new to CT surgery

[problem child]

I'll try to make this brief:

 

recently hired to a CT surg service where I am fast-track training in the SICU (then OR, floor).

 

I am 7 years a PA; worked in many surg specialties, but never CT. never thought of working in CT until a recruiter got a hold of me a few months ago and talked me into applying. got interview, got hired..they knew I had no experience, said they would train me.

 

well, they are training me, but it feels more like I am being beaten to a pulp (scolded, rushed, distracted, berated, shamed, punished, threatened with job loss, embarrassed, humiliated...) over what (I think) are pretty normal knowledge gaps and mistakes. and it's not like I'm working alone, where one mistake on my part will cost the life of a patient. there are always at least 10 (very skilled) people around at any given time capable of jumping to the aid of any patient who might take a turn for the worse. 

 

I am intelligent and motivated, responsible and conscientious. why does this training have to be so degrading, humiliating, abusive, and punitive? I go home every day (after a 12 hr shift) not knowing if I should listen to them saying I "should" know this or that (8 weeks in!!!)???!!?, or "shouldn't" NOT know this or that, (8 weeks in!!!)?!?

 

should I just take a hint and accept that I am proving on a daily basis that I am an idiot, and I should just go home? or is this just the nature of the training? and if so, why does it have to be so MEAN?

[rcdavis]

Welcome to cc/cts mind set.

There is a lot of trial by fire mentality,

And a lot if time the whole team isn't on board with touchy freely teaching. Especially on AM rounds, when each attending really only wants to know about the status of his patient's, and rarely could care about the others..

They all really only want to do one thing: get through rounds and get to the OR by 6-7am.

 

Get you a mentor.

 

LEARN. Marino's and bojars.

 

LEARN how to interpret the numbers ( tamonade? Too full? Beans not putting out?)

 

Pulling lines, wires, tubes are easy.. Be sure you know when.

 

Learn how to manipulate the IABP, the intra cardiac pacer, the vent.

 

Most importantly, while you are getting the patient ready for rounds, start with a format, to follow with each patient;

 

". This pt, ms smith, is a 62 y/o wf, POD #1 emergent on pump 3vessel cabg ( list vessels and graft site), With DM, htn, Etc.

 

Quiet night. Extubated at 10hrs post op, maintaining 02satsvwith supplemental 02 at...Following commands.

 

( summary of what has happened to her over previous 12 hours... Returned to OR, needed fluid in or out, any distress and what you did)

 

Current Meds (pressors, antiarrythmics, etc)

 

Chest tubes have (..cc) drainage over the last 4 hours and plan on pulling this afternoon.

 

Daily cxr

 

I/0 is____

 

Wound status sternotmoy, donor set

 

Etc, and then, for each patient, establish a care plan:

 

Swallow study, feeding, drugs, step down plans etc

 

This essentially starts the potpourri of the team's input( pulmonary, cardiology, physical therapy)

 

The big problem in this business is putting complex process which are interdependent, in order, determining the cause and the effect, and making appropriate interventions.

 

You and you mentor should start with a subject a week, ( cadaveric vs porcine valvevrepair, why? Which approach to the heart, ,minimally invasive versus sternotomy, and why?) and run thru the "standard complications" and what the numbers tell)

 

You might be balking a little at what you perceive as micromanagement... Especially if you have had some autonomy in the past..

Remember you are dealing with surgeons who had to run a lot of their decisions by their attendings even with they were a PGY 8!

 

I have been where you are. Hang in there. Study, study, study.

 

Get good at lines tubes and drugs, and especially at when the patient needs to go back to TGE OR, when he ends to have the sternotomy wires cut, etc.

 

It really falls into place at about the 6 month mark...

 

You will inevitably pull a IABP line, pop the top and do everything right, and STILL tear the femoral artery as she comes out., and stand there with a face full of squirting blood while feeling for and gaining finger pressure control of the proximal femoral artery..

 

You will still miss the recurrent air leak and extubate a patient who developed another OTC just as you are presenting him...

 

These things happen, and are unavailable.. Tough it out, learn from it.

 

Remember WHO is in charge!

 

Each day, you have the surgeon on call ( and of course those surgeons who want to be called for "their" patients.

 

When in doubt, call THE DUTY surgeon, be prepared to give him the numbers the rate, rhythm, pressures, swan or central line numbers, the hgb, the renal output, tube drainage,mand get his advice.

 

MANY people may be meandering through the unit, see the patient and feel free to give you spurious advice.. DO NOT act on that advice until you check w/your attending. The attending, at this point of your training, needs to be involved MORE than less.

 

They will be schizophrenic about you calling: they really do want to be called, but, being surgeons, will give you grief for calling.

 

Water off the duck's back...

 

You can do this

 

Btw, befriend and use your nurses .., these chicks are pretty smart.. And will acquiesce to your authority better as you grow in the job.. Use them to help tell you when to call, they will sense when you no longer need to call

 

You are undergoing the transition from a medical to a surgical PA.

 

 

Do not give up. Give it a year.. You will be surprised how much you ARE learning... And a lot of the "mean-ness" I'll bet is embarrassment and frustration at not being "on top of it".

 

The other PAs were either like you or went to the Cornell or montifiorie surgical program..

 

Hang in there. Become studly.

 

Pm Andersen. He does this for a living.

 

Good luck.

[Guest JMPA]

I recommend reading "Manual of perioperative care in adult cardiac surgery" robert m bojar,

it contains a wealth of knowledge, is easy to read, and covers all basic necessities. you do have an opportunity that others couyld only dream of, i agree and say stick it out a year.