Independence

While I have been doing adult anesthetics independently for quite some time, doing the same for pediatric cases is a big step. Residency is meant to transition us to independent practice, but it's not that easy. Attendings need to be comfortable with graduated supervision, to nudge us towards flying on our own. In pediatrics, this is especially difficult. It requires a keen awareness, flexibility, and preferably, two extra hands. Kids respond to mask anesthesia in a dozen different ways, some requiring immediate response. Often a single practitioner has to place the IV one-handed, asking a circulating nurse to prepare an arm and darting it in while masking the child. Then, to give IV induction agents and intubate the child. All this may be expected to happen in five minutes. To a seasoned anesthesiologist, this is no big deal, but for a learning resident, it's a lot to manage.

I had a few anesthetics that were completely independent. My attending sat in the back, watched, and gave me feedback. It was hard. If things were not prepared properly, I didn't have an extra set of hands to get things set up. I had to plan ahead, communicate clearly with my nurse, and know what step would come next. But it was always such a thrill when I accomplished everything without the attending getting out of her chair. It gives me confidence that I'll be ready for independent practice when I finish.