WEBVTT 00:00:09.369 --> 00:00:12.130 Hello, anesthesia enthusiasts, and welcome back 00:00:12.130 --> 00:00:14.890 to Style Points. We have a special episode for 00:00:14.890 --> 00:00:16.929 you today, and it is one that has been three 00:00:16.929 --> 00:00:20.769 years in the making. Longtime listeners may recall 00:00:20.769 --> 00:00:24.489 Episode 7, The Wisdom of Interns. We sat down 00:00:24.489 --> 00:00:26.809 with a class of graduating interns right before 00:00:26.809 --> 00:00:30.160 they started as CA1s. They talked about emotional 00:00:30.160 --> 00:00:32.960 growth, leaning on the class above them, and 00:00:32.960 --> 00:00:35.880 learning how to tell sick from not sick. Then, 00:00:35.899 --> 00:00:39.479 in episode 21, The Wisdom of CA1s, we brought 00:00:39.479 --> 00:00:41.640 them back after their first clinical anesthesia 00:00:41.640 --> 00:00:44.619 year. That time, we heard about the first case 00:00:44.619 --> 00:00:46.840 where the attending walked out of the room, about 00:00:46.840 --> 00:00:49.119 borrowing a little bit of style from every faculty 00:00:49.119 --> 00:00:51.560 member they worked with, and about learning to 00:00:51.560 --> 00:00:55.020 roll with the punches. Today is the third installment 00:00:55.020 --> 00:00:58.210 from that same class. These residents have now 00:00:58.210 --> 00:01:01.429 finished CA2 year and are a few weeks into CA3. 00:01:02.310 --> 00:01:04.030 We're doing something a little different this 00:01:04.030 --> 00:01:06.890 time as a bonus. We're going to play back part 00:01:06.890 --> 00:01:09.549 of their intern episode and listen to their reactions. 00:01:10.750 --> 00:01:14.170 Without further ado, I bring you The Wisdom of 00:01:14.170 --> 00:01:20.769 CA2s. Thank you for staying a little bit later. 00:01:21.349 --> 00:01:25.010 No worries. I mean, it's almost 930. I know. 00:01:26.280 --> 00:01:32.599 It can't be too greedy. 9 .30 a .m. is a really 00:01:32.599 --> 00:01:35.099 late time for you to be leaving as a senior. 00:01:35.260 --> 00:01:37.859 I just want to make sure that we're not stressing 00:01:37.859 --> 00:01:39.859 you too much. I mean, I've already talked to 00:01:39.859 --> 00:01:43.920 HR about how this is unacceptable, but we can 00:01:43.920 --> 00:01:46.299 worry about that another day. It's Monday soon, 00:01:46.319 --> 00:01:49.959 isn't it? Pam on Mondays? Yeah, yeah. Okay. Just 00:01:49.959 --> 00:01:54.620 wanted to double check on that for you. Garrett, 00:01:54.680 --> 00:01:57.439 thank you so much for joining us today. Thanks 00:01:57.439 --> 00:02:00.680 for having me. You've done a couple of these 00:02:00.680 --> 00:02:04.120 so far. You've done the Wisdom of Interns episode 00:02:04.120 --> 00:02:07.500 and you've done the Wisdom of CA1s episode. And 00:02:07.500 --> 00:02:10.719 now this is the Wisdom of CA2 episode. So the 00:02:10.719 --> 00:02:13.840 thing that I want to ask you first is, what did 00:02:13.840 --> 00:02:19.060 you learn during your CA2 year? I think CA2 year, 00:02:19.180 --> 00:02:21.319 especially at this program, you really learn 00:02:21.319 --> 00:02:25.080 a lot. You learn to deal with, you know, the 00:02:25.080 --> 00:02:26.900 adversity that comes with anesthesia, but that's 00:02:26.900 --> 00:02:28.520 something that you're learning along the process 00:02:28.520 --> 00:02:31.319 of your entire residency. But during our CA2 00:02:31.319 --> 00:02:33.439 year with going to so many different locations 00:02:33.439 --> 00:02:36.919 and working with different attendings, I think 00:02:36.919 --> 00:02:39.939 I learned a lot about my actual anesthesia style 00:02:39.939 --> 00:02:44.699 and started developing my own anesthesia style. 00:02:45.500 --> 00:02:48.639 that I'm looking forward to as a CA3 and going 00:02:48.639 --> 00:02:50.479 to be doing more cases and becoming even more 00:02:50.479 --> 00:02:53.400 independent, being able to kind of tinker with 00:02:53.400 --> 00:02:58.699 and use and adjust as I am moving one step closer 00:02:58.699 --> 00:03:01.659 to being an attending. Is it easier to visualize 00:03:01.659 --> 00:03:03.520 the type of attending that you're going to be 00:03:03.520 --> 00:03:07.939 here shortly? I think in many ways, yes. I'm 00:03:07.939 --> 00:03:10.199 very comfortable with the anesthesia, but also 00:03:10.199 --> 00:03:13.620 now that I'm becoming a CA3 and doing some of 00:03:13.620 --> 00:03:16.960 the more attending focused rotations, pretending, 00:03:17.259 --> 00:03:21.379 doing the AOD rotation, seeing how much I don't 00:03:21.379 --> 00:03:23.419 know about those different roles. It's also kind 00:03:23.419 --> 00:03:26.400 of hard to see the steps that I need to make 00:03:26.400 --> 00:03:27.819 to become an attending, but I think that's still 00:03:27.819 --> 00:03:31.639 just the process of growing. I remember you as 00:03:31.639 --> 00:03:35.020 an intern, and you've always been an excellent 00:03:35.020 --> 00:03:37.419 resident in this program. What's the biggest 00:03:37.419 --> 00:03:40.819 difference between you as an intern and you now? 00:03:42.379 --> 00:03:49.539 I think... As an intern, I was portraying a lot 00:03:49.539 --> 00:03:51.840 of fake confidence because it helps the patients 00:03:51.840 --> 00:03:54.900 and it also, I feel like, helps the attendings 00:03:54.900 --> 00:03:57.139 trust you a little bit better. But I think that 00:03:57.139 --> 00:04:00.479 now that I'm a CA2, I have real confidence in 00:04:00.479 --> 00:04:04.379 my ability and in my anesthetics. And I know 00:04:04.379 --> 00:04:08.139 now that I know more, um, I realize how much 00:04:08.139 --> 00:04:11.020 I didn't know and still don't know. So I think 00:04:11.020 --> 00:04:15.219 that, um, whereas as an intern, you know, I portrayed 00:04:15.219 --> 00:04:17.060 confidence, but was a little bit scared about 00:04:17.060 --> 00:04:21.319 everything. I'm able to know what I should be 00:04:21.319 --> 00:04:24.920 scared of now. And I think I'm, um, more like 00:04:24.920 --> 00:04:28.139 cautious, but in a good way as a CA2 than I was 00:04:28.139 --> 00:04:32.060 as an intern. So. You feel like you've faked 00:04:32.060 --> 00:04:34.240 it and now you're getting ready to make it, I 00:04:34.240 --> 00:04:36.740 suppose? Yeah, I think that's a summary of what 00:04:36.740 --> 00:04:40.779 I just said, yeah. So you've worked with dozens 00:04:40.779 --> 00:04:43.800 of attendings in our residency who all do things 00:04:43.800 --> 00:04:47.980 in totally different ways. How are you deciding 00:04:47.980 --> 00:04:51.000 what parts of that you want to keep for your 00:04:51.000 --> 00:04:53.019 practice versus things that you might want to 00:04:53.019 --> 00:04:57.990 discard? That's hard. And working with a lot 00:04:57.990 --> 00:05:00.029 of different attendings here and at other institutions 00:05:00.029 --> 00:05:03.490 as we do our away rotations, I find that I really 00:05:03.490 --> 00:05:05.529 like trying to do things all different kinds 00:05:05.529 --> 00:05:07.550 of ways and do new things so I can see if I like 00:05:07.550 --> 00:05:10.589 them or see if I don't. A lot of it is from personal 00:05:10.589 --> 00:05:12.529 experience, like how did that anesthetic go? 00:05:12.649 --> 00:05:14.790 Is that something that I want to continue? Did 00:05:14.790 --> 00:05:17.230 it actually make a difference that I found tangible 00:05:17.230 --> 00:05:21.389 or that I saw for the patient? And then I'll 00:05:21.389 --> 00:05:23.410 start incorporating those things. And I also 00:05:23.410 --> 00:05:26.069 will lean on my mentors, attendings, and other 00:05:26.910 --> 00:05:29.430 residents in the program and ask them, you know, 00:05:29.449 --> 00:05:31.290 have they had similar experiences with these 00:05:31.290 --> 00:05:34.790 other methods or what they like to do and kind 00:05:34.790 --> 00:05:37.490 of use a little bit of all of that to see what 00:05:37.490 --> 00:05:41.250 I like and formulate my own style. Is there anything 00:05:41.250 --> 00:05:44.649 that you sort of thought about what this job 00:05:44.649 --> 00:05:46.709 would be or what your career would be like that 00:05:46.709 --> 00:05:51.149 you thought as an intern, but you think now might 00:05:51.149 --> 00:05:53.230 have been a little bit misguided or you've changed 00:05:53.230 --> 00:06:00.189 your mind about? I'm not sure. I think as an 00:06:00.189 --> 00:06:06.170 intern, I didn't fully conceptualize or understand 00:06:06.170 --> 00:06:10.170 all of the roles that an attending anesthesiologist 00:06:10.170 --> 00:06:14.750 really encompasses in their day to day. I think 00:06:14.750 --> 00:06:18.790 that as it was the next step in my learning to 00:06:18.790 --> 00:06:21.069 learn how to perform operating room anesthesia, 00:06:21.230 --> 00:06:24.569 I was kind of tunnel visioned on developing that 00:06:24.569 --> 00:06:30.139 aspect of my professional career, but I didn't 00:06:30.139 --> 00:06:33.980 realize all of the other things. For example, 00:06:33.980 --> 00:06:36.420 just running multiple different rooms, the interpersonal 00:06:36.420 --> 00:06:39.860 relationships and how important they are, the 00:06:39.860 --> 00:06:43.079 AOD work and board running and other aspects 00:06:43.079 --> 00:06:46.199 that an attending anesthesiologist performs. 00:06:46.399 --> 00:06:47.519 And I think that's something that I'm going to 00:06:47.519 --> 00:06:50.379 learn a lot more about this year. How does it 00:06:50.379 --> 00:06:53.879 feel to be closer and closer to ready to graduate? 00:06:56.830 --> 00:06:59.569 good in some ways and scary and others scary 00:06:59.569 --> 00:07:02.230 in ways that didn't used to be scary. But now 00:07:02.230 --> 00:07:04.610 that I'm, you know, thinking about those next 00:07:04.610 --> 00:07:06.670 steps and being an attending anesthesiologist 00:07:06.670 --> 00:07:10.870 and I know, you know, I'm happy to be starting 00:07:10.870 --> 00:07:14.110 my career here at UC where I know the support 00:07:14.110 --> 00:07:17.279 networks and. the people that I can always ask 00:07:17.279 --> 00:07:19.519 for help when I need, but just that additional 00:07:19.519 --> 00:07:22.079 level of independence is kind of scary to think 00:07:22.079 --> 00:07:24.040 about that I don't have an attending to call 00:07:24.040 --> 00:07:26.879 in the room. I'll still call the AOD or some 00:07:26.879 --> 00:07:29.759 of the other faculty, but I am the attending 00:07:29.759 --> 00:07:31.860 that gets called. So thinking about that's a 00:07:31.860 --> 00:07:35.579 little bit scary, but at the same time, it's 00:07:35.579 --> 00:07:39.980 exciting to almost be done. I'm going to play 00:07:39.980 --> 00:07:44.379 for you a clip of you as an intern. or having 00:07:44.379 --> 00:07:47.680 just graduated from your intern year and i'm 00:07:47.680 --> 00:07:50.220 going to be curious about your reaction to this 00:07:50.220 --> 00:07:55.720 hold on i'm interested too uh i'm garrett um 00:07:55.720 --> 00:07:58.939 a few things i learned from intern year it's 00:07:58.939 --> 00:08:00.740 hard because i learned a lot during intern year 00:08:00.740 --> 00:08:03.800 but something i think that helped me a lot and 00:08:03.800 --> 00:08:05.220 it's probably gonna help me going in the future 00:08:05.220 --> 00:08:09.290 is just trying to be kind to and You know, as 00:08:09.290 --> 00:08:11.329 friendly as you can with all of your co -residents, 00:08:11.529 --> 00:08:14.790 even if they're not in your own specialty, at 00:08:14.790 --> 00:08:17.730 the very least cordial. And also, even if it's 00:08:17.730 --> 00:08:19.970 like a rotation that you're not too excited to 00:08:19.970 --> 00:08:22.990 do, you know, trying to show up to work every 00:08:22.990 --> 00:08:26.370 day, eager to learn and eager to help the team 00:08:26.370 --> 00:08:30.189 as best you can. I feel like if you do that, 00:08:30.310 --> 00:08:32.730 then the people that you're working with, your 00:08:32.730 --> 00:08:36.590 seniors, your faculty, they kind of they notice 00:08:36.590 --> 00:08:39.919 that and. it provides you a lot more opportunity 00:08:39.919 --> 00:08:46.120 and it allows you to have, you know, a little 00:08:46.120 --> 00:08:49.879 bit more independence than if you're not showing 00:08:49.879 --> 00:08:52.200 up as eager to work. I've heard, you know, some 00:08:52.200 --> 00:08:55.919 seniors that say, you know, I was on these rotations 00:08:55.919 --> 00:08:57.500 I didn't really like, so I just tried to do the 00:08:57.500 --> 00:09:00.220 bare minimum. But if you're expected to go to 00:09:00.220 --> 00:09:03.200 work every day and you show up. giving your best, 00:09:03.259 --> 00:09:05.220 then it really gets noticed and it allows you 00:09:05.220 --> 00:09:07.679 to have more opportunities, more procedures, 00:09:08.019 --> 00:09:10.179 which is something that I really tried to do. 00:09:10.659 --> 00:09:13.220 When I was on my ICU rotations, they saw that 00:09:13.220 --> 00:09:16.559 I was a hard worker and they knew that I was 00:09:16.559 --> 00:09:19.019 interested in procedures and would seek me out 00:09:19.019 --> 00:09:20.360 if they knew there was something that I wanted 00:09:20.360 --> 00:09:23.899 to do because they valued the way that I presented 00:09:23.899 --> 00:09:25.940 myself on a day -to -day basis. So I think that 00:09:25.940 --> 00:09:28.600 that's something that was really valuable during 00:09:28.600 --> 00:09:30.580 my intern year and something that I would recommend 00:09:30.580 --> 00:09:34.799 doing for any incoming interns, regardless of 00:09:34.799 --> 00:09:36.200 the rotation that you're going to be a part of. 00:09:36.980 --> 00:09:39.139 So what do you think? What's your reaction to 00:09:39.139 --> 00:09:45.600 that? I forgot about 75 % of what I said. That 00:09:45.600 --> 00:09:49.620 was interesting to listen back to. I think that... 00:09:50.169 --> 00:09:52.110 Yeah, some of the things that I mentioned as 00:09:52.110 --> 00:09:54.590 far as coming in and treating people with kindness 00:09:54.590 --> 00:09:56.370 is something that's kind of a part of my character 00:09:56.370 --> 00:09:59.769 and always I try and do every day and give people 00:09:59.769 --> 00:10:02.649 the benefit of the doubt. But it was interesting 00:10:02.649 --> 00:10:05.570 towards the beginning, something that, you know, 00:10:05.570 --> 00:10:10.610 I feel maybe it's the senioritis and I'm always 00:10:10.610 --> 00:10:12.409 showing up to work. But something I could improve 00:10:12.409 --> 00:10:17.370 on is working on that eagerness to come in every 00:10:17.370 --> 00:10:20.100 day and continue learning. I feel like as an 00:10:20.100 --> 00:10:22.559 intern, that was something that I had more of 00:10:22.559 --> 00:10:24.740 than I do now. And it was interesting hearing 00:10:24.740 --> 00:10:28.120 me talk about that and maybe something I could 00:10:28.120 --> 00:10:33.480 improve on as I'm getting old and bitter. You 00:10:33.480 --> 00:10:38.580 don't strike me as one of our more bitter residents 00:10:38.580 --> 00:10:41.379 over the years. I've always thought you've come 00:10:41.379 --> 00:10:43.820 to work with a good attitude. Well, thank you. 00:10:44.559 --> 00:10:47.429 Lastly. I'm going to ask you the style points 00:10:47.429 --> 00:10:50.409 question. What style points or points of personal 00:10:50.409 --> 00:10:52.850 preference have brought you success in and out 00:10:52.850 --> 00:10:57.629 of the operating room? I think something that 00:10:57.629 --> 00:11:00.990 I may have said as a CA1 as well, but that I've 00:11:00.990 --> 00:11:05.090 tried to continue doing for every patient as 00:11:05.090 --> 00:11:08.309 I've progressed is when I'm thoughtfully developing 00:11:08.309 --> 00:11:13.539 the anesthetic plan for any patient. Not just 00:11:13.539 --> 00:11:15.340 doing things because that's how it's done here 00:11:15.340 --> 00:11:17.039 or doing things because that's like the routine, 00:11:17.299 --> 00:11:20.600 but actually trying to individualize and craft 00:11:20.600 --> 00:11:26.460 the best anesthetic for a person that I can. 00:11:28.139 --> 00:11:31.460 Treat them as if they're family, you know, as 00:11:31.460 --> 00:11:34.179 if it's your family member there. And, you know, 00:11:34.200 --> 00:11:35.899 focusing on patient -centered care and doing 00:11:35.899 --> 00:11:38.279 everything with a purpose is something that I'm 00:11:38.279 --> 00:11:40.879 being a little more thoughtful about as I'm continuing 00:11:40.879 --> 00:11:43.799 to learn. Thank you so much for joining us today. 00:11:44.059 --> 00:11:53.039 Absolutely. Thank you for having me. Are you 00:11:53.039 --> 00:12:00.000 ready to get started? Yeah, let's do it. Morgan, 00:12:00.240 --> 00:12:03.080 thank you for joining us. I'm excited to be here. 00:12:03.840 --> 00:12:07.799 So tell me, what did you learn during CA2 year? 00:12:09.080 --> 00:12:12.799 So I think the... biggest difference between 00:12:12.799 --> 00:12:18.799 CA1 me and CA2 is that I had a child. Is that 00:12:18.799 --> 00:12:21.879 why you weren't on the last episode? That is 00:12:21.879 --> 00:12:25.159 exactly why I wasn't on the last episode. We 00:12:25.159 --> 00:12:26.960 never got to making that up, but that's okay 00:12:26.960 --> 00:12:28.620 because I'm here now so we can talk about the 00:12:28.620 --> 00:12:33.639 whole experience. Yeah, so I spent most of CA1 00:12:33.639 --> 00:12:36.500 year pregnant, working through the challenges 00:12:36.500 --> 00:12:40.440 of that. including, you know, like thinking about 00:12:40.440 --> 00:12:43.460 where I was in the operating room, what cases 00:12:43.460 --> 00:12:46.559 I was assigned to, taking care of myself as well 00:12:46.559 --> 00:12:50.379 as my patients, trying to study for basic. It 00:12:50.379 --> 00:12:53.500 was a new adjustment. And I think the biggest 00:12:53.500 --> 00:12:56.639 thing I learned in CA2, I started the year, I 00:12:56.639 --> 00:13:01.220 got through most of the first rotation, most 00:13:01.220 --> 00:13:05.019 of July, and then I went out with my baby. And 00:13:05.019 --> 00:13:10.019 so I had this huge gap that allowed me time to 00:13:10.019 --> 00:13:12.740 take care of myself and my family and then also 00:13:12.740 --> 00:13:18.240 just see how my priorities changed a lot. And 00:13:18.240 --> 00:13:21.789 so CO2, I think I... learned a lot about how 00:13:21.789 --> 00:13:26.870 imposter syndrome works and working to overcome 00:13:26.870 --> 00:13:30.909 that and try to see myself in different lights, 00:13:31.029 --> 00:13:34.330 seeing that I am a mom on one side, that I'm 00:13:34.330 --> 00:13:36.529 also a resident on another side and how those 00:13:36.529 --> 00:13:39.570 two can mesh together at the same time and how 00:13:39.570 --> 00:13:44.429 that can help me take care of my patients. So 00:13:44.429 --> 00:13:51.779 it's been very interesting. It's separating my 00:13:51.779 --> 00:13:58.940 time out. And so in a lot of CA2, it became very 00:13:58.940 --> 00:14:01.539 clear to me that my time here needs to be completely 00:14:01.539 --> 00:14:06.139 focused on education and taking advantage of 00:14:06.139 --> 00:14:08.500 the times when my attendings are in the room, 00:14:08.620 --> 00:14:12.500 asking them lots of questions and trying to expand 00:14:12.500 --> 00:14:18.620 my knowledge from that perspective. And now as 00:14:18.620 --> 00:14:22.860 I start CA3, I can see. So in CA2, I think I 00:14:22.860 --> 00:14:28.779 missed out on a bit of being the senior for some 00:14:28.779 --> 00:14:31.399 of the juniors when they started out. And so 00:14:31.399 --> 00:14:33.740 I've gotten a lot more of that experience this 00:14:33.740 --> 00:14:35.539 year. So I've been taking advantage of that and 00:14:35.539 --> 00:14:38.559 seeing the things that I did in CA1 that I can 00:14:38.559 --> 00:14:43.539 prevent them from doing. honestly helping them 00:14:43.539 --> 00:14:46.879 like instill confidence in themselves. And when 00:14:46.879 --> 00:14:49.360 I get to help them out in cases, it helps me 00:14:49.360 --> 00:14:52.580 see the progress that I've made and the things 00:14:52.580 --> 00:14:55.879 that I can continue to improve upon. This is 00:14:55.879 --> 00:15:00.100 a big year. So you learned how to be a doctor 00:15:00.100 --> 00:15:03.620 and you also learned how to be a mom. Yeah. And 00:15:03.620 --> 00:15:06.100 how being a mom makes me a much better doctor, 00:15:06.179 --> 00:15:11.710 actually. Tell me more about that. Yeah, seeing 00:15:11.710 --> 00:15:14.610 before when I took care of patients, like I felt 00:15:14.610 --> 00:15:17.490 like I was seeing them for who they were. But 00:15:17.490 --> 00:15:20.809 now being a mom, I see them as if I was like 00:15:20.809 --> 00:15:25.710 if I were their parent and how much more terrifying 00:15:25.710 --> 00:15:29.269 it is, probably from their perspective, their 00:15:29.269 --> 00:15:31.549 family's perspective, and just trying to really 00:15:31.549 --> 00:15:35.370 take the time to talk with families and make 00:15:35.370 --> 00:15:39.879 a better connection pre -op. I think it was something 00:15:39.879 --> 00:15:42.039 that I thought that I was doing a good job before, 00:15:42.159 --> 00:15:47.240 but now I can see where taking the time when 00:15:47.240 --> 00:15:49.460 I first meet the patient to get to know them 00:15:49.460 --> 00:15:51.940 and to get to know their family and really dive 00:15:51.940 --> 00:15:54.500 into the things that they're nervous about can 00:15:54.500 --> 00:15:57.299 be helpful. And then when I'm in the OR, just 00:15:57.299 --> 00:16:00.379 it helps me talk to the patients a little bit 00:16:00.379 --> 00:16:01.980 better, especially before they're asleep, because 00:16:01.980 --> 00:16:03.399 that's always something that I feel like a lot 00:16:03.399 --> 00:16:06.779 of us are not comfortable with at the very start. 00:16:09.039 --> 00:16:12.039 Taking more time to like once the patient is 00:16:12.039 --> 00:16:14.679 asleep to double check my positioning of the 00:16:14.679 --> 00:16:18.120 patient, thinking more deeply about like, is 00:16:18.120 --> 00:16:20.220 this a comfortable position? Would I want to 00:16:20.220 --> 00:16:23.639 wake up with this tape all over my arm? Just 00:16:23.639 --> 00:16:26.039 different things like that and making sure that 00:16:26.039 --> 00:16:28.940 the patient is seen more as a complete human. 00:16:31.059 --> 00:16:34.139 So you feel like it unlocked basically a new 00:16:34.139 --> 00:16:37.259 level of empathy for you. Yeah. And with waking 00:16:37.259 --> 00:16:45.000 up patients, too, just being able to more. I 00:16:45.000 --> 00:16:48.299 don't really know what the what the correct words 00:16:48.299 --> 00:16:50.820 are for it, but like as I'm waking them up, I 00:16:50.820 --> 00:16:53.899 see them more as the patient who is being greatly 00:16:53.899 --> 00:16:56.679 influenced by this anesthesia, like not getting 00:16:56.679 --> 00:16:58.840 annoyed when the patient's thrashing around. 00:16:58.960 --> 00:17:00.860 Like, unfortunately, I kind of see them like 00:17:00.860 --> 00:17:05.440 a child waking up, seeing my child grow up like. 00:17:06.639 --> 00:17:12.099 She is the opposite of like a stroke patient, 00:17:12.240 --> 00:17:14.759 like a patient comes in, you know, they've lived 00:17:14.759 --> 00:17:16.319 their whole life. They've been normal. And then 00:17:16.319 --> 00:17:20.720 suddenly their neuro status is like completely 00:17:20.720 --> 00:17:22.740 reversed. Right. So I watched my kid like learn 00:17:22.740 --> 00:17:24.839 how to like she already knew how to breathe when 00:17:24.839 --> 00:17:26.900 she came out. Thank goodness. But she learned 00:17:26.900 --> 00:17:29.720 how to like use her arms. And then it was like 00:17:29.720 --> 00:17:32.420 continued to develop. I saw her like start to 00:17:32.420 --> 00:17:34.720 learn how to use her hands and her voice. And 00:17:34.720 --> 00:17:40.490 so. you can kind of just view it in the opposite 00:17:40.490 --> 00:17:42.109 light. Like patients coming out of anesthesia, 00:17:42.170 --> 00:17:44.470 like they're regaining all of their control of 00:17:44.470 --> 00:17:47.089 their bodies again. And so just trying to be 00:17:47.089 --> 00:17:49.670 empathetic when you do have like the patient 00:17:49.670 --> 00:17:53.690 that's thrashing or delirious and just taking 00:17:53.690 --> 00:17:55.750 them for what they are and helping them out again. 00:17:57.089 --> 00:18:00.089 I wonder if you'd be willing to listen to your 00:18:00.089 --> 00:18:04.289 Wisdom of Interns episode and hear what you had 00:18:04.289 --> 00:18:08.309 to say and see what you think. Sure. All right. 00:18:08.329 --> 00:18:11.529 I'm Morgan. A few things that I learned during 00:18:11.529 --> 00:18:15.390 intern year. One would be relying on the class 00:18:15.390 --> 00:18:18.329 above me, especially like asking questions when 00:18:18.329 --> 00:18:22.150 I felt like maybe things weren't going the way 00:18:22.150 --> 00:18:25.640 maybe I had expected. And that maybe my experiences 00:18:25.640 --> 00:18:28.819 weren't meeting what expectations that I had 00:18:28.819 --> 00:18:30.980 for that rotation. And so just reaching out and 00:18:30.980 --> 00:18:33.660 kind of getting advice or support, I felt like 00:18:33.660 --> 00:18:35.680 was really helpful and kind of put things into 00:18:35.680 --> 00:18:39.819 perspective. And then the other thing would be 00:18:39.819 --> 00:18:44.380 feeling as an intern that every time you got 00:18:44.380 --> 00:18:48.400 a call that you were expected to solve. the question 00:18:48.400 --> 00:18:51.900 that was presented to you and fixing all of your 00:18:51.900 --> 00:18:54.880 patient's problems, which is not possible at 00:18:54.880 --> 00:18:58.960 some times. And so one of the things would be 00:18:58.960 --> 00:19:01.619 some of the little recalls you'd get about like 00:19:01.619 --> 00:19:04.160 a patient having a little bit of like a headache 00:19:04.160 --> 00:19:07.859 or a little bit of stomach pain, something like 00:19:07.859 --> 00:19:10.839 that, that after asking all the important questions, 00:19:10.880 --> 00:19:12.599 making sure they didn't have any like red flag 00:19:12.599 --> 00:19:15.599 symptoms. Just asking the patients, you know, 00:19:15.619 --> 00:19:17.339 often they'd say like, yeah, I've had something 00:19:17.339 --> 00:19:20.599 like this before. And, you know, especially if 00:19:20.599 --> 00:19:22.259 it's like a headache, you could be like, well, 00:19:22.299 --> 00:19:24.119 what do you usually do when you get a headache? 00:19:24.440 --> 00:19:26.819 And sometimes they'd be like, I'll just like 00:19:26.819 --> 00:19:28.759 sleep it off and drink some water. And you can 00:19:28.759 --> 00:19:31.680 say, all right, let's try that first. You don't 00:19:31.680 --> 00:19:33.779 have to always give them Tylenol. Or if you do 00:19:33.779 --> 00:19:36.099 give them Tylenol, that might work and that might 00:19:36.099 --> 00:19:37.960 be fine. And you don't need to go further than 00:19:37.960 --> 00:19:41.200 that. And so it's okay to always just like take 00:19:41.200 --> 00:19:43.720 a step back and not fix everything right in the 00:19:43.720 --> 00:19:49.519 moment. So what's your reaction to that? I think 00:19:49.519 --> 00:19:54.180 it's just me on the flip side of it. Like before 00:19:54.180 --> 00:20:00.940 I felt like I was trying to know that I could 00:20:00.940 --> 00:20:05.799 rely on those above me and trying to instill 00:20:05.799 --> 00:20:08.240 that in. the people who are going to be the next 00:20:08.240 --> 00:20:12.599 interns. And I think that's still true. It's 00:20:12.599 --> 00:20:14.740 fun to be on a little bit of the opposite side 00:20:14.740 --> 00:20:17.000 of it. I'm still very reliant on my attendings 00:20:17.000 --> 00:20:22.079 at times. But being the CA3 who can now help 00:20:22.079 --> 00:20:25.519 the interns and help the CA1s, just trying to 00:20:25.519 --> 00:20:30.119 make sure that they feel the same psychological 00:20:30.119 --> 00:20:34.180 safety in their work. There have been a couple 00:20:34.180 --> 00:20:36.940 of times where I've... now been on elective and 00:20:36.940 --> 00:20:41.559 been asked to go help some of my younger co -residents 00:20:41.559 --> 00:20:45.079 and there was there's never a hesitation in me 00:20:45.079 --> 00:20:47.460 to to not go help them it's an immediate drop 00:20:47.460 --> 00:20:51.079 everything go help them teach them if there's 00:20:51.079 --> 00:20:54.079 something to be taught or rightly just point 00:20:54.079 --> 00:20:56.660 out yeah great job calling somebody you definitely 00:20:56.660 --> 00:21:00.220 need help in here this patient situation is more 00:21:00.220 --> 00:21:05.049 than your CA1 knowledge can usually hold. And 00:21:05.049 --> 00:21:07.890 so it's been really fun from that aspect. And 00:21:07.890 --> 00:21:11.369 I think just continuing along that path, starting 00:21:11.369 --> 00:21:14.690 CA3, there's definitely topics that I know that 00:21:14.690 --> 00:21:18.210 I want to work on, I want to get better at. When 00:21:18.210 --> 00:21:22.829 I am going to be on GA, handpicking the cases 00:21:22.829 --> 00:21:24.849 that I want to make sure that I'm good at so 00:21:24.849 --> 00:21:27.789 that when I'm attending, I've been faced with 00:21:27.789 --> 00:21:30.680 some of these difficult cases. know what to do, 00:21:30.839 --> 00:21:33.640 know what to even just resource later, because 00:21:33.640 --> 00:21:35.279 not everything's going to stick in my brain, 00:21:35.380 --> 00:21:37.400 but being able to develop a strong foundation 00:21:37.400 --> 00:21:41.500 now, I think will be really helpful. What are 00:21:41.500 --> 00:21:44.619 you most worried about or conversely excited 00:21:44.619 --> 00:21:48.960 about between here and graduation? I'm excited 00:21:48.960 --> 00:21:52.940 to see how everything I've learned so far comes 00:21:52.940 --> 00:21:57.259 together. At NCA2, we spend a lot of time at 00:21:57.259 --> 00:22:02.190 other rotations. We go to some outside hospitals. 00:22:02.589 --> 00:22:05.269 And so bringing back a lot of the things that 00:22:05.269 --> 00:22:08.130 I've learned from those places, creating the 00:22:08.130 --> 00:22:12.549 person that I want to be, creating the anesthesiologist 00:22:12.549 --> 00:22:16.369 that I want to be, continuing to learn from my 00:22:16.369 --> 00:22:19.650 attendings here and my co -residents. I'm just 00:22:19.650 --> 00:22:23.359 excited to see who I end up becoming. at the 00:22:23.359 --> 00:22:26.059 end of CA3, which is also terrifying, though, 00:22:26.079 --> 00:22:27.859 because it leads right into being an attending 00:22:27.859 --> 00:22:31.359 and being in charge of making those decisions. 00:22:31.740 --> 00:22:34.539 And so I'm very nervous about becoming attending 00:22:34.539 --> 00:22:37.759 someday very soon. But I'm trying to take that 00:22:37.759 --> 00:22:40.279 in the perspective of instead of being like scared 00:22:40.279 --> 00:22:41.920 about it and nervous about it and not wanting 00:22:41.920 --> 00:22:45.599 to do it, instead developing what I can now while 00:22:45.599 --> 00:22:49.160 I have extra support around me and just try to 00:22:49.160 --> 00:22:54.730 nail down some more things. Yeah. Lastly, what 00:22:54.730 --> 00:22:57.170 style points or points of personal preference 00:22:57.170 --> 00:22:59.630 have brought you success in and out of the operating 00:22:59.630 --> 00:23:05.809 room? I'd say like in the operating room, the 00:23:05.809 --> 00:23:08.130 things, you know, I feel like I can recognize 00:23:08.130 --> 00:23:10.309 when there's an emergency, when there's not an 00:23:10.309 --> 00:23:12.529 emergency. I know when to ask for help, when 00:23:12.529 --> 00:23:15.970 to not ask for help and not being afraid to just 00:23:15.970 --> 00:23:17.410 ask for help and then not needing it, which is 00:23:17.410 --> 00:23:24.420 always the best situation. But I think. especially 00:23:24.420 --> 00:23:27.019 being in an academic setting where you're doing 00:23:27.019 --> 00:23:31.779 procedures on patients who are not the average 00:23:31.779 --> 00:23:34.559 patient, who have maybe had some other complications, 00:23:34.619 --> 00:23:37.619 things that complicate your ability to do like 00:23:37.619 --> 00:23:41.119 a normal central line or an arterial line when 00:23:41.119 --> 00:23:43.799 they've already had so many and the same admission, 00:23:43.940 --> 00:23:48.700 is trying to set yourself up for success. And 00:23:48.700 --> 00:23:50.799 feeling confident before starting the procedure. 00:23:51.160 --> 00:23:53.700 Anytime I have started the procedure and not 00:23:53.700 --> 00:23:57.500 felt confident that I can do it, it doesn't go 00:23:57.500 --> 00:24:01.079 well. I nine times out of 10 fail in that experience. 00:24:01.420 --> 00:24:04.720 And so at that point, just asking the people 00:24:04.720 --> 00:24:08.880 around you to maybe double check your work before 00:24:08.880 --> 00:24:12.380 you get started or just ask like literally earlier 00:24:12.380 --> 00:24:16.420 today, I was helping a case get started and I 00:24:16.420 --> 00:24:18.430 was going to do an IV, something that. is very 00:24:18.430 --> 00:24:21.509 simple to me at this point as a CA3, but I looked 00:24:21.509 --> 00:24:23.289 at my colleague and I was like, do you think 00:24:23.289 --> 00:24:25.869 I can put an 18 or a 16 in that? I think that's 00:24:25.869 --> 00:24:27.589 an 18 and I should get an ultrasound for the 00:24:27.589 --> 00:24:30.029 16. And they're like, I agree. I'm like, great. 00:24:30.650 --> 00:24:33.390 So we, we also need an 18. So I put in the 18 00:24:33.390 --> 00:24:35.490 there and then I went to the other side and got 00:24:35.490 --> 00:24:38.630 in the 16, but it was like, I didn't feel quite 00:24:38.630 --> 00:24:42.200 confident. And I knew that I wasn't going to 00:24:42.200 --> 00:24:44.180 succeed if I probably would have put that 16 00:24:44.180 --> 00:24:46.200 in there and I would have blown a vein and needed 00:24:46.200 --> 00:24:49.900 to then do two more IV pokes. And so I think 00:24:49.900 --> 00:24:52.839 just helping myself try to find that confidence 00:24:52.839 --> 00:24:55.180 in doing my own procedures, but then translating 00:24:55.180 --> 00:25:00.160 that to those that are going to be younger than 00:25:00.160 --> 00:25:03.839 me. And like this weekend, I worked with one 00:25:03.839 --> 00:25:07.750 of our CA1s and they were. quite nervous before 00:25:07.750 --> 00:25:10.150 they were going to do an arterial line. And I 00:25:10.150 --> 00:25:12.190 just looked at them and I was like, yeah, I've 00:25:12.190 --> 00:25:15.509 been there. I have had those same feelings. And 00:25:15.509 --> 00:25:17.769 so I was like, let's take a second. And they 00:25:17.769 --> 00:25:19.509 were like looking around like, what's going on? 00:25:19.650 --> 00:25:21.970 And I was like, I just wanted you to take a breath. 00:25:22.109 --> 00:25:23.730 Like, you ready to do this? And they're like, 00:25:23.849 --> 00:25:27.750 yeah. You could just see, you could just see 00:25:27.750 --> 00:25:30.349 them relax a little bit that I was like, okay, 00:25:30.369 --> 00:25:32.309 and now we're going to do it. And then they crushed 00:25:32.309 --> 00:25:37.210 it. So it was great. Morgan, thank you so much 00:25:37.210 --> 00:25:39.390 for joining us. Thanks. Thanks for having me. 00:25:45.450 --> 00:25:50.210 Okay, you ready to get started? Yeah. AJ, thank 00:25:50.210 --> 00:25:53.809 you for joining us. Thank you for having me again. 00:25:55.289 --> 00:25:59.089 So tell me, what did you learn during your CA2 00:25:59.089 --> 00:26:03.890 year? CA2 year is a lot. It's more responsibility 00:26:03.890 --> 00:26:07.089 as a resident. You're no longer a CA1, so you 00:26:07.089 --> 00:26:10.410 are entrusted to do bigger cases. You're entrusted 00:26:10.410 --> 00:26:12.509 to do lines with a little bit less supervision 00:26:12.509 --> 00:26:14.890 where the attending doesn't have gloves on supervising 00:26:14.890 --> 00:26:18.789 you the whole time. So I think the big thing 00:26:18.789 --> 00:26:21.329 that was learning and starting to learn is just 00:26:21.329 --> 00:26:23.890 accepting more responsibility, taking on bigger 00:26:23.890 --> 00:26:26.450 roles, whether that be on call, holding the phone, 00:26:26.549 --> 00:26:28.650 holding the pager, doing the consult yourself, 00:26:29.089 --> 00:26:33.049 or stepping up and asking to do cases. Because 00:26:33.049 --> 00:26:35.450 as a CA1, you're just... kind of drinking out 00:26:35.450 --> 00:26:38.049 of a fire fire hose early where you're just trying 00:26:38.049 --> 00:26:40.390 to learn the basics of anesthesia and you're 00:26:40.390 --> 00:26:43.170 put in whatever case is assigned to you but once 00:26:43.170 --> 00:26:44.829 you get a good feel for what's happening i think 00:26:44.829 --> 00:26:46.769 you have the opportunity to kind of start requesting 00:26:46.769 --> 00:26:50.849 cases um and start trying a little bit different 00:26:50.849 --> 00:26:53.069 things like by the end of ca1 you understand 00:26:53.069 --> 00:26:55.569 how to do like a mac case but maybe trying something 00:26:55.569 --> 00:26:58.569 different or a different medication or Being 00:26:58.569 --> 00:27:00.990 more open to asking questions about what is an 00:27:00.990 --> 00:27:03.230 attending like to do for specific things versus 00:27:03.230 --> 00:27:07.069 like, how do I do this? So what do you think 00:27:07.069 --> 00:27:10.150 the biggest differences between the intern version 00:27:10.150 --> 00:27:13.890 of you and the you sitting here now? I think 00:27:13.890 --> 00:27:19.309 confidence is the big thing. And early on, because 00:27:19.309 --> 00:27:21.809 knowledge comes with time. We are in a field 00:27:21.809 --> 00:27:24.920 where you gain. lots of experience. And through 00:27:24.920 --> 00:27:26.619 that experience, you get more comfortable. And 00:27:26.619 --> 00:27:28.079 then as you get more comfortable, your skills 00:27:28.079 --> 00:27:32.640 improve. But having the confidence, one to step 00:27:32.640 --> 00:27:35.440 up and do things as well as to ask questions. 00:27:35.740 --> 00:27:38.380 I know there's a lot of times where you may have 00:27:38.380 --> 00:27:41.039 questions, you might not even know what questions 00:27:41.039 --> 00:27:44.019 you have, because you aren't aware. But at this 00:27:44.019 --> 00:27:46.480 point, I think I'm very comfortable and confident 00:27:46.480 --> 00:27:49.599 in my own abilities to just stop at any point 00:27:49.599 --> 00:27:51.910 to ask like, Why did you do this? Or how do you 00:27:51.910 --> 00:27:55.130 like to induce for a patient with specific hemodynamic 00:27:55.130 --> 00:28:00.170 things? So I think that's a big part of it. I'd 00:28:00.170 --> 00:28:03.049 like, with your permission, to play a bit of 00:28:03.049 --> 00:28:06.210 your Wisdom of Interns episode. And I'd be curious 00:28:06.210 --> 00:28:08.109 to hear your reaction. I'm excited to see what 00:28:08.109 --> 00:28:11.130 that version of me had to say. So my name is 00:28:11.130 --> 00:28:14.910 AJ Pagan. And some things I learned about intern 00:28:14.910 --> 00:28:18.960 year. I think really investing in your intern 00:28:18.960 --> 00:28:22.359 class is really important. We had a unique experience 00:28:22.359 --> 00:28:25.380 where we had six people from where I went to 00:28:25.380 --> 00:28:28.599 med school, UC, join our class. I wasn't necessarily 00:28:28.599 --> 00:28:31.440 friends with them in medical school, but starting 00:28:31.440 --> 00:28:35.579 residency, we've gotten very close. And I think 00:28:35.579 --> 00:28:37.500 that's been a great experience for all of us. 00:28:37.759 --> 00:28:41.319 And getting close, we've kind of built this friendship. 00:28:42.069 --> 00:28:44.930 past just colleagues. We do lots of things together. 00:28:45.230 --> 00:28:47.910 And then I think it extends into work where we're 00:28:47.910 --> 00:28:50.289 always willing to help each other out, whether 00:28:50.289 --> 00:28:52.049 that be on like an internal medicine rotation 00:28:52.049 --> 00:28:54.869 or someone's getting swamped in the OR when we're 00:28:54.869 --> 00:28:56.750 on anesthesia and we know that you're having 00:28:56.750 --> 00:28:59.049 trouble setting up a room or something. And I 00:28:59.049 --> 00:29:00.890 think just taking that extra step to get to know 00:29:00.890 --> 00:29:04.289 each other goes a long way, both like academically 00:29:04.289 --> 00:29:07.549 in your career and then outside of work. It's 00:29:07.549 --> 00:29:09.410 always good to have a lot of new friends wherever 00:29:09.410 --> 00:29:12.950 you're moving to. OK, so what's your reaction 00:29:12.950 --> 00:29:17.509 to that? Pretty good answer. I think just kind 00:29:17.509 --> 00:29:20.630 of stemming off that culture is everything. And 00:29:20.630 --> 00:29:23.130 when you train and then when you go on to practice 00:29:23.130 --> 00:29:27.150 is like establishing a culture of like it's a 00:29:27.150 --> 00:29:29.269 team effort. We always say it. You're going to 00:29:29.269 --> 00:29:31.710 hear it throughout any program or anywhere you 00:29:31.710 --> 00:29:35.390 train, anywhere you interview. But actually having 00:29:35.390 --> 00:29:38.349 a culture of cohesiveness and where everyone 00:29:38.349 --> 00:29:41.950 works together. And when you ask for help, you 00:29:41.950 --> 00:29:44.029 don't just get one person. You get a whole team 00:29:44.029 --> 00:29:46.269 of people to come help you. And I think that's 00:29:46.269 --> 00:29:48.869 something that our class, I mean, classes before 00:29:48.869 --> 00:29:51.690 us obviously established and passed it down to 00:29:51.690 --> 00:29:54.690 us. But it's something now as CA3s and, you know, 00:29:54.690 --> 00:29:57.670 being with the new CA1s in the OR and then when 00:29:57.670 --> 00:30:00.529 the new interns come by for their anesthesia 00:30:00.529 --> 00:30:03.109 rotations, just emphasizing on what we do here 00:30:03.109 --> 00:30:06.049 and what we do well here is the culture and how 00:30:06.049 --> 00:30:09.089 if an emergency comes up or you have a question, 00:30:09.599 --> 00:30:12.900 All of our phones are going off and there are 00:30:12.900 --> 00:30:14.720 so many people that are coming almost too much 00:30:14.720 --> 00:30:16.559 help when there's like five or six residents 00:30:16.559 --> 00:30:21.059 show up when someone asks for help. I think that 00:30:21.059 --> 00:30:23.980 it was really interesting hearing you talk about 00:30:23.980 --> 00:30:27.839 putting your efforts and focus back in your classmates. 00:30:28.140 --> 00:30:33.539 And now you're one of our chief residents. Could 00:30:33.539 --> 00:30:38.869 you reflect on how. focusing on your classmates 00:30:38.869 --> 00:30:44.509 transitioned into leadership? Yeah, I think whenever 00:30:44.509 --> 00:30:46.589 you start investing in people and you starting 00:30:46.589 --> 00:30:50.069 to get to learn more of the surface level, like 00:30:50.069 --> 00:30:52.910 how I mentioned there, it goes a long way in 00:30:52.910 --> 00:30:55.630 terms of just understanding the way they take 00:30:55.630 --> 00:30:57.849 in like their why. I think that is like a big 00:30:57.849 --> 00:30:59.549 thing in medicine. Big thing in anyone's career 00:30:59.549 --> 00:31:01.650 is like understanding the why and why you're 00:31:01.650 --> 00:31:03.430 interested in this, why you decided Cincinnati, 00:31:03.710 --> 00:31:06.319 why you're interested in. specific fellowship, 00:31:06.539 --> 00:31:08.839 because you really just get to learn more about 00:31:08.839 --> 00:31:11.180 that person. And then taking that the step forward 00:31:11.180 --> 00:31:14.940 is in the chief role is, you know, now that I 00:31:14.940 --> 00:31:17.000 understand more and more about the class more 00:31:17.000 --> 00:31:19.519 there, you can have more individual conversations. 00:31:20.359 --> 00:31:23.220 And you're more comfortable discussing like harder 00:31:23.220 --> 00:31:27.140 topics. Like, if, like, we have to change call, 00:31:27.299 --> 00:31:29.880 for example, I feel very comfortable now going 00:31:29.880 --> 00:31:31.859 up to one of my, honestly, friends at all at 00:31:31.859 --> 00:31:34.059 this point, and saying, like, this is a scenario 00:31:34.059 --> 00:31:36.789 and I was very open early on and we had such 00:31:36.789 --> 00:31:39.869 an open relationship that now it's much easier 00:31:39.869 --> 00:31:41.869 to have difficult conversations. And I think 00:31:41.869 --> 00:31:43.869 that'll be something that I do moving forward. 00:31:45.730 --> 00:31:50.470 What's something that as an intern, you had a 00:31:50.470 --> 00:31:53.150 concept of, but turned out to be completely different 00:31:53.150 --> 00:31:56.890 or that you've changed your mind about? That's 00:31:56.890 --> 00:32:07.119 a good question. I think. I think early on intern 00:32:07.119 --> 00:32:12.460 year, something that I had questions on or something 00:32:12.460 --> 00:32:15.819 that I thought that was very important and necessary 00:32:15.819 --> 00:32:19.259 at the time was like procedures and doing well 00:32:19.259 --> 00:32:21.599 in those. And I always thought that like your 00:32:21.599 --> 00:32:24.700 procedural competence related to like your intelligence. 00:32:24.740 --> 00:32:28.559 And if you didn't get the IV or you. Didn't get 00:32:28.559 --> 00:32:31.779 the airway perfectly or your line didn't go completely 00:32:31.779 --> 00:32:34.539 according to plan. You thought the entire case 00:32:34.539 --> 00:32:38.400 was a disaster. And in the grand scheme of things, 00:32:38.559 --> 00:32:40.279 like you're attending or you're seeing your resident 00:32:40.279 --> 00:32:42.440 probably doesn't even remember that because it's 00:32:42.440 --> 00:32:44.400 the first couple of minutes of the case. And 00:32:44.400 --> 00:32:47.420 then you just go ahead and did this bigger case 00:32:47.420 --> 00:32:49.119 or any case that went completely according to 00:32:49.119 --> 00:32:51.940 plan. But all you could fixate on is this one 00:32:51.940 --> 00:32:54.779 little aspect of the case didn't go well. And 00:32:54.779 --> 00:32:57.420 early on, I. It was pretty hard on myself, I 00:32:57.420 --> 00:32:59.880 feel like, to be perfect when it came to that, 00:33:00.000 --> 00:33:02.539 which, I mean, no one will be. Like, why would 00:33:02.539 --> 00:33:04.460 you be good at lines when you've never done one 00:33:04.460 --> 00:33:07.200 in an intern year you're not around? Especially 00:33:07.200 --> 00:33:08.799 on internal medicine, you don't have the opportunity 00:33:08.799 --> 00:33:11.720 to, you know, practice your skills. And then 00:33:11.720 --> 00:33:13.980 coming to realize now and something I tell the 00:33:13.980 --> 00:33:16.259 juniors when I'm doing stuff is no one will remember 00:33:16.259 --> 00:33:17.819 this. I know you're going to be hard on this 00:33:17.819 --> 00:33:20.859 on yourself, but talk with the senior resident 00:33:20.859 --> 00:33:23.119 and be open because, I mean, I'm open about how, 00:33:23.180 --> 00:33:26.549 like, early on I struggled with. specific things 00:33:26.549 --> 00:33:29.750 and now they come pretty easily so and then just 00:33:29.750 --> 00:33:31.869 being able to kind of laugh at yourself when 00:33:31.869 --> 00:33:34.309 you can look back and say I wasn't good at this 00:33:34.309 --> 00:33:37.210 or I did this mistake and now I get to teach 00:33:37.210 --> 00:33:41.630 about it what are you excited about or worried 00:33:41.630 --> 00:33:47.250 about between now and graduation I'm excited 00:33:47.250 --> 00:33:51.440 to do To kind of just build upon things and have 00:33:51.440 --> 00:33:54.259 like more open conversations with staff about 00:33:54.259 --> 00:33:56.460 like little nuancy things that people like to 00:33:56.460 --> 00:34:00.539 do. I think at this part I am comfortable doing, 00:34:00.559 --> 00:34:03.880 you know, a very general case. And now it's just 00:34:03.880 --> 00:34:07.220 kind of picking the brain of the supervisor to 00:34:07.220 --> 00:34:09.380 say, like, what do you like to do in specific 00:34:09.380 --> 00:34:13.599 scenarios? Because I know I've heard from lots 00:34:13.599 --> 00:34:15.460 of people that first year of attending SHIP is. 00:34:16.329 --> 00:34:18.250 Even worse than your first year or like your 00:34:18.250 --> 00:34:20.630 CA1 year when you're just experiencing so many 00:34:20.630 --> 00:34:22.050 different things that you haven't seen before. 00:34:22.250 --> 00:34:25.530 So just trying to pick their brains on things 00:34:25.530 --> 00:34:27.989 that they experienced as a first year or like 00:34:27.989 --> 00:34:32.210 a relatively new staff. So you can be kind of 00:34:32.210 --> 00:34:35.110 ready for all the different things that pop up 00:34:35.110 --> 00:34:38.710 as an attending. Lastly, can you tell me about 00:34:38.710 --> 00:34:41.010 your style points or points of personal preference 00:34:41.010 --> 00:34:42.769 that have brought you success in and out of the 00:34:42.769 --> 00:34:48.880 operating room? So early on, I focused on understanding 00:34:48.880 --> 00:34:51.760 kind of the surgery around the case. So you can 00:34:51.760 --> 00:34:53.639 kind of get your timing and cadence right when 00:34:53.639 --> 00:34:57.099 it comes to like your anesthetic. So early on, 00:34:57.119 --> 00:34:59.800 I would if I had just something simple like a 00:34:59.800 --> 00:35:02.420 gallbladder, like just understanding how they 00:35:02.420 --> 00:35:04.599 do the procedure. So when they're at X, Y, Z 00:35:04.599 --> 00:35:07.139 step, you can anticipate where to go now. And 00:35:07.139 --> 00:35:09.019 that's something I've kind of take moving forward. 00:35:09.909 --> 00:35:12.429 And then the bigger thing I've done now that 00:35:12.429 --> 00:35:14.650 I tell everyone to do is you have to have active 00:35:14.650 --> 00:35:17.550 reflection time. Because going back to what I 00:35:17.550 --> 00:35:21.250 said is we are really good at emphasizing the 00:35:21.250 --> 00:35:24.329 little things that went wrong. But if you just 00:35:24.329 --> 00:35:28.550 did a 10 -hour liver transplant and all you could 00:35:28.550 --> 00:35:31.250 remember is your central line wasn't great, that 00:35:31.250 --> 00:35:34.070 was a pretty good case. And so taking the time 00:35:34.070 --> 00:35:36.889 to think of... what did I do that went well? 00:35:36.969 --> 00:35:38.969 What did I do that I could improve on? And then 00:35:38.969 --> 00:35:41.010 like, what will I learn moving forward? And like 00:35:41.010 --> 00:35:43.909 physically saying these things out loud help 00:35:43.909 --> 00:35:47.769 you think of to kind of get away of like the 00:35:47.769 --> 00:35:49.849 possible one little hiccup that happened. And 00:35:49.849 --> 00:35:51.750 then the rest of the case went completely fine. 00:35:53.269 --> 00:35:55.409 AJ, thank you so much for joining us. Thank you 00:35:55.409 --> 00:36:03.750 for having me. Brian, thank you so much for joining 00:36:03.750 --> 00:36:08.539 us. Thank you. So first things first, what did 00:36:08.539 --> 00:36:14.280 you learn during your CA2 year? I feel like CA2 00:36:14.280 --> 00:36:17.599 year, at least for us here, is a good opportunity 00:36:17.599 --> 00:36:20.280 to go to a variety of different health systems 00:36:20.280 --> 00:36:23.460 and different anesthesia environments and just 00:36:23.460 --> 00:36:26.599 learning the subtle things that are different 00:36:26.599 --> 00:36:28.199 in each of those locations, whether it's at a 00:36:28.199 --> 00:36:31.039 different hospital, if it's at children's, working 00:36:31.039 --> 00:36:34.340 with kids. doing more ambulatory work. It's just 00:36:34.340 --> 00:36:37.880 sort of our year that we get out of the regular 00:36:37.880 --> 00:36:44.500 OR here at UC and see everything else. So there's 00:36:44.500 --> 00:36:47.199 probably a different guy sitting in front of 00:36:47.199 --> 00:36:49.320 me now than was sitting in front of me a couple 00:36:49.320 --> 00:36:52.380 years ago. And I'm curious, what's the difference? 00:36:52.920 --> 00:37:01.230 How have you changed? I don't know. I certainly 00:37:01.230 --> 00:37:04.690 feel like, at least within anesthesia, I try 00:37:04.690 --> 00:37:08.250 to just be much calmer than maybe I was starting 00:37:08.250 --> 00:37:13.789 off. Early on, the little things seem big and 00:37:13.789 --> 00:37:16.329 bad, and then eventually you feel like you've 00:37:16.329 --> 00:37:19.210 seen a variety and you can kind of come with 00:37:19.210 --> 00:37:21.750 a clearer headspace to when problems arise in 00:37:21.750 --> 00:37:25.650 the OR. You've worked with a bunch of attendings 00:37:25.650 --> 00:37:30.110 over time. Some attendings, I'm sure you've learned 00:37:30.110 --> 00:37:33.150 stuff that you want to keep. Other attendings, 00:37:33.150 --> 00:37:35.469 there's probably stuff that you want to discard. 00:37:35.929 --> 00:37:39.210 How do you keep that straight? What do you think 00:37:39.210 --> 00:37:43.590 is your methodology for deciding what you want 00:37:43.590 --> 00:37:46.650 to keep? I'm always open to trying new things 00:37:46.650 --> 00:37:48.670 when there's an attending that wants to show 00:37:48.670 --> 00:37:52.730 me something new. I think what I decide to keep 00:37:52.730 --> 00:37:54.789 versus just disregard if someone's showing me 00:37:54.789 --> 00:37:59.329 something is often if there's... a logic or basis 00:37:59.329 --> 00:38:01.989 behind it i tend to adopt it more readily versus 00:38:01.989 --> 00:38:05.449 the i got burned once attitude where it may have 00:38:05.449 --> 00:38:09.349 happened one time and if they think that a certain 00:38:09.349 --> 00:38:11.670 intervention or doing something differently would 00:38:11.670 --> 00:38:13.969 have changed that a lot of times it probably 00:38:13.969 --> 00:38:17.489 wouldn't have but um when that's kind of the 00:38:17.489 --> 00:38:19.690 mentality i tend to not hold on to it as much 00:38:19.690 --> 00:38:21.250 um and i feel like when they're explaining why 00:38:21.250 --> 00:38:24.750 they do certain things they can kind of they 00:38:24.750 --> 00:38:28.559 kind of know whether which uh which realm they 00:38:28.559 --> 00:38:32.199 fall into what do you do with situations where 00:38:32.199 --> 00:38:39.280 you've been burned once uh i i usually try not 00:38:39.280 --> 00:38:41.800 to deviate too much i just try to keep things 00:38:41.800 --> 00:38:44.880 the same unless there's a clear like flaw leading 00:38:44.880 --> 00:38:47.099 to it but if it's just like oh this bad thing 00:38:47.099 --> 00:38:52.449 happened and it I don't know. I'm sure I'm adopting 00:38:52.449 --> 00:38:54.429 some things where I got burned once. I'm doing 00:38:54.429 --> 00:38:57.590 it differently now. But in my mind, I don't think 00:38:57.590 --> 00:39:02.869 I'm doing it. There's probably some name for 00:39:02.869 --> 00:39:08.969 that effect. Yeah. Willfully ignoring it. I am 00:39:08.969 --> 00:39:13.070 going to have you listen briefly to the things 00:39:13.070 --> 00:39:15.150 that you learned during intern year. And then 00:39:15.150 --> 00:39:17.530 I'm curious what your reaction will be to that. 00:39:19.299 --> 00:39:23.139 I am Brian Upton. I think the biggest things 00:39:23.139 --> 00:39:24.980 I learned from intern year is just how quickly 00:39:24.980 --> 00:39:28.599 you progress. So I think everyone starts off 00:39:28.599 --> 00:39:31.820 pretty timid and uncomfortable with the amount 00:39:31.820 --> 00:39:33.659 of knowledge that they have. But kind of there's 00:39:33.659 --> 00:39:37.099 a point through intern year where all of a sudden 00:39:37.099 --> 00:39:38.980 things just make sense. All of your training 00:39:38.980 --> 00:39:42.420 kind of kicks in and things just start flowing. 00:39:42.559 --> 00:39:43.820 And I think that's when a lot of people really 00:39:43.820 --> 00:39:44.940 feel like they're getting into their rhythm. 00:39:45.659 --> 00:39:47.460 So that was something I didn't quite expect. 00:39:47.800 --> 00:39:50.019 I think for me, it came out of after doing one 00:39:50.019 --> 00:39:52.219 of the ICU rotations, I came back to the floor 00:39:52.219 --> 00:39:55.099 and like everything just seemed simpler after 00:39:55.099 --> 00:39:57.780 that. I think a combination of having some ICU 00:39:57.780 --> 00:40:00.159 experience, seeing sort of what the the edges 00:40:00.159 --> 00:40:02.739 of physiology could be and then bringing it back 00:40:02.739 --> 00:40:05.619 to patients that aren't to that extreme. And 00:40:05.619 --> 00:40:07.599 it just kind of put everything in perspective 00:40:07.599 --> 00:40:11.500 and was easier to manage at that point. So what 00:40:11.500 --> 00:40:15.840 do you think? Yeah, I. still agree with everything 00:40:15.840 --> 00:40:19.099 i said uh i actually think it continues on though 00:40:19.099 --> 00:40:22.139 like beyond engineer just things uh you know 00:40:22.139 --> 00:40:24.440 again once you get into anesthesia then it's 00:40:24.440 --> 00:40:26.320 you know the things once you start seeing a number 00:40:26.320 --> 00:40:29.400 of times i feel like you get to a point that 00:40:29.400 --> 00:40:32.900 kind of it again it clicks you start seeing sort 00:40:32.900 --> 00:40:35.360 of through everything in the bigger picture of 00:40:35.360 --> 00:40:39.059 what's going on in the or um you know probably 00:40:39.059 --> 00:40:43.139 happens sometimes later in ca1 year uh but a 00:40:43.139 --> 00:40:48.199 similar perspective on just how the year unfolds 00:40:48.199 --> 00:40:49.940 where you get comfortable with what you're doing. 00:40:51.400 --> 00:40:55.300 What are you looking forward to between now and 00:40:55.300 --> 00:40:58.699 graduation, which is just in a few short months, 00:40:58.719 --> 00:41:01.320 it feels like? I mean, for the most part, I'm 00:41:01.320 --> 00:41:03.579 enjoying what I'm doing. I'm just keeping on. 00:41:04.260 --> 00:41:06.579 I'm doing fellowship next year. So looking forward 00:41:06.579 --> 00:41:08.500 to sort of moving on to that next chapter. So 00:41:08.500 --> 00:41:11.190 I've got a few. rotations this year that I'll 00:41:11.190 --> 00:41:15.550 be doing in the more peds realm to try to better 00:41:15.550 --> 00:41:17.510 prepare myself for the start of my fellowship 00:41:17.510 --> 00:41:24.289 year. So lastly, what style points or points 00:41:24.289 --> 00:41:26.329 of personal preference have brought you success 00:41:26.329 --> 00:41:29.710 both in and out of the operating room? I think 00:41:29.710 --> 00:41:32.389 just trying to have a rhythm with things that 00:41:32.389 --> 00:41:35.449 you do, whether it's talking to all the pre -ops. 00:41:35.949 --> 00:41:38.469 Roughly the same way, asking the same questions 00:41:38.469 --> 00:41:41.389 in the same order. When you set up for a procedure 00:41:41.389 --> 00:41:44.929 or for induction, having the same checklist when 00:41:44.929 --> 00:41:47.949 you're getting to time to extubate. Again, having 00:41:47.949 --> 00:41:52.230 a set standardized way to approach it. I've tried 00:41:52.230 --> 00:41:54.889 to hammer down my routines that way, and I feel 00:41:54.889 --> 00:41:57.349 like when things get chaotic, you just fall back 00:41:57.349 --> 00:42:01.050 to what you know and that order of things, and 00:42:01.050 --> 00:42:03.949 you tend not to forget things when you do it 00:42:03.949 --> 00:42:07.289 that way. Brian, thank you so much for joining 00:42:07.289 --> 00:42:16.389 us. Thank you. Nate, thank you for joining us. 00:42:16.769 --> 00:42:20.030 Thank you for having me. So tell me, what did 00:42:20.030 --> 00:42:25.610 you learn during your CA2 year? So much. It's 00:42:25.610 --> 00:42:27.929 actually a great question because reflecting 00:42:27.929 --> 00:42:29.809 on it, I think it probably went by the fastest. 00:42:30.170 --> 00:42:33.280 Really? For me, at least. I think a big part 00:42:33.280 --> 00:42:35.179 of that had to do with a lot of the external 00:42:35.179 --> 00:42:38.519 rotations we did, the wide diversity and variety 00:42:38.519 --> 00:42:41.880 of cases we did, as well as applying and going 00:42:41.880 --> 00:42:44.940 through the fellowship process, which felt really 00:42:44.940 --> 00:42:47.960 early, especially now post -match with a year 00:42:47.960 --> 00:42:52.739 of residency left to go. And so it was definitely 00:42:52.739 --> 00:42:55.679 a year where there were some new aspects, like 00:42:55.679 --> 00:42:57.940 doing pediatrics for the first time, but then 00:42:57.940 --> 00:42:59.760 going through and repeating a lot of rotations 00:42:59.760 --> 00:43:03.780 like neuro, cardiac. OB, things like that. And 00:43:03.780 --> 00:43:06.599 progressing and developing everything that you 00:43:06.599 --> 00:43:09.380 learned CA1 year and sort of refining it and 00:43:09.380 --> 00:43:14.039 advancing it. And now going into CA3 year, reflecting 00:43:14.039 --> 00:43:15.780 on everything and thinking like, what do I polish 00:43:15.780 --> 00:43:17.539 up on? Because now I should know how to do everything. 00:43:18.300 --> 00:43:23.059 And kind of seeing the value in CA3 year and 00:43:23.059 --> 00:43:25.940 having the chance to kind of become really well 00:43:25.940 --> 00:43:28.760 -rounded before graduation. What are some of 00:43:28.760 --> 00:43:31.840 the finishing touches that you're hoping to put 00:43:31.840 --> 00:43:35.760 on before you graduate yeah i think um you know 00:43:35.760 --> 00:43:38.639 anesthesia is a very technical specialty uh and 00:43:38.639 --> 00:43:42.360 so one example would be like uh ob and araxial 00:43:42.360 --> 00:43:46.159 skills um i feel like ca1 year was figuring out 00:43:46.159 --> 00:43:48.440 what to do ca2 year was getting more reps and 00:43:48.440 --> 00:43:51.019 getting more refined and i think for ca3 year 00:43:51.019 --> 00:43:54.699 um fine -tuning that and really developing like 00:43:54.699 --> 00:43:57.840 your style how you like to do things and like 00:43:57.840 --> 00:44:01.099 why you do things i think that's developing that 00:44:01.099 --> 00:44:06.440 why is sort of where CA3 year becomes fun. What 00:44:06.440 --> 00:44:08.179 do you think the biggest difference is between 00:44:08.179 --> 00:44:11.619 you and the intern version of you that did this 00:44:11.619 --> 00:44:14.480 a couple years ago? Yeah, that's fun to think 00:44:14.480 --> 00:44:19.719 about. I think the me now versus intern me, I 00:44:19.719 --> 00:44:23.860 think intern me was just very excited and clueless 00:44:23.860 --> 00:44:27.599 about everything and wanting to just kind of 00:44:27.599 --> 00:44:30.239 take everything in and learn everything. I'm 00:44:30.239 --> 00:44:33.139 not really having sort of a sense for like how 00:44:33.139 --> 00:44:35.820 I do things or like what I like or don't like. 00:44:36.320 --> 00:44:40.239 Whereas now I can I can say for sure there are 00:44:40.239 --> 00:44:41.679 a lot of things like this is why I do it this 00:44:41.679 --> 00:44:44.739 way. This is why I like it this way. And then 00:44:44.739 --> 00:44:48.019 I think one fun aspect of that, too, is maybe 00:44:48.019 --> 00:44:50.039 getting the point now where you sort of maybe 00:44:50.039 --> 00:44:52.219 teach juniors that you have of your own students, 00:44:52.460 --> 00:44:55.059 junior residents and things like that on what 00:44:55.059 --> 00:44:56.260 you've learned and why you do things the way 00:44:56.260 --> 00:45:00.269 you do. If it's OK, I'd like to. pull up your 00:45:00.269 --> 00:45:04.230 episode from the wisdom of interns and we'll 00:45:04.230 --> 00:45:06.150 listen to what you had to say about your intern 00:45:06.150 --> 00:45:09.789 year. Yeah, that'd be great. My name is Nate. 00:45:09.869 --> 00:45:13.449 I'm one of the residents at UC. And I'd say the 00:45:13.449 --> 00:45:16.250 biggest thing I learned this year that I took 00:45:16.250 --> 00:45:19.829 away from was how to advocate for myself and 00:45:19.829 --> 00:45:23.230 how to advocate for others. I found that, at 00:45:23.230 --> 00:45:24.650 least from my experience going through intern 00:45:24.650 --> 00:45:27.329 year, there were several opportunities that came 00:45:27.329 --> 00:45:32.570 up where there were things that maybe to me appeared 00:45:32.570 --> 00:45:35.889 like they could be improved upon. And so I reached 00:45:35.889 --> 00:45:38.949 out to my seniors, to my faculty, to discuss 00:45:38.949 --> 00:45:41.050 ways that, you know, we can make things better. 00:45:41.489 --> 00:45:44.449 And I feel that as an intern, sometimes that 00:45:44.449 --> 00:45:46.070 can be intimidating or sometimes you feel like 00:45:46.070 --> 00:45:48.250 that's not your place to do that. But I think 00:45:48.250 --> 00:45:49.789 one thing that I definitely took away from this 00:45:49.789 --> 00:45:52.269 year was that, you know, everyone has the opportunity 00:45:52.269 --> 00:45:54.869 to do that, that, you know, it doesn't depend 00:45:54.869 --> 00:45:56.429 on what year you are, if you're a junior or senior, 00:45:56.550 --> 00:45:59.010 et cetera. I think that. That's really insightful, 00:45:59.070 --> 00:46:00.550 and it's really hard to do when you're just starting 00:46:00.550 --> 00:46:02.050 out as an intern, especially if you're going 00:46:02.050 --> 00:46:04.929 to a location you haven't been before. What was 00:46:04.929 --> 00:46:07.250 kind of your process when you saw something you 00:46:07.250 --> 00:46:09.530 didn't think was right? What did you do to get 00:46:09.530 --> 00:46:11.690 in touch with people that could help? Yeah, so 00:46:11.690 --> 00:46:13.210 I think the first thing for me is trying to get 00:46:13.210 --> 00:46:16.909 feedback from my peers immediately to see, you 00:46:16.909 --> 00:46:18.949 know, if what I was feeling was out of the norm 00:46:18.949 --> 00:46:21.869 or if, you know, things are par for the course 00:46:21.869 --> 00:46:25.110 and maybe that I was just experiencing sort of 00:46:25.110 --> 00:46:28.090 the status quo. And if something was unusual 00:46:28.090 --> 00:46:30.150 or if we feel like, you know, the experience 00:46:30.150 --> 00:46:33.090 is something that is not in line with what it 00:46:33.090 --> 00:46:35.210 should be, then I would reach out to my seniors 00:46:35.210 --> 00:46:38.030 to get their feedback on it. And then depending 00:46:38.030 --> 00:46:40.949 on that process, then going up to faculty. And, 00:46:41.190 --> 00:46:43.250 you know, here I would say I'm very fortunate 00:46:43.250 --> 00:46:45.869 that I have very supportive seniors and faculty 00:46:45.869 --> 00:46:47.750 and staff, and I always feel empowered to be 00:46:47.750 --> 00:46:50.940 able to bring things up. So in terms of advice, 00:46:51.039 --> 00:46:52.980 I would say, you know, for any prospective students, 00:46:53.159 --> 00:46:55.639 definitely look at programs where you can feel 00:46:55.639 --> 00:46:57.039 empowered to do that, where you are comfortable 00:46:57.039 --> 00:47:00.280 speaking and being able to advocate for yourself 00:47:00.280 --> 00:47:02.219 and others. I definitely think that's important. 00:47:02.539 --> 00:47:04.380 Are there any questions you think applicants 00:47:04.380 --> 00:47:06.139 could ask when they're on the interview trail 00:47:06.139 --> 00:47:09.019 to kind of get a feel for how receptive senior 00:47:09.019 --> 00:47:12.659 people are at people advocating this way? Yeah, 00:47:12.699 --> 00:47:17.320 absolutely. I think on the interview trail. It 00:47:17.320 --> 00:47:20.280 was a good sign if the program themselves advertised 00:47:20.280 --> 00:47:23.820 a system. So I know coming here from UC, that 00:47:23.820 --> 00:47:25.739 was something that was highlighted, the feedback 00:47:25.739 --> 00:47:30.400 system, you know, multiple residents, multiple 00:47:30.400 --> 00:47:32.800 faculty talking about like there are ways to 00:47:32.800 --> 00:47:35.699 escalate concerns. And so that's already a green 00:47:35.699 --> 00:47:37.119 flag. You're on the interview trail and you see 00:47:37.119 --> 00:47:41.219 that. If I don't hear anything about that, then 00:47:41.219 --> 00:47:44.559 I begin to ask simply, is there a system for 00:47:44.559 --> 00:47:47.530 feedback? Is there a system? Like if I have concerns, 00:47:47.630 --> 00:47:51.230 is there a system in place to allow residents 00:47:51.230 --> 00:47:55.449 to express their concerns? So I'm curious to 00:47:55.449 --> 00:47:59.070 hear your reaction to that. Yeah, it felt honestly 00:47:59.070 --> 00:48:03.690 a lot closer than it's been three years. Like 00:48:03.690 --> 00:48:06.750 I remember my thought process and thinking through 00:48:06.750 --> 00:48:08.969 actually those specific rotations and scenarios 00:48:08.969 --> 00:48:12.110 that made me feel that way. um and that still 00:48:12.110 --> 00:48:14.929 stand true um even you know now coming into the 00:48:14.929 --> 00:48:17.409 final year of residency i still think that uh 00:48:17.409 --> 00:48:21.130 you know every rotation every block even there 00:48:21.130 --> 00:48:23.250 are things that can be improved upon um and i 00:48:23.250 --> 00:48:26.130 think i think having a mindset of like trying 00:48:26.130 --> 00:48:29.829 to continually improve uh the experience is really 00:48:29.829 --> 00:48:32.429 important um especially now coming into the last 00:48:32.429 --> 00:48:33.889 year of residency and looking back and thinking 00:48:33.889 --> 00:48:36.110 through all the rotations i've gone through um 00:48:36.110 --> 00:48:38.679 just thinking like My input and what I did to 00:48:38.679 --> 00:48:40.599 kind of make those who came after me have a better 00:48:40.599 --> 00:48:43.639 experience is really important. Whether that's 00:48:43.639 --> 00:48:47.320 here at UC or at off -site rotations, I think 00:48:47.320 --> 00:48:51.079 every little bit of feedback matters. And I still 00:48:51.079 --> 00:48:54.599 feel that way about our program and how supportive 00:48:54.599 --> 00:48:57.739 we are and how important we take feedback. And 00:48:57.739 --> 00:48:59.559 I would still give that same advice to applicants 00:48:59.559 --> 00:49:02.880 now to look out for that in a program and to 00:49:02.880 --> 00:49:05.659 be cognizant of that as they're evaluating programs. 00:49:07.239 --> 00:49:10.820 I'm curious if there's anything that you've really 00:49:10.820 --> 00:49:13.519 changed your mind about since intern year. If 00:49:13.519 --> 00:49:15.699 there's anything that you are maybe a little 00:49:15.699 --> 00:49:18.900 bit misguided about or that you just feel differently 00:49:18.900 --> 00:49:27.639 about. In terms of expectations, I don't think 00:49:27.639 --> 00:49:31.900 I was necessarily misled in any way. It's kind 00:49:31.900 --> 00:49:34.739 of weird to think because I think also me coming 00:49:34.739 --> 00:49:36.260 in intern year or even finishing intern year. 00:49:36.760 --> 00:49:39.219 I didn't really have any specific expectations 00:49:39.219 --> 00:49:42.619 going to my anesthesia year. I think for me, 00:49:42.639 --> 00:49:45.639 the big one was that I would be trained really 00:49:45.639 --> 00:49:48.579 well and that I would have a very good experience 00:49:48.579 --> 00:49:53.019 and develop to become a strong clinician, which 00:49:53.019 --> 00:49:55.719 I think all those expectations have been met. 00:49:56.719 --> 00:49:59.599 And so I think for me personally, with my professional 00:49:59.599 --> 00:50:02.099 development and my personal growth, I would feel 00:50:02.099 --> 00:50:04.739 like our program has really helped me achieve 00:50:04.739 --> 00:50:08.989 that. And then one thing that I continue to advertise 00:50:08.989 --> 00:50:10.650 and I continue to feel strongly about is the 00:50:10.650 --> 00:50:12.809 quality of our people, especially our quality 00:50:12.809 --> 00:50:16.130 of our co -residents. I can definitely speak 00:50:16.130 --> 00:50:18.389 on my class and the class below me and even the 00:50:18.389 --> 00:50:24.110 CA1 class now. We do a very good job of finding 00:50:24.110 --> 00:50:28.210 people who are very connected and cohesive and 00:50:28.210 --> 00:50:31.489 like -minded. And so it makes for a really fun 00:50:31.489 --> 00:50:36.809 time, especially now. being a CA3 and working 00:50:36.809 --> 00:50:38.630 with like CA1s where there is a little bit of 00:50:38.630 --> 00:50:44.610 a gap, but still feeling very connected and even 00:50:44.610 --> 00:50:46.969 forming like friendships that I wouldn't have 00:50:46.969 --> 00:50:52.170 expected. So between now and graduation, what 00:50:52.170 --> 00:50:54.550 are your goals? What are your thoughts? What 00:50:54.550 --> 00:50:57.429 do you hope to accomplish? Yeah, that's a great 00:50:57.429 --> 00:50:58.690 question. And that's one I've been thinking about 00:50:58.690 --> 00:51:01.409 a lot, especially for me, where I am going into 00:51:01.409 --> 00:51:04.300 a fellowship after residency. There's technically 00:51:04.300 --> 00:51:06.659 another year of training beyond this before I 00:51:06.659 --> 00:51:10.280 enter attending hood. I think for me, I want 00:51:10.280 --> 00:51:14.739 to use the opportunity now until the end of residency 00:51:14.739 --> 00:51:16.599 to basically be as well -rounded as possible 00:51:16.599 --> 00:51:19.840 to do things that I know that I'm going to have 00:51:19.840 --> 00:51:22.179 kind of a little bit of a gap in because I'll 00:51:22.179 --> 00:51:23.940 be doing a cardiac fellowship. And so next year 00:51:23.940 --> 00:51:28.000 we'll all be cardiac devoted. And so, you know, 00:51:28.019 --> 00:51:30.340 I want to be cognizant about skills like OB, 00:51:30.559 --> 00:51:33.840 PEDS. Um, and then some of the other general 00:51:33.840 --> 00:51:36.380 cases where, uh, I really want to make sure I 00:51:36.380 --> 00:51:37.860 feel very comfortable with those and feel like 00:51:37.860 --> 00:51:40.739 I have a good background in those before I transitioned 00:51:40.739 --> 00:51:43.000 to a fellowship where I'll be so focused on one 00:51:43.000 --> 00:51:45.320 specialty, but then after I'm done, I'll likely 00:51:45.320 --> 00:51:48.300 be kind of a mix of everything again. And then 00:51:48.300 --> 00:51:52.719 being mindful to, to not feel like a year out 00:51:52.719 --> 00:51:57.179 from now I'm deficient in things. Um, so those 00:51:57.179 --> 00:51:59.519 are my, my personal goals and, you know, for 00:52:00.199 --> 00:52:01.980 For my peers who are also going into fellowship, 00:52:02.219 --> 00:52:06.460 I think they also share similar thoughts. So 00:52:06.460 --> 00:52:09.099 lastly, before you go back to your cardiac case, 00:52:09.320 --> 00:52:13.199 what style points or points of personal preference 00:52:13.199 --> 00:52:16.019 have brought you success both in and out of the 00:52:16.019 --> 00:52:18.719 operating room? Yeah, I think that's a great 00:52:18.719 --> 00:52:23.260 question. And I think for me, at least, from 00:52:23.260 --> 00:52:26.460 the feedback that I've gotten, I think two things 00:52:26.460 --> 00:52:31.550 stand out. And that one is preparation. And what 00:52:31.550 --> 00:52:33.409 I mean by that is really taking ownership of 00:52:33.409 --> 00:52:36.230 your patients. So since the start of CA1 year, 00:52:36.449 --> 00:52:39.469 my mindset has always been like, this is my case. 00:52:39.489 --> 00:52:42.230 This is my patient. Like, even if I'm the junior 00:52:42.230 --> 00:52:44.670 resident, even if I have no idea what's going 00:52:44.670 --> 00:52:46.269 on, it's my first day in the cardiac ward and 00:52:46.269 --> 00:52:48.510 I don't even know what bypass is. Like, this 00:52:48.510 --> 00:52:50.769 is my patient and I'm here to take care of them. 00:52:51.349 --> 00:52:55.110 And everyone around me, my senior, the fellow, 00:52:55.190 --> 00:52:57.650 the attending, they're there to help me facilitate 00:52:57.650 --> 00:53:02.409 taking care of this patient. But I think having 00:53:02.409 --> 00:53:05.170 that mindset of really taking ownership of the 00:53:05.170 --> 00:53:07.050 case, taking ownership of the care of the patient, 00:53:07.190 --> 00:53:10.489 and thinking just right from the beginning, like, 00:53:10.489 --> 00:53:12.409 you know, if it was just me taking care of this 00:53:12.409 --> 00:53:15.230 person, what would I want to do? Or how should 00:53:15.230 --> 00:53:17.349 I go about it? I think that puts a lot of onus 00:53:17.349 --> 00:53:19.369 and responsibility on the person. And it makes 00:53:19.369 --> 00:53:22.989 you think about questions to ask. Because when 00:53:22.989 --> 00:53:24.670 you think like, okay, if everyone leaves the 00:53:24.670 --> 00:53:27.389 room right now, is this me? What do I do? I think 00:53:27.389 --> 00:53:30.730 that really sparks a lot of good questions. Like, 00:53:30.849 --> 00:53:33.010 how much of this medicine should I give? Is there 00:53:33.010 --> 00:53:35.570 anything I should look out for? What is an emergency 00:53:35.570 --> 00:53:40.190 in this case? And I think that's really brought 00:53:40.190 --> 00:53:45.510 a lot of success to my time in residency. Nate, 00:53:45.550 --> 00:53:47.570 thank you so much for joining us. Thank you for 00:53:47.570 --> 00:53:52.789 having me. That's it for this episode of Style 00:53:52.789 --> 00:53:55.780 Points. When I think about this mini -series 00:53:55.780 --> 00:53:58.280 of episodes, it makes me nostalgic in a certain 00:53:58.280 --> 00:54:01.400 kind of way. For me, one of the great benefits 00:54:01.400 --> 00:54:03.840 of a career in academic medicine is witnessing 00:54:03.840 --> 00:54:06.300 people develop and change during their residency 00:54:06.300 --> 00:54:09.820 and eventually become fully -formed anesthesiologists 00:54:09.820 --> 00:54:11.860 who people trust with their lives every day. 00:54:12.699 --> 00:54:15.019 I hope that this series of episodes together 00:54:15.019 --> 00:54:18.659 provides a bit of that magic for you. Eventually, 00:54:18.820 --> 00:54:21.139 if any of these residents want to sit down with 00:54:21.139 --> 00:54:23.590 me one more time down the road, We may do this 00:54:23.590 --> 00:54:27.190 again. If you're new to the show, episodes 7 00:54:27.190 --> 00:54:30.530 and 21 are in the feed. These are the same voices 00:54:30.530 --> 00:54:33.889 all the way through residency. Please consider 00:54:33.889 --> 00:54:36.230 leaving us a rating or a review. That's what 00:54:36.230 --> 00:54:39.110 helps other people find the podcast. And you 00:54:39.110 --> 00:54:42.590 can reach us at stylepointspodcast at gmail .com. 00:54:43.530 --> 00:54:47.849 Take a deep breath. Open your eyes. We're all 00:54:47.849 --> 00:54:48.409 done.