Workhorse - anesthesia CCM

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I'm applying to CC fellowships this cycle and have heard some very different opinions regarding the value of "work" as part of training.

The fellows at some places (Brigham, CCF) have said that they value their lifestyles and study time, and that compared to "workhorse" programs, their clinical exposure is just as good with less hours in the hospital and more time available to study. The programs that have a reputation (or who self-identify) as workhorse programs (UPMC, Vanderbilt?) Say that the time spent in-house is key to the training they offer, and to not accept anything less as a substitute. It's only a year after all, right?

Any recent grads or other applicants who can provide a little insight? What should someone hoping on working in am academic ICU someday be focusing on?

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I'm applying to CC fellowships this cycle and have heard some very different opinions regarding the value of "work" as part of training.

The fellows at some places (Brigham, CCF) have said that they value their lifestyles and study time, and that compared to "workhorse" programs, their clinical exposure is just as good with less hours in the hospital and more time available to study. The programs that have a reputation (or who self-identify) as workhorse programs (UPMC, Vanderbilt?) Say that the time spent in-house is key to the training they offer, and to not accept anything less as a substitute. It's only a year after all, right?

Any recent grads or other applicants who can provide a little insight? What should someone hoping on working in am academic ICU someday be focusing on?

Learn it now or learn it later. I think cases and variety of cases is important in critical care training. Reading? Trying doing and doing a lot. There is a big difference between reading about ZOMFG asthma and managing it on a vent at the bedside especially if you have the real luxury of doing so under the mentorship of a giant in the field and your responsibility is to learn.

You'll pick up whatever you eventually need to. We all do. You survive and learn regardless. I just think it's nice to do a lot of that outside of the context it being your responsibility, reputation, and license.
 
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I'm applying to CC fellowships this cycle and have heard some very different opinions regarding the value of "work" as part of training.

The fellows at some places (Brigham, CCF) have said that they value their lifestyles and study time, and that compared to "workhorse" programs, their clinical exposure is just as good with less hours in the hospital and more time available to study. The programs that have a reputation (or who self-identify) as workhorse programs (UPMC, Vanderbilt?) Say that the time spent in-house is key to the training they offer, and to not accept anything less as a substitute. It's only a year after all, right?

Any recent grads or other applicants who can provide a little insight? What should someone hoping on working in am academic ICU someday be focusing on?
I am at a place like (but slightly harder than) some of the former, and I agree with them. I have never read and learnt so much in a year. I have never been a literature guy, and now I contradict even my attendings occasionally, while quoting studies. I know more echo than I ever have. I broke my program's longstanding record on the SCCM MCCKAP (our ITE). And I had my best training time ever, while reading critical care-related stuff almost every day, even while on vacation. Not exaggerating.

Surely a graduate who has worked 12 months intensively in the ICU will hit the ground running, no doubt. But if you are a 260+ Step 2, especially with a medical internship, you will benefit much more from a slightly more relaxed fellowship, as long as you get to do everything a fellow does in an intense fellowship (overnight in-house calls, triage, running the rounds, procedures, you name it), just with more elective time, or more academic days, or easier rotations, or more variety (don't neglect the value of MICU training) etc., you get my drift. And as long as you use that time wisely, try to read as much as possible, pass your oral boards, get all kinds of ultrasound training, fill your blanks.

Maybe I am subjective and wrong, but personally I feel that I have grown a lot during this year, and I can respond better and more professionally to surgeons and anybody, even in the Anesthesiology forum. I don't consider myself a "viceroy" for nothing, when I am on call. People who call me really expect me to fix their patients, even if I don't take them to the ICU. They want and rely on my expertise (which still has a lot to grow). @jdh71 is 100% right when he points out how important is to run the show and learn from your mistakes on somebody else's license.

Now I have met a grad from one of the aforementioned relaxed fellowships, and was completely unimpressed. I have also met an intense fellowship grad, and he was way more impressive. But he was the kind of smart hard-working guy I am sure would do fine anywhere. You know yourself better than anybody. I know that I would have hated the Columbia rhythm, to give an example. If you are not disciplined enough (my case, to be honest), choose a place where others will dictate your training, just choose a well-balanced one. If you are a motivated self-starter, choose an easier but still true fellowship, one where you are not just a super-resident, but you are really a junior attending, and have a blast. Just don't waste your time in a place where you are just a glorified observer. Intensive care can be beautiful, both for proceduralists and theorists, and this year can be a game changer for you, even if you will only practice anesthesia afterwards.

You might want to ask the question in the Anesthesiology forum, too.
 
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If you are not disciplined enough (my case, to be honest), choose a place where others will dictate your training, just choose a well-balanced one. If you are a motivated self-starter, choose an easier but still true fellowship, one where you are not just a super-resident, but you are really a junior attending, and have a blast. Just don't waste your time in a place where you are just a glorified observer. Intensive care can be beautiful, both for proceduralists and theorists, and this year can be a game changer for you, even if you will only practice anesthesia afterwards.

Always thankful for your insight and recommendations, FFP!
 
To make clear and avoid my opinion being given too much weight, I'm an incoming intern. Having had exposure to a workhorse program, I would agree with FFP 100%. People I worked with were exceptional, but they were exceptional people. If you go from "insane workhorse" to "still really busting ass" you're going to free up a large amount of potential reading time (relative to what you would have otherwise), and I can't imagine that isn't more beneficial than the relatively small increase in clinical exposure
 
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