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Anaesthesia!

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Hey,

 

Anaesthesia rules! Post your questions here to find out why!

 

Best of luck!

Timmy

You've explained it now, Timmy. Sounds a lot more interesting than my preconception of the specialty. I noticed you said dealing with the ABCs when something goes wrong in a surgery is a 'con'....I'd personally say that is a pro!

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Hey,

 

Yes, dealing with the ABCs in any emergency situation is definitely a pro.

What I meant by including it in the 'con' column is that you're potentially going to be having to clean up messes made by other people, such as patients flatlining or becoming unstable during a surgery for whatever reason, which often occurs unexpectedly, so you always have to be on your guard, especially when the conversation around the surgical field suddenly decreases markedly. The point that I was trying to make was that as the anaesthesiologist, you're ultimately the one responsible for the well-being of your patient intra- and post-op, not the guy holding the scalpel, doing all the damage!

I guess it's not that big a deal, but it just goes to show that there's a lot more to anaesthesia than sitting around all day, watching people sleep!

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Hey Timmy!

 

Fully half (3/6) of the gas vacancies Canada-wide after the first round of CaRMS this year were at UWO. Was this a statistical fluke, or is there a reason that the candidates and the programme didn't have greater love for each other this year?

 

Cheers,

 

pb

 

 

http://www.carms.ca/pdfs/2007MatchResults/Summary_of_Vacancies_by_Medical_School_and_Discipline_en.pdf

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I'm wondering if anyone here goes to a school that does not offer any mandatory exposure to anasthesia during clerkship. My school eliminated the anasthesia block a few years back so they could fit in more psych and FM - worst decision ever! Thus, we have no idea about anasthesia unless we take it upon ourselves to set up 4th year electives in it - something that will ultimately work against anyone that is gunning for one of the "PRODUCE" specialties.

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I'm wondering if anyone here goes to a school that does not offer any mandatory exposure to anasthesia during clerkship. My school eliminated the anasthesia block a few years back so they could fit in more psych and FM - worst decision ever! Thus, we have no idea about anasthesia unless we take it upon ourselves to set up 4th year electives in it - something that will ultimately work against anyone that is gunning for one of the "PRODUCE" specialties.

 

UWO does not have any mandatory anesthesia rotations but out of the 12 weeks of our surgery rotation, only 4 weeks gen sx and 2 weeks emerg are required. You need to pick 3 2-week selectives out of surgical specialties and anesthesia. Lots of students choose to do anesthesia.

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Hey,

 

Hey Timmy!

 

Fully half (3/6) of the gas vacancies Canada-wide after the first round of CaRMS this year were at UWO. Was this a statistical fluke, or is there a reason that the candidates and the programme didn't have greater love for each other this year?

 

Cheers,

 

pb

 

The reason for this abberancy is multi-factorial. I'll supply a few of those reasons, gleaned from talking with some of the higher ups in the program...

 

1. Western's timing in the CaRMS circuit - Western was the last stop on the tour this year, which meant that most of the stronger candidates interviewed had already decided on somewhere else that they were more interested in going for residency and ended up either canceling their interviews or not showing up at all. What was left over wasn't exactly impressive, so I heard.

 

2. Overall poor quality of candidates interviewed - any program in any specialty can fill quite easily, so it's not like nobody ranked Western as part of their final list- there were many to choose from. It's just that the overall (lack of?) quality of candidates interviewed compelled the program to compile a much shorter final rank list, leaving a lot of these people off of it. As it turned out, a lot of the higher quality candidates had already made up their minds to go somewhere else, as evidenced by the empty spots when it was all said and done, hence the unmatched spots. Since the philosophy of our program director is that he would rather have people who want to be here and would contribute to the program rather than simply fill the spots with warm bodies, he has always said that he'd rather a spot go unfilled in the first round rather than given to someone who he did not think would be a good fit for the program and take his chances in the 2nd round. This year's results definitely reflected that philosophy. In addition, it was noted that some of the candidates interviewed were overly demanding and otherwise difficult to get along with, moreso than in previous years. If they're difficult to deal with as candidates, then they'd be infinitely more difficult to deal with as residents and frankly, who needs the headaches associated with dealing with these people on a daily basis?

 

3. Poor showing by the program at interview day - perhaps this is an unfair criticism since I wasn't really there, but I did hear that one of the major failings of our program on interview day was the failure to address the 6 PM ORs, a major issue for most of the candidates, who seemed happier to go somewhere where the ORs only run until 3 or 3:30 PM (ie: the rest of the country). Sadly, the fact that the ORs run until 6 PM here was pretty much the extent of some candidates' knowledge about the London program and the failure of our speakers to address this issue at the information sessions definitely didn't improve that perception in the least. Again, tying into #2 above, rather than rank a bunch of people who wouldn't be happy here, it was in the interest of the program not to rank these people who were arriving with pre-conceived reservations as to how late the ORs run. I don't think that we did that good of a job selling London as a destination overall, but it's always the OR times that are the big issue here.

 

4. Lack of "local talent" - usually there are 1-2 candidates each year who did medical school at Western that end up staying here for residency. This year there was a definite paucity of local talent as none of the local candidates ended up being ranked by the program.

 

5. Program willingness to have spots go unmatched rather than filling them for the sake of filling them - tied in with reason #2, our PD was willing to take the hit and risk looking bad based on the 1st round match results rather than compromise overall program and resident harmony. The cohorts of residents in this program are top-notch in terms of personality, knowledge and ability and the different cohorts mesh well with each other, which makes for an excellent program overall. Besides, with the IMGs and 2nd round in the equation, there was still quite a talent pool to choose from, and having met the new PGY-1s last night, it is clear that the program has made the right choice by waiting until the 2nd round to complete their resident complement.

 

So there's a bit of insight into why things turned out the way that they did. In terms of the 3 candidates that Western did get in the 1st round, the program is very happy with those 3 and they are definitely top candidates. As for the candidates that matched here as part of the 2nd round, the program is again very happy to have these people, as they are all again excellent candidates who may not have considered anaesthesia at Western amongst their top picks in the 1st round this year. Hope this helps!

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Hey anesthesia folks,

 

What is first year of a gas residency like in terms of demands? My wife and I are trying to sort out the timing of our 2nd child and are wondering how the R1 year will compare to clerkship (which I start in a few weeks). Thanks for any info.

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Hi

 

I wanted to get the perspective of someone who has recently went through the match. Of your collegues that applied for the Anaesthesia residency positions, how many were unable to match to it? From looking at the carms website, I noticed there were a few spots unfilled after the first and second rounds for 2007, so why would anyone who really wanted it not get it? Is it just because these unfilled spots may be undesirable locations?

 

Thanks

 

 

 

__________________

UBC Med '11 (VFMP)

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1rst year gas is essentially redo clerkship with a little bit more responsibility. it is essentially a rotating year, so what you get in clerkship should be a good guage of what is to come in R1 anesthesia. The fun begins in second year where you spend the majority of the doing what you want to do.

 

As far as competitiveness of anesthesia. If you want anesthesia AND ARE WILLING TO MOVE you have a very good chance of getting it, barring any red flags on your app. It is fairly competitive if you limit yourself to 1 or 2 programs. I know a few people that wanted anesthesia that didn't get it but it was because they limited themselves only a few programs. I do know a few people that used it as a back up and didn't match to both thier first choice specialty and anesthesia. In our class two years ago there were 10 that applied to anesthesia and 7 that got it (the other three limited the number of places they were willing to go to.)

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I have a question about Canadians studying medicine in the US - is Anaesthesia a specialty that is typically "easier" to match back (as in coming back to Canada) into?

 

Just asking based on reading that the competitive specialties are pretty much not a realistic option for Canadians who studied outside of Canada. I know that Family Practice is quite fair game to us, so I wanted to know if Anaes was sorta like FP or is it like Rads in terms of matching back into Canada from the US.

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It varies year to year, but Anesthesia is typically competitive enough that using as a back up or coming and an IMG is going to be difficult. It certainly is much more competitive than fam med., int. med, and some of the other easier to match to specialties. That being said it definately isn't impossible.

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Great posts on this thread :) ! I'm in my clerkship and I'm starting to seriously think anesthesia might be for me. I've only had limited experience with anesthetists so far (but all have been good!), and it's my last rotation this year, but I like what I hear and see so far.

 

Just wondering...is it common for anesthesia residents who do an extra year fellowship in ICU to eventually practice both? Or are you restricted to doing one or the other?

 

Thanks!

ms

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I've heard from a couple of places about the higher risk of drug addiction and suicide in anaesthesiologists when compared to other specialists, but is it really as common as people make it out to be? I'm hoping that someone more familiar with the specialty can shed a bit of light on this.

 

Thanks so much!

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misersizer: Glad to hear you are interested in anesthesia. It is a great specialty. I love going to work everyday (something I have never experienced before). It also makes you quite comfortable in dealing with real sick people (even without extra ICU training). I certainly find when we are called stat to various locations within the hospital (cath lab, ER, codes, traumas) we frequently are looked upon for management advice in those acute situations, and when we give suggestions people listen. I find anesthesia teaches you to step back in a crisis and look at the big picture (figure out what is really going on and treat it). I think that is why quite a few anesthesiologists do ICU after thier anesthesia residency. I would say it is common for anesthesia residents to do an ICU fellowship after anesthesia training. The amount of time you have to do in your fellowship in ICU depends on where you train. Some places allow you to combine your final year anesthesia residency with your first year ICU fellowship allowing you to complete a full Royal College fellowship in ICU one year after you complete your anesthesia training. Other schools don't have that option and therefore for you to be Royal College certified in ICU you have to complete a 2 year fellowship in ICU. When you co mplete that fellowship your practice profile quite frequently depends on yourself. It is very common for someone to do 10-16 weeks a year in the ICU and the remainder in the OR. Some prefer to focus solely on ICU and other prefer to do less, it really depends on your preference and the needs of the center that you practice at. I hope this helps.

 

bayervillager- You are quite correct that anesthesia has a higher addiction risk than other specialties. The reasons given are many and I think it is probably a combination of things (although some of the thoeries out there seem rediculous to me). Here are some of the reasons given: 1. easy access to the drugs of abuse- we use narcatics in virtually every patient, add to that things like cocaine, ketamine etc... sure there are typically safeguards but they are pretty loose 2. Apparently our personalities are such that we are at greater risk of abuse 3. Stress, anesthesia can be stressful especially if you let it get to you- bad things happen and it is hard to deal with sometimes thats why it is important to know you have a great support system around both at home and at work, I think it is a good question to ask in interviews (what kind of supports are available for residents when things become stressful. Our program has numerous sessions a year about this and has people in place to contact if things are difficult). 4. Some thoery about proximity to patients that are exhaling minute amount of narcatics (seems kind of loose argument to me- when was the last time you saw the anesthesiologist lying on the pillow beside the patients head for the majority of the case- the surgeons are frequently closer to the patients head than the anesthesiologist) 5. I have heard the thoery that curiosity has also played a role, many of use give these drugs hundreds of times a week without ever having the drugs given to us. Not sure if I completely buy this one either.

 

Anyway suffice to say the risk it there. It is important to be aware of the risk. I think programs that don't talk about it are failing thier residents and staff. Our program has 2-3 sessions a year where we discuss it (we even have people come in that have had a problem in the past). We have many safeguards in place including access to help from many points (a lot of which are confidential). We have a staffmember that we can report what we consider suspicious or concerning behaviour to. This staffperson then keeps all of the info. confidential and compiles it to decide whether they should look into it more carefully. All of this is confidential. I believe many times with addiction in these instances there are a lot of signs but people don't see them all at once so putting the entire puzzle together is difficult (that is why we have that one staff person who we can report specific warning signs to) (for example: this resident has been extremely stressed lately, someone else notices that they are working much more than we would expect volunteering to stay late all the time in extra early volunteering to do call, another staff anes. notices this resident goes to the bathroom frequently during the day and comes back looking a little different, someone else notices a couple of syringes in their locker, someone else know that residents spouse and the spouse state that they have been different lately, each peice of the puzzle may not be totally significant by itself but put is altogether and there is great need to be worried). Another thing we do is have a session for our spouses/significant others to attend so that they know to look for warning signs and how to access help it they become worried. I think that with all of the proper systems put in place the risk can be decreased or at least disasters can be decreased. Certainly the awareness that it can happen and has happened has probably decreased the risk of addiction in the more recent years.

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I'm currently completing a mandatory anesthesia elective, and as much as it pains me (you get the point) to say this as a surgeon-wannabe, anesthesia is a pretty awesome field (what can I say, procedures are sweet, even non-surgical/life-saving ones). I'm going to strongly suggest an anesthesia elective to my bro.

 

BTW, TimmyMax, it's refreshing to find someone who's not in love with infernal medicine (I swear everyone in my class has at least enjoyed it). Probably the only rotation I dread as a soon-to-be surgery intern (up to 3 months at some places, yikes).

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I'm currently completing a mandatory anesthesia elective, and as much as it pains me (you get the point) to say this as a surgeon-wannabe, anesthesia is a pretty awesome field (what can I say, procedures are sweet, even non-surgical/life-saving ones). I'm going to strongly suggest an anesthesia elective to my bro.

 

BTW, TimmyMax, it's refreshing to find someone who's not in love with infernal medicine (I swear everyone in my class has at least enjoyed it). Probably the only rotation I dread as a soon-to-be surgery intern (up to 3 months at some places, yikes).

 

finalement, tu as choisi quel résidence?

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I have read alot of this blog/thread and like the information so far. I wondered if it would be possible to get a summary with the following information:

 

1.) Number of hours on average on the training program year by year

2.) Avg. on call hours for each year of the program

3.) Avg. salaries after training. (this seems hard to get realistic info on)

4.) Current hot topics in research?

5.) Fellowship areas of interest.

 

Thx

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The answers to you questions will be very site specific but I will post what happens in my program:

 

1) Hours vary, but for us from 2-5 pretty much have the same schedule (except for studying); typical week:

M- OR starts at 8 am therefore should be there by 7:15 to get things set up

OR scheduled end by 4 pm (that varies quite often runs late therefore OR end between 4-5) if there is an inpatient you are scheduled to do anesthesia for the next day go and see that patient before you go home

T- same thing

W- samething except 3:30-4:30 are talk rounds for residents (residents and staff discuss interesting/tough cases they dealt with in the last week typically in the form of an oral exam type answer)

Th- On call start at 4:00 pm go straight through until next morning at 8:00 am (slim to no chance of sleeping between being in the or, dealing with code blues, being on the trauma team, and doing labor epidurals not much time to sleep)

F- go home at 8 sleep till noon, Friday afternoon is our resident half day have a didatic teaching session (presented by 1 resident and 1 staff each resident does about 3 per year) from 1-3:30

S- Day call 8:00 am until 4 pm

Sunday- night call 4 pm until monday morning at 8 am, go home for the rest of monday

 

This obviously is very call dependant for example if you don't have a call shift that week you work monday to friday 7:15 to say 4:30 pm

 

2) Our program shares the call evenly from 2nd to 5th year (the later half of the year the 5th years can reduce thier call schedule if they choose to study)

this make it a very good call schedule for us typically we do between 4 and 6 call shifts a month depending on how many residents are on service at that time

 

3) I hate to answer this question as I am not an attending but I do believe typically if you work full time you can expect greater than 300 K, certainly there are a lot of people that make a lot more (work more make more) and many that choose to work less

 

4) Hot topics in research?? not too sure i don't really like research so don't pay too much attention to the hot topics sorry, suffice to say there are a lot of anesthesia scientific journals out there therefore a lot of topics being researched at any given time

 

5) many opportunities for fellowship: ICU, PICU, peds anes., neuroanesthesia, thoracic anes., cardio anes. =/- echo certification, regional anesthesia, obstetrical anes, ultrasound guided regional anesthesia (kind of hot area now), ambulatory anesthesia

 

Hope all that helps.

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Hi,

 

Could either TimmyMax +/or Kosmo...or anyone else in anesthesiology right now comment on whether they feel satisfied with the amount of "patient impact" they have?

 

There are obviously many pros to the specialty. But it seems an odd kind of specialty, in the sense that, you don`t really diagnose anything and you don`t really treat anything either (aside from if you work in the ICU or do pain management). What are your thoughts on that?

 

Thanks!

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Outside the typical questions like why do you want to do this etc, what else is asked?

 

It sounds like the ethical scenarios come up in interviews often (ie. another anest often has bathroom breaks and certain vials are missing)...

 

There must be more aspects that I am not thinking of. Input would be appreciated.

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Hi TimmyMax/Kosmo,

 

I've really enjoyed reading your posts in this thread!

 

I'm in my third year and I've recently become interested in anaesthesia after a short but very hands-on experience I had with an anaesthesiologist. Due to the majority of my school's elective time being at the beginning of clerkship, I've only been able to arrange one two-week pre-CaRMS elective at my home school, along with my core two-week anaesthesia rotation. I was wondering, how important it is to have lots of anaesthesia elective experience in terms of being a competitive applicant? Do programs tend to look down on applicants with little elective experience, even if they've only realized anaesthesia might be for them once clerkship started? I'd appreciate any insight you'd be able to give.

 

Thanks!

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Hey,

 

 

 

The reason for this abberancy is multi-factorial. I'll supply a few of those reasons, gleaned from talking with some of the higher ups in the program...

 

1. Western's timing in the CaRMS circuit - Western was the last stop on the tour this year, which meant that most of the stronger candidates interviewed had already decided on somewhere else that they were more interested in going for residency and ended up either canceling their interviews or not showing up at all. What was left over wasn't exactly impressive, so I heard.

 

2. Overall poor quality of candidates interviewed - any program in any specialty can fill quite easily, so it's not like nobody ranked Western as part of their final list- there were many to choose from. It's just that the overall (lack of?) quality of candidates interviewed compelled the program to compile a much shorter final rank list, leaving a lot of these people off of it. As it turned out, a lot of the higher quality candidates had already made up their minds to go somewhere else, as evidenced by the empty spots when it was all said and done, hence the unmatched spots. Since the philosophy of our program director is that he would rather have people who want to be here and would contribute to the program rather than simply fill the spots with warm bodies, he has always said that he'd rather a spot go unfilled in the first round rather than given to someone who he did not think would be a good fit for the program and take his chances in the 2nd round. This year's results definitely reflected that philosophy. In addition, it was noted that some of the candidates interviewed were overly demanding and otherwise difficult to get along with, moreso than in previous years. If they're difficult to deal with as candidates, then they'd be infinitely more difficult to deal with as residents and frankly, who needs the headaches associated with dealing with these people on a daily basis?

 

4. Lack of "local talent" - usually there are 1-2 candidates each year who did medical school at Western that end up staying here for residency. This year there was a definite paucity of local talent as none of the local candidates ended up being ranked by the program.

 

Hey Tmax (and others)

 

So after spending a month with a GP who does clinic, gas two days a week, obs 1 week a month and covers the ER, my career differential has narrowed to three: ortho, gas or FM +/- ER/gas/obs.

 

Can you expand on what make a "strong" applicant for gas (and for UWO specifically)?

 

I'm doing two weeks of gas in 3rd year (Dr. Robinson, Windsor) and two weeks at UWO UH in 4th year. Am also trying to set up an ICU elective at my home school. The other things I'm thinking about for electives are away electives in ortho and gas, and a couple of FM electives.

 

Does this sort of mix make me sufficiently competitive without being excessively focused?

 

Thanks,

 

pb

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