Anesthesia Elective

[Guest MDFEVER]

Hi,

I am looking into doing an anesthesia elective at either UWO or U of T later this year. I was wondering if anyone could comment on the anesthesia programs at those schools. More importantly, I would love some suggestions on good preceptors (good teachers etc.) to contact!

 

Thanks in advance.

[Guest TimmyMax]

Hey,

 

I'm 100% biased here, but UWO is definitely the best school for anaesthesia! Otherwise, I wouldn't have ranked it first!

As for good teachers/preceptors, they are generally assigned through the electives/departmental office. There are two pretty standard preceptors (both are excellent teachers/educators/clinicians) who you will technically be "under", but to be honest, I did two electives at UWO, never worked once with either of my supposed preceptors (you usually work in a different room under a different preceptor every day- anaesthesia is weird that way), and matched here as my first choice of specialty and location.

Hope this helps!

 

Best of luck!

Timmy

[mdfever]

Hey Timmy,

Thank you for your quick response. I finally can get back in here. (long story)

I am planning to do a two weeks elective at UWO, will it be too short to have a better understanding of anesthesiology and get a good reference letter? As a resident, what do you think about the prospect of anesthesiology? Do you think Canada will start to train nurses like in US? Thank you in advance.

[TimmyMax]

Hey,

 

Two weeks should be lots of time to get a quick exposure to anaesthesia and more than enough time to get a decent letter of recommendation. All of my anaesthesia electives were two weeks long, and although the time seemed to fly by (especially at UWO), I was still able to get good letters and end up where I wanted to be in the specialty that I wanted, so all turned out well.

As a resident, I am very excited about the prospect of anaesthesiology! Sadly, I don't get to do any anaesthesia until the end of this year as all nine months of my off-service rotations come first, but at least Eternal Medicine is out of the way so I have other, more exciting rotations to look foward to in the meantime. I am very happy with how everything has worked out and I am looking forward to getting started on a great career in a great specialty!

As for training nurses to give anaesthesia like they do in the US, I really can't see that happening for a long time here, if it even happens at all. We already have Respiratory Therapists that are very good at what they do, so I really don't see what role a Nurse Anaesthetist would play. In addition, I personally don't like the idea of people giving "cookbook" anaesthesia- there's a lot that can go wrong with a person who is under anaesthetic, and the sooner that one can recognize the warning signs, the better the outcomes in terms of averting potential catastrophes. If I was to go under the knife myself for whatever reason, I'd much rather have an full-fledged/fully-trained anaesthesiologist giving me gas than someone else! That's my two cents on the issue.

 

Best of luck!

Timmy

[Kirsteen]

Hi there,

 

I'm currently in day two of a two-week Anesthesia mandatory rotation and I'd love to hear some tips re: how to spruce up the experience. So far, I've found it to be, for the most part, quite boring. This, despite chatting with my preceptor on various Anes-related topics during the course of the day. Any advice on how to make the most of this rotation aside from offering to do all the maneuvers and asking questions on related topics?

 

Cheers,

Kirsteen

[TimmyMax]

Hey,

 

Boring, eh? Are you actually getting to DO anything rather than merely offering to do the procedures? It doesn't sound like it! If you're not involved in the case at all, I'll be the first to agree that anaesthesia can be very boring indeed!

 

Some suggestions...

 

- get involved with the procedures! You should be intubating patients (at least attempting to intubate every patient) by this stage in the game and your preceptors should be letting you have shotgun, unless they want you to do it a certain way, in which case they should do the first one and then you should do the rest.

- you can also show up a few minutes early and set up the room. I realize that as a clerk, you won't know much about setting up and preparing the machine, but try to think of what the necessary equipment is you'll need to at least do the intubation and get that set up. Your preceptor may or may not be happy with you drawing up drugs ahead of time, but at least you can offer to do that- remember to label everything! Offer to draw up drugs during the case as well if you're bored. You can also help out with patient positioning- if you don't know why this is important, ask!

- try to see the patient ahead of the case and do the anaesthetic assessment on your own first and then present your findings to your preceptor. Examine the patient's airway. Is there a reason to suspect that this person might be a difficult intubation? Find out the important questions to ask on pre-op assessment and then go from there. Examining the patient ahead of time may not always be possible depending on how fast (or slowly) your room turns over, but in a teaching hospital environment, this should be very doable.

- you can always offer to chart. It's boring and sometimes done electronically, but the pre-op assessment and induction record always needs to be filled out eventually.

- try your hand at writing the post-op orders. Discuss with your supervisor the various options for post-op analgesia. What drugs are available and which does he or she prefer to use? How come? PCA pump orders are kind of cool to write out as well. Ask about how these work.

- other procedures that you should be doing include IV starts (anaesthesia is probably the best rotation for mastering these!), Foley catheterizations, helping with basic monitoring equipment set-up, hanging and changing bags, arterial blood gases, intubations (of course), arterial lines, central lines, epidurals and spinals. As a clerk, the latter four will vary in availability and usually will be on a "see 1, do 1" basis, but you may luck out!

- ask questions! Most anaesthesiologists love to teach, and you basically have a 1-on-1 tutor for the whole day, so take advantage! This is a great time to bone up on resp and cardio physiology, but feel free to ask about anything, whether it is related to anaesthesia (ie: what the monitors do, how they work, etc.) or anything else! Anaesthesiologists, you will find, are very knowledgeable and aware when it comes to the entire scope of medicine and you never know what little tidbits of medical minutiae you can pick up from your friendly neighbourhood anaesthesiologist!

- ask if you can play with the other anaesthesia "toys". If it's a slow day with relatively simple cases and your supervisor is keen on teaching, he or she certainly won't mind breaking out the glide scope, lightwand or the other options for you to try your hand at!

- finally, if there are no other clerks or residents around, go from room to room! This is how it was when I was a clerk in Windsor, and there they actively encouraged us to go from room to room and to get as many intubations and IV starts as possible. I stopped counting intubations after my first few days since I was getting so many each day. TA rooms are great for taking your IV skills to the next level, once you are beyond the beginner stage.

- if this all fails and you're still bored, watch the surgery! Your anaesthesiologist won't get upset, trust me, because the best ones always take a keen interest in the progress of the operation, even if it's from the oh-so-comfortable confines of the anaesthesiology chair. At a glance, they only appear to be doing nothing...

 

So there's some things that I can think of off the top of my head to get you started. If all else fails, bring a good book to read, but just make sure it's medically related (ie: surgical recall), you might draw the ire of your supervisor if you show up with The Da Vinci Code (but then again, you might not)!

 

Best of luck!

Timmy

[kosmo14]

Timmy is right Anesthesia is far from boring, but only if you take an active role. It can be extremely boring if all you do is watch what your preceptor does. In many cases you have to make a point to ask to do things. If you have a good staff person most of the time they will let you take the reigns as long as you are safe and show some interest. I would suggest you start your day by talking to your staff person and asking if they would be comfortable if you took a more active role in the anesthetic for that day. Meaning see the patient (I always showed up at least 45 min early and got the room ready- check the machine, get your IV stuff ready, draw up the rescue drugs (atropine, succ, ephedrine, phenylephrine - I drew them up, labeled the syringe, and then left the container I drew them up from beside the syringe just so the staff can review it and feel more assured that the right drug was drawn up), then get your airway stuff ready I always had a 7.0 ETT with stylet in it ready for emergencies, get some oral airways ready, tape, check your laryngascope and the back up, once that is done go see the patient and do your history and anesthetic PE focusing on Cardio, resp, and AIRWAY. When this is done come up with an anesthetic plan (ie/ spinal vs con. sedation vs GA; do you need a ETT or can you manage with an LMA, decide what type of induction would be appropriate for example someone with severe GERD might need a rapid sequence, what type of monitoring do you think they need) once you have the plan talk to the staff person. Start by saying the room is set up, machine checked, rescue drugs drawn up, I saw the first patient and thier hx is ..... thier airway exam is this ...., I think this person would do well with a GA with a LMA, I think we could use midazolam, fentanyl, propofol and roc for induction do you mind if I draw them up. Once they are drawn up get ready your specific airway equipment for that case ie/ LMA. Then when the patient comes in put in the IV then help put on the appropriate monitors. Then ask the staff person if you can manage the induction with thier help. Tell them what drugs you plan to use, how much, and in most cases they will say go ahead. This gives you the opportunity to administer the drugs as well as manage the airway. Once you have the airway secured, help with positioning. After that I would ask if you could chart for them. Then play an active role in the management of that patient, if you see the ET CO2 go up come up with your diff for it happening and suggest a course of action, if you see the HR and BP go up do the same. It makes it much more interesting that way. It also forces you to think about your effect on the physiology of the patient (the neat part of anesthesia). Once everything is charted and patient is stable and you are getting to the "boring" part this is the time to get ready for the next case (spike your IV bag, get your IV stuff ready, draw up the drugs) then you have some time to discuss a topic with the staff person.

 

That is my suggestion for making Anesthesia interesting. Remember if you don't ask to do it, you may not be given the chance (if a central line is going to be needed ask to do it, if it is a routine intubation ask to use a light wand, glide scope, fast track LMA, bullard etc... all the neat toys of anesthesia.)

 

Hope this helps out.

[Kirsteen]

Hey there lads,

 

Thanks very much for the tips. I thought I'd been pretty proactive thus far, e.g., arriving 30-45 mins. early to do the Hx/Px of the first patient and offering to intubate, change IV bags (at my current hospital all the IVs are started by the time the patient reaches the porter who brings them to the OR suite--feh!), but there are definitely a number of other things I'll try tomorrow based on your suggestions. Thanks for that! (Seriously, I was considering asking the surgeon for some sort of trocar to, for fun, pop one of my eyeballs out today, I was so bored.)

 

Cheers,

Kirsteen

[Kirsteen]

Hello again,

 

Again, thanks so much for your tips--these past three days they worked wonderfully. By yesterday I was basically running the show: interviewing the patient, setting up the rooms, intubating, placing IVs and inducting, and the reverse at the end of the operation, in addition to setting up the cart for the next patient. What I think also helped were my preceptors. I was working with two different folks over the past three days who were: 1) a lot more amenable to letting me take charge; 2) extremely friendly and good-natured. This apparently can make a large difference to the daily Anes experience as I've actually found the last three days to be quite enjoyable, which is in sharp contrast to days one and two.

 

Thanks again,

Kirsteen

[TimmyMax]

Hey Kirsteen,

 

Good work! Nice to hear that your last few days were more enjoyable than your first couple! Anaesthesia is infinitely more enjoyable the more you are able to get involved! Glad that kosmo and I could be of some service!

Unfortunately, as you already have learned, the anaesthesia experience, especially as a clerk, can be very consultant-dependent. Some are surly and don't like having students (or even residents) around, while others welcome all comers with open arms and are happy to let you run the show. As a rough theoretical general rule, the more a consultant lets you do, the better anaesthesiologists they tend to be, because they are confident that no matter what you do to screw up a case, they will be able to undo everything and solve the problem. That's what I've found in my travels, anyway.

 

Best of luck!

Timmy

[blue2]

Hi All,

 

Thanks for all of the fantastic posts, they are all very helpful! I was just wondering if anyone could give some suggestions on positive anesthesia elective experiences at UofT. Their elective list is quite extensive and I was wondering if anyone could help. I am interested in a career in anesthesia so would like to make the most of the elective.

 

Thanks!

[Kirsteen]

Hi All,

 

Thanks for all of the fantastic posts, they are all very helpful! I was just wondering if anyone could give some suggestions on positive anesthesia elective experiences at UofT. Their elective list is quite extensive and I was wondering if anyone could help. I am interested in a career in anesthesia so would like to make the most of the elective.

 

Thanks!

Hi there,

 

You can also book UofT electives with preceptors who are not listed in their elective catalogue. If you can, contact some UofT Anes residents and ask them their advice on where to work and who to work with. Regarding the latter, ask them who the best preceptors are. (I did this with each of my three electives there and was very pleased with each experience and its outcomes.)

 

With respect to elective set-up I'd recommend that you book Anes electives as early as you can. There are a schwag of my classmates who are keen on matching to Anes this year and I know that some of them had some problems getting the elective spots and time that they wanted.

 

Cheers,

Kirsteen