My experience of anaesthetics and ICU in medical school consisted of little more than two weeks; a combination of spending time in the intensive care unit and in theatres, mostly shadowing trainees and being overwhelmed by the complexity of the patient bedside. So when it came to starting my ICU rotation as a first year doctor, I worried that I would very much be out of my depth.
What suprised me is how quickly I settled into the daily routine and how much I loved this placement.
The daily routine
The day starts with an in-depth morning handover – a discussion of all the patients in the unit and any others in the hospital or Emergency Department that have been referred. Coming from a general surgery job, my main surprise was the level of detail with which each patient was reviewed. I appreciate that in ICU there was the luxury of a greater staff to patient ratio, which meant we could afford to spend more time on each patient, along with the fact that they had much more complex, multi-system problems that needed addressing requiring a more detailed approach than I was jused to on the ward. At the patient’s bedside, we discuss the patient’s progress and ongoing issues, do a full A-to-E assessment, medication and therapies review, go through blood test results and look at any relevant imaging. A plan for the day would then be formulated and – like most wards – the majority of the day would then be spent carrying out these jobs once the ward round had finished.
The role of the FY1
Previously I had assumed that as the FY1, my job would mainly consist of requesting referrals and writing the patients’ discharge summaries, much as it had been on the wards, however one thing I loved about my ICU experience was how closely the team worked together everyday, and it felt like there was very little hierarchy within the team. I was allowed, and even more so encouraged, to get properly stuck in and try my own hand at procedures such as arterial lines and central lines. Whilst emergencies happened and there were of course some stressful occasions, overall ICU is a well-controlled environment, which makes it a safe place to learn new procedures and build your skills. And aside from the fancy procedures, which let’s be honest will only really be useful if you pursue a career in this specialty, being taught cannulation and how to use an ultrasound scanner by anaesthetic trainees is a valuable learning experience for any new doctor. These are skills which have been truly useful to me throughout my training.
One of my favourite parts of the job would be going to see referrals or airway emergencies in the Emergency Department with the registrar carrying the bleep. This was a great opportunity to step out of the FY1 role and observe the assessment and resuscitation of trauma, drug overdoses and other life-threatening emergencies. I found this exciting and loved the adrenaline rush from even just watching, and as my confidence grew, I slowly dipped my toe into assisting wherever I could. I was grateful for how supportive the trainees always were and amazed that even in such high stress situations, they were able to remain so calm to not only manage the patient but also offer teaching when possible.
What I learned
I learnt a lot about what consituted a suitable admission to ICU and why often it is not appropriate to put someone through such invasive treatment. This was a real-eye opener for me, as prior to my placement I had often thought of ICU as place where patient issues can just be ‘fixed’ once it is not possible to do so on the ward. I found the juxtaposition in ICU so interesting – while on one hand every patient is surrounded by multiple pumps and tubes and machines with numbers, on the other hand when I watched the ICU doctors making an assessment of the patient they would go right back to the basics of an A-E assessment, looking at the fluid balance, nutrition and the medications they were on. There was no quick fix – it was a lot of logical thinking and working through each system one at a time.
ICU is an unpredictable place which meant the busier days were balanced out by just as many quieter days when the patients remained relatively stable and not much would happen. As an FY1 this was a great opportunity for me to learn from the trainees. ICU can also be an overwhelming place to work, and I sat through many difficult conversations with family members and witnessed disagreements within the team about the best course of action for the patient. As the FY1, I would mostly just observe these conversations but informing family members with routine daily updates gradually became part of my role. These conversations can be uncomfortable but ultimately rewarding, and doing them daily in the ICU is a great place to feel more confident with an essential part of the job, whichever area of medicine you end up in.
My 4 month placement in ICU was a steep learning curve as I learned more medical abbreviations and terminology, and was introduced to more medical equipment than ever before. As well as learning the conventional FY1 role of doing discharge summaries and ward jobs, it is a fantastic place to learn hands-on medicine, practical skills and engage deeply with patient physiology. Being an FY1 can often feel like a glorified admin role where you lose sight of the overall patient and are simply doing admin jobs; but being in ICU really makes you appreciate how all members of the multi-disciplinary team can come together to provide good patient care every day. Every patient would be discussed with the nursing staff, the pharmacists, physios, the dieticians and other members of the multidisciplinary team and we all worked together to do our best for the patient. Being an FY1 in ICU, I was forced to think deeply about some of the fascinating and complex physiology which I had not thought of since medical school. There was less focus on following treatment algorithms and more on working through each issue logically, which is something I have tried to apply to any patient I see.
Whether you want to pursue a career in anaesthetics/ICU or not, I found having an ICU job one of the most valuable foundation jobs for improving your skills as a doctor.
About the Author
Aarushi Agrawal is a Foundation Year 1 doctor and aspiring anaesthestist working in the South of England