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The Wisdom of CA-1s · Style Points

• 0:10
  Anesthesia enthusiasts, and welcome back to Style
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  Points. We have a special episode for you today.
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  If you're a longtime listener of the show, you
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  might remember listening to Episode 7, entitled
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  The Wisdom of Interns. It was a series of mini
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  -interviews where our residents shared stories
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  and advice from their intern year. Now, we're
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  bringing them back, having completed their first
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  year of clinical anesthesia training, their CA1
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  year. You'll hear my co -host, Nate Moore, introducing
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  them. Without further ado, I bring you The Wisdom
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  of CA1s. I have Dr. Brian Upton with me to share
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  his wisdom. He took a quick break from his pediatric
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  rotation to record with us today. Take it away,
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  Brian. Thanks for having me, Nate. I'm happy
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  to share sort of my words of wisdom over the
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  CA1 year. I think one of the things I've noticed
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  the most CA1 year is really how much all of us
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  have grown as we've gone through the year. And
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  I know certainly for myself, you know, I like
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  there was an early case, like one of the first
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  few where I was like kind of on my own. The attending
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  was there for induction, left within like a minute
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  of getting the tube in. And it was some like,
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  I don't know, 30 or 40 year old female, pretty
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  healthy for a guy in case. And the blood pressure,
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  like I heard a little chirp looked over and it
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  was like 45 over 20. And I was like, oh, my gosh,
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  like I knew in my mind, like all the things to
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  do. But then like the attending left, I saw the
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  number just like that sheer panic that I'm sure
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  a lot of us have felt looked up the heart rates
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  also like 45 minus like 180. And I knew what
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  to do and did it. And the patient responded and
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  we continued on. But I remember just like truly
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  how panicked I was. It was like first few weeks
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  being left alone, having to make those decisions.
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  And then I feel like. fast forward later on in
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  the year and I feel like I'm just so comfortable
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  there's things far worse than that going on I'm
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  just like oh yeah you know do this trying to
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  channel my like zen energy that a lot of the
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  more senior anesthesiologists have I think one
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  particular memory I have of this where I'm just
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  like oh yeah like everything's fine even though
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  it's not there was an eCPR case coming in They
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  had very few lines in, so I was trying to put
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  in a MAC catheter, a central line, with the Lucas
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  device going. And if people don't have an eCPR
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  program at their institution, that's like the
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  piston on the chest, right? Doing CPR for us.
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  Yeah, so they came in with what's called a Lucas
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  device, so just very aggressive CPR. And it's
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  really hard to put a central line when all the
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  whole body is shaking. Both vessels, the crowded
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  and the SVC, sorry, the IJ are pulsing. The lights
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  are going on and off because they're shooting
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  fluoro. And it's very, I remember having a very
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  like out of body experience from just like all
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  this is going on and it somehow just felt comfortable.
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  Like I knew what to do, what needed to be done
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  despite all this chaos going around. That was
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  one of those moments where I was like, wow, I've
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  really come a long way. Very steep learning curve
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  CA1 year, but I feel like myself and a lot of
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  my co -residents have just developed very quickly
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  and have gotten to these big cases, feeling comfortable
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  with them. And I think that's one of the unique
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  things about CA1 year is just how much growth
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  we've all had. All right, next up is Dr. AJ Pagan.
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  AJ, tell us about your CA1 year. Hi. Yeah, CA1
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  year is really fun. It's really challenging in
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  a lot of new ways that you probably didn't have
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  to experience as an intern. I think where what
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  I felt CA1 is the challenging is just everything
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  is new so quickly. Every day you're doing a different
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  case that you've never done. Sometimes working
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  with a new attending in a new environment and
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  there's just so much unknown. So you're kind
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  of, you feel like you're lost at first. And then
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  on top of that, it's, we kind of say is roll
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  with the punches is because you have lots of
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  attending sometimes telling you how to do one
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  way and then the very next day they tell you
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  to do something different. But I think that could
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  be fun too because you're learning so many different
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  ways to safely do anesthesia in such a quick
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  way and you realize when you step back that in
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  a couple months you can do just about any case
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  rather effectively. I think some specific stories
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  that I remember of some challenging things have
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  to do with like Mac cases where there's lots
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  of different ways to do Macs, lots of different
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  drugs you can do. But I remember times where
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  one day you set your propofol infusion on a higher
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  way and the attending will tell you that it's
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  too high. And then the next day you do it low
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  and the attending will tell you it's too high.
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  That's fun, but it can kind of get a little bit
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  frustrating. But it's great because you get to
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  learn how to do a Mac. hundred different ways.
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  Um, and I think advice that I would give to the
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  CA ones is like, kind of, like I said, is come
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  to every day, like ready to learn as well as
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  just kind of roll with whatever case you're doing.
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  Um, and then don't get down on yourself too early.
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  Um, you're a CA one. You've never done any of
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  this stuff before. No one expects you to be perfect.
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  No one was perfect when they started. Um, you're
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  going to blow IVs. You're going to goose the
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  tube. Um, early on, and that's all fine. Talk
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  with your senior residents and just ask them
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  for their funny stories. We all have a million
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  stories of funny things that we've done. And
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  you're like, oh, I will never do that. But then
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  you'll do something and then you get to pass
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  it on to your juniors. And then there's going
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  to be days where you absolutely kill it in the
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  OR, where you're nailing IVs, doing big lines,
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  doing big cases. And that's why CA1 is great.
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  Next up with us is Dr. Garrett Dunn. Take it
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  away. Hey, I'm Dr. Garrick Dunn, again. A couple
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  of things that I learned going into CA one year,
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  getting through CA one year. First and foremost,
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  that it's a lot different than intern year. Intern
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  year was trying to get oriented to the hospital
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  and everything and just the life of being a resident.
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  And then CA one year, really stepping into the
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  professional field that I wanted to. become a
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  lifelong learner in i was trying to both orient
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  myself to that day -to -day lifestyle but also
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  working harder to retain all of the information
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  that i could knowing that this was actually the
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  specialty that i was working in I'd say one of
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  the things that I found very important, especially
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  now that I'm starting CA2 year and I'm trying
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  to formulate my own anesthetic plans and my own
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  anesthetic style, was really trying to absorb
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  everything I could when working with different
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  faculty and working with different residents
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  because everybody had their own styles, whether
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  it was just the room setup or their style of
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  anesthetic management in general. I'm trying
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  to absorb everything I could from all of the
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  different styles and formulate it to make my
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  own individual style and find out what type of
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  anesthetic I preferred and that I saw and found
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  was typically leading to the best patient outcomes.
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  Of course, you know, trying to make sure that's
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  in line with all the research that we look at
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  and the guidelines that we use to kind of direct
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  our anesthetics. But I remember one of the attendings
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  told me there's a million ways to do, you know,
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  anesthesia correctly and well. So kind of coming
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  up with what's more comfortable for you is something
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  I found really important. I don't have a particular
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  story about. ca one year it's really drinking
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  from the fire hose a lot of the times and there's
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  ebbs and flows as there are with anything but
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  um i think an important takeaway as well was
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  You know, there's going to be harder times. There's
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  going to be harder cases, whether it's a liver
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  transplant, your first liver transplant, especially
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  where it's really difficult management in itself.
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  And you feel like you're not prepared, even though
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  you don't realize there's so many people that
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  are looking over your shoulder and you have so
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  much more support than you really feel at the
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  time. Or it's even more standard and what you
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  thought were going to be straightforward cases
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  where something unexpected happens. Sometimes
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  that can. gets you down. And I found that it's
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  been really, really important to try and maintain
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  composure during those moments because it makes
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  the moment smoother when things do go awry or,
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  you know, go sideways and also moving forward
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  from those moments. I think it's important to
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  be able to reflect on, you know, difficult outcomes
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  or difficult cases. But ultimately, our job as
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  anesthesia providers is to try and make sure
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  that the next anesthetic is something that we're
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  able to provide and provide to the best of our
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  ability. So learning and moving forward from
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  those moments is something that I've definitely
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  improved on throughout the year and something
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  that is a really valuable skill to be able to
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  have. Next up speaking with us is Dr. Nate Pham.
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  Take it away, Dr. Pham. All right. Hi, everyone.
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  Thank you again for having me. I'm part of the
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  CA1 advice group. All right. So, yeah, CA1 year,
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  it's a lot. But it's also been a really fun year.
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  And looking back, it's really incredible how
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  much you grow and how far you go, especially.
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  uh now as a ca2 and like helping the new ca1s
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  uh it's remarkable to see how far you come during
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  during just a short 12 months um yeah uh really
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  starting off it you feel like sort of a dry sponge
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  and it's a flood of information that you soak
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  and you continue to soak and it it feels like
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  there is no end in sight as to when when you're
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  done soaking and you know now now you can process
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  the information and things like that But definitely
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  it takes a couple of months to adjust. But once
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  you do adjust, I do feel like there is definitely
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  a transition point in the year where you go from
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  feeling clueless all the time to feeling like,
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  oh, I actually have something under me now. And
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  then start actually doing things and developing
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  who I am and who you will be as your own anesthesiologist
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  in the future. Tell me about that transition
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  point too. I bet that felt weird and that your
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  role was changing, but I bet it felt rewarding
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  too that you were kind of turning a corner. Yeah,
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  absolutely. I think for me that that came about
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  halfway through the year, especially coming around
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  to our cardiac rotation and doing that month
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  and getting that under the belt. I still remember,
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  I think for me it was in a liver transplant.
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  um that I did during my cardiac month where for
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  the first time in the liver transplant I was
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  like I know what I'm doing I was like this that
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  doesn't feel completely random and now it's like
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  oh I actually know how to do this resuscitation
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  and I actually understand what's going on in
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  the surgery and the various phases and steps
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  and and uh that that that for me definitely was
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  a defining moment where it went from doing what
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  other people was telling you to do And making
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  that synthesis between like what you read, what
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  you've experienced and what you're doing hands
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  on now and seeing that actually play out during
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  the case. And it felt very rewarding. And I think
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  that was definitely a big transition point. Because
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  after that, I went on to one of our offsite surgical
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  centers and everything felt like a cakewalk.
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  It was nice. All right. Next up is Dr. Max Chow.
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  Take it away, Dr. Chow. Hey, everyone. I'm Max.
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  I'm sure as everyone else has been saying, you
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  know, starting off CA1 year, incredibly, incredibly
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  difficult, just learning how to do everything,
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  how to do it right. If you're doing things right,
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  a lot of things to organize. I feel like towards
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  the end of CA1, you know, you start to get a
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  grasp of Knowing the steps and you're able to
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  reintroduce your own personal touch and flair
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  and what makes you you and how that interacts
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  with you as a professional. I think back to just
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  like a couple of weeks ago, we were doing ambulatory
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  surgery cases, just like OMFS dental stuff. And
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  there was a patient who was nonverbal. He was
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  60 years old. He was there in same day surgery
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  with his caretaker. And I remember. talking to
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  her and just like figuring out like how well
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  he does, you know, like what makes him happy,
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  like how well does he communicate? And then through
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  that conversation, I learned that he liked to
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  listen to 90s R &B. That's what she played for
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  him, like whenever they're just hanging out at
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  home. And so I see this guy, he's... you know
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  has a lot of difficulties communicating both
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  like non -verbally especially verbally and yeah
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  i can at least tell like he's just not exactly
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  understanding what's going on he's definitely
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  scared um so after we do our safety handoff and
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  start rolling off to the operating room i turn
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  on some 90s r &b on spotify um so mariah carey
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  started going on and um he was really liking
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  it we just had it on full blast he was singing
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  along to the best of his ability you know people
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  were turning around like seeing what was going
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  on like smiling just seeing this guy go down
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  and you know we took away a lot of his fear and
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  a lot of his anxieties i'd like to think so i
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  think you know as you as you go through ca1 as
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  you learn through the steps of like um, oh, I've
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  got to do this, this, this, that, um, and like
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  kind of pulling it all together, you know, you
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  get to reintroduce what makes you, uh, you as
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  a practitioner and it, you know, makes things
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  a lot more enjoyable, prevents a lot of the burnout,
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  um, that's associated with medicine. And I think
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  it just, you know, overall also provides just
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  better patient care. They can relate to you as
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  a person, you know, it's like, oh, you know,
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  that's just another guy taking care of me. Just
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  like happens to know, um, some certain stuff
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  that can, you know, get me through this safely.
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  So I think that's a big piece of what I learned,
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  or I guess it was relearning, coming out of CA1.
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  I'd like to welcome Dr. Claudia Mort to the stage.
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  Let's hear it from Dr. Mort. Hi, everyone. It's
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  been about a year since I last participated in
• 15:41
  this podcast. In that last year, I've learned
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  a lot, but two things that stand out to me among
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  those are learn to have fun. We're in a very
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  serious job where you see the very worst of people.
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  You see very sad things. You see diagnoses that
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  will change those people's lives forever and
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  the families of our patients. But I found that
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  one thing that really helps with this whole process
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  of learning tons of information at once and just
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  experiencing those highs and lows within yourself
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  and sharing those moments with patients is to
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  have fun. For example, recently I was asked to
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  pull out a central line in PACU from a patient.
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  And for that, usually we hold pressure for about
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  10 minutes. So you're just standing with the
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  patient for 10 minutes. It can be very awkward.
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  But one way that I decided to change that is
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  to actually ask the patient, hey, what's your
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  favorite music? And then I pull up my Pandora.
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  And we add that station to my list. And then
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  we listen to their favorite music during that
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  time. And it just like really lightens the mood.
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  It makes time go by quickly. Last time we did
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  that, my patient loved Frank Sinatra. And I was
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  like, do you like karaoke? Because I love karaoke.
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  And he sang his favorite song. And we just had
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  a blast. And it went by so quickly. Now, I do
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  feel like I'm going to remember him for a really
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  long time because of that. It was just a really
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  special connection. So I encourage you to have
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  fun. I bet he appreciated that, too. I think
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  it's easy to forget when you're learning so much
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  CA1 year that your patients are just like you
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  in a lot of ways. They're somebody's child, somebody's
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  parent. It's cool when you get to connect with
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  them like that. Yeah, it really helps a lot if
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  you're spending like. over half of your life
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  here when you can just let yourself go and also
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  enjoy the process as well. Next up is Dr. Anne
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  Burgess, who stopped by on her way to the TEE
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  simulator to share some wisdom with us. Take
• 18:27
  it away, Anne. Thank you. Thank you. Going into
• 18:30
  CA2 year, my advice to rising CA1s would be to
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  embrace the discomfort zone and be aggressive
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  about learning opportunities. Now is the time
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  to try and fail, because you will fail, and you'll
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  have the support of seniors and faculty. There's
• 18:45
  rarely a situation that you're genuinely alone
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  in residency, so take advantage of that. The
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  discomfort zone is where you learn, so request
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  the big case. Ask to do procedures, IVs, atypical
• 18:56
  nerve blocks, if appropriate. Try new anesthetic
• 18:59
  plans. Try different laryngoscope blades. Can
• 19:03
  you do an anesthetic with the same ingredients
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  every time? Sure. But you'll be a better clinician
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  if you push yourself to be familiar with all
• 19:09
  your tools. I certainly regret not experimenting
• 19:12
  earlier. It sounds silly, but I'm still a bit
• 19:15
  of an Atomidate hater because I didn't use it
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  very often early. I wish I'd done more blind
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  A -lines when I had the opportunity because I
• 19:23
  feel like I currently lack that particular skill,
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  especially in an emergency. CA1 is where you
• 19:28
  get a lot of your reps in, so make the most of
• 19:30
  it. Pushing yourself into bigger and more complex
• 19:33
  cases builds a strong foundation to deal with
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  the unexpected. In a way, it acts to desensitize
• 19:39
  your own sympathetic response to an emergency,
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  which is genuinely helpful when faced with chaotic
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  overnight traumas 18 hours deep into your call.
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  Take care of yourself. We're all learning, and
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  all your feelings about said learning are absolutely
• 19:53
  valid. I promise you are not alone. Lean on your
• 19:57
  co -residents and your faculty. You're going
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  to do great. Everyone has bad days, and sometimes
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  the bad days are where we learn the most. The
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  worst cases I have been in this year, I still
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  carry with me, but I know they have made me a
• 20:09
  more compassionate and competent clinician. Hang
• 20:12
  in there and always be learning. That's it for
• 20:18
  today's episode of the podcast. On a personal
• 20:20
  note, one of the most gratifying parts of my
• 20:23
  job is seeing anesthesia residents go through
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  the transition from being a brand new intern
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  to being a competent resident and eventually
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  seeing them as a fully capable and confident
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  anesthesiologist. Listening to the wisdom of
• 20:35
  my residents inspires me to be a better anesthesiologist
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  as well. If you enjoyed this podcast, I'll also
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  refer you back to Episode 7, The Wisdom of Interns,
• 20:44
  where we heard from these same residents a year
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  earlier. As always, please consider leaving us
• 20:50
  a rating or review. That's what helps other people
• 20:53
  find the podcast. You can contact us at styleformspodcast
• 20:57
  .gmail .com as well. Take a deep breath. Open
• 21:01
  your eyes. We're all done.