What are the expectations of PA Student competency during a SICU rotation?

[TPA16]

I am feeling slightly down after finishing my rotation in SICU. My preceptor said Im a hard worker but I have a lot of learning to do. it almost sounded like I should have known more by my 7th rotation. I will admit, my rotations have all been shit and basically free labor and not so much learning. I will say upfront that i understand the learning curve is huge and I am not on the level of a seasoned ICU PA but I still feel embarrassed because I was on the verge of applying for a job at this ICU and the attending basically said I'm not ready.

During PA School we were taught slim to nothing about critical care. in 5 weeks i went from

- not even understanding how to use an EMR, to being able to easily chart out a patients round presentations, trend relevant lab values and understand the utility. explain to a patient why this lab matters

- not really understanding CXRs/CTs to being able to point out to you most lung pathology with confidence and if they have been trending better or worse including vascular congestion, Pleural effusions, atelectasis, PTXs, PNAs, 

- not even knowing there was more than one pressor to knowing the nuances between most of them and indications/surviving sepsis protocol

- not even knowing about intubation/ventilators to knowing the protocols and how to adjust vent settings due to acid/base disorders

i also learned how to assess perfusion and volume status given net I/O's, weight changes, urine outputs, Flotrac, IVC diameter, fluid challenges

I could make more bullets but you get the idea. Basically what I'm trying to say is... I learned a lot. a whole lot. I am pretty impressed with how much i learned and internalized in 3 weeks (short rotation)

 

I will also admit that my presentation skills during rounds have been disorganized  here and there in that I don't always remember the details of patients/aometimes go over irrellevant issues/miss out key events (missing from the notes)

I don't know if either: the attending right and I didn't learn as much as i should have and that I'm not ready, or I just haven't been able to express what I've learned and with more time could have proved myself.

 

any responses would be appreciated

 

thank you

 

[jpshoe]

I'm still on rotations as well so take this with a grain of salt. I did an ICU rotation as my third rotation and it's definitely a huge learning curve. So much so that I switched another elective to do another ICU rotation. My program didn't do much to educate us on the nuances of critical care either and I think the main reason is because the ICU is a tough place for a new grad. I'm not really a fan of most post-grad programs/residencies/fellowships, but I feel critical care is one where it would be extremely helpful. You can't beat yourself up over this, even the most junior attending in the ICU has 5-6 years of residency/fellowship under their belt, you had 3 weeks.

You got a lot out of the rotation and that's what is important. Maybe you're like me and quickly realized it would be extremely difficult to be a new grad in the ICU w/ the limited exposure we get. I was fortunate enough to work with a great preceptor and got in a lot of procedures with a ton of 1-1 teaching, but there is no way I would feel comfortable working in that setting any time soon. Don't beat yourself up over one attending's comments. Just know that you learned a ton, but still have some development to do. Three weeks is just enough time to get into the swing of things before it's time to move on. Good luck the rest of the way!

[Randito]

I think that being acknowledged as a hard worker with a lot to learn is exactly where you should be right now. I think that what you learned in 3 weeks sound pretty impressive especially since I'm willing to bet you didn't have any ICU or even inpatient medicine experience as a new grad.

For example, I work in a surgical sub specialty and routinely have patients in the SICU and am still not that comfortable with vent settings and the nuances of different vasopressor therapy. My attendings defer management of those to the SICU team, however these are things I would like to get better at for general knowledge or furture position. 

If you're truly interested in working there or ICU in general, speak to some of the PAs and ask them what you should be doing to prepare. They were all students before they became ICU studs. You may be surprised, motivation and work ethic may open some doors.

[ALC0313]

Sounds like you learned a lot to me! All I did on my SICU rotation (9 years ago) was change lines and assist the residents with trachs and pegs, and then talk to the families for them because they hated doing family rounds. Most PA programs are geared towards primary care, because that's what the PANCE is geared towards. There's just not enough time to go in depth with critical care. It's definitely a valuable rotation though because if you work in a hospital in any capacity you'll deal with the ICU at some point, so to even be familiar with the drugs they use and how to work a vent is great. Every PA I know that works in critical care was given something like a 6- month training period and has plenty of backup on the unit.

[MT2PA]

How many rotations do you have total?  Sure you learned a lot but I think you should have known quite a bit of that prior to your 7th rotation.  

As one of my attendings told me 'you can't blame XYZ for not knowing something' (i.e. your shit rotations).  Take some initiative and learn it yourself.

SICU is a very difficult patient population and few PA educations will prepare you for that.  Honestly if you want to truly work in SICU, you should consider a critical care residency.  IMO that's one of the fields where it's worth it and possibly necessary.

[PeteK777]

Growth mindset dude. You DO have a lot of learning to do. So do I. That's not a bad thing, and it doesn't mean that you haven't done a good job. Take the feedback, put your nose to the books, consider a residency or a program with robust onboarding and come back stronger. It's short sighted to be upset that your attending isn't recognizing growth. That isn't her (or his) job. We should be giving students detailed feedback like this in every rotation. 

 

P

[MikeyBoy]

On 9/29/2017 at 10:32 PM, TPA16 said:

I will say upfront that i understand the learning curve is huge and I am not on the level of a seasoned ICU PA but I still feel embarrassed because I was on the verge of applying for a job at this ICU and the attending basically said I'm not ready.

I will also admit that my presentation skills during rounds have been disorganized  here and there in that I don't always remember the details of patients/aometimes go over irrellevant issues/miss out key events (missing from the notes)

I don't know if either: the attending right and I didn't learn as much as i should have and that I'm not ready, or I just haven't been able to express what I've learned and with more time could have proved myself.

 

I agree with everyone else and wanted to highlight what you said- you admit your presentations are disorganized, how could someone give you a glowing review? This is critical care, where there (often) is not time to hand hold. Would you feel better if he gave you a canned positive review?

 

Now that [that reality] is out of the way, I'll share you my experience. I did fantastic in my ICU rotations (I did 4 months during PA school)- but when it came down to applying for a job there, was I ready? HECK NO. Did it hurt? HECK YEAH. But, I worked med-surg/telemetry at night for the next 4 months, gained experience and confidence, then started in the MICU. Could not have worked out better, and I am a better PA for it. 

 

It's a process my friend, your learning/potential is on a steep upward curve and the sky is the limit. Just keep chugging along, keep a good attitude, and remember- you won't feel comfortable in an ICU for at least 5 years unless your faking it, cause something will always knock you down, and you'll learn from it. HAPPY THANKSGIVING!

[Houstonian]

A lot of ACP’s who are hired to work in the ICU are NP’s who were formerly ICU nurses.  PA programs are NOT AT ALL geared to critical care training...they are geared to primary care, which is about as far from critical care as one can get. Agree with others who recommended ICU residency if that is an option.  

There is no way that a 3-week rotation can compare with several years of hands on experience working with ICU patients.  

[EMEDPA]

I did trauma surg/critical care as my first rotation and it was a challenge. I had a bit of a leg up as I scheduled ATLS thew week before the rotation and had years as a medic and ER tech under my belt so was comfortable with a portion of the material already, but it was still tough. I echo the comments above about the residency. always a good idea, but especially for a specialty like critical care. also take the FCCS course at some point. it covers the first 24 hrs of ICU care.

http://www.sccm.org/Fundamentals/FCCS/Pages/default.aspx