critical care rotation

[KasaNOVA]

Please list critical care rotations available for 4th year students.. I am not having much luck finding them,... please specify 2wk or 4wk.... thanks...

Also, any advice on good ones???

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[trkd]

I'd be interested to know as well. Anyone?

 

[lmh14]

I'd be interested to know as well. Anyone?

The SICU rotation at MetroHealth Medical Center (through Case Western) is EXCELLENT. I think it's only offered as 4 weeks. Great teaching.

 

[southerndoc]

The SICU rotation at Memorial Health in Savannah is also awesome. You have to go through Mercer University School of Medicine.

In 4 weeks time, I put in about 30 central lines (most of them subclavians), 4 chest tubes, a couple percutaneous trachs, a couple bedside percutaneous PEG's, needle decompressed a chest, and assisted with an emergent thoracotomy.

Students are expected to do all the procedures with resident supervision. When I rotated, there was no call. You worked everyday with your choice of 4 days off the entire month. The hours were long (5a-8p most days), but well, well worth it. The teaching was good, and the procedural experience is unmatched. Plus, Savannah isn't a bad city to visit!

 

[OSUdoc08]

Any good ones in Texas?

 

[inositide]

Are you serious? 30 subclavians just for you in 26 days of work?

 

[southerndoc]

Are you serious? 30 subclavians just for you in 26 days of work?

30 central lines, "most of them" subclavians.

 

[Blade28]

Damn, that's very impressive!

 

[trkd]

I'd like to give this a hearty BUMP. Trying to decide between SICU and MICU. I hear no difference but surely there must be some. I'm looking for someone to say "The _ICU= more procedures". Come on guys, fill in the blank, is it SICU or MICU?

 

[leorl]

I'll be doing a Critical Care elective in Cleveland Clinic (attached to CWRU), so they accept students for rotations too. 4 wks, can start on any Monday, they provide you with a place to stay as well. Have to get the application in early enough, I think.

On a side note, does anyone know how well-correlated CCU is to Emergency med? Over in these parts (europe), CCU/ICU tends to be attached with anesthesiology

 

[militarymd]

I'll be doing a Critical Care elective in Cleveland Clinic (attached to CWRU), so they accept students for rotations too. 4 wks, can start on any Monday, they provide you with a place to stay as well. Have to get the application in early enough, I think.

On a side note, does anyone know how well-correlated CCU is to Emergency med? Over in these parts (europe), CCU/ICU tends to be attached with anesthesiology

In the U.S., CCM is rarely attached to anesthesiology.

 

[AJM]

I'll be doing a Critical Care elective in Cleveland Clinic (attached to CWRU), so they accept students for rotations too. 4 wks, can start on any Monday, they provide you with a place to stay as well. Have to get the application in early enough, I think.

On a side note, does anyone know how well-correlated CCU is to Emergency med? Over in these parts (europe), CCU/ICU tends to be attached with anesthesiology

This may just be my lack of understanding of european abbreviations, but when you say CCU do you mean coronary care unit or critical care unit? If you're referring to the cardiac one, that's pretty much in the realm of cardiologists -- most intensivists don't deal with the CCU except to do consults there when they're having difficulty with the vent and so on.

As far as emergency med and the ICU, there are a growing number of critical care fellowships available for EMed-trained physicians, however there is not much of an EMed presence in CCM at this time.

 

[cchoukal]

I'd like to give this a hearty BUMP. Trying to decide between SICU and MICU. I hear no difference but surely there must be some. I'm looking for someone to say "The _ICU= more procedures". Come on guys, fill in the blank, is it SICU or MICU?

The mantra at my medical school was SICU = more procedures, MICU = more teaching. You're going to have years to get better at procedures, and, frankly, you can train a monkey to do most of them. As a medical student, the thing that you really (should) want is to improve your diagnosis and medical decision-making. It doesn't sound sexy, but in the middle of the night as an intern/resident when the fit hits the shan, there's nothing sexier than not laying a deuce in your own scrubs. Find a rotation where there's deliberate teaching and where medical students are made accountable and more "autonomous."

 

[militarymd]

The mantra at my medical school was SICU = more procedures, MICU = more teaching. You're going to have years to get better at procedures, and, frankly, you can train a monkey to do most of them. As a medical student, the thing that you really (should) want is to improve your diagnosis and medical decision-making. It doesn't sound sexy, but in the middle of the night as an intern/resident when the fit hits the shan, there's nothing sexier than not laying a deuce in your own scrubs. Find a rotation where there's deliberate teaching and where medical students are made accountable and more "autonomous."

In the middle of the night, it's usually the ability to do some procedures that keeps the patients alive.

 

[leorl]

Thanks. It's an MICU elective that I'm scheduled for. It's my second choice - I wanted EM, but it was the closest 2nd to EM that was described in the brochure.

 

[cchoukal]

In the middle of the night, it's usually the ability to do some procedures that keeps the patients alive.

Sure, I guess, but first you need to know what's wrong and what to do about it (ie., which procedure to do and when. And why. And why not). To me that's the hard part.

 

[militarymd]

Sure, I guess, but first you need to know what's wrong and what to do about it (ie., which procedure to do and when. And why. And why not). To me that's the hard part.

You said "when s hit hits the fan in the middle of the night".

When things hit the fan, it is usually pretty easy to figure out what is wrong

Respiratory failure/distress......pretty easy to figure out....not much to think about....tube


Hypotension/CV collapse......pretty easy to figure out......lines and fluids....

For the scenario that you gave, being able to intubate and slam lines and tubes in is more important....

Once the dust has settled, then I agree things get harder, but that's when the attendings show up to tell you what to do.

 

[Sugar72]

Any good ones in Texas?

It's not texas - but I did a critical care rotation at Ochsner in New Orleans and I thought it was really good in terms of teaching. Good lectures, very good review of important literature. Not a lot of opportunities for lines but really good didactics. Also, no call unless you want to take it and they reimburse you $500 for living expenses. I learned a lot on that rotation.

 

[SilverStreak]

I'd like to give this a hearty BUMP. Trying to decide between SICU and MICU. I hear no difference but surely there must be some. I'm looking for someone to say "The _ICU= more procedures". Come on guys, fill in the blank, is it SICU or MICU?

It probably depends on where you work, but I'd say the MICU would be better for procedures. Most patients go to surgery and have the lines placed, get tubed, get the chest tubes put in, etc. The MICU patients usually come in from the ER or nursing homes needing everything to be done when they arrive in the unit. And, you come to a point hopefully when you can anticipate because of a patients history, presenting symptoms, clinical data that you should need a central line, or they're probably gonna end up tubed. Sometimes you can't help those middle of the night situations in the ICU, but I agree with Mil give me a doc that can get it done quick any day.

 

[southerndoc]

It probably depends on where you work, but I'd say the MICU would be better for procedures. Most patients go to surgery and have the lines placed, get tubed, get the chest tubes put in, etc. The MICU patients usually come in from the ER or nursing homes needing everything to be done when they arrive in the unit. And, you come to a point hopefully when you can anticipate because of a patients history, presenting symptoms, clinical data that you should need a central line, or they're probably gonna end up tubed. Sometimes you can't help those middle of the night situations in the ICU, but I agree with Mil give me a doc that can get it done quick any day.

I agree. Most central lines in SICU patients are placed in the OR.

At my institution, 75% of central lines, a-lines, and intubations are done in the ED. The MICU still gets a fair number of procedures from bump ups from the floors.

 

[leorl]

Just started MICU rotation at Cleveland Clinic. It's fantastic, I love it and am really enjoying myself. Seems like there are plenty of procedures to do in MICU. Central lines, a-lines, intubations, etc. I asked them what the real difference between SICU and MICU was procedure or concept-wise. they couldn't really tell me any. If I find out, I'll let you know.