Starting anesthesia residency

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SDF1

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Hey all,

Looking to gain some insight into what I should do to prepare for July 1 when I will be starting as a CA-1.

A little background on me, currently wrapping up my PGY3 year in general surgery at a large program in NYC. Long road to realize surgery was not for me. Spoke to my PD, chairman, etc - most where shocked to say the least, but supportive. Entered the match again, and matched at a great place in the tri state area.

What should I do to prepare for CA-1 year? I have been 100% surgery up until recently, and don't want to enter the year with a "surgical" way of thinking. I don't know jack about anesthesia.

Any input would be a huge help! (What should I read in between now and July, pointers, etc.)

Thanks!
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Pick a book such as Baby Miller or M&M and get through it as fast as you can. Read Jaffe the night before your cases.
 
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Also highly recommend Stoelting's Coexisting Diseases. I recommend it to all medical students/CA-1s. It does a great job giving a refresher over disease before discussing anesthetic implications. Personally, I'd skip M&M, it's too light IMO to really learn much. The only chapter I personally found helpful was the machine one, it does a better job than most breaking it down into something a little easier to digest
 
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SDF1 said:
Hey all,

Looking to gain some insight into what I should do to prepare for July 1 when I will be starting as a CA-1.

A little background on me, currently wrapping up my PGY3 year in general surgery at a large program in NYC. Long road to realize surgery was not for me. Spoke to my PD, chairman, etc - most where shocked to say the least, but supportive. Entered the match again, and matched at a great place in the tri state area.

What should I do to prepare for CA-1 year? I have been 100% surgery up until recently, and don't want to enter the year with a "surgical" way of thinking. I don't know jack about anesthesia.

Any input would be a huge help! (What should I read in between now and July, pointers, etc.)

Thanks!
Click to expand...


Stanford puts out a good bare-bones guide.
http://ether.stanford.edu/ca1_new/CA-1_Tutorial Textbook_2016.pdf

I used "baby" Miller early on. If you were successful in surgery, you know the drill. Show up early, be engaged, etc etc.

Welcome to the other side of the curtain.
 
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Big M&M (Morgan & Mikhail) fan here. Stanford guide and Stoelting's are also excellent. Most important is to read about your patient and try to understand the anesthetic plan each day - that will do you well.
 
I'd say just mentally prepare for the daily occurrence of the surgeons who know nothing more than what surgery they're doing talking to you like you're the idiot......

In all honesty I love the Surgeon turned Anesthesiologist cases and they're almost as interesting as CRNA turned Anesthesiologist.

Congrats on doing the tough thing and changing paths.
 
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Robotic Wis-Hipple said:
I'd say just mentally prepare for the daily occurrence of the surgeons who know nothing more than what surgery they're doing talking to you like you're the idiot......

In all honesty I love the Surgeon turned Anesthesiologist cases and they're almost as interesting as CRNA turned Anesthesiologist.

Congrats on doing the tough thing and changing paths.
Click to expand...

I completely agree. My wife is surgeon who wants to turn to anesthesia. Her indepth interest in the overall wellbeing of her patients is astounding and refreshing. Proud to be her husband no doubt :)
 
SDF1 said:
Hey all,

Looking to gain some insight into what I should do to prepare for July 1 when I will be starting as a CA-1.

A little background on me, currently wrapping up my PGY3 year in general surgery at a large program in NYC. Long road to realize surgery was not for me. Spoke to my PD, chairman, etc - most where shocked to say the least, but supportive. Entered the match again, and matched at a great place in the tri state area.

What should I do to prepare for CA-1 year? I have been 100% surgery up until recently, and don't want to enter the year with a "surgical" way of thinking. I don't know jack about anesthesia.

Any input would be a huge help! (What should I read in between now and July, pointers, etc.)

Thanks!
Click to expand...


Reading baby Miller or a basic book might be good prep, but honestly just mentally preparing for the change is probably most important. Your job as the anesthesiologist will be to manage the medical conditions of the patient having surgery. The surgeon will worry about what they are doing, you gotta worry about the rest of the patient. Getting comfortable acutely managing things like COPD, MI, DKA, sepsis, massive resuscitation, etc. I mean you get some of that in surgery, just not quite as much or in depth as you will in anesthesia. You will spend a lot more time thinking about things like cardiac output, SVR, etc than you ever considered as a surgery resident.

Don't worry too much about the details, though. When you start as a CA-1 you aren't expected to know anything. Showing up and being willing to work hard, listen to advice, and study is all they will ask of you.
 
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Yep prepare to be humbled and afraid. Humbled for the first 4 months when you can't even out an IV in a rope of a vein.

Fear when your first patient desats on you and you haven't a notion what to do

But it's all good mate. It's the best job in the world. Good choice
 
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Thank you all for the comments. I have never had an issue with exams, etc, and have always been in the top quarter of my residency in terms of that. I know the usual, show up early, etc. I never had a "surgical" personality, hence one of my reasons wanting to switch.

Not sure if there a primer of something I should know on day 1. The others in my CA1 class are just finishing intern year, meanwhile I will be walking with a few years of surgery under my belt.

What Im worried about is exactly what was said above, I feel comfortable placing central lines, a lines, etc - all under ultrasound. But cannot remember the last time I placed an IV, intubated, etc.
 
SDF1 said:
Thank you all for the comments. I have never had an issue with exams, etc, and have always been in the top quarter of my residency in terms of that. I know the usual, show up early, etc. I never had a "surgical" personality, hence one of my reasons wanting to switch.

Not sure if there a primer of something I should know on day 1. The others in my CA1 class are just finishing intern year, meanwhile I will be walking with a few years of surgery under my belt.

What Im worried about is exactly what was said above, I feel comfortable placing central lines, a lines, etc - all under ultrasound. But cannot remember the last time I placed an IV, intubated, etc.
Click to expand...

IVs and tubes will come with time, I wouldn't worry.

As far as a primer for day 1, the Stanford ca1 guide is a good start, and can be found on Google.
 
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I'd also say don't walk in with a PGY4 attitude. I know you have knowledge/experience and that will pay dividends, just don't act like you're not a "true CA-1".

Most programs will give you some kind of boot camp or hand holding the first few weeks because being the only one in the room thinking about the whole patient, their hemodynamics, and most importantly their airway/ventilator management is a fair amt of responsibility.

If you feel like reading something I'd second M&M and prioritize sedative hypnotics, respiratory physiology, and ventilators
 
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[QUOTE="SDF1, post: 18823381, member: 313315"

What Im worried about is exactly what was said above, I feel comfortable placing central lines, a lines, etc - all under ultrasound. But cannot remember the last time I placed an IV, intubated, etc.[/QUOTE]

Don't worry because it's not like interns get to do a lot of those things either. You will get plenty of hands on teaching to learn those things at the start.
 
d9sccr said:
Also highly recommend Stoelting's Coexisting Diseases. I recommend it to all medical students/CA-1s. It does a great job giving a refresher over disease before discussing anesthetic implications. Personally, I'd skip M&M, it's too light IMO to really learn much. The only chapter I personally found helpful was the machine one, it does a better job than most breaking it down into something a little easier to digest
Click to expand...

I used M&M all through residency and to help study for written boards and it helped me quite a bit. I would also highly recommend it.
 
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Hey guys, I'll also be starting CA-1 in July. Can someone kindly post the amazon link to baby miller please?
 
I agree with suggestions aimed at learning about medical disease processes and pathophysiology. I'm astounded pretty much daily at how little surgeons (and internists turned proceduralists, aka GI) know about medical disease processes in general these days.

Stoelting's book on Anesthesia and Co-Existing Diseases is good, though a bit dry, because it goes over the medicine that we should know.

I'd spend some extra time on managing cardiopulmonary derangements: COPD and ventilator challenges, ADHF, management of the heart failure patient in non-cardiac surgery, asthma, etc. Oh, don't forget Neuro as well: Elevated ICP, cerebral physiology, and the list goes on.

It's much more medicine than you probably realized. If you had good SICU training, then that might give you an edge, too.


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Pick yourself up a copy of Yao and Artusio. By all means, go thru Baby Miller or Morgan/Mikhail and make it your primary source. But pick up Yao and Artusio early on in your training and go thru it gradually at your own pace over the next 2-3 years. By the time you graduate, you will be able to destroy both the written and oral boards bc of that book. Boards will be a joke. I personally know examiners and question writers who use Yao as their go-to when they need to review material themselves.
 
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Thank you all for the feedback.

Now that I've had a few days to dwell on my previous posts - what really is provoking my anxiety is the "unknown". I've grown comfortable in surgery. Read the texts, aced ABSITE, feel comfortable performing basic operations with supervision, etc.

I am getting a whole new field that has a lot more medicine in it (a lot of which I have forgotten, and/or bred in a culture by my attendings that medical problems are dealt with by internists). This particular fact was one of the reasons why I also decided to switch. Maybe now I am getting a little buyers remorse, or more likely I am just a bit nervous and anxious being out of my comfort zone - which is a good thing.
 
SDF1 said:
Thank you all for the feedback.

Now that I've had a few days to dwell on my previous posts - what really is provoking my anxiety is the "unknown". I've grown comfortable in surgery. Read the texts, aced ABSITE, feel comfortable performing basic operations with supervision, etc.

I am getting a whole new field that has a lot more medicine in it (a lot of which I have forgotten, and/or bred in a culture by my attendings that medical problems are dealt with by internists). This particular fact was one of the reasons why I also decided to switch. Maybe now I am getting a little buyers remorse, or more likely I am just a bit nervous and anxious being out of my comfort zone - which is a good thing.
Click to expand...

I'm not much further than you, but I think I can relate. I'll be honest the first month or two, the learning curve can be steep, and in my short experience, I think feeling some level of anxiety and nervousness at our stage is a good thing. It makes us realize how little we know or how little we can be in control of things, and we will compensate by reading more or being more prepared, neither of which are bad things.
 
You have 2 more years of clinical experience than your cohorts. First month or 2 is tough for everyone. You'll be a beginner again but you'll be more than fine.
 
SDF1 said:
I am getting a whole new field that has a lot more medicine in it (a lot of which I have forgotten, and/or bred in a culture by my attendings that medical problems are dealt with by internists). .
Click to expand...

Medicine is easy: even nurses can do it :p
If you want to learn about anesthesia you can start here.
 
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You are probably ahead of the game already being a surgery resident for 3 years. I didn't read anything before starting CA1 year and I'm doing fine. You learn on the job (if you are at a good program) and learn during lectures/didactics/simulations.
 
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