Anesthesia rotation red flags

[emtdan]

I just got off doing an away rotation at Jefferson and was very disappointed. I will no longer be applying to this residency.

Any other red flag programs you rotated at that you will no longer be applying to

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[anes]

I just got off doing an away rotation at Jefferson and was very disappointed. I will no longer be applying to this residency.

Any other red flag programs you rotated at that you will no longer be applying to?

Why so disappointed?

 

[emtdan]

I did not want to air a residency's dirty laundry out on a forum - anyone can feel free the pm me if they are interested in the particular issues.

 

[BuzzPhreed]

#1 red flag: as many CRNAs/SRNAs as residents in the program.

 

[twoliter]

#1 red flag: as many CRNAs/SRNAs as residents in the program.

That's not a red flag if it'sdone right. If it's done correctly, it can help prevent residents from fighting for the good cases and shift some of the workload off the residents. What's so bad about a lot of CRNAs?

 

[IlDestriero]

I'm not sure why you wouldn't want to post what you didn't like about the program. Everyone is entitled to an opinion, and you have a month of insider info. People do it all the time. Many more will read this post than would ever PM you.

 

[anes]

That's not a red flag if it'sdone right. If it's done correctly, it can help prevent residents from fighting for the good cases and shift some of the workload off the residents. What's so bad about a lot of CRNAs?

Where I trained, the crnas weren't there to help us have less work. We ended up having to relieve them when our cases were done. Many times they would be relieved at 1pm by a resident, even though they were getting paid for the whole day (until 4-5 pm). And at night if the on call resident was a CA1 or even sometimes CA2 we would go take over a lap appy that was being done by a crna so that they could do the major trauma that was about to roll in.

At our program the order was attending>crna>feces>resident.

 

[IlDestriero]

That's not how we use CRNAs, though you might have to relieve them if you're on call. But, they've done a lot of the rooms you don't want as a resident. They free you up to do the more interesting cases.

 

[risnwb]

Where I trained, the crnas weren't there to help us have less work. We ended up having to relieve them when our cases were done. Many times they would be relieved at 1pm by a resident, even though they were getting paid for the whole day (until 4-5 pm). And at night if the on call resident was a CA1 or even sometimes CA2 we would go take over a lap appy that was being done by a crna so that they could do the major trauma that was about to roll in.

At our program the order was attending>crna>feces>resident.

Can you be serious? What kind of program director / residency program in general takes residents out of trauma cases to do an appy. Sounds like a program run by a lazy private group who are using the residents as cheap labor... Crazy... Too bad that kind of thing happens anywhere .


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[BuzzPhreed]

Where I trained, the crnas weren't there to help us have less work. We ended up having to relieve them when our cases were done. Many times they would be relieved at 1pm by a resident, even though they were getting paid for the whole day (until 4-5 pm). And at night if the on call resident was a CA1 or even sometimes CA2 we would go take over a lap appy that was being done by a crna so that they could do the major trauma that was about to roll in.

At our program the order was attending>crna>feces>resident.

^^ This. And you think you're going to always get the "choice" cases?

 

[BuzzPhreed]

That's not how we use CRNAs, though you might have to relieve them if you're on call. But, they've done a lot of the rooms you don't want as a resident. They free you up to do the more interesting cases.

BULL****. (Sorry. Gotta call that.)

 

[IlDestriero]

BULL****. (Sorry. Gotta call that.)

I'm not sure what you mean? What's bullshït? The fellows always get the most appropriate cases every day (they are assigned first), the residents get the best cases for them (which isn't always the next most complex cases), and the CRNAs get everything else. Trainees are almost never (or actually never for some locations) offsite in MRI, rad onc, Onco, GI, dental, etc. where the cases are very low yield.
So what's the bull you're asserting? We take pride in training residents and fellows. Do they take over cases when the CRNAs go home in the evening? Yes. Because they're the call team. That's what the call team does. Do we keep non call residents late to relieve CRNAs? No we do not. Because of the way we schedule (only 2:1) and close rooms at specific times, the late attendings will sit and finish themselves if necessary. That is really only an issue in the summer months and Christmas holiday period when we are extra busy.
Perhaps your residency program abused you, we don't.

 

[kazuma]

We definitely have to relieve nurses even if your we're not on call because our institution can't seem to figure out how to schedule blocks efficiently. Some days are light some days non call folks stay as late as 8 or 9 but that's fairly rare. Attendings never finish thier cases solo unless its to cover for the ITE or in july when the CA1s are still doubled up. Overall its nice to have the nurses around because they do low yeild cases nobody wants like GI lab. They never do traumas unless they are coming in to lend an extra pair of hands to hang blood on the Belmont. If a nurse is assigned to a room we want we can usually swap rooms.

 

[anes]

Can you be serious? What kind of program director / residency program in general takes residents out of trauma cases to do an appy. Sounds like a program run by a lazy private group who are using the residents as cheap labor... Crazy... Too bad that kind of thing happens anywhere .


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The official policy was that residents should be doing the better cases (traumas overnight), but it was ultimately at the discretion of the on call attending. We had a small pool (2-3) attendings who did around 90% of nights. Guess what decision they would make regarding resident use at night.

 

[anes]

I'm not sure what you mean? What's bullshït? The fellows always get the most appropriate cases every day (they are assigned first), the residents get the best cases for them (which isn't always the next most complex cases), and the CRNAs get everything else. Trainees are almost never (or actually never for some locations) offsite in MRI, rad onc, Onco, GI, dental, etc. where the cases are very low yield.
So what's the bull you're asserting? We take pride in training residents and fellows. Do they take over cases when the CRNAs go home in the evening? Yes. Because they're the call team. That's what the call team does. Do we keep non call residents late to relieve CRNAs? No we do not. Because of the way we schedule (only 2:1) and close rooms at specific times, the late attendings will sit and finish themselves if necessary. That is really only an issue in the summer months and Christmas holiday period when we are extra busy.
Perhaps your residency program abused you, we don't.

Hah... An attending doing a case by themselves. I never once saw that in residency.

 

[repititionition]

Where I trained, the crnas weren't there to help us have less work. We ended up having to relieve them when our cases were done. Many times they would be relieved at 1pm by a resident, even though they were getting paid for the whole day (until 4-5 pm). And at night if the on call resident was a CA1 or even sometimes CA2 we would go take over a lap appy that was being done by a crna so that they could do the major trauma that was about to roll in.

At our program the order was attending>crna>feces>resident.

Please tell us where you trained so those coming behind you can avoid it.

 

[BobBarker]

Late and call residents would relieve CRNAs at our program. But residents did all index cases, interesting rooms, procedures. Fiberoptic tube in a CRNA room? A resident would be found to do it. CRNAs did the undesirable cases, wound washouts, benign hysts, etc

 

[B-Bone]

I trained at a program like IlD's where CRNAs were used to do routine cases while residents got the interesting stuff. CRNAs routinely relieved residents daily (usually between 3 and 5 pm), as we had multiple shifts of CRNAs for this purpose. At night, residents generally didn't sit cases (except rarely CA-1s), but rather supervised CRNAs or helped out on big cases (trauma, cardiac, transplant, etc). CRNAs in house at night (three of them) meant that the CA-1 usually slept through the night on call, unless it was totally slammed with 4 rooms going aft midnight or if something cool was happening. CRNAs meant every resident got to go to every lecture. I am not a CRNA apologist, but if used right, they can really facilitate a great learning environment for residents. I felt bad for the MD only programs where the residents were the workforce and had to sit every single lap chole and knee washout. While you do learn a lot sitting your own cases, there are diminishing returns on sitting your 100th cataract (a case I never actually did in residency).

 

[anes]

Please tell us where you trained so those coming behind you can avoid it.

Heh... It was mostly the nights that sucked with certain attendings. There is a hierarchy, and I knew it and I knew my place.

With other attendings it was much better. If I had to go back, I would still rank the program #1. Its just that I know I'm not as important as a crna (as a resident, at that particular program). It was only 3 years.

 

[emtdan]

I'm not sure why you wouldn't want to post what you didn't like about the program. Everyone is entitled to an opinion, and you have a month of insider info. People do it all the time. Many more will read this post than would ever PM you.

I edited my first comment.

 

[repititionition]

I trained at a program like IlD's where CRNAs were used to do routine cases while residents got the interesting stuff. CRNAs routinely relieved residents daily (usually between 3 and 5 pm), as we had multiple shifts of CRNAs for this purpose. At night, residents generally didn't sit cases (except rarely CA-1s), but rather supervised CRNAs or helped out on big cases (trauma, cardiac, transplant, etc). CRNAs in house at night (three of them) meant that the CA-1 usually slept through the night on call, unless it was totally slammed with 4 rooms going aft midnight or if something cool was happening. CRNAs meant every resident got to go to every lecture. I am not a CRNA apologist, but if used right, they can really facilitate a great learning environment for residents. I felt bad for the MD only programs where the residents were the workforce and had to sit every single lap chole and knee washout. While you do learn a lot sitting your own cases, there are diminishing returns on sitting your 100th cataract (a case I never actually did in residency).

Similarly, many of us would love to know where can get experience like this!!!

(And yes, I get that people are less likely to potentially out their identity on a public forum - I'm waiting on my application to the private forum to be approved...)

 

[Mman]

BULL****. (Sorry. Gotta call that.)

Sorry. At my program which is as big as any name around, the CRNAs were used to fill in the schedule after all resident assignments were made. I literally never once was put in the trach/peg room in 3 years. Never got the garbage BS boring cases. The CRNAs never picked a single room to assign until every resident was in a more interesting room first.

That's how it should work and that's how it did work.

 

[DrBeaker]

Hah... An attending doing a case by themselves. I never once saw that in residency.

I have done all my own cases at an academic center thus far. It's 50/50 as far as training residents or doing your own

 

[anes]

I have done all my own cases at an academic center thus far. It's 50/50 as far as training residents or doing your own

I know it happens. Just not where I trained.

 

[Jeff grad]

Dan, I see that you have deleted your original comment. But thanks to Google cache it can be found here: http://webcache.googleusercontent.c...-red-flags.1098111/+&cd=1&hl=en&ct=clnk&gl=us

(Full text at bottom)

Emtdan, I am a Jefferson grad. I don’t know you personally, but I know students like you. Sorry, but I’m going to be blunt here. Think of it as tough love.

Look at your post. For a brand new MS4, you have a high opinion of your skill level. Do you really think that an PGY3 resident is “threatened” by you? Nobody cares that you have performed intubations in the field. Seriously, we don’t. If anything, it can make you more dangerous because you may be perceived as someone who is not teachable. Your combination of arrogance and “I got this” attitude would make me way less likely to let you touch my patient.

You chose to rotate at a pediatric hospital affiliated with Jefferson. There is no way that an attending is going to let you touch a kid, especially when they need to train brand new anesthesia residents starting their rotation. It wasn’t the residents who wouldn’t let you do intubations and IVs. It would have to be the attending who made that call. And did you really think you’d get to do blocks?

You say that you have worked with “MANY” CA2s from different programs. How is this possible? It’s September. You just spent at month at Dupont. Maybe you did 2 other outside rotations? Unlikely, but possible. So…n=2?

Although your CA2s had just finished studying for the boards, in your opinion, they have a low fund of knowledge. How would you know this? Do you seriously think you are qualified to comment? But maybe you’re right- perhaps the residents weren’t experts on pediatric anesthesiology yet. It was their first peds rotation. It’s a lot to master.

You seem arrogant and entitled. You have to earn the right to take care of patients. Nobody cares that you’ve signed up for an anesthesiology rotation. It doesn’t mean that you are going to touch a patient if you have a bad attitude or the attending doesn’t trust you. I wish you the best of luck with the match.


Original comment:
I just got off doing an away rotation at Jefferson and was very disappointed. I will no longer be applying to this residency.

Any other red flag programs you rotated at that you will no longer be applying to?

EDIT: As I am getting lots of pm's as to why I did not like Jefferson I will copy and paste what I replied back below.

"So the biggest red flag to me was the unpreparedness of the CA2s. I have worked with MANY CA2s from different programs and the ones I worked with at Jeff had little confidence which made it very awkward in the OR and generally APPEARED to have a lower fund of knowledge than other residents I've worked with at other programs. HOWEVER, the CA3 I worked with was awesome, and very smart, so I do not know what happened with the CA2 class.

Also, the CA2s saw me as someone trying to take away their intubations and IVs and blocks etc, and treated me like **** because of it. Generally were unpleasant in the OR with me there. The residents had been very nice though and easy to get along with prior to working with them - ie. if I had run into them in the hallway or break room etc. So obviously it had to do with me being seen as a "threat" which is very immature considering every other place I had gone to was fine. I think this also played into the unpreparedness and inexperienced part of their class - that they didn't feel comfortable in their skills yet to let a few procedures get shared."

emtdan, Yesterday at 11:29 AM

 

[eablackwell]

I pretty much take what most people say about programs with a grain of salt, unless I hear it from an attending that was recently a resident at that program or a number of current residents. I already applied to Jefferson before reading this, and it doesn't make me regret my decision at all.

I also think it's very difficult to generalize about a program being bad or good based on something like CRNAs/SRNAs, or if you didn't get to do a lot in a 4th year rotation. Hospitals, much like anesthesiologists, can handle the same situation quite differently. CRNAs are something we are going to have to deal with throughout our careers, no matter where we train or practice, and I find it a lot easier to play ball/get along than get upset over something I can't change.

I recently rotated in anesthesia at a hospital that has no CRNAs on staff but they do train SRNAs, and attendings run their own cases, unless they are assigned a resident or student for that particular case. I loved the program and was able to do many airways, IVs, and changed over the rooms for each case, although students were not allowed to do blocks, which I understand. I was lucky enough in 3rd year during ob/gyn to make nice with an anesthesia attending that allowed me to do a spinal for a c-section, but I 100% understand the concern that someone they don't know at all, at their hospital for a month, may not be competent enough to perform blocks. Heck, most attendings I know that don't do them regularly are not confident when it comes to regional blocks. Intubation and extubation can be fatal, but attendings know how to fix things (to a point) if you mess up or miss, so in general I think programs are more likely to let you give an airway a try if the patient is easy to ventilate.

This year I also rotated at a hospital that had pretty much the same number of SRNAs/CRNAs as residents, and everyone got along very well. They covered each other for lunch breaks and if something personal came up, and it wasn't always residents that were jilted by late cases. Everyone seemed to share the burden of those unfortunate cases equally. I understand that most programs are not like this, but I don't see CRNA/resident ratio as an end of the world situation, just something to take into consideration.

 

[scutdoc]

For what it's worth, if anything, here are a few which come to mind, though I trust there are others and better than what I have to say (and I can't comment on the CRNA issue because I honestly have no idea):

* How is the program's ACGME's accreditation? 1 year? Are they on probation?

* How are the didactics? Are residents themselves the ones mainly providing the didactics? How often do didactics occur each week? Are residents usually able or unable to attend didactics?

* What's the volume of cases like? Are residents barely meeting ABA numbers?

* Same with procedures. Are residents barely meeting ABA numbers?

* Are residents being sent out to other places besides their own institution in order to meet their numbers?

* What's the pass rate for recent graduates?

* Where are recent graduates? Are they able to find a job in the local area if they wish to stay? How about in the greater region?

* If they want to pursue fellowship, are they able to get a fellowship easily or with difficulty?

 

[Jeff grad]

http://forums.studentdoctor.net/threads/jefferson.799712/
http://forums.studentdoctor.net/threads/jefferson-vs-tufts.1054417/
http://forums.studentdoctor.net/threads/2014-match-rank-list-thread.1050350/#post-14808159
Maybe some current residents can chime in.

 

[Consigliere]

Red flag: programs that are all about that bass, that bass.......no treble.