Another fine example of teaching attendings selling residents out for $$.

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teep

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Scenario: I'm at work 0530, 2h b4 my 1st case, finished setting up the room, and even went and saw my post-ops while waiting for my pt to get to pre-op.

Me: Goodmorning Doctor x

Attending: Goodmorning teep.

Me: I have my room ready to go or a general or MAC, but I think this 1st case may be ok with an ax block, and MAC... whaddya think.

Attending: I've decided to put you in with one of the CRNA's b/c it's illegal for me to add an extra room.

Me: Hmm. So what changed from yesterday.

Attending: It was a really slow day.

Me: Ok

Me (thought): Did this chump just sell me out for a cuppla extra bucks?

So I got to spend the day with an anal nurse who refused to let me touch the pt, and wanted to go in to the pathophys of common conditions (btw it's quite alarming to see how little they really know about pathophys) while talking down to me b/c she has 7 yrs anes experience blah, blah, blah...

Maybe I'm over-reacting, and someone here can set me straight, but this is my golden opportunity to learn, and I'm getting the impression I'm getting sidestepped. Also, getting there, doing all the scut, and then some, and then spending the day licking the sac of a nurse doesn't seem like a very educational way to do residency.
If I'm right, though, when I'm chief I'll be changing things around in that CRNA factory.
 
You interested in making a change there? Then post the residency program. Then go to the director and tell him you don't ever want to be paired up with a crna again. If you are, you will switch programs.

I would also tell the director that you would rather not work with the staff person that did this to you. This may stir the pot quite a bit but are we not talking about how our residencies are selling out the profession? Who better to make them sweat than there residents? Then once the word gets out about their program (after you post the program here) they will struggle to fill in the next couple of years and they will figure it out.
 
If you wish, I'll post your program for you. I have heard the same about your program b/4. I had some classmates that went there. You could do a lot better.
 
I would be careful about posting program names. It might run into a legal issue.
 
CremeSickle said:
I would be careful about posting program names. It might run into a legal issue.
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i understand that programs don't want to be defamed on here, but it seems fair to report educational practices. it would be beneficial to applicants and, ideally but probably not realistically, hold programs accountable for their treatment of housestaff.

then again i'm just a lowly med student, so what do it know...
 
CremeSickle said:
I would be careful about posting program names. It might run into a legal issue.
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BS. Please post the name of the residency program. Everybody has a right to know so we can avoid the scabs and sellouts.
 
I bet there is some ACGME or RRC rule stating that you cannot be taught by a CRNA in the OR. Might be worth to check.


Why are you so early setting up?
 
Dear TEEP:

From your ID I see that you are a medical student. There is nothing wrong with a medical student learning from a nurse. If you are lucky nurses will teach you more about patient care than any attending. I think that most CRNAs have knowledge in anesthesia that they can pass on to medical students. Its too bad you choose not to take advantage of the experience. Residents on the other hand are a different case. Residents are apprentice anesthesiologists and should be educated by an anesthesiologist. Putting them in a room with a CRNA would be wrong. However, even attendings can learn from nurses, respiratory therapist, pharmacist etc. and you should not let this get in your way to being a better doctor.
 
atrxnasd said:
Dear TEEP:

1 From your ID I see that you are a medical student.

2 Residents are apprentice anesthesiologists and should be educated by an anesthesiologist. Putting them in a room with a CRNA would be wrong.

3 However, even attendings can learn from nurses, respiratory therapist, pharmacist etc. and you should not let this get in your way to being a better doctor.
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1 From his post it seems he is a CA1 resident. He probably has not updated his info in the last 2 years.

2 Agree

3 You can learn how to be a better person, not so much anesthesia.
 
No medical student sets up a room 2 hours before a case. The guy/gal is a resident.

I don't believe you can get in trouble for posting the name of your program. Its an opinion and this is an open forum, though some of you may disagree.
 
teep said:
So I got to spend the day with an anal nurse who refused to let me touch the pt...
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unacceptable.

teep said:
... and wanted to go in to the pathophys of common conditions (btw it's quite alarming to see how little they really know about pathophys) while talking down to me b/c she has 7 yrs anes experience blah, blah, blah...
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had i been put in this situation (which i NEVER was at my recently finished program), i would've handled the situation differently. i would've flipped the script. whenever the crna felt the need to teach me about pathophys, i would've taken it a level deeper and pimped him/her back about things that they don't know. i'm sure that, for example, if the discussion was about diabetes (very common condition) i would've started asking him/her about why cataracts develop at a faster rate than in non-diabetics, and then asked about the sorbitol pathway in the lens. i would have asked them about the fructose pathway in the liver. i would have talked about beta receptors in adipose tissue, and asked if they knew why insulin actually causes weight gain. i would've had a discussion about the pathophysiology of neuropathic pain, and why diabetics are particularly prone to it. you get my drift? all of that knowledge is ulitmately important important to pre-operative, peri-operative, and post-operative care - something that they will dismiss from ignorance.

if you pimp someone beyond their knowledge base, they quickly learn to shut up. the additional upside is that you get to keep some of your 1st and 2nd year med school knowledge fresh.

as for your other complaints, i agree with noyac. you should first make your concerns known to your program director and chair. if the situation is not rectified, i would post the name of the program so others looking for residency spots can avoid it this coming interview season/match year. that will send the strongest message possible to the program.
 
Yo
I'm a CA-1. As far as what the student posted about having an opportunity to learn, I did give the CRNA a chance to teach a bit, but an MS3 knowledge base is by far and away much more complete than a CRNA's. They may be wise 2/2 experience, but they will never acomplish the depth that you, or any other MD, has.

I set up that early b/c I can, and I like having extra time to do things. Even if I'm done with everything, let's not forget that the ITE is next week and every study opportunity needs to be taken advantage of.

I would go to the director, but the accused is the chief at that site.

I won't post the name, but I will say that this guy is pretty old, and should be retiring w/i the next 5-6 yrs. When he does, it'll be my chance to slip in there and take his spot. If I do get that chance, I'll make some real changes around that place.

Noyac's other recc's are pretty good, though, and maybe I'll ask to be put at the busier hospital. I know some may think I'm crazy for getting out of a "vacation" rotation to get into a busy one, but oh well.

Actually, I just may end up posting the program a little later.
__________________
 
.
 
Oh boy! I have an eerie feeling about this.
 
VolatileAgent said:
unacceptable.



had i been put in this situation (which i NEVER was at my recently finished program), i would've handled the situation differently. i would've flipped the script. whenever the crna felt the need to teach me about pathophys, i would've taken it a level deeper and pimped him/her back about things that they don't know. i'm sure that, for example, if the discussion was about diabetes (very common condition) i would've started asking him/her about why cataracts develop at a faster rate than in non-diabetics, and then asked about the sorbitol pathway in the lens. i would have asked them about the fructose pathway in the liver. i would have talked about beta receptors in adipose tissue, and asked if they knew why insulin actually causes weight gain. i would've had a discussion about the pathophysiology of neuropathic pain, and why diabetics are particularly prone to it. you get my drift? all of that knowledge is ulitmately important important to pre-operative, peri-operative, and post-operative care - something that they will dismiss from ignorance.

if you pimp someone beyond their knowledge base, they quickly learn to shut up. the additional upside is that you get to keep some of your 1st and 2nd year med school knowledge fresh.

as for your other complaints, i agree with noyac. you should first make your concerns known to your program director and chair. if the situation is not rectified, i would post the name of the program so others looking for residency spots can avoid it this coming interview season/match year. that will send the strongest message possible to the program.
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Advanced concepts? Are you joking? Anyone can pick up a physiology book and Anesthesia and Coexisting dz's and learn these concepts in an hour. Pathways? Come on a 4th grader can memorize pathways. You are kidding right?
 
My former anesthesiology residency program strictly prohibited the placement of resident doctors in the same cases as CRNAs. I am pretty sure the ACGME prohibits this...I know you certainly can't be formally evaluated by nurses.
Second, there may be confusion should a crisis happen (i.e. who is in charge). Not a good position to be in.

I would talk with your program director about this incident. You don't have to do it in a confrontational manner. Just say that you were placed in a room with a CRNA and you didn't feel comfortable and ask how should you handle this situation in the future. If your PD is supportive (he/she better be!) then next time this situation occurs you can say "I am sorry but my program prohibits residents being assigned to CRNA rooms, so I would be happy to shadow you and learn the ins/outs of supervising multiple rooms, or I can go read."
 
3 You can learn how to be a better person, not so much anesthesia.[/QUOTE]

I am a physician who practices anesthesiology. True, I know more anesthesiology than the mid-level providers I work with but they can still teach me other things that are important in my role in patients care. A Pharm D explained the role of trough levels of vancomycin. An RT told me about new features on the ventilator I was using. A PACU nurse told me a patient was not quite right and because she wasn't ignored that trigerred interventions that could have altered the patient' course.
So I would say you can learn to be a better person and physician by listening to others and since anesthesiology is the practice of medicine anything that makes you a better doctor will make you a better anesthesiologist.
That said residents should not be learning ANESTHESIA from CRNAs/ AAs or anyone with inferior training. In order to be consultants they should be taught by other consultants. Anything less is unacceptable!
 
teep said:
Yo
I won't post the name, but I will say that this guy is pretty old, and should be retiring w/i the next 5-6 yrs.
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Thats the crux of it. This scumbag made a conscious decision to sell out his profession because he'll be out of the game by the time the consequences of his actions come home to roost.

He wasnt happy making 300k per year. He was so greedy that he wanted an extra 50k per year by bringing in CRNAs and selling you guys out.

I still have yet to see a surgeon sell out his profession by letting his midlevel run the procedure solo. And general surgeons make quite a bit less money than MDAs.

Your field has a problem with too many greedy people in it. Its obviously not a doctor-thing, it appears to be somewhat specific to anesthesia.
 
atrxnasd said:
3 You can learn how to be a better person, not so much anesthesia.

I am a physician who practices anesthesiology. True, I know more anesthesiology than the mid-level providers I work with but they can still teach me other things that are important in my role in patients care. A Pharm D explained the role of trough levels of vancomycin. An RT told me about new features on the ventilator I was using. A PACU nurse told me a patient was not quite right and because she wasn't ignored that trigerred interventions that could have altered the patient' course.
So I would say you can learn to be a better person and physician by listening to others and since anesthesiology is the practice of medicine anything that makes you a better doctor will make you a better anesthesiologist.
That said residents should not be learning ANESTHESIA from CRNAs/ AAs or anyone with inferior training. In order to be consultants they should be taught by other consultants. Anything less is unacceptable!
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Best post of the thread. Totally agree.

If assigned to a CRNA room, learn from them as much as you can. Don't let the day go to waste. I learned blind nasals from a CRNA because the attendings weren't interested in teaching them. But if you find yourself in a CRNA room more often than you like, get it rectified.
 
MacGyver said:
Your field has a problem with too many greedy people in it. Its obviously not a doctor-thing, it appears to be somewhat specific to anesthesia.
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Riiiiiiiighhhhhhhht. Because we all know that in no other field of medicine are physicians greedy.🙄
 
I don't really think the original poster's issue is due to greed, but it is still a major violation. The issues at hand are as follows:

An attending can supervise CRNAs at a 4:1 ratio. The RRC (ACGME) mandates that residents be supervised at a ratio of 2:1 or less. The attending probably made the decision that he could not provide an adequate supervisory level(ie the ratio would be 3:1 or 4:1) but by assigning a CRNA as the primary provider, he could remain "legal."

The next issue is that the RRC absolutely forbids residents to be instructed by CRNAs. This practice would get a program on probation pretty quick if it was discovered.

So, in essence, it sounds as if the attending broke a rule in order to comply with another.

In my opinion, if this was happening more than on a very rare occasion, I would have a chat with the program director of chairman. It is a big deal. While I agree with the poster who stated that there is something to be learned from everyone, the original scenario is not allowed. There will be other opportunities for you to learn those little nifty things from the seasoned CRNAs (and you will meet some really good CRNAs who have seen and done a lot).
 
The_Sensei said:
Riiiiiiiighhhhhhhht. Because we all know that in no other field of medicine are physicians greedy.🙄
Click to expand...

Of course greed exists in every specialty, but anesthesiology puts that definition to a whole other level. MDAs are the only field who are actively selling out their profession in the name of money. You gotta admit it looks pretty bad for MDAs compared to surgeons. General surgeons average about 100k less than MDAs, but you dont see them hiring PAs to do 10 cases solo every day so they can make extra money.

I've seen how MDAs work. Far too many of them let CRNAs handle their entire workload while they surf the internet in the doctors lounge. Dont tell me thats not common, I'VE SEEN IT HAPPEN. Does that mean all the MDAs are lazy? Of course not, but there are far too many people in the lazy category.

Behind every CRNA there's an MDA who wasnt happy with his fat 300k salary.
 
MacGyver said:
I've seen how MDAs work. Far too many of them let CRNAs handle their entire workload while they surf the internet in the doctors lounge. Dont tell me thats not common, I'VE SEEN IT HAPPEN. Does that mean all the MDAs are lazy? Of course not, but there are far too many people in the lazy category.
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anecdote.

but, since we're sharing anecdotes, it's funny how the only people i'd see in the lounge eating breakfast and drinking coffee before case starts were the 4-5 crnas we'd assigned for the day.

i would resist the urge to "learn" from crnas. i'm not sure that they are providing the same level of instruction or competence when it comes to what you need to know. maybe for the very basic stuff, like starting IV's, when you are a junior and haven't mastered the basic skills is okay. but, generally for the stuff that you need to know to pass the boards... you're just not going to get it from them.
 
Gern Blansten said:
I don't really think the original poster's issue is due to greed, but it is still a major violation. The issues at hand are as follows:

An attending can supervise CRNAs at a 4:1 ratio. The RRC (ACGME) mandates that residents be supervised at a ratio of 2:1 or less. The attending probably made the decision that he could not provide an adequate supervisory level(ie the ratio would be 3:1 or 4:1) but by assigning a CRNA as the primary provider, he could remain "legal."

The next issue is that the RRC absolutely forbids residents to be instructed by CRNAs. This practice would get a program on probation pretty quick if it was discovered.

So, in essence, it sounds as if the attending broke a rule in order to comply with another.

In my opinion, if this was happening more than on a very rare occasion, I would have a chat with the program director of chairman. It is a big deal. While I agree with the poster who stated that there is something to be learned from everyone, the original scenario is not allowed. There will be other opportunities for you to learn those little nifty things from the seasoned CRNAs (and you will meet some really good CRNAs who have seen and done a lot).
Click to expand...


Another way to make sure residents are not screwed is to make sure we rectify the teaching attending reimbursement rule which is only reimbursing resident teaching at 50%.

As expected, the AANA is always lobbying against it.
 
VolatileAgent said:
unacceptable.....

you should first make your concerns known to your program director and chair. if the situation is not rectified, I would post the name of the program so others looking for residency spots can avoid it this coming interview season/match year. that will send the strongest message possible to the program.
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The program I went to or chairman was very anti CRNA so we only has two or three CRNA’s and only at the VA. They did the easiest case got plenty of brakes never stayed past 1500, were usually supervised by an attending that also was watching a green resident needing help on a challenging case. Other places I have worked the CRNA were paired with junior residents or supervised by senior residents. To think that every day in residency will be education is asking to much. If residency was an optimized educational experience every minute of every day you world be able to graduate in six months to a year. A larger part of being a resident is providing low cost labor to the hospital. If you get paired with this type of CRNA think of it a opportunity to catch up on your reading or get some out of the room time to catch up on other projects.

If you complain you will make waves and make enemies and be labeled a trouble maker, it does not matter how right you are and how wrong they are. The chairman and teaching attending don’t see your education as much of a priority. Yes they will pay lip service to how important they feel education is but if you challenge them or make waves, they will get even. They can and will make the rest of your residency hell and provide you with poor letter of recommendation. I have seen chairmen go as far as send out references full of lies to keep you from getting a job. Unfortunately every where you go to work after residency will request a reference from your former residency program, giving them plenty of opportunity to get even.

The motto of residence unfortunately is, “Thank you Sir can I have another.”

Posting the name of the program so others looking for residency spots can avoid it this coming interview season/match year is the only thing that might provoke some change, that will send a message back to the program chairman.
 
urgewrx said:
Why are you so early setting up?
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he wants to get a head start.. whats the big deal. i was a real early bird at the beginning to..
I think its awesome that he starts early like this.. shows initiative
 
huron said:
While the program I went to or chairman was very anti CRNA so we only has two or three CRNA’s and only at the VA. They did the easiest case got plenty of brakes never stayed past 1500, were usually supervised by an attending that also was watching a green resident needing help on a challenging case. Other places I have worked the CRNA were paired with junior residents or supervised by senior residents. To think that every day in residency will be education is asking to much. If residency was an optimized educational experience every minute of every day you world be able to graduate in six months to a year. A larger part of being a resident is providing low cost labor to the hospital. If you get paired with this type of CRNA think of it a opportunity to catch up on your reading or get some out of the room time to catch up on other projects.

If you complain you will make waves and make enemies and be labeled a trouble maker, it does not matter how right you are and how wrong they are. The chairman and teaching attending don’t see your education as much of a priority. Yes they will pay lip service to how important they feel education is but if you challenge them or make waves, they will get even. They can and will make the rest of your residency hell and provide you with poor letter of recommendation. I have seen chairmen go as far as send out references full of lies to keep you from getting a job. Unfortunately every where you got to work after residency will request a reference form former residency program, giving them plenty of opportunity to get even.

The motto of residence unfortunately is, “Thank you Sir can I have another.”

Posting the name of the program so others looking for residency spots can avoid it this coming interview season/match year is the only thing that might provoke some change, that will send a message back to the program chairman.
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i agree with your post.. however i think he SHOULD make it known but make it known absolutely anonymously..call the acgme and lodge an anonymous complaint. even if they ask your name say i am not giving you my name. Like the above poster people in academics are full of rage and vengefulness. they will get back at you. Play the passive aggressive role learn as much as you can and when you finish get a job in an md only practice.. or better yet get a faculty job there and try to change the system.

If your program is doing this to you, there are probably multiple other deficiencies. anyway private message me and ask me any question you want ive been through this already.
 
johankriek said:
he wants to get a head start.. whats the big deal. i was a real early bird at the beginning to..
I think its awesome that he starts early like this.. shows initiative
Click to expand...

I understand getting early during your first few months, but isn't 5am a bit too early for a 7:30 start? He then had 2 hrs to kill! I have found that showing early does not really matter. What matters is getting the pt in the room before 7:30am. People will notice how slick you are when you are consistently able to start cases on time without making a fuss.

Surgeon "Where is Dr Smith?"

Circulator "Who knows, but don't worry. He is slick as sht!"

:laugh:
 
urgewrx said:
I understand getting early during your first few months, but isn't 5am a bit too early for a 7:30 start?
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it's actually one of the "warning signs" of drug diversion...

not acusing you of that, lvspro/teep 🙂
 
VolatileAgent said:
it's actually one of the "warning signs" of drug diversion...

not acusing you of that, lvspro/teep 🙂
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That's what I thought but did not want to say it. But, since you did...
 
urgewrx said:
I understand getting early during your first few months, but isn't 5am a bit too early for a 7:30 start? He then had 2 hrs to kill! I have found that showing early does not really matter. What matters is getting the pt in the room before 7:30am. People will notice how slick you are when you are consistently able to start cases on time without making a fuss.

Surgeon "Where is Dr Smith?"

Circulator "Who knows, but don't worry. He is slick as sht!"

:laugh:
Click to expand...

dude
he came in at 530.. he likes to take his time.. its his first month. make sure everything is right.. thats a good sign.. dont teach him your bad habits..

and who cares if some nurse or murse thinks you are slick.. just make sure you are taking care of the patient.. its not a show..
 
VolatileAgent said:
it's actually one of the "warning signs" of drug diversion...

not acusing you of that, lvspro/teep 🙂
Click to expand...

really?

why would that be?

I thought always taking over cases being post call and staying in the hospital.. and **** is a sign of drug diversion
 
johankriek said:
dude
he came in at 530.. he likes to take his time.. its his first month. make sure everything is right.. thats a good sign.. dont teach him your bad habits..
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He was done by 5:30 and this was his first week (wednesday being a holiday) which means that setting up must have taken like 30 min.

He was there at 5 am.
 
teep, I assume you are a CA-1? If so when are you in the room by yourself, 1 week, 2 weeks, 1 month? I remember about 2 or 3 weeks I think. Before that we were 1:1 with attendings, now they might step out, but had no other responsibilities. Sounds like you got screwed by the staffing. Your attending probably had 1 other resident room, or 2 CRNA rooms, and couldn't have you as well. Or needed to run 2 rooms and it was just too early to be left alone. While it wasn't right, your choices are to leave the case and go read or stay and try to learn something. I don't recall being paired up with a CRNA, but I have picked up quite a bit of practical knowledge when they come in to give breaks, especially my early CA-1 year. You did the right thing, you stayed and sucked it up. If it becomes a pattern, or even if it happens again you should go to your program director and explain. He/she knows the ACGME rule, but might not know what is actually going on in the trenches.
 
2ndyear said:
Your attending probably had 1 other resident room, or 2 CRNA rooms, and couldn't have you as well. Or needed to run 2 rooms and it was just too early to be left alone.
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I would prefer to shadow a senior resident than a CRNA
 
I don't know if it's still done or not, but the residency I'm most familiar with had an anesthetist in the room with first year residents for their first month. It was still the resident's case, not the anesthetist's. Obviously the attending can't be in the room every minute. The anesthetist was there mainly to answer questions about equipment, logistics, procedures, etc. How do I hook up and zero the A-line - how do I get blood gas results - why is my EKG not working?

Anesthesiology is a never-ending process of education. The field is constantly changing. Except for O2, N2O, sux, and fentanyl, I use totally different agents and drugs than what I used 28 years ago when I started. Our only monitors were an EKG, BP cuff, and a precordial - no pulse ox, no ETCO2. Who taught me how to use all the new stuff? Everyone - attendings, CRNA's, AA's, residents, students - literally everyone. I have AA students now that know about drugs I've never used such as Precedex. I'll teach them how to use a GlideScope which they've never seen before. I may have seen a new piece of equipment when the sales rep was here that one of my docs didn't, so I'll show them how it's used.

Don't be so arrogant that you think you can't learn something from just about anyone, whether it's an attending with 30 years of experience or a brand new AA that just graduated from school and is up on the latest drugs that your hospital hasn't even seen yet or the circulating RN that knows exactly what a certain surgeon wants for their case.
 
VolatileAgent said:
unacceptable.



had i been put in this situation (which i NEVER was at my recently finished program), i would've handled the situation differently. i would've flipped the script. whenever the crna felt the need to teach me about pathophys, i would've taken it a level deeper and pimped him/her back about things that they don't know. i'm sure that, for example, if the discussion was about diabetes (very common condition) i would've started asking him/her about why cataracts develop at a faster rate than in non-diabetics, and then asked about the sorbitol pathway in the lens. i would have asked them about the fructose pathway in the liver. i would have talked about beta receptors in adipose tissue, and asked if they knew why insulin actually causes weight gain. i would've had a discussion about the pathophysiology of neuropathic pain, and why diabetics are particularly prone to it. you get my drift? all of that knowledge is ulitmately important important to pre-operative, peri-operative, and post-operative care - something that they will dismiss from ignorance.

if you pimp someone beyond their knowledge base, they quickly learn to shut up. the additional upside is that you get to keep some of your 1st and 2nd year med school knowledge fresh.

as for your other complaints, i agree with noyac. you should first make your concerns known to your program director and chair. if the situation is not rectified, i would post the name of the program so others looking for residency spots can avoid it this coming interview season/match year. that will send the strongest message possible to the program.
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Dudes, we touched upon these issues in our Biochem 1st year. But, will we be getting more of the pathophys in year II?? I'm thinking yes, and it'll tie it all together.

Mainly we discussed how ketoacidosis and insulin insufficiency can lead to hypokalcemia, we discussed AGEs(advanced glycation end products, like HB-A1c, and the polyol pathway and how it relates to nerve function. We also learned how other AGEs (collagen) can cause atherosclerosis in advanced stage diabetes. Didn't get too much, SPECIFICALLY, on how this relates to cataracts (but, I could connect the dots from the above pathologic mechanisms), other than mentioning how sorbitol brings with it an elevated osmotic gradient (causing interocular pressure increases??).

That's one of my big frusterations with 1st year. Kind of just enough (really not enough) to be dangerous.

Does this stuff get covered in a more specific PATHOPHYSIOLOGICAL way in 2nd year?? I hope so.

Also, for kicks/practice (and perhaps a refresher to you guys), I'm going to post answers to all these issues (with mechanisms) in the private forum later today. Gotta run now though.

Let me know, though, if 2nd year will reinforce (or hopefully ADD to) stuff like this. Like I said, we learned the data, but it wasn't so much emphasized in a pathologic sense, per se. We kind of just covered in in biochem.
 
This happened 2d in a row. D1 was CRNA shadow day, and day 2 was a combo of the same with the delightful addition of doing all his pre-ops... bc an md sig is needed on those🙄
 
2ndyear said:
teep, I assume you are a CA-1? If so when are you in the room by yourself, 1 week, 2 weeks, 1 month? I remember about 2 or 3 weeks I think. Before that we were 1:1 with attendings, now they might step out, but had no other responsibilities. Sounds like you got screwed by the staffing. Your attending probably had 1 other resident room, or 2 CRNA rooms, and couldn't have you as well. Or needed to run 2 rooms and it was just too early to be left alone. While it wasn't right, your choices are to leave the case and go read or stay and try to learn something. I don't recall being paired up with a CRNA, but I have picked up quite a bit of practical knowledge when they come in to give breaks, especially my early CA-1 year. You did the right thing, you stayed and sucked it up. If it becomes a pattern, or even if it happens again you should go to your program director and explain. He/she knows the ACGME rule, but might not know what is actually going on in the trenches.
Click to expand...

We spend a whole month shadowing a CA-1, by the end of which we should be doing everything alone... which I was, and proved to this particular attending on a few occasions. In fact, on my 3rd day shadowing, he gave me a case to run by myself, and sent the resident on break, and then followed it up by saying "excellent job teep". The month that I speak of was last month. We were told that come D1 of CA-1, we would have our own rooms b/c we had our opportunity to learn what we needed for a very basic MAC/GA. Furthermore, we have circulating nurses who have direct lines to the attending phones, and can get someone in there in less than 15 seconds (which is our policy) unless a critical event trumps my event. So, since July 1st, I should have been doing my own cases LIKE THE REST OF MY COLLEAGUES IN THIS PARTICULAR PROGRAM!!

Oh, and please stop with the "you can learn from everyone" crap sermon. I do try to learn from all my encounters, but when someone who's education is far inferior to mine wants to discuss concepts that I've mastered 5 years ago, and then do so in a condescending fashion, I start to get a little suspicious of their motives. Save your BS lectures about learning from a nurse for someone who is a nurse. I'm an MD, and as such deserve to be taught by someone who has the depth that will be tested on all my exams.
I'm not trying to sound high and mighty, but I signed on a dotted line with the express gaurantee that CRNA's do not interfere w/our education, and now I'm realizing that those selling the contract were FOS.

Getting in early in an attempt to be a "good resident"= diverting drugs? I think you may be spending too much time inhaling your own vapors. As I sasid before, I'm an early starter, and use my "extra" time productively (ie. board study at this particular moment). 0500 is about the time I like to be there. I gives me luxury of getting things done MY WAY, and not having someone sitting over my shoulder saying "now check the ballon, and then put a stylet in...". Everyone else starts to get there about an hour after I set things up... including the block room, for all my cases in nice little containers labeled with my own, and my patients names, so there's no confusion. I was told on more than one occasion last month by our PD that he's hearing good things about me, and that I should continue to do things as I have been.

BTW, for the MS3/4's that are rotating thru gas, do as many tubes as you can. It's a very small (not minor) part of what we do, and I have yet to miss one. I even nailed one that was a known "difficult airway," on my first shot, and it was the chairmans case, no less. I did over 100 as a student, and I think 50 is the number people throw around where u start to get proficient w/it. It won't help with the million other things u have to do, but it's a good moment to grab the spotlight.
 
teep,
You seem to be a hardworking conscientious resident. I would give the program director and chairman the benefit of the doubt and assume they do not know that this is going on. I would have a casual talk with them and ask if that is the normal process, kind of play dumb and don't have an angry demeanor. I sincerely doubt that there would be any repercussions from innocently asking about your situation. If they know about and condone it, then the problem is much more serious.
With regards to getting to work early, the other posters are correct that it can be a sign of drug abuse. I doubt they were intending to accuse you of this, but were probably just pointing out a fact. One of the reasons that narcotic abuse is so difficult to detect is that most of the symptoms and signs are the same as the qualities of a devoted, hard working resident(ie always at the hospital, arrives early, stays late, volunteers for extra shifts, volunteers to do the "big" cases etc). Don't be bothered by the comments. They were not directed towards you in an accusatory fashion.
 
Gern Blansten said:
teep,
You seem to be a hardworking conscientious resident. I would give the program director and chairman the benefit of the doubt and assume they do not know that this is going on. I would have a casual talk with them and ask if that is the normal process, kind of play dumb and don't have an angry demeanor. I sincerely doubt that there would be any repercussions from innocently asking about your situation. If they know about and condone it, then the problem is much more serious.
With regards to getting to work early, the other posters are correct that it can be a sign of drug abuse. I doubt they were intending to accuse you of this, but were probably just pointing out a fact. One of the reasons that narcotic abuse is so difficult to detect is that most of the symptoms and signs are the same as the qualities of a devoted, hard working resident(ie always at the hospital, arrives early, stays late, volunteers for extra shifts, volunteers to do the "big" cases etc). Don't be bothered by the comments. They were not directed towards you in an accusatory fashion.
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😱
I didn't realize the parallels were so close!
Either way, I was in early during my prelim yr, and would either read, or help out my other resident buddies w/procedures so they could get the heck out on time. Our program's pretty busy, and help from ancillary staff is shaky. You can usually get what you need, but you have to do all the paperwork, and phone calls yourself, and then the ancillary comes in for a handoff just b4 pt is turfed/dc'd, etc... It sucks bc it gobbles up time, but is good bc you really get to learn about all the things that make a typical IM pt go from start to finish.
I'm not too sure it would be a good idea to be a "whistleblower" in any way. I don't want to defame the program, nor do I wanna get this guy in trouble. I will continue to do what I do, and when the time comes to take my opportunity... I will.
 
Gern Blansten said:
One of the reasons that narcotic abuse is so difficult to detect is that most of the symptoms and signs are the same as the qualities of a devoted, hard working resident(ie always at the hospital, arrives early, stays late, volunteers for extra shifts, volunteers to do the "big" cases etc).
Click to expand...

99% of the time it's the smartest, hardest working, good looking, all american kid.

Anesthesia is probably the only specialty in medicine where it is ok to be a slacker.
 
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