Tips for anesthesiology observership

[leviathan]

I'm going to tag along with an anesthesiologist next month. Those of you who know me know I am definitely interested in many aspects of the field with my RT / paramedic background. I don't want to seem too overbearing by asking too many questions, but also don't want to seem disinterested. Any suggestions on what I should do during the observership so we both have a positive experience?

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[lfesiam]

I'm going to tag along with an anesthesiologist next month. Those of you who know me know I am definitely interested in many aspects of the field with my RT / paramedic background. I don't want to seem too overbearing by asking too many questions, but also don't want to seem disinterested. Any suggestions on what I should do during the observership so we both have a positive experience?

I understand your spectrum as:

Dis-Interested--------------Just Right---------------Annoying

Well, there is no one good answer to your question. First, try to get the feel of the anesthesiologist whom you will be shadowing. What is his or her personality? Is he/she an academic or a private practice anesthesiologist?

Start by being humble + keeping questions at appropriate times (not when he/she is not busy doing a procedure that requires concentration). You can't go wrong with that! Have a great time bud!

Great book to get for PIMP-guarding during your rotation: Anesthesia Secrets by James Duke, M.D.

 

[leviathan]

I understand your spectrum as:

Dis-Interested--------------Just Right---------------Annoying

Exactly. Not only that, but also being aware of things that I can avoid doing during pre-op / surgery / post-op where I could get in the way .

Well, there is not one good answer to your question. First, try to get the feel of the anesthesiologist whom you will be shadowing. What is his or her personality? Is he/she an academic or a private practice anesthesiologist?

Private practice / community hospital as far as I know.

Great book to get for PIMP-guarding during your rotation: Anesthesia Secrets by James Duke, M.D.

Will look into it, thanks bro!

 

[tyroja00]

Well, this past year I completed 4 rotations at 4 different places and I received pretty good feedback and was told that I would be ranked highly at each and this is with middle of the road scores. So, take this with a grain of salt as it worked for me but maybe not for you. The Anesthesia Secrets book is a great book to read. Other than that:

1. I was proactive, but not in the way. I placed ECG leads, strapped arms down, helped with connecting lines (biz, temp., ECG, TOF, etc.), carted off the bed from the room, etc., all the while STAYING out of the way. I repeated this post-operatively (getting along with nurses that in return speak well of you helps).

2. I developed rapport with the patient and actually knew the patient history. If you really want to impress and feel comfortable, do a preop and ask the doc if they would mind looking at it.

3. Know the basic drugs and when to use them (for example epi vs. neo). Properly label the drugs you draw.

4. Learn to properly mask ventilate the patient all the while maintaining visualization of the chest, appear confident when intubating (you can risk it and try to tape the eyes of the patient, but some attendings just want you to concentrate on the airway). Ask to adjust the table to your proper height. Tell the attending when you see cords. If you don't, back out. Just have a good routine. Intubation and bag ventilation is a simple thing that anyone with practice can get good at, but for some reason students get judged by this ability.

5. Keep an eye out for when the fluid bag is running low and be helpful and ask if they need another. Pretty much try to be helpful; this does not mean intrusive.

6. Learn the quirks of the attendings you are working with.

7. Ask a few questions once in awhile, but don't constantly ask questions in the OR. Sometimes residents/CRNA/AA/Attendings like to relax. It's okay to just shoot the breeze with them.

8. Ask if you can help with anything for setting up for the next case; but make sure you know what that entails. Usually that is drugs (fentanyl, versed, lidocaine, propofol, succs/roc/vec), a couple of tubes, laryngoscope, OG tube, and airways/masks.

9. Stay with the patient and be a fluid part of the team and play nice to EVERYONE including PACU nurses to CRNA's, if you are really bad or really good, you will be talked about, so be the latter.

10. Learn something from one person that is intelligent and use it to cleverly bring up the topic to another person thereby making you look informed which technically you are (ex: "...so during pregnancy a women is more susceptible to chemical pneumonitis due to relaxed sphincter tone, increased abdominal pressure,...and this is why it is preferable to...?").

Finally, show up on time and be appropriately enthusiastic (some people don't like super happy people when they are in the trenches). I hope that helps and I am sure I am forgetting some things.

 

[RussianJoo]

thank you for the great post. i am sure it will help me in a few months when i do my elective.

 

[doctor712]

hey!

i was going to go back into the OR this week, on break from school. but i decided my plate was full enough this month. so, LUCKY YOU!

in case you won't be doing much that is listed above on your observership, (which is all great advice) i would suggest staying close to your attending and be ready for anything.

often when i was observing (i've actually been through paperwork laden "med student" anesthesia observerships even though im pre-med, with a total of 200-300 hours with anesthesia) i would always be within a couple arm lengths of the anesthesiologist. might be behind his chair, at the corner of his cart, on the 60+ side of the BIS. point being, i wasn't ever intrusive, but the last thing i wanted was an attending to say to me, "hey, d712, come over here so you can see this...what are you going to see from ALL the way over there." usually, it's the shy med student who is teetering somewhere between the C-arm and the nurses computer that really doesn't get a chance to see things.

be generous, if there is a shy student around, give up your cushy spot just over the curtain so said student can see a little too. don't compete, ever.

if anesthesia is using a TEE, simply ask, "may i watch too?" I'll betcha within a minute or two attending will see your interest and start pointing things out, "that's the aorta...and this is a view of the left ventricle outflow..." all that stuff.

be early. it always takes me a long time to put those stupid booties on my size 14 shoes, don't trip over yourself balancing on one foot to get into the OR on time because you're in a rush. been there, done that, ONCE.

i ask questions, i think that's what it's all about. i use my general sense of whether or not attending is in the mood, has the time, is swamped and annoyed, and the rest is really easy. if i've done an anesthesia observership and i don't know the color of propofol, i haven't seen enough.

it's my feeling that you want your resume to not only show a 2 week observation in anesthesia, but, if you really love it, your brain should be able to back up what you've seen. if only a little.

see you in the OR,
D712

 

[RussianJoo]

D712, thank you for more great advice.

the advice you give is great for not only an anesthesia observership, but i have been using it for all of my 3rd year of med school and it has showed because I have been getting A's on all my core rotations thus far. (knock on wood, i got two more to go.)

I always try to include others if I know something interesting is about to go down. or if I have seen something before i'll step aside and let my fellow classmates scrub in or whatever. I have been lucky and my group of classmates is all like that. we constantly tell each other about interesting patients that we saw in a particular day, not to brag but to try and show those patients to to the rest of the group if they want to see.

some residents are more competitive and don't understand this, i kind of feel bad for them, we're all just trying to learn.

however, when it's just the attending and me, I do ask to do as much as possible. I feel like they've done these procedures millions of times and don't mind letting me give it a try, most of the time the let me try it and I succeed. the good attendings will teach you and help you try a procedure again if you fail the first time, and won't simply do the procedure themselves. Some attendings are scared to let you try something like intubating because they don't know how much you know and if they can trust you. that's where you need to have book knowledge to show them that you know what you're doing and what you're talking about. If you sound confident and are eager to try 9 out of 10 times they'll let you.