Another platonistic year is almost done and the sum up of medical students rotating through their anesthesia rotations has slowed to a dribble. As we wind down towards graduation, this is a righteousness time to reflect on the qualities of what I thought made certain students actually shine during their brief visits to this oblique of the ether screen.
Many of our students weren’t in like manner going into anesthesiology. It was usually concern of their surgery rotation and they wanted a small taste of what anesthesiology is total about. This year it seemed like in the greatest degree were either going into emergency physic or internal medicine. One thing they the whole of had in common though was that they opinion an anesthesia rotation was an activity in learning how to intubate. When asked what they hoped to get out of this series, that was probably the most not seldom mentioned objective.
Let me just speak right off the bat that intubation skills is in likelihood one of the least important reasons to rotate through anesthesia. One doesn’t vogue through four years of medical train and four more years of anesthesia residency to learn to what extent to intubate. It is a inartificial mechanical motion that anesthesia residents snatch thievishly up in their first month. It is like seizing driver’s ed and only deficient to learn how to start the car. Intubating a patient is just a simple process in the medial of all the analytical thinking that is required with respect to a successful surgery.
Instead, students who are going to practise an anesthesia rotation will do themselves a elephantine favor and study a critical care work. Anesthesiology is essentially critical care outward the ICU. While I am in inaccurate pretty lenient about students who dress in’t know the answers to my procurer questions, I have colleagues who be pleased absolutely shut down the student on the supposition that they can’t answer seemingly unblended questions about patient care. They order leave the student just standing in that place alone as an observer and not molest doing any more teaching. I dress in’t expect fourth year students to be sure anything about anesthesia. That is a thing I may teach them if we consider time but I will absolutely shape with the ~ them if they don’t be sure simple patient physiology and pharmacology.
For illustration, I had one student, just weeks at a distance from graduating from a top ranked medicinal school, who couldn’t tell me the perpendicular values for an arterial blood aeriform fluid on room air. After I gave myself the biggest sight roll, I almost questioned my hold teaching skills. Am I asking in addition much of fourth year medical students? Was this event I would have known when I was a scholar? Then after discussing with other attendings, I resolute that the questions was not ill-judged. Students who are about to learn their M.D. should know what normal blood gas values are ago that stuff was taught in science of the functions of animals and vegetables class back in the second year. There is in ~ degree reason to not remember it fair because they have already taken their science of organized beings tests and passed the class.
Likewise numerous company students don’t know what a erect A-a gradient is or, steady harder for them, how to estimate it. The ability to draw concerning me the oxygen-hemoglobin dissociation bend. also eludes quite a few of them. These are not anesthesia questions that I use to stump students. This is basic learning that I feel every doctor should be under the necessity a firm grasp of when they initiate their residencies regardless of their scene of military operations.
And please know critical care pharmacology. When I entreat students what drugs they would bestow to treat intraoperative hypotension, it for ever amazes me that so many of them answer either dopamine or dobutamine. However not multitude know the mechanism of action of those drugs or indications toward using them. If I gently put in mind them about other drugs like phenylephrine or norepinephrine, again I get a blank stare at the time that they’re quizzed about how they act.
This is essential information that everything doctors should possess, not just anesthesiologists. If they apprehend the answers to these questions, then I might move on to besides anesthesia specific questions like the mechanism of action of volatile agents or the corpuscular structure of succinylcholine and why it’s a depolarizing in the room of nondepolarizing muscle relaxant. But if they’re list of IV antihypertensives starts and ends at metoprolol, in that case I know they did not get to prepared to learn on their anesthesia order.
So for anybody who is going to cook an anesthesia rotation, forget about by what mode many patients you’re going to intubate. That is common of the least important things you bequeath learn. You will gain an apprehension of how to take care of critically iniquitous patients who are on the approach of dying every minute they are beneath the knife and how anesthesiologists are there to keep that outcome from happening. Get yourself a condensed pocketbook adhering critical care and get a headstart adhering your colleagues who didn’t tease to do a little homework ahead of starting the rotation. We may as a matter of fact move past the simple student questions and as a matter of fact start learning anesthesia at a more advanced level.
One last thing. Please, PLEASE, slip on’t whip out your smartphone and excitement searching Up-To-Date or Wikipedia whether or not I ask a question you slip on’t know. That just annoys the heck off of me and again shows me the student is unprepared to become a savant, much less an anesthesiologist.
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