Intensive Care and Anesthesia

Now that I am back to doing mostly anesthesia, there is no doubt in my mind that doing subspecialty training in critical care has made me a better anesthesiologist. It could simply be the effect of doing another year of clinical training, but I think it's more than that. It's also more than just the book learning, the medical knowledge of being in the ICU. Critical care does teach a lot that anesthesiologists don't regularly think about; we look at trials on complex ventilator management, focus on organ systems anesthesiologists are less familiar with, and see the natural history of complicated disease processes. But there's also a skill component to it. One of the most important things I learned as an ICU fellow is the ability to manage complex crisis situations in an articulate fashion. So often as an ICU fellow I would arrive at a code with no idea who the patient was or what happened, but I would be expected to take control of that situation. In the operating room, I translate those intangible skills into assessing the last-minute emergent add-on case of a sick patient needing major surgery. When time matters (when seconds count), I quickly determine what I need to know to care for someone effectively. In the last year I also learned leadership and communication skills that we don't often get in medical training. When a medical crisis happens, I keep calm, and indeed, I notice that in my anesthetic management now. Situations that used to cause me panic and cause my brain to lock up now flow smoothly. I am a much better physician after a year of ICU training.

This fascinates me because I had all the knowledge and procedural skills I needed to be an anesthesiologist after completing residency. Fellowship just put me into a myriad of situations that accelerated learning from experience. I think most physicians who deal with crisis situations learn these nuanced approaches and subtle perspectives over time; ICU fellowship simply drew it out of me.