During our intern year at BCM, categorical anesthesiology residents are introduced to anesthesia at Ben Taub on a rotation that we call “Mentor Mode.” While on this rotation, we are paired up with an upper-level anesthesia resident (either CA-1, CA-2, or CA-3) each day. The general purpose of this month is to become acquainted with the Ben Taub system (as this is where we spend the majority of our CA-1 year) and to master the basics of daily OR anesthesia! Once we start CA-1 year on July 1, we are placed into our own rooms, so the goal of this “Mentor Mode” month is to eventually feel fully comfortable determining a basic anesthetic plan, setting up the OR, drawing up medications, placing monitors, managing IV lines, documenting the case, and building basic strategies for optimizing the patient throughout the surgery. We also start to fine-tune our procedural skills like intubation, IV placement, and arterial line placement, but since these are skills that will grow with time, there is no pressure to have them completely mastered by the end of the month! I do, however, always recommend trying your best to improve mask ventilation skills as much as possible because - as many brilliant anesthesiologists have told me - if you can mask ventilate, you can keep the patient alive!
In the world of anesthesia, the typical day actually starts the afternoon before, when we learn about our assigned case(s) for the following day. That evening, I would touch base with the resident whom I was assigned to work with on the following day to discuss the plan for our case(s), any special setup that would be needed, and the time that we should begin setting up. For the typical case, it is usually fine to start setting up at 6:30, but I would arrive a little earlier than that in the beginning when I was still getting the hang of room setup. Certain types of cases, especially cardiac cases, require a more advanced setup and typically require more time, but I found that the upper-level resident usually walked me through the setup for those cases! In the morning, I would arrive and set up the operating room, always using the trusty “MSMAIDS” mnemonic that we all know and love. The upper-level resident would usually meet me in the OR, and we would walk to the pre-op area together to find the patient. After introducing ourselves to the patient, we would take a history and perform a physical exam to verify the chart review we had previously completed. We would also document the patient’s consent for anesthesia after informing them of the risks and benefits of the planned anesthetic. Some patients are familiar with anesthesia, but some may have questions or fears, so it is important to gauge their comfort level and ensure that their questions have been answered! Unless the patient already had an IV (which may happen if they arrived from an inpatient floor or the emergency department), we would place one in the pre-op area after using an injectable local anesthetic. Once the surgical team and OR were ready, we would transport our patient to the OR. Once in the room, we would induce, intubate, and monitor the patient throughout the surgery before emerging and extubating at the end of the case. The patient would then be transported to PACU for recovery.
Throughout this entire process, Mentor Mode interns are working with an upper-level resident and an attending, which allows us to meet our future colleagues and learn high-yield tips and tricks from different people. More than anything, the rotation allows us to develop a sense of comfort in the operating room. Throughout the month, we are expected to perform more of the basic tasks completely on our own, including room setup, documentation, and airway management—though backup is always available! We begin to more clearly understand when to administer certain medications or make changes to the ventilator. It can be overwhelming at times to be learning an entirely new specialty, but the residents and attendings at BCM are so wonderful and supportive that the learning curve starts to seem less steep, and the goals start to seem more attainable. When I was on my Mentor Mode month, I found myself especially concerned about IV placement. The IV catheters at BCM were a different style than I had used in the past, and it seemed like every time I tried to place an IV, I was unsuccessful. I felt really defeated about it until one of the CA-1s (now a CA-2) offered to help me with my technique. He first reminded me that procedural skills will develop over time, but then he took me aside and let me place an IV in his own arm while teaching me every step of the way. I then requested to work with him the following day, and he helped me find patients who needed IVs so I could practice more. As a CA-1 now, I sincerely attribute my (somewhat) improved IV placement abilities to KK James. Thanks KK!!
All in all, Mentor Mode is a genuinely enjoyable rotation during which interns are introduced to the Ben Taub OR and the basic expectations of a BCM anesthesia resident. Mentor Mode is definitely a favorite rotation amongst the intern class each year because it honestly feels like a reward! It’s our chance to take a break from learning (necessary and valuable!) information about other specialties to finally get a glimpse of the field that we have all committed the rest of our lives to. Four weeks sounds like a short time, but it’s honestly amazing how comfortable I felt by the end of the month. For any potential future BCM residents reading this, I hope to someday see you paired up with me on your Mentor Mode month!