What type of intern year pre-anesthesiology

[sebsvenmdc]

Hi Guys, just wondering, what do you advise in terms of:

Best prep for CA-1:
1) Categorical
2) Prelim-IM
3) Prelim-surgery
4) Transitional

Easiest to survive (I don't mean, most chill, I mean easiest to not get kicked out!):
1) Transitional
2) Categorical
3) IM
4) Surg

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[MTGas2B]

Best Prep:

I would vote prelim IM. You'll work hard, but best learning potential, especially if you take advantage of ICU time.


Easiest to survive:

A little harder to answer, probably more program dependent than type dependent. I've had friends who work their butts off transitional programs. I did prelim surgery and it was pretty chill. If you don't want to get kicked out, prelim med and surgery probably would keep you just for the labor, just knowing they won't have to put up with your "kicked out" behaviors after the year is over.

Why are you worried about getting kicked out?

 

[sebsvenmdc]

Best Prep:

I would vote prelim IM. You'll work hard, but best learning potential, especially if you take advantage of ICU time.


Easiest to survive:

A little harder to answer, probably more program dependent than type dependent. I've had friends who work their butts off transitional programs. I did prelim surgery and it was pretty chill. If you don't want to get kicked out, prelim med and surgery probably would keep you just for the labor, just knowing they won't have to put up with your "kicked out" behaviors after the year is over.

Why are you worried about getting kicked out?

Hey, thanks for the advice. Oh, I'm not worried about behavior or knowledge base. I'm just not really confident in my clinical skills and efficiency in the hospital. I'm attempting to address this with lots of practice, improving physical exam skills, doing H&Ps faster, following administrative details. I'm just kind of concerned about getting lost or being too slow with the patient load of intern year. At least, I have a year to try to improve that. I spent too much of MS3 focused on the shelf exams at the expense of developing my clinical skills - the irony is that I didn't ace any of those stupids shelves (scores in the 80s).

 

[RedAnesthesia]

Hi Guys, just wondering, what do you advise in terms of:

Best prep for CA-1:
1) Categorical
2) Prelim-IM
3) Prelim-surgery
4) Transitional

Easiest to survive (I don't mean, most chill, I mean easiest to not get kicked out!):
1) Transitional
2) Categorical
3) IM
4) Surg

You forgot one on the list. Prelim Family Medicine. I am doing that this year before my CA-1 year and it was a smart move on my part. It is essentially like a transitional year and get a ton of electives including ICU.

 

[Gimlet]

I'm going to put in a plug for categorical. Unless you have the stats to compete with Derm and RadOnc superstars for the best cushy TYs, I think it could be the way to go...depending on the way the categorical year is planned.

Obviously you get farmed out to other services as an intern (which can suck or be not so bad depending on the service), but in my program we spent 4 months rotating in Anesthesiology-run services (Pain clinic, Pre-op clinic, closed-unit SICU, anesthesia). It was a good way to get to know some of the staff in the department, as well as my co-interns who will be going through residency with me. At the start of CA-1 year, there will be less of a learning curve for the categoricals as far as systems-based things go (EHR, hospital logistics, etc) which allows them to concentrate more on clinical learning.

 

[sevoflurane]

This was my first year in a categorical program:

3 mo. anesthesia
3 mo. ICU
1 mo. ED
1 mo. cards
1 mo. renal
1 mo. pulm
1 mo. trauma
1 mo. gen surg.

Got to pass some gas and hit some pretty important rotations. Wasn't cush, but wasn't a killer year either. Just right.

 

[lord_jeebus]

The content matters more than what kind of prelim it is. I learned a lot of useful things in the unit, in the ED, on cards, and on pulm. I learned very little on the wards besides how to navigate the bureaucracy of one particular hospital, and how to be a social worker.

 

[CambieMD]

This was my first year in a categorical program:

3 mo. anesthesia
3 mo. ICU
1 mo. ED
1 mo. cards
1 mo. renal
1 mo. pulm
1 mo. trauma
1 mo. gen surg.

Got to pass some gas and hit some pretty important rotations. Wasn't cush, but wasn't a killer year either. Just right.

Above is a dream prelim year. Anesthesia patients can have any variety of co-existing diseases. We have to have a good grasp of int. medicine. I would not suggest a surgical prelim year.

Cambie

 

[Ignatius J]

Quite honestly, no matter what intern year you do, you will walk into CA-1 year feeling like you don't know anything again.

The best thing you can do is read anesthesia on your own to prepare yourself. Intern year isn't really set up to help you out in the OR. I see it as more of a logistical step to getting where you need to go. Try and start IVs, try to start lines, etc. Just try and get some hands on stuff.

So yeah, your CA years will teach you anesthesia. If you want to learn a lot about medicine or surgery, do that. But you will be just fine without it.

Just my two cents.

 

[fakin' the funk]

Quite honestly, no matter what intern year you do, you will walk into CA-1 year feeling like you don't know anything again.

The best thing you can do is read anesthesia on your own to prepare yourself. Intern year isn't really set up to help you out in the OR. I see it as more of a logistical step to getting where you need to go. Try and start IVs, try to start lines, etc. Just try and get some hands on stuff.

So yeah, your CA years will teach you anesthesia. If you want to learn a lot about medicine or surgery, do that. But you will be just fine without it.

Severely disagree.

Intern year is a hurdle for sure, but TRY to learn something during it. Like, appropriate doses of appropriate antihypertensives. How to manage heart failure. What inhalers COPD'ers should be on. Renal disasters. It's nice if you can do lines and if you can read anesthesia, but really, this is a year for you to form the broad, knowedgeable basis of the rest of your career.

Internship may suck but it does help you as a physician.

 

[Mista Suprane]

i did a gen surg prelim.

positives: procedural skills (line placement), fast rounds, OR time, learning how to deal with surgeons

negatives: longer hours possibly, chance of malignancy.

do it if you like surgery; if you hate it, do something else. as far as malignancy goes, you may find that large academic prelim medicine programs could be more malignant than a community surgery program (this was the case in baltimore where i did my surg prelim).

also, don't underestimate the positive of learning how to deal with surgeons. they are usually babies, they want what they want when they want it. you will spend your entire intern year learning to work the intricacies of these demands, and learning how NOT to offend surgeons and give in to reasonable requests ("yes sir"). it honestly does help when you are on the opposite side of the ether curtain. plus, you can look over the drape and know how long they are REALLY going to take to remove the L colon/close the skin/do the vascular anastomosis/finish the case/etc. your anesthesia attending will often be WRONG about such things.

additionally, whenever i can, i work it in the conversation with them that i did surgical internship: you would be surprised at how much more this makes them respect you both in an out of the OR (ICU, etc.) and how it can make an unpleasant surgeon very nice to you. they will look at you as a hard worker and as someone who understands them - i have been told several times by surgical attendings that i "think like a surgeon." - remember these will be your OR colleagues for the REST OF YOUR CAREER - and if you have walked a mile in their shoes, it will make your relationship with them better. on many occasions, as even a CA-1 resident, i was able to resolve conflicts in cases where my attending was not able to, due to this relationship. and when you have to stand your ground about something you feel strongly about (which happens often), they can and will respect your decision more.

i know a lot of you may poo-poo all this stuff, but it certainly makes my life a lot easier. if you are truly on the fence, consider the above before making your decision.

this all being said, if you a rockstar with amazing board scores (which I was not) DO THAT CUSHY TRANSITIONAL. everything you need to learn about being an anesthesiologist you will learn in anesthesiology residency. all you need to learn in your intern year is HOW TO BE A DOCTOR. - which you will learn in ANY internship. cards/pulm/rads/surgery blah blah blah who cares. try to do an ICU month if you can, otherwise fill your schedule with blow-off electives. everyone starts CA-1 year with a different skill set based on their internship, and honestly 6 months in, except for minute differences, you can hardly tell who did what for their CBY. enjoy that intern year, it can be the most fun year of your life if you have an easy internship - don't miss this chance if it is an option for you.

my two cents.

 

[urge]

Internal medicine or a tailored transitional year (categorical is about the same) would be best for your future. There is already a surgeon in the OR. Whatever you manage to learn in 1 yr is pretty much useless since you are not bringing anything new to the table. What is lacking in the OR is an internist. You can fill this void with good training. Learn to read ekg's well, read PFT's, treat copd, diabetes, dka, ischemia, heart failure... You don't need to know how to clean wounds, examine a belly, or feed people. Many anesthesia programs have recognized this and have changed their name to "Perioperative Medicine".

I remember when I interviewed for anesthesia, there was a d-bag anesthesia resident trying to convince me that a surgery internship was the best since he knew "exactly when they were throwing their last stitch and could fine tune his wake up for that moment". What a tool!

 

[Mista Suprane]

Learn to read ekg's well, read PFT's, treat copd, diabetes, dka, ischemia, heart failure...e".

to the OP --->

most of the above are managed differently, and in a much more simple fashion during a case (in hours) in the OR VS. on the floor (in days/weeks) as i'm sure you can imagine. not so sure the medicine year helps you all that much with these particular things, vs. just a couple ICU months during ANY internship.

What a tool!

once again, to the OP--->

and this is just a comment from someone who clearly doesn't have a good relationship with surgeons. although i did mention the timing of the cases as a factor, honestly, the ability to understand where they are coming from, and their motivations is invaluable. whether you do a fellowship, academics, or private practice, developing that relationship and keeping surgeons happy is an important part of being an anesthesiologist - don't you want to be the guy that every surgeon requests to work with? you really don't think that has some effect on becoming partner, or even keeping your job? sure, maybe not as much being a safe, efficient, and competent clinician - but if you don't think it matters, you're just fooling yourself. i think jet would agree.

i'm also not saying that you HAVE to do a surgical internship to have a good rapport with surgeons; just emphasizing that it helps. A LOT.

and now comes the obligatory - "what do you know, you're just a resident. i've been in private practice for 3/5/10 years! i actually have a great relationship with the surgeons! i play golf with them on the weekend! one guy even lets me bang his wife!"

whatever, dude.

 

[DO4lifer]

medicine prelim. you work hard, but the knowledge is priceless. gave me a solid foundation when pre-op'n patients.

you look for "cush" after residency.

 

[cfdavid]

My categorical PGY1 year is as follows:

cardiology
SICU
CCU
NICU/PICU (2 weeks each)
OB
General Medicine
Rads
Surgery/Trauma service
Pulmnonary
ER
Pain
Anesthesiology

In terms of training, I'd say that the Rads month could be replaced with an extra month of Gen Med, but hey at least it's a month to study for StepIII. Otherwise, I think it's pretty well rounded.

 

[aredoubleyou]

Its kind of amusing that anyone thinks it makes a difference

 

[cfdavid]

Its kind of amusing that anyone thinks it makes a difference

I agree in that it's for sure way more about what you make of your PGY1 year, than the actual rotations.

I can see arguements for/against most types of programs. As long as you work hard and learn (which is kind of hard to "avoid"), I generally agree that differences will be very slight.

 

[Ignatius J]

Its kind of amusing that anyone thinks it makes a difference

Yep, there are 3 general types of responses:

politically correct response- Try and learn as much as you can so you can become a well-rounded physician

gunner response- You will use all the floor knowledge you have gained and apply that to the OR which is totally necessary in understanding the patient's comorbidities and developing an intraoperative plan

realistic response- It's another year that you have to complete to make it to CA-1 year. I don't think anyone can tell the difference between CA-1s who did a ball-busting medicine prelim year or did cush transitional years. Try and learn some procedures and a little pathology, but if you don't catch it all then don't fret. Just get ready to bust tail in the OR next year.

 

[CambieMD]

medicine prelim. you work hard, but the knowledge is priceless. gave me a solid foundation when pre-op'n patients.

you look for "cush" after residency.

Well said!!!

Cambie

 

[RussianJoo]

I don't think it really matters either. I would say do one that gives you the most free time to study for step3 and learn some IM and ICU basics.

My categorical year is as follows:
CCU
SICU
GI consult
Cards consult
3 months of IM floors
MICU
Surgery/trauma
Pulm Consult
ER
Anesthesia

And we have PAT clinic once a week for half our day.


I am kind of jealous of the guys who have no IM floor months. I am going to hate dealing with all that social B.S. oh and I am kind of scared of the Trauma month as well, I hear we get abused and scutted during that month since we're not surgeons.

Just be careful with some TY I canceled a few when I found out that it was basically an IM prelim year with 2 electives instead of floor months.