Micu

[kocker]

SICU at my school.... not necessarily the best reputation for education.
MICU at my school.... known to have some pretty great attendings, some autonomy, more teaching.

Applying to gs this fall, so is the MICU a waste of a rotation/SICU MUCH more beneficial?

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[filter07]

MICU aka where patients go to die

 

[Winged Scapula]

SICU at my school.... not necessarily the best reputation for education.
MICU at my school.... known to have some pretty great attendings, some autonomy, more teaching.

Applying to gs this fall, so is the MICU a waste of a rotation/SICU MUCH more beneficial?

I don't think it matters in terms of matching. A letter from a MICU attending is usually viewed favorably and if you feel like you would get better teaching, it would be the best choice, IMHO.

 

[europeman]

first off.... what do you mean the sicu isn't "known for education?"

who runs the SICU.... surgeons or anesthesiologists or both?

are you going to be a surgeon? then do sicu!

listen. 95% of your education 3rd and 4th year of med school is what YOU make of it. asking questions... seeing things, reading, etc. it's not the 2 hours of attending rounds on your medicine rotation.

listen, i suspect your sicu is run by surgeons which are usually a bit more abrasive, perhaps impatient, perhaps focused on work... i.e. the PROTOTYPICAL surgeon personalities!

they will change very quickly if you express an interest in surgery and their sicu. they will be MUCH more willing than any MICU to show you procedures.

lastly, the sicu is cooler. more tubes in patients, more complicated patients.

please explain more and we can go from there

and while i respect winged scapula... i disagree. generally, surgeons prefer letters from surgeons for applications.... and while true it's better to get a good MICU letter than worthless sicu letter... i suspect it's possible for you to get an oustanding SICU letter from a trauma/critical care attending or somethign which will be way way way more worthwhile than any micu letter. more relevant too

 

[Winged Scapula]

I never said that surgeons didn't prefer letters from surgeons. However, the OP asked if there was a SIGNIFICANT difference in matching, nor did he even mention whether or not he needed a letter from his ICU rotation.

I see no evidence anywhere that a SICU letter from a surgeon makes a significant improvement in one's application over a MICU letter, especially if the rest of the LORs are from a surgeon.

There is something to be said for not loading up your 4th year with all surgical rotations.

 

[kocker]

There is something to be said for not loading up your 4th year with all surgical rotations.

the above is sort of my thinking. I may also do a few weeks of gi and ir, get some lines and see some ercp etc.

By the time i get to the mic/sicu I should be finished with letters and all that.

not to mention, there will be much less performance anxiety in the micu....

bottom line is, i am going to do one or the other, but if being in the sicu 4th year will make me that much better of a resident, obviously thats where i belong.

 

[europeman]

first off...i agree, you should NOT do all surgical rotations! do rads, do cards, etc. But do NOT do MICU over SICU if given the chance! The SICU is a SICU rotation... it's not a surgical rotation where you are in he OR.

if you have surgeons or anesthesiologists (preferably surgeons) as your SICU attendings, you will learn about PERI-OPERATIVE critical care and medicine. If you do MICU, you will just learn about ICU in general.

I think it's importan to have good exposure to the surgeons who know a lot about SURGICAL infections, antibiotics for SURGERY patiens, shock, resuscutation, ARDS, renal failure and vents because it's a whole different world than he MICU. In the MICU someone has some renal failure and some trouble breathing and you intubate them, call it CHF, and get dialysis. In he post-op surgery world, this patient may have abdominal compartment syndrome and needs an emergent laparotomy. The whole mentality and training is different.

Surgical infections are whole different world than the standard uro-sepsis MICU little old lady from nursing home. Surgical ICU's tend to be more picky and know more about IV fluids and such which is an integral part of what you will be doing as a surgical resident.

ALso, you will (or should) have more opporunity to DO procedures. Most micu's only do lines.... some do a procedure here and there. IN the SICU you will have the opportunity to do chest tubes, lines (most SICU's are more liberal doing subclavians rather than jus IJ's too), and even intubations (lots of sicu's even do their own intubations now).

This is what the SICU is about.

 

[JackADeli]

I don't think it matters in terms of matching. A letter from a MICU attending is usually viewed favorably and if you feel like you would get better teaching, it would be the best choice, IMHO.

I have to agree. If you have a reasonable if not good application with decent letters from surgeons... a MICU letter should be fine. Go where the teaching is. You don't need everything from a surgeon all the time for your application. You actually don't even need an ICU letter....

Use your MS4 time to get the best education you can. I have had SICU rotations that were absolutely non-educational. Yes reading is important.... but you can read at home on a MICU rotation too. Thus, the key is what you are being taught in the unit and at bedside. If it isn't in one ICU experience then choose a different one if you can. I think it is silly to believe that just because it is SICU it must be educational.

JAD

PS: don't get so hung up on chest tube placement or trachs either.... I never performed a single one of those procedures during my ICU experiences in medical school. It didn't hurt me in residency. I did plenty as a PGY1.

 

[Winged Scapula]

I have to agree. If you have a reasonable if not good application with decent letters from surgeons... a MICU letter should be fine. Go where the teaching is. You don't need everything from a surgeon all the time for your application. You actually don't even need an ICU letter....

Use your MS4 time to get the best education you can. I have had SICU rotations that were absolutely non-educational. Yes reading is important.... but you can read at home on a MICU rotation too. Thus, the key is what you are being taught in the unit and at bedside. If it isn't in one ICU experience then choose a different one if you can. I think it is silly to believe that just because it is SICU it must be educational.

JAD

PS: don't get so hung up on chest tube placement or trachs either.... I never performed a single one of those procedures during my ICU experiences in medical school. It didn't hurt me in residency. I did plenty as a PGY1.

Exactly.

There is a WIDE variety of experiences in medical school. Like JAD, I never did any chest tubes or trachs in medical school nor did I do any central lines.

We had some interns who had done tons of stuff.

I did plenty during residency and was just as proficient as them very swiftly.

There is plenty of time during a surgical residency to learn about surgical care. If the best teaching is in the MICU and you are going into GS, I'd take the chance to do a rotation which will offer me some critical care skills which CAN be translated to the SICU and shed some more insight into the land of IM, so it won't seem so foreign when you get those dead gut consults from all the Levo drips.

 

[Thanatos]

MICU aka where patients go to die

My chiefs refers to MICU consults as "search and rescue" missions.

 

[sqtab]

MICU aka where patients go to die

My chiefs refers to MICU consults as "search and rescue" missions.

I rotated through both the MICU and SICU.

The following experience was at the same location....

MICU:
Patients were often very sick.
Patients were quickly intubated, but also seemed to remain on the vent.
Quite a few patients went from sick to sicker. I never saw so many people die. Seemed like we were so frequently having family meetings or preparing for one.

SICU:
Patients were often very sick. Many had been through operations with significant risk. A few had been there for months.
There seemed to be more judicious use of the vent. There also seemed to be greater emphasis on keeping patients on the vent for only as long as necessary.
While we did lose patients in the trauma bay during the Golden Hour (following GSW, MVC, or what have you), regarding those that were actually admitted to the SICU, I cannot recall a patient ever being lost during my time there, though I did hear of one that passed away a month or so after I had left. Even the few patients that developed major complications peri-operatively, patients that could have been fully expected to die, somehow actually walked out of the hospital.

The difference struck me like night and day.

Questions:
1. Is this experience typical, biased, irrelevant, nonsensical, crazy, way out there, or what?

2. What experiences have others had?

3. If this perceived difference is frequently real and relevant, then I also wonder what factors others may think might make such a difference.

 

[europeman]

the answer is that the SICU is just better!

 

[sleeping]

the answer is that the SICU is just better!

I use to believe this also.

But, realized that:

MICU: Most patients are dying from chronic diseases, that we can't fix.

SICU: Most patients are dying from acute diseases, that we can fix.

 

[SLUser11]

I use to believe this also.

But, realized that:

MICU: Most patients are dying from chronic diseases, that we can't fix.

SICU: Most patients are dying from acute diseases, that we can fix.

Agree.

We have to remember that these are two completely different patient populations. Plenty of MICU patients had their fate set prior to ever setting foot in the hospital. We just spend millions of dollars delaying the inevitable.

I will openly admit that I've walked into the MICU on "search and rescue" missions, and there are plenty of situations where patients were grossly mismanaged (especially when they had severe surgical disease). Still, I promise that the medicine docs can come up with plenty of examples of the opposite being true.

As surgery residents in the SICU, we manage all types of medical problems, from chronic DM/CAD/HTN to acute MI/Renal failure/Afib etc. You don't think the cardiologists and nephrologists have a friendly chuckle when they read some of our orders?

I'm not above occasional medicine and ER bashing, as it is fun, and there are plenty of entertaining stories. However, I don't think we should be encouraging this antagonistic learned behavior with the med students. Just like an young child that hears a curse word from their parent and then repeats it a hundred times, med students will emulate our behavior quickly, despite any true experience in the matter to back up their biased opinion.

When some of these situations arise, I try my best to hold my tongue, because I don't think we should be breeding bad behavior. All we do is continue to feed the cycle of antagonism that makes the hospital work environment so miserable. We may feel like the big bad saviors in these situations, but really we're just a bunch of s@#t-talkers with minimal insight into our own deficiencies.


Stepping down off my soapbox now.....

 

[ESU_MD]

In my program, we had an interesting combination- micu attendings would manage the sicu on certain weeks. essentially, the surgery resident would round with the micu attending as his staff for critical care issues. it was actually one of the best learning situations I've had in residency. The micu staff has a different perspective on things. It is also a good dynamic because it allows you to realize that they arent just the micu idiots, and gives you a chance to learn how to interact in a multidisciplinary environment. Plus, I always thought that the medicine staff secretly liked working on the sicu with the sicu residents., would often ask questions about procedural things etc..

and yes- despite what you've been taught, sometimes it IS ok to give lasix to a postop patient!

 

[goooooober]

and yes- despite what you've been taught, sometimes it IS ok to give lasix to a postop patient!

WHAT!!! How dare you in a surgery forum. I am both shocked and offended by this statement.

Winged Scapula, go easy on him. I think 6 months of suspension from this forum should suffice.

 

[Winged Scapula]

WHAT!!! How dare you in a surgery forum. I am both shocked and offended by this statement.

Winged Scapula, go easy on him. I think 6 months of suspension from this forum should suffice.

I'll try, but if ESUMD mentions "bolusing" a patient with 150 cc of NS then he's outta here! Damn MICU training.

 

[JackADeli]

In my program, we had an interesting combination- micu attendings would manage the sicu on certain weeks. ...it was actually one of the best learning situations I've had in residency. The micu staff has a different perspective on things. It is also a good dynamic because it allows you ...a chance to learn how to interact in a multidisciplinary environment...

I trained under a similar model. I found the SICU & MICU attendings were the better for the team work and interactions. The residents and patients all benefitted from this model.

... if ESUMD mentions "bolusing" a patient with 150 cc of NS then he's outta here! Damn MICU training.

I agree, those patients are so sick it would be malpractice to be so overly aggressive. You should never bolus more the 50-75cc at a time!!! That is why the protocol is.... "bolus over one hour"

 

[deleted50541]

I'm not above occasional medicine and ER bashing, as it is fun, and there are plenty of entertaining stories. However, I don't think we should be encouraging this antagonistic learned behavior with the med students. Just like an young child that hears a curse word from their parent and then repeats it a hundred times, med students will emulate our behavior quickly, despite any true experience in the matter to back up their biased opinion.

When some of these situations arise, I try my best to hold my tongue, because I don't think we should be breeding bad behavior. All we do is continue to feed the cycle of antagonism that makes the hospital work environment so miserable. We may feel like the big bad saviors in these situations, but really we're just a bunch of s@#t-talkers with minimal insight into our own deficiencies.


Stepping down off my soapbox now.....

Absolutely agree with your bolded statements. Now a fourth year sub-I with very impressionable third years under my supervision, I try very hard to suppress my bad mouthing of other services (learned behavior from my residents) and encourage third years to learn from everyone they rotate with, regardless of their "chosen" field. In turn, this reminds me to avoid feeding "the cycle of antagonism" and remember my own shortcomings as a doctor-in-training.

 

[lemonade02]

just trolling around SDN...

i'm internal medicine unfortunately...at a good place where the surgery residency is also very good...and let's be real...surgeons aren't very good at the non-surgical aspects of intensive care..most of you guys have no idea what you are doing..

we in medicine laugh at surgeons all the time but i respect you guys for what you can do which i cannot, which is operate. i didn't realize you guys laugh at us in the same way as with ER...that's insulting...just keep in mind we consult you for CYA, not because we actually trust your clinical non-surgical judgement.

 

[lemonade02]

again i want to emphasize i respect your field greatly, you guys actually do something to help patients..i'm in internal medicine because i really want to do GI but i hate almost every minute of my job as an IM resident

 

[Winged Scapula]

just trolling around SDN...

You might want to be careful with that.

It is considered trolling to come into a specialty forum and insult the users there. Just as if we came into the IM forum and insulted the users there directly. Trolling is a violation of the SDN TOS.

And you might want to reconsider your statement that the surgery residency at your hospital is good...because if medicine residents are laughing about how they (the surgical team) manages non-surgical medical issues, then I'd define that as NOT GOOD. General surgeons pride themselves on knowing how to manage medical issues and this is generally found to be true by IM.

 

[ESU_MD]

just keep in mind we consult you for CYA, not because we actually trust your clinical non-surgical judgement.

why would you consult a surgeon for a non-surgical issue anyway?

 

[JackADeli]

just trolling around SDN...

...and let's be real...surgeons aren't very good at the non-surgical aspects of intensive care..most of you guys have no idea what you are doing..

we in medicine laugh at surgeons all the time but i respect you guys for what you can do which i cannot, which is operate. i didn't realize you guys laugh at us in the same way as with ER...that's insulting...just keep in mind we consult you for CYA, not because we actually trust your clinical non-surgical judgement.

again i want to emphasize i respect your field greatly, you guys actually do something to help patients..i'm in internal medicine because i really want to do GI but i hate almost every minute of my job as an IM resident

Your entire statement demonstrates a complete lack of understanding or appreciation of what a good general surgeon is trained and capable of doing.... You should reflect on what the definition of "respect" is cause you clearly do not "respect" surgery based on your trolling statement.

it's kind of like "jumbo shrimp"
or
"your ugly but I appreciate your inner beauty"
or
"thats not urine.... it's localized rain on your leg"

give us all a break. Your statement lacks respect and is quite insulting and to try and imply otherwise is insulting to one's intelligence.:troll:

 

[Moonglow]

**************

 

[ddmo]

MICU: It's like hospice with levophed.