and everyone moves out of my way and then thanks me profusly for tubing the barfing morbidly obese patient on the floor on the first shot
    :)
    but then I am less than 11 months and two tests away from being an anesthesiologist. (yeah!!!) only you can decide if anesthesia is right for you... but for the OP I am thinking not. A rotation is necessary, you need to see it and think I wanna do that.... you will not have the full appreciation for everything the anes doc is doing or thinking or what is going on... you won't get the whole picture, but the glimpse is necessary.

    anesthesia is really fun now (except for peds, i don't like peds) -- fine tuning my skills, including my people skills, predicting which ventricle (or both) is gonna be in trouble coming off pump and heading it off at the pass with the right pharm, lines / spinals / epidural / etc that go in so easy and quick we are waiting for what feels like forever for the damn surgeon, sicko vascular emergency that runs like clockwork, iso down, breath spontaneously, tube pulled as the drapes come off... that feeling like all is right in the world and I can control it all... its priceless and makes me happy... it doesn't always go that way of course.... there will always be bad mojo days where I have apparently angered the anesthesia gods in some unknown way :) but when it all goes right its the best feeling in the world
    if that sounds lame to you, reconsider, anes might not be for you.
     
  15. muhali3

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    I like that, being able to rectify a very bad situations quickly and thinking on your feet.

    But I'm also very hyper-analytical like many IM docs. I like deep intellectual stimulation. I could easily see myself as some infectious disease/epidemiologist physician at the CDC.

    I guess I'm asking if anesthesia requires a lot of inductive/deductive reasoning? Is there a lot of theory involved or is it mostly a learn-from-experience type of thing?
     
  16. h2oriderz

    h2oriderz ASA Member
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    I'm not sure anyone really enjoyed pharm as a second year med student -- I know that I didn't. Don't get hung up on that particular aspect of the field.

    Physiology is king in the OR -- particularly pathophysiology. A pt's PMHx combined with the specific surgery are the two things that assist us in making a diagnosis and treating it in the OR. Believe me when I say you will be doing plenty of dianosing in the OR. The pharmacology will make more sense when you are in these types of situations and are forced to make decisions. For me, this brought pharmacology to life and actually made it pretty fun :thumbup:

    Enjoy your elective time in the OR -- have fun with it. I think you will know if you want to pursue a career in anesthesiology by the end of it. If not, you can look forward to sticking scopes up people's butts in the future. :laugh:
     
  17. pgg

    pgg Laugh at me, will they?
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    Elective rotations are very important.

    I considered infectious disease for a while as a med student. In the end, it turned out to be a lot less detective/thinking work than I expected and the absolute deal-killer was the internal medicine residency up front.

    There's tons of theory and background knowledge needed for anesthesia. The great thing about it is that we apply that theory and see results immediately.
     
  18. medsend

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    It seems to me that there are people who are very passionate about 1 field. I have many reservations about Anesthesia and Internal Medicine.

    I don't particularly enjoy long rounds, writing long notes, i like minimal-moderate patient interaction, to have enough free time and to be compensated decently...this steers me away from medicine and landed me towards anesthesia - because I like working with my hands, having a start to finish kind of day, see instant results....maybe I just haven't found the right specialty for myself, which is very disappointing given that its August and at this point
     
    #17 medsend, Aug 6, 2011
    Last edited: Aug 8, 2011
  19. cfdavid

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    Yeah, it's necessary to get at least some exposure. We can all envision to one extent or another. Also, you'll need good LORs.

    I'm just saying that for me it was very different.
     
  20. cfdavid

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    All of the above. My experience as a new CA-1 is that anesthesia is easy to "look good" at. It's easy to be a technician. But, there's plenty of strong theory, some clinically relevant and some not (just like many other fields/concepts in medicine). So, to become a skilled anesthesiologist requires much much more than just learning to "do" stuff at the head of the bed.

    My PD likes to say that in anesthesia we have our very own dog lab right in front of us (I love dogs, but it's his expression not mine). How true that is. Simple things like pneumoperitoneum (i.e. laparoscopy) impacts things like heart rate. You see that, very often, first hand, and you think about what's happening. Sometimes you intervene and sometimes you don't. Frankly, I've "intervened" just because I wanted to see how fast ephedrine (or glyco or atropine, depending on the situation) would impact physiology. Right in front of me. It's really cool IMO.

    Just the other day we were talking about ETC02. The very next day, we see a rise in the baseline, maybe 5 mmHg. I reflected back how that morning, the CO2 canister looked a little worse for wear. So, we order a new one to the room. Slap it on, and bam, the curve changes. That sh.t's testable, but also very practical.

    A lot of the time you do learn from making mistakes (hopefully not big ones)...

    When you're sitting on pressure control, not aware that they just deflated the patient, and you see your tidal volumes creeping into unfomfortable territory, you tend to appreciate respiratory physiology and vent settings that much more. Also the fact that you can't fall asleep at the wheel......

    When you reverse a patient prior to getting that final PTH level back, you really begin thinking about repercussions of having to reparalyze the patient because you got all ahead of yourself...... Thinking of the ramifications of another dose of reversing agent (PONV) yet alone the time (i.e. thinking about pharmacology of rocuronium) involved takes "theory" and brings it home......

    Not sure you need to love pharmacology as a med student. It's a different ball game, though, when you have a REASON to learn the pharmacology of the drugs that you'll be using (many of them) for the rest of your career. THEN, when you're pushing the drugs, making decisions about how that drug will effect the patient, your anesthetic plan, and timing with respect to the length of procedure, again it's a different ball game. That's the kind of thing you just need to DO in order to appreciate.
     

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