As residents rotating in ICU Baylor St. Luke’s Medical Center, a large quaternary care hospital, we have the privilege of caring for a diverse population of high acuity patients. We routinely care for patients following heart or lung transplantation as well as those with mechanical circulatory support devices such as VADs, Impellas, and various ECMO configurations. Treating acutely ill patients with specialized support devices and unique physiology can be challenging at times, but new residents quickly become comfortable guiding care with the support of seasoned faculty, fellows, mid-level providers, and nurses.
Mornings consist of chart review, pre-rounding, and then team rounding starting at approximately 7:30 a.m. The team usually consists of two fellows (one cardiac anesthesia fellow and one critical care fellow), two anesthesia residents, and multiple midlevel providers along with an ICU attending who is on service for one week at a time. With a patient census on average between ten and twenty, there is an excellent balance between discussion-based and practical hands-on learning.
The majority of notes and orders are finished during morning rounds; therefore, most afternoons are spent caring for patients in the immediate post-operative period, performing procedures, or learning from our attendings during informal teaching sessions. From placing arterial lines on VAD patients without pulsatile arterial flow, inserting central lines or dialysis catheters, to practicing TTE technique and interpretation, the procedural experience during the month is a perfect complement to bring to your future practice both in and out of the OR. The mix of medicine and anesthesiology world-class attending faculty are great at tailoring teaching to each resident’s interests and taking time during afternoon rounds to point out interesting findings on POCUS or quickly sketch a patient’s VVAV ECMO configuration.
All in all, the BSLMC’s ICU rotation is a tremendous learning opportunity and a unique rotation even within the Texas Medical Center. Although this is an unparalleled experience for any resident pursuing a fellowship in critical care or cardiac anesthesia, every resident who rotates through the service becomes a better anesthesiologist by the end of the month.
