this is your second extremely vague post about this. do you have anything that is actually helpful to say?
Sorry I am new to the forums and was just posting a generalization. I put my complete thoughts in the other thread and again here:
Here are my impression of the program:
Typical Day:
The night before I'm expected to preop all of my patients ahead of time using our paper records, call each patient up and then call my attending to go over the plan. If I have 4-5 patients it can take about 90 mins otherwise I'm usually done in 45 mins.
Roll in around 5:15. Since we moved to the tower recently, EVERYTHING is super spread out and everything takes longer in the morning. Our lockers are still in the old locker room by the abandoned Atrium ORs (unlike the CRNAs, SRNAs, Attendings, floor nurses, support staff etc who have lockers in the new tower where the OR are located). So after we change, we've got a bit of a hike through two buildings via 2 elevators to get to the OR (which themselves are very large and spread out) so that
adds an extra 10-15 mins onto our day. And if you leave something in your locker (a snack, lunch, book etc) no way you have time to get to it during your break, it's just too far. In my OR setting up by about 535-540. Set up can take a while since nothing is connected, started or set up and half the time we're going room to room to find equipment (it's rare to even have your equipment in the room) such as infusion pumps, IV tubing, drug labels, blankets (to use as pillows because we rarely have donuts), bottles of gas for the machines, headstraps, something even monitoring cords. Techs? We are the anesthesia techs. We do everything from A-Z including room turnarounds. No other program has residents turn around their own rooms. When I mean nothing is set up, I mean
even the IV bags and tubing we use, we assemble all that ourselves, set up our machines, airway stuff, drugs, A line bags etc. If I have a heart or complex case, believe me I'm coming in at least an hour earlier since I'll spend all morning (or the night before) running around room to room or to the supply room to simply gather the bags, tubing, pumps, TEE probe etc that I'll need. It sucks having such poor tech support available esp for a big and spread out OR complex.
Done setting up by 615,
run to AM lecture (620-640) where 20-30 of us cram into a little conference room only has sitting/table room for 6-7 people. Finish lecture, run back to the OR complex to see our patient, finalize our preops, pop the IV/Aline in and ready to roll back by 710. In the OR by 715. Work until lunch which we usually get sometime between 1130-300ish (it's rare but on occasion I have gotten a 15min AM break). Take 30min lunch break and back to it
until 6-8ish. Go home, preop my patients, call etc.
This schedule is pretty typical for most residents (CA1-3), when they're on the general ORs. Toughest part is the turnover (lightening quick, less than 20mins, private practice mentality) since we get no help whatsoever from techs or nurses during turnover so we gotta drop the patient off at PACU, wait for the PACU nurses (who are quite slow) to get to the slot, get vitals, sign out. Run back to our room, turn over the monitoring equipment, airway, suction, set up the bed, grab our IV bags (you make all of them up in the AM), grab our drugs (draw everything up in the AM, no time during turnover) and grab our records and run to preop. See the patient, complete or finalize the history (depending if you got a hold of them the previous night), final the plan with the attending, do your physical exam, airway exam, grab the glidescope/setup your fiberoptic (if you need it) pop the IV, make sure the nurse gave you antibiotics and roll to the OR.
All in 20mins.
OR workload is very strenuous, surgeons here (esp gen surg, ENT, ortho) are private practice and very fast so you're scrambling all day to set up for your next case and trying to meet time on the the turnover so the attending doesn't chew you out.
In the SICU you'll be Q3 call, calls usually run about
29-30hrs (you'll log 28 though) and average
80 hrs per week. NSICU is Q4-5 call. General ORs you'll average 65-70/wk. Call is 24hr call, lasts til 7am the next AM. You start out with 2-4 calls a month as a CA1 and work up to 7 calls a month as a CA2 or CA3 though it can be as low 3-4. You'll have about 2 late calls a month where you do a normal day but then stay late to get people out of rooms, you can often stay until 8-10pm on these days. Pain/Regional is lighter on the hours. OB is 7a-6p when on days and 6p-7a when on nights.
You also do a rotation a Skokie Northshore which is fun since you have better hours, much better teaching and a chiller more helpful OR environment (great techs who actually make your IV bags for you and can help troubleshoot, set some equipment if you need help, help during turnovers from nurses), attendings that may preop your next patient to move things along, lots of teaching, INTRAOPERATIVE ELECTRONIC RECORDS!!! You also may do a month of hearts at Resurrection or Evanston to round out your heart numbers.
Teaching:
Faculty are split into 4 groups. Group1 (30%): Faculty who are chill to work with but aren't around for 98% of the case (other than induction and sometime extubation). They don't really teach much and aren't really hands on Group2 (15%): Faculty who are super demanding, yelling, on your butt about minor stuff and who the residents dread working with but they do teach a decent amount Group3 (30%): Faculty who are super demanding, yelling, on your butt about minor stuff and who the residents dread working with but really don't teach much and at the end of the day you're not really sure what if anything you've learned Group4 (25%) Faculty that are chill to work with, are very hands on, they actively teach and try and make sure you get something out of every case and more importantly are available to help if we need it or answer questions for our education The PD is definitely a group 3 kind of guy and unfortunately is one of the most intimidating, angry, red in the face yelling attendings I've ever worked with. He sets the tone for the program. Teaching in the OR is pretty rare, it's more of a learn by doing kind of place, and a learn by reading kind of philosophy which is hard since there isn't much reading time. Conference: Monday, Tuesday, Thursday, Friday is AM conferences (620-640). Attending led, somewhat helpful but it's hard to really explore/dive into a topic in 20mins especially when we're all rushing to set up our rooms. We have grand rounds every Wednesday from 630-800 and have visiting lecturers about every 1-2 months from Tuesday 4-6. They got rid of the weekly Tuesday lectures because they were unable to get people out of the ORs for those lectures so a bunch of people kept missing them since they could not relieve them. Now with the occasional Tuesday evening lectures, if I'm stuck in a case and miss half or all of it, it's only missing 1 lecture a month instead of every week like how it was previously. From an organizational standpoint, our program is pretty poor. Our residency coordinator is EXTREMELY bad at her job. From taking care of orientation materials, getting your fellowship paperwork through, keeping track of your fellowship records or even residency records. It's all EXTREMELY bad. We have to double and triple check that stuff or things fall through.
Atmosphere:
Our resident group is pretty diverse. I was talking with some of the CA1s and their class is pretty varied in terms of backgrounds.
Rush usually can't fill from the match so they leave a decent number of spots to be filled post match. Out of 20 applicants you'll usually have around 5 that scrambled into anesthesia when they couldn't match into another specialty (ortho, ent, plastics, surgery), a couple IMGs (either Americans going to Caribbean schools or overseas) and a few DOs. We all get along great though and go out a decent amount when possible. I do have a life outside of work but it's not easy. The physical environment is nice, new ORs, but everything is really spaced out now. ORs on 3 floors of the tower (4th is interventional, 5th is general, 7th is Ortho,NeuroSx), plus cases still in the abandoned Atrium (peds hearts, cystoscopy, some ENT/Plastics) and Endoscopy in the way far away and way abandoned Endo suites in the old radiology wing. I hated going there since you have older/different monitors, older/different machines, they have no equipment down there so you have wheel EVERYTHING over from the tower to Endo suites literally 2-3 blocks away. Most of the day is in the tower though and while its new and nice, it's also really spread out and I've often had attendings with cases on a couple different floors. Cafeteria is minimal, more like a little side cafe, with the same fcuking fish as entree every. god. damn. day. Call rooms are nice and new though. In the tower we have Pixis in each OR, Drager monitors and top of the line Drager Apollo machines. Unfortunately our intraop records are 100%
paper charts, even the preops are done on paper records so it's difficult or impossible to review previous records, filling them out takes forever and no matter what you've heard, there are no plans to make anything electronic (not even our preop H&Ps). Skokie recently got electronic intraop records (in addition to the electronic preop H&Ps which they've had for years) and it's amazing.
Conclusion:
Honestly, looking back I ranked this program higher than I would have had I known more. I've got friends at nearly every program in Chicago and I think it's safe to say
we are the hardest working residency in Chicago. We work the most hours, do the most cases, have the least amount of OR help (several other programs have tech that'll help turnover the rooms, nurse that'll put your IV in your next patient and attending that'll help move things along by saying hi to the next patient or give you an AM break or ensuring you get lunch at a decent time). We have one of the shortest room turnovers of any program in Chicago and have the least help so you really never get to sit down and think about your anesthetic plan or have a thorough discussion with the patient or attending.
It's all reactionary; we are basically anesthesia techs, not anesthesia residents. The board is run sloppily and often the call people or late call people are not put into rooms to get whosoever is in there out right away. Sometimes they're just twiddling their thumbs in the call room waiting for an assignment while people who aren't on any call are left to rot in their rooms. I often feel that our schedules are shifted like crazy just to fill in voids left by CRNAs or SRNAs taking vacation days. You'll come in first thing in the morning, set up your room and lo and behold your were pulled into another room and have 10 mines to setup everything , preop a patient you know nothing about. No one paged, emailed or call about the scheduling change. Often you'll get pulled to a different rotation or pulled off a rotation to take over a general room, or pulled to go to skokie or an away site with no notice. I feel that the SRNAs schedules are never tampered with (i.e. when they're on Neuro or Skokie they are left on their designated rotation for the month) while we get pulled off to fill in OR gaps. Another downside is there is very little preoperative medicine here at Rush. In this era, when CRNAs are fighting for our jobs we need to distinguish ourselves as physicians but broadening our skill set to more than just the OR. Other programs (U of C, UIC, County, they are the ones I know of for sure) often have a preop clinic where you, a couple residents and an attending staff and see patients all day. Your job is evaluate them, complete the preop, and recommend further testing if indicated. This is the of realm of medicine we can use to separate ourselves from Nurses by bringing our medical backgrounds and understanding of cardiopulmonary medicine to the forefront "surgical home." Plus, it offers a way to have the preop done ahead of time in a controlled environment so you're not combing through all of their records at 9pm the the night before in a hurry. But we have no real preop clinic. We have an APEC rotation where we may see 2 patients a day in a clinic setting, then we sit around paging the coordinator to find out which attending has a few minutes to spare from the OR to discuss the patient with you and that's it. You spend the rest of the day running around the hospital filling out preop forms for addons or getting pulled to cover ORs. And since our records are not electronic whoever does the cases you see in clinic, has to fill out the preop H&P anyways. Overall, I will say that you probably come out well trained from Rush since you do SO many cases and I do feel prepared once I on my own.
But I honestly don't know if Rush is worth it. I mean how many total knees do I have to do...after you've done 200, are you really gonna gain that much by doing 5 more in a day and having to be stuck there until 7pm, wouldn't I gain more reading at that point? And on that point, despite the ortho work load here, most are total hips, total knees and spines. Very little in the way of regional (which really surprised me), so little that some residents had to get a 2nd regional month to get their numbers. We just don't do that much ankle, elbow, wrist and hand. But if you think about it, we don't have a regional fellowship at Rush, probably for good reason. We have very little time for reading and it has begun showing with poor scores on our in service training examination. We've done poorly for a couple years now so our program has hired some teaching expert to "teach us how to study." Seriously, her whole program is abstract lessons that have nothing to do with anesthesia, but are there simply to teach us how to study. We had these 2 hours sessions every 3-4 weeks on Tuesday from 4-6. We know how to study, we simply don't have the time. Finally, there is very little in the way of research here at Rush. Maybe some in the pain department but other than that we're not a very academic program, no other ongoing research projects (heck, our only fellowship program is Pain, nothing else). Our attendings do have stacks of case presentations for us to present at conferences though so you can program get an Abstract if you really work the case presentation. Honestly, you can be just as well trained coming from a much less stressful, much less malignant program. Especially since with the longer hours allow for much less time for reading/studying.
Looking back I definitely would have ranked Loyola and UIC above Rush if I were to do it again. Yes, I'll come out well trained at Rush, and yes they have a good pain program (which is why like 1/3 - 1/2 of each class goes into pain) but it's honestly not worth it and I would probably have a better chance of doing well on my inservice training exams and boards at a program that emphasized didactics and academics and gave a chance to actually study. Out of a class of 20, maybe 7 go into pain, 3 into regional, 2 CT, 2-3 Peds, maybe 1 Critical Care, the rest private practice.
Good luck with everyone's match, please make informed decisions!
