Unable to complete critical care rotation in prelim year. Will it cause issues for Advanced/"R" Positions?

[Enik]

Hello All,

I was hoping someone could help me with this. I've done a fair amount of searching but unable to find an answer.

Long story short, I applied to a different specialty, went through SOAP, match surgery prelim, saw the light, decided to apply Anesthesia. COVID put a damper on things at my hospital and I will most likely be unable to complete a critical care rotation during intern year. From what I read, a critical care and EM rotation (one each) were required for when you start PGY-2 year. There was a mention that EM can be completed by start of CA3 year but no mention of Critical Care.

I'm pretty much done with interviews at this point and didn't ask many programs. I asked two programs in regards to R spot, one told me "don't worry about it" one said "its not ideal but we will have to be creative in how to make this predicament work, it is definitely not ideal" . If anyone knows the ACGME rules better or has been in similar situation, i would appreciate advice and it would definitely put my mind at ease.

Technically, I still could try to do my Critical Care rotation. However, this would involve me being a huge pain the ass to my program and screwing over my fellow interns. My program has been a very kind to me going through the re-application process and my fellow interns have been a godsend with regards for covering for me as it is. I definitely don't want go that route unless absolutely necessary.

I would hate to match somewhere and have to forfeit a spot because of something stupid. Programs have told me that not having a STEP 3 completed by start of PGY-2 will cause me to forfeit the spot. I just wonder if same applies now.

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[FiO2@21]

You should be able to make it up during your anesthesia years.

 

[deleted171991]

You should be able to make it up during your anesthesia years.

I am not so sure. I would call the ABA and ask. These are American Board of Anesthesiology (not ACGME) rules. Board certification is a must, at the end of residency.

Or I would be a pain to my program, definitely. There are still 5 months remaining. I would try to find a colleague who would swap rotations, somebody from a specialty that doesn't need ICU.

And, yes, get that Step 3 out of the way, even if programs allow it to be postponed. One should focus exactly on one thing during Anesthesiology residency, especially as a CA-1: on Anesthesiology.

 

[Justice4all]

No. I was in similar situation,but will communicate either with the coordinator or PD for peace of mind.

 

[deleted171991]

Let's talk rules, e.g. https://theaba.org/pdfs/Policy_Book.pdf

"Acceptable clinical base experiences include training in internal medicine, pediatrics, surgery or any of their subspecialties, obstetrics and gynecology, neurology, family medicine or any combination of these as approved for residents by the directors of their training programs in anesthesiology. The clinical base year should also include rotations in critical care and emergency medicine, with at least one month, but no more than two months, devoted to each. Other rotations completing the 12 months of broad education should be relevant to the practice of anesthesiology."

It says "should", not "must", so I think OP should be fine. What seems to matter is the total at the end of the 4 years.

 

[abolt18]

We've had people move over after their surgery intern year and those people just end up getting their schedule moved around a bit if they need to make up a rotation that would have otherwise been done during intern year. I think there is a lot of flexibility.

 

[Katheudontas parateroumen]

Yeah I think you should be ok. I have a few R people in our program that had to do extra EM or ICU rotation during the CA years to make up for their intern year. As long it’s communicated to your PD once the time comes.

 

[Beeftenderloin]

Resident in my program did a PGY1 OB year then switched to anesthesia starting as a CA1. Just did an extra ICU month during CA1 year. No biggie.

 

[Ronin786]

It only matters if your PD wants it to matter.

 

[2010houston]

Agree should not be a problem; would not at all expect this to keep you from matching to an R position

 

[deleted697127]

It only matters if your PD wants it to matter.

haha come on. Don’t scare the kid for no reason. He applied to a different specialty, SOAPed into prelim surgery and then decided to apply into anesthesia likely after rotation schedules and staffing were decided for the year.

Plenty of people make up ICU months during residency. If your program wont let you make up the months during clinical anesthesia years, which they should, your worst case scenario would be extending residency a month or two to make up the rotations. I highly doubt it would come to that. These are graduation requirements not pre-residency requirements. You certainly shouldn’t lose your spot in the match.

 

[agolden1]

Speak with the PD at your R spot program. At my shop, several advanced/R spot people didn't have enough critical care their intern year. Having them do additional months has not been an issue at all.

 

[JiPo]

It won’t matter. Worst case scenario, you lose an elective month later in your Anesthesiology training.

 

[Ronin786]

haha come on. Don’t scare the kid for no reason. He applied to a different specialty, SOAPed into prelim surgery and then decided to apply into anesthesia likely after rotation schedules and staffing were decided for the year.

Plenty of people make up ICU months during residency. If your program wont let you make up the months during clinical anesthesia years, which they should, your worst case scenario would be extending residency a month or two to make up the rotations. I highly doubt it would come to that. These are graduation requirements not pre-residency requirements. You certainly shouldn’t lose your spot in the match.

I'm not scaring anybody. The reality is no PD is going to drop a person they match because of a missing rotation. If they want it to matter as far as ABA certification then it'll matter and they find a way to redo the rotation. If the PD doesn't care, nobody will care. There is no transcript of residency as far as I know.

 

[deleted875186]

It only matters if your PD wants it to matter.

This is the actual answer.

I just graduated in June, we had people who’s rotations were messed up due to Covid, the consensus seems to be that everyone will graduate on time if it’s no fault of their own. But yes, should be able to just do an extra tear of ICU during anesthesia training.

 

[deleted697127]

I'm not scaring anybody. The reality is no PD is going to drop a person they match because of a missing rotation. If they want it to matter as far as ABA certification then it'll matter and they find a way to redo the rotation. If the PD doesn't care, nobody will care. There is no transcript of residency as far as I know.

This is just incorrect. Sure, maybe people slip/sneak through the cracks even with a PD looking the other direction but that doesn’t change the fact that there are very real standard requirements set by the ABA. They are not exactly hard to find. I would bet a program director, resident, and their program could find themselves in trouble with the board should they get caught skirting clearly outlined minimum requirements. Maybe you can find a chill program director that hooks you up with a doctorate of online nursing while you’re at it.

“By the end of the CA-3 year, required experiences in perioperative care must include four months of distinct rotations in critical care medicine with progressive responsibility.”

 

[deleted875186]

This is just incorrect. Sure, maybe people slip/sneak through the cracks even with a PD looking the other direction but that doesn’t change the fact that there are very real standard requirements set by the ABA. They are not exactly hard to find. I would bet a program director, resident, and their program could find themselves in trouble with the board should they get caught skirting clearly outlined minimum requirements. Maybe you can find a chill program director that hooks you up with a doctorate of online nursing while you’re at it.

“By the end of the CA-3 year, required experiences in perioperative care must include four months of distinct rotations in critical care medicine with progressive responsibility.”

Yes there are ACGME requirements, not ABA I believe. If a resident doesn’t complete them for some extenuating circumstance, the program get get cited from the ACGME, but I don’t think there are any consequences on the resident, I believe they can still graduate.

 

[deleted697127]

Yes there are ACGME requirements, not ABA I believe. If a resident doesn’t complete them for some extenuating circumstance, the program get get cited from the ACGME, but I don’t think there are any consequences on the resident, I believe they can still graduate.

https://theaba.org/pdfs/Policy_Book.pdf

 

[abolt18]

This is just incorrect. Sure, maybe people slip/sneak through the cracks even with a PD looking the other direction but that doesn’t change the fact that there are very real standard requirements set by the ABA. They are not exactly hard to find. I would bet a program director, resident, and their program could find themselves in trouble with the board should they get caught skirting clearly outlined minimum requirements. Maybe you can find a chill program director that hooks you up with a doctorate of online nursing while you’re at it.

“By the end of the CA-3 year, required experiences in perioperative care must include four months of distinct rotations in critical care medicine with progressive responsibility.”

I think going back the question was if the lack of the ICU rotation will matter? And the correct answer really is, the lack of ICU rotation will only matter if the PD makes it matter, in the sense that it's not going to keep someone from matching. Most PDs I think would just make a simple adjustment to your schedule to make sure you meet the minimum requirement. They are not going to "hold it against you" though (which is what I thought the original question was asking).

 

[deleted875186]

https://theaba.org/pdfs/Policy_Book.pdf

I stand corrected.

To the point above though, I don’t think the ABA has any way of really cracking down unless your PD gives them a transcript or rotation schedule showing your lacking in something.

 

[Ronin786]

This is just incorrect. Sure, maybe people slip/sneak through the cracks even with a PD looking the other direction but that doesn’t change the fact that there are very real standard requirements set by the ABA. They are not exactly hard to find. I would bet a program director, resident, and their program could find themselves in trouble with the board should they get caught skirting clearly outlined minimum requirements. Maybe you can find a chill program director that hooks you up with a doctorate of online nursing while you’re at it.

“By the end of the CA-3 year, required experiences in perioperative care must include four months of distinct rotations in critical care medicine with progressive responsibility.”

Show me what is incorrect in what I said. There is no transcript for residency. If the PD cares about meeting the ABA requirements they will find a way to meet the ABA requirements. Many PDs realize that a few weeks don't actually matter or will make it up with "call requirements" or whatever. But sure, go ahead and equate that with an online DNP.

 

[deleted697127]

Show me what is incorrect in what I said. There is no transcript for residency. If the PD cares about meeting the ABA requirements they will find a way to meet the ABA requirements. Many PDs realize that a few weeks don't actually matter or will make it up with "call requirements" or whatever. But sure, go ahead and equate that with an online DNP.

Most residency programs have defined rotation schedules....you know, like a transcript. Yeah. I am in favor of strict adherence to minimum requirements and preventing watered down value of being board certified. I do not think it’s a good idea to mess with requirements set forth by a licensing board. It’s a very slippery slope to think it’s okay to blatantly blow off clearly defined requirements. Does watching someone do a block count? Does giving a coresident a break during bypass count for your CABG numbers?

 

[GassYous]

Show me what is incorrect in what I said. There is no transcript for residency. If the PD cares about meeting the ABA requirements they will find a way to meet the ABA requirements. Many PDs realize that a few weeks don't actually matter or will make it up with "call requirements" or whatever. But sure, go ahead and equate that with an online DNP.

Are you sure? I had to log cases and make sure we made the minimum case counts.

 

[Ronin786]

Are you sure? I had to log cases and make sure we made the minimum case counts.

There aren't specific ICU case requirements in the logs.