Starting Off On the Right Foot

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“The only thing more difficult than doing anesthesia is watching someone else do it.”

This particular refrain is something that occurs to me pretty much every time I go in an OR to help out any of my anesthesia colleagues.  It’s true, but it’s hardly borne out of arrogance as you might think at first.  The fact is we’re all solitary creatures as far as work goes, and we’re used to occupying the time and real estate behind the surgical drapes by ourselves.  But it’s a different thing being in the role of an attending.  There is a purpose to sharing the time and space behind the drapes with a resident.  And if you’ve had the chance to read Part One of this discussion, I hope you really understand and believe that we share a common goal.

In case you missed it:  Part One:  Two’s Company, Three’s a Crowd

 

But don’t get me wrong…It’s not always easy or necessarily fun being either attending or resident.  As we go through this discussion here in Part Two, try to put yourselves in the other person’s shoes.  Try to understand the motivation and remember the purpose that the other person represents.  We’re all on the same team and nobody is “after” anyone else’s job.  Your failure as a resident only reflects poorly on my efforts as an attending, so how can we let that not happen?  Let’s explore a few myths and a steadfast truth or two…

Myth No. 1

“I’ve got to dazzle my attending with my {knowledge/skills/etc}.”

I’m gonna just tell you not to waste your time.  No attending expects to or likes to be dazzled by a resident.  Attendings who have been in practice for many years simple become “undazzleable”…at least by anything anesthesia-related.  You can think that this is arrogance on the part of the attending, but you’d be mistaken…and you’d certainly be doing yourself a disservice if you thought the lack of dazzle was in any way your fault.

As individual anesthesia professionals go, our practice evolves over time to suit our needs, our habits, our personalities, and our particular efficiencies or lack thereof.  It’s a bit like Pangea and the continental drift theory…We start out as similar creatures, but our anesthesia practices evolve in the absence of other people to the point that it becomes so different from person to person.

Ok, maybe I’m being a little dramatic and wishful here, but as a resident you should expect your attendings to dazzle you on a daily basis, not the other way around.  Get them to show you what they do and why, and I guarantee that you will come away with a few new ideas.  So, seize this opportunity as a resident.  Don’t isolate yourself to the one or two “easy” attendings.  Drop the dazzle, work with as many atendings as you can tolerate, expose yourself to as many different ways of doing the same thing.  And at the end of the day, you’ll be able to pick and choose facets from all the different methods to incorporate into your own evolving practice.

Truth No. 1

You’ll never again get this opportunity to listen to the soundtrack of so many attendings after your schooling ends.  Keep your ears open, eyes, and most-importantly keep your mind open to all ideas.  And make a mixtape of all the “best of” for your own practice.

Myth No. 2

“I need to get every tube in, every spinal, every A-line, etc…or I am a failure.”

Nothing can be further from the truth, or we would all be failures.  Enough said.

Truth No. 2

There will be plenty of “firsts” in your anesthesia career:  First wet tap, first esophageal intubation, first intraoperative death…you get the idea.  Learn from them:  figure out how to recognize them, how to deal with them, and how you can best avoid them.  But don’t fool yourself into believing that you will ever see the last of them.

Myth No. 3

“I need to remember everything that I have learned in lectures and reading…otherwise, I might kill a patient or otherwise fail clinicals.”

For most people, clinical rotations are a welcome and refreshing change from didactic lectures.  You finally get to start doing all the stuff that you’ve been reading about and practicing in the sim lab.  There’s no way to really fully prepare for it, no matter how much reading you do or how much you remember of your lectures or how many times you [successfully] intubate manikin Annie.  It’s just different.

And as unprepared as I’m telling you that you will be, your attendings aren’t gonna let you start maiming patients in any way anytime soon.  Trust that fact and do away with the fear, because that fear will keep you from being open-minded to new techniques and new ideas.

Truth No. 3

There is so much to learn as a new anesthesia practitioner that it understandably becomes overwhelming at times.  At the same time, there is much to be learned simply by asking the question “Why?”  For everything that you do everyday, ask yourself why you are doing it a certain way or why it is the way it is.  “Why is the smallest vial of Fentanyl 2mLs and Morphine is 1mL?” or “Why do you tape the tube clockwise vs. counter-clockwise?” or “Why do they still make endotracheal tubes curved instead of the hockey-stick shape that everyone seems to like?”  You’d be amazed at the things you learn by closely examining everything that you do in any given day.


If you’ve read this far, then I hope that some of what I’ve written here makes sense. These are general ideas that I hope you can keep in the back of your mind and maybe decrease the level of angst associated with your residency.  As usual, if you like content like this, you can let me know by clicking on the “Like” button or by leaving me a comment below.  Don’t be afraid to let me know what questions you might have, too.   Spread the word to anyone else who might be interested.

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