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Core rotations, such as surgery or internal medicine, may seem daunting at first, but medical students become much more comfortable in their role as the days go on. The general expectation of students to be punctual, compassionate, interested, and see their assigned patients just comes with the territory. Elective rotations like anesthesiology, however, are more complicated in the fact that they are much more hands-on and procedurally heavy, and students often feel a great deal of impostor syndrome when they realize they have yet to learn how to place IV lines, assist in regional blocks, or perform the holy grail of the field: intubation. Students (myself initially included) often find it difficult to justify asking for a letter of recommendation from their preceptor, because they mostly feel “in the way” as they stand in the OR watching the anesthesiologist handle everything, nodding fervently while in reality having many unanswered questions. But it does not have to be this way. There are steps an eager student can take to successfully navigate their anesthesiology rotation, learning the skills they will need for a future career in the field, and impressing their attendings.
Anesthesia is a very “get in there and do it” type of field, with a lot of pharmacologic theory and rationale behind the decision-making for a given patient. I was lucky enough on my first rotation to receive a packet delineating expectation and a general rundown of the “why’s” of the anesthetic plan. Regardless, it would be in your education’s best interest to ask your preceptor for how to prepare to understand the following: pre-operative assessment, induction and airway management, intraoperative complications and management, emergence, extubation, and post-operative care. Bonus points if you learn how the actual medications work. That way when your preceptor allows you to draw up the medications and administer them, it is not just mindless pumping; you will know why you are pushing them. A rotation can only teach you so much, and it’s up to you to meet that effort halfway and read up on certain things at home to build your fund of knowledge and integrate the experiences you glean from that day.
Do not be afraid to step outside your comfort zone. Introduce yourself to the OR team and anyone involved in patient care and bring a positive attitude with you. Don’t be afraid to admit your lack of experience in anesthesia and ask questions; this will show your preceptor and OR staff that you are truly engaged and interested and perhaps land you your first opportunity to intubate or start an IV. If you are offered an opportunity to get involved with a procedure such as an A-line or epidural, do not shy away from it and instead channel your passion into learning a new skill.
Never forget that practice makes perfect either and begin to understand the flow of the OR and of your attending in particular, being helpful whenever possible without being overly pushy.
Remember that there is a side to anesthesia that involves seeing patients and interpersonal communication skills. In a field that starts bright and early like anesthesia, it is important to show up even earlier and be ready to round on your patients for that day, after already having done some pre-op “homework” on the cases the night before. When you are behind the drapes, fight the urge to pull out your cellphone; instead, ask insightful questions or have a conversation with your attending and get to know them better. Doctors are normal people too and provide quite entertaining conversations, and in this way, you can maintain friendly relationships with your potential future colleagues and show your human side. Ask them about billing and charting, and the side of the specialty that no anesthesiologist enjoys dealing with, and learn everything about anesthesia so that you further demonstrate genuine interest, but also so that you become more informed as to what you will be dealing with. Remember to ask for their feedback every week, with tips on how to improve, which demonstrates a willingness to admit one’s weaknesses and exhibit personal growth. As always, the cliché “be a good student” also applies here. Now go out there and show those anesthesia rotations your mettle!
posted November 2020
