what's the first week of anesthesia residency like? what are the highlights? challenges? what
sorts of cases do you do? in this video I'm going to tell you all about it! what's up
everybody my name is Max Feinstein and I'm an anesthesia resident the Mount Sinai Hospital
in New York City I just finished my first week of CA-1 year and I actually would have done a
month of anesthesia during my intern year except covid happened so this is actually
the first time that I've been doing anesthesia since I was a 4th year medical student doing
away rotations in this video I'm going to share with you an overview of what sort of cases I did
what the highlights of the week were some of the challenges and then also what I've been
studying and how I've been studying it you can either jump to the sections below using
the chapter headings or you can just watch all the way through if you enjoye this video I'd
really appreciate it if you like it below and also subscribe to the channel in terms of the
cases that I did this week everything was very straight forward from an anesthesia perspective
so patients were really healthy so that would be ASA-1s and 2s using the stratification system from
the American Society of Anesthesiologists and also the cases were very straight forward from
a surgical standpoint so a lot of abdominal cases cholecystectomies, hernia repairs. but there were
also a couple other different types of cases mixed in like thyroidectomy, parathyroidectomy,
and one of the thyroidectomies was actually trans oral which meant that we had to do a
nasal intubation so I did a fiber-optic nasal intubation which is really sweet and then most
of these cases were with adults although I did have one pediatric patient but for the most part
all the peds cases are just saved for a pediatric specific rotation because there are such unique
and aesthetic considerations for that that it's its own sub-specialty. in terms of highlights
one of the biggest things that stuck out to me compared to the internal medicine rotation I
just came off of was the significant lack of note writing that resembled novel authorship. in fact,
I can actually see off in the corner of this room that it looks like there's a current medicine
intern who's in the middle of really lengthy H&P. looks like he's getting on to his seventh maybe
eighth paragraph, oh he looks like he's picking up the phone-- he looks distressed, I wonder
what could be... Oh it looks like his patient just eloped after he spent an hour and a half
writing the H&P. You hate to see it. By contrast, anesthesia note writing is lightning fast. in fact
in having just spoken this sentence, an anesthesia resident down the hall just finished seven notes.
it's been said that a senior anesthesia resident can write notes faster than the human eye can
actually. see I wanted to see this for myself, so I actually went out and I found some very
rare footage of an anesthesia senior resident writing notes, and it's been digitally slowed
down so you can actually catch him starting and finishing notes. it's really incredible
so besides not missing note writing one of the things that's been a huge highlight here is I
have way more autonomy compared to when I was an intern. the starting point for that autonomy
is actually the night before a case occurs because I'll look up a patient, see what the surgical plan
is, and then I get in touch with my anesthesia preceptor and talk about what I would like to do.
and so really the question is what anesthetic plan I would like to use for this case? to give you an
example of something that I think about, yesterday I had a case that was a robotic hernia repair
and since they're going to be using insuflation I thought it'd be important to paralyze the patient,
which means that we have to do general anesthesia and we have to insert an endotracheal tube versus
another case that I had yesterday which was an open hernia repair which didn't require paralysis
so we were able to do it under MAC sedation. and that's all just before we start the case. so then
once I actually get into the operating room my anesthesia preceptor will ask me what induction
medications I'd like to use, what dose I'd like to use, what I'd like to use for reversal,
when I'd like to give it and so forth. so I really get a lot more independence in terms of decision
making but obviously with a safety net right there to make sure that I'm on the right track. one of
the other highlights that's been very personally rewarding has been helping relax patients who are
very nervous about their upcoming surgery. so part of the way that I do that is just talking
with the patient and reassuring them, answering any questions that they have before they go in for
their surgery. "Dr. Feinstein, I'm really scared about the surgery-- I legitimately haven't been
able to sleep or think about anything else in the last five days" "Don't worry Mr. Patient,
I'm gonna be there for the whole surgery taking care of you while you're asleep." But then the
other part of it is giving them a milligram or two milligrams of versed which can really help
relax them. "And also I've got this medication here that's gonna help you feel nice and relaxed"
Shoop Shoop Shoop! "Bro Feinstein, that gold chain you got on is sick as..." Other highlights include
doing awesome procedures. I mentioned I did a nasal fiber-optic intubation for the first time
which was really enjoyable to do, I also did a number of different nerve blocks including
a subcostal block and ilioinguinal block for abdominal surgeries. And of course placing IVs,
doing intubations, all of these are commonly done procedures in anesthesia and it's been
great being able to do them. a couple last highlights are things that I just really
don't miss about my intern year. the first one is the lack of rounding. I really don't miss walking
around for four to five hours at a time when I've got a to-do list with forty items on it
and I'm unable to do them because I'm on rounds. and the last thing but I really don't miss about
being an intern is the physical or emotional dependence on my multi-colored pen. Peace! I'll
break challenges down into two main categories. one is book knowledge and the other is practical
knowledge. in terms of book knowledge there's just so much to learn. I'll use drugs as an example:
so for drugs you have to learn things like the mechanism of action, indications,
contraindications, side effects, allergies duration of action, and lots of other aspect
of the drug. then the other category of clinical knowledge is the kind of stuff that you wouldn't
necessarily get reading from a textbook, so that might be how to use the particular
ventilator that's in your operating room or the ins and outs if your monitoring equipment,
or just the overall flow for how the operating room goes, and case starts and finishes,
and then how you need to do your charting. the last challenge is a little bit embarrassing
to mention but I do have to say that my left arm is actually fairly sore. at baseline I'm
already pretty out of shape and especially after covid I haven't been going to the gym for months,
but then after a week of doing direct laryngoscopy where I'm lifting people's heads using my hand
it's actually pretty sore. I'm a little ashamed to admit it but I'm just putting it out there
the last thing I want to talk about is studying because this is also a really big component of
being a resident. at the end of the day when I get home from the hospital and after I've looked at my
patients and talked with my attending about what my anesthetic plan is, then I also have to spend
time reading. I personally use what's referred to as "Baby Miller" to get started. other people
have different preferences but for the most part it's a lot of the same knowledge just conveyed
in different ways the best way for me to learn is with flashcards so I actually make flashcards with
a lot of the pertinent stuff that I'm reading and then put that into an Anki deck which I study on
my phone during downtime in the hospital. chances are you're already familiar with Anki which has a
free desktop app but I'd highly recommend plucking down the 25 bucks to just get the mobile app so
you can take it with you on your phone. the other source of information for my Anki cards is what
I've written down throughout the course of the day. so for the most part these are clinical
pearls that my preceptor has told me as we've been in cases. I always just make sure to carry around
a little sheet of paper so that I can write this information down and study it at the end of the
day. well that wraps up this video and overall it was a really exciting and also really tiring week
but I couldn't be more delighted about being in anesthesia. I'd love to hear any feedback
if you want to write it in the comments below. thanks for watching and I'll see you next time