What happens to your skills in Critical Care?

[MDAforthewin]

For those of you who did gas to critical care: What happens to your OR skills? Is it inevitable that you lose them if you decide to go full time CC thus preventing you from ever getting a gas job down the road? I know many on this board advocate that doing your own cases early on in your attending career really solidifies your abilities. Obviously this would never happen if you went full time critical care.

Thanks for the insight.

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[Stank811]

Your OR procedural skills remain on par…as a fellow I had to perform all the difficult intubations, IV, CVLs, swans, art lines etc…and the numbers are not insignificant. One thing that does get rusty is speed and fluidity between cases…you start to loose the art of anesthesia practice. Following CC fellowship I was much more comfortable doing bigger more complex cases that lasted hours as opposed to a room filled with tonsils.

 

[Ezekiel2517]

It's just like anything else, you'll be a little rusty but you regain your form after a few cases. After a CCM fellowship, you'll become more proficient with many procedures and learn some new ones, such as chest tubes and perc trachs

 

[fakin' the funk]

After a CCM fellowship, you'll become more proficient with many procedures and learn some new ones, such as chest tubes and perc trachs

Depends on your program.

I did zero of each of these at my fellowship.

 

[BobBarker]

Depends on your program.

I did zero of each of these at my fellowship.

But you got really good at writing notes, right?

 

[Sonny Crocket]

But you got really good at writing notes, right?

LMAO

 

[deleted171991]

Maybe I am old-fashioned or uninformed, but I think the point of a CCM fellowship is mostly to become a better thinker, not a better doer. Of course, you have to learn the monkey skills but, when I read about somebody who did 100+ central lines during the fellowship, I am not so sure it was a good learning experience. To me, it suggests that the fellow was more like a resident (unless it was a really big and busy ICU). Of course, the same goes for "I did zero lines during my fellowship", which makes me wonder whether s/he was just an "observer".

Again, this is just my inexperienced thinking, from somebody who hasn't done a CCM fellowship.

 

[Consigliere]

Can't comment on the original post but apparently girls only dig guys with skills.

www.youtube.com/embed/XsiiIa6bs9I

 

[Ezekiel2517]

Maybe I am old-fashioned or uninformed, but I think the point of a CCM fellowship is mostly to become a better thinker, not a better doer. Of course, you have to learn the monkey skills but, when I read about somebody who did 100+ central lines during the fellowship, I am not so sure it was a good learning experience. To me, it suggests that the fellow was more like a resident (unless it was a really big and busy ICU). Of course, the same goes for "I did zero lines during my fellowship", which makes me wonder whether s/he was just an "observer".

Again, this is just my inexperienced thinking, from somebody who hasn't done a CCM fellowship.

The OP was only asking about OR skills. It goes without saying that you will learn the medicine that makes you an intensivist. And it depends on the program but I hardly wrote any notes or H/P's during fellowship. Interns, residents, and NP's took care of them. As a fellow, you get to focus on the higher level stuff and will be responsible for running rounds and making the important decisions. It's a nice change from the OR where you're basically the surgeon's bitch, especially in private practice.

 

[seinfeld]

You can always go back to the OR but going back to the ICU is a heck of a lot harder.

FFP IMHO is correct about becoming a better thinker. For me it ends up making me less scared of what could happen as I have seen and managed it all.

 

[fakin' the funk]

But you got really good at writing notes, right?

I got better at doing some procedures on incredibly sick people
I got better at working in a team, communicating with surgeons and nurses and consulting teams, and standing my ground
I got better at working with patients who aren't anesthetized, and their families
I got better at realizing the repercussions of my clinical decisions for the patient's next hours, days, weeks, and years

...and yes, writing notes.

 

[urge]

But you got really good at writing notes, right?

Not even that. ICU fellows & attendings are so sloppy nowadays that they only copy and paste their notes without having any relevance to patient care.

Here they don't even document a physical exam. The only thing there is the self populated vital signs.

If you want to know how the patient is doing you have to read the nurses notes, or any consults.

 

[deleted126335]

What you don't use you lose. Doesn't mean that it can't be relatively quickly reacquired.

 

[Triple AAA]

Personally, having trained at different institutions that had different strengths and weaknesses, I learned several skills in ICU fellowship that did not have when I finished my residency. These include both my knowledge base and my procedural expertise.The knowledge/thinking part of it also reinforced concepts that I had learned during residency that I hadn't quite understood at the time.

 

[G-Man82]

But you got really good at writing notes, right?

I'm a new fellow as of July 1st. It's hard to generalize still since the unit I'm in is a trauma unit run by the trauma surgeons, but in this unit the fellows and residents don't really write daily progress notes! The residents fill out something in the computer that pre-populates everything but the A/P that the attending dictates. It's really odd.

So far though, it seems worth the extra year. There's a lot to learn here.

 

[kazuma]

I was wondering about this too. I moonlighted on some weekends/holidays in the OR when I was on my CCM rotations and it was nice to be able to go back and forth between both fluidly. However, I don't believe I will have any OR based moonlighting opportunities as a CCM fellow next year. It would be nice to be able to take an OR shift once a month to keep up your speed and efficiency, but I think a lot of it will be like riding a bike since we've been doing it for 3 years prior to fellowship.

I definitely want to practice both OR and CCM and I'm willing to take a full time CCM gig upon graduation if I need to. I would hope that I'd be able to pick up some locum gigs on some my weeks off to keep my OR skills up.

 

[Consigliere]

I definitely want to practice both OR and CCM and I'm willing to take a full time CCM gig upon graduation if I need to. I would hope that I'd be able to pick up some locum gigs on some my weeks off to keep my OR skills up.

CRNAs got that covered brah.

 

[Baller MD]

CRNAs got that covered brah.

lmao