Concerned about inadequacy of my residency training

[pgg]

You'll be OK, especially if your biggest shortcomings are monkey skills like blocks or lines.

No one knows everything right out of residency. Certainly some people graduate stronger or more experienced than others, but the purpose of residency is to make you safe. Getting and staying good is a lifelong task and the learning curve for everyone is steep for a few years out of residency.

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[urge]

A misconception most people have about surgery internship is that you are expose to very little medicine...which is not true, in my training programs most of this patient had multiple medical comorbidities and get admitted for things like abscess...the abscess is extremely easy to drain but very often you are managing their diabetes, afib, CKD, hyponatremia, sepsis, etc...we rarely ever called medicine consult in the ICU we just manage the patient medical issues on our own...while i might have been a surgery intern, i only spent 5 months in surgery...the rest of the time i was in the ICU and ED....So yes i saw a breadth of pathology and i doubt med interns are well equiped in medicine than me, i had a lot of interactions with them and no i was not impress...let stop beating a deadhorse.

You should go to the ABIM and tell them they doing it wrong. They should be doing surgery residencies if they want to learn Internal Medicine.

 

[aimedicine]

You should go to the ABIM and tell them they doing it wrong. They should be doing surgery residencies if they want to learn Internal Medicine.

Im out bruh. No mas!

 

[Planktonmd]

You should go to the ABIM and tell them they doing it wrong. They should be doing surgery residencies if they want to learn Internal Medicine.

 

[wickedskillz]

I also recommend the ICU rotation for lines, and another cardiac rotation or two if you can get it. Put a subclavian line in any ICU patient with a chest tube, they are pneumo proof. With another ICU month and 1-2 cardiac months you should be ace with your lines, or at least par with most residents. Regional experience is probably the hardest to get in most programs. At least learn how to do the easy blocks like fem, pop/sci, axillary, supraclav, interscalene and TAPs. They honestly aren't very hard to learn, and like everyone says, if you end up at a job which you need to do blocks, someone will teach you.

 

[epidural man]

I am a soon to be CA-3 and so far I have either little or no experience in the following areas:

CVC (non IJ)
A-lines (non radial)
Regional Blocks (had a rotation, but did very few blocks)
FOI
Massive Transfusion (no transplant, rare trauma)
Probably lacking in some other stuff I cant think of off the top of my head...

I dont see it being likely that Im all of a sudden going to be able to accomplish these things during my CA-3 year. I dont really feel like the training I am getting will prepare me to practice independently. Is possible to transfer to another residency at this point, or am I destined to be a hack?

I like your honesty and candor.

You'll be fine. Seriously.

I have nothing new to add, but i'll "talk" anyway.

Probably 90+% of anesthesiologist don't do SC lines, and never ever will again. don't sweat that.

Academic places put in A-lines way more than private practice jobs. I bet there are a ton of anesthesiologists that haven't done an a-line YEARS. They just aren't used that much in private practice because surgeons are fast, and they don't loose blood. As a resident, rotating at other hospitals including Kaiser, I was always shocked at the cases they would do without lines. My staff would always say (with reference to central access and A-line on what I thought where BIG cases like whipples and stuff) "put it in if you want, we usually don't for that."

But having said that, I have never regretted having an A-line. This year, have a very LOW threshold to put in an A-lines. Tell your staff you will do it after the drapes come up as to not delay anything. I can't imagine your staff having heart burn about that because it doesn't slow the room down, and it is pretty darn safe. Of the things you mentioned, A-lines are important to get comfortable with. Doing an ALIF? Put in an A-line. Doing a cercival fusion with myelopathy? do an aline? Belly case >4 hours? A-line. Someone fat >3 hours? Easily justifiable to do an A-line because a BP cuff every 3 minutes can cause nerve damage, make horrible looking marks and bruises, cause post-op pain, etc - have a low threshold for A-line. You can find them if you push for them.

Practice with ultrasound. If you get good at putting in an A-line with ultrasound with an in-plane technique, you are unknowingly improving your regional skills, AND your central - line skills. I never do central lines, but I don't fear them because I feel very confident that I can - with direct visualization - put a tip of any needle in any point in the body with great control.

Central lines...eh. I can't think of a real reason you need one ever. Seriously...why is a central line ever really needed? 14 gauge flows faster. With CardioQ or flowtrac, you get good enough data and makes a CVP useless. All of us have given vasoactive stuff peripherally - maybe it is risky, but so is putting in a central line. Practice putting in a RIC or two - that should get your seldinger technique down. (next case that turns 180, put a RIC in the saphenous - good practice.....and bloody as all get out.)

 

[urge]

I like your honesty and candor.

You'll be fine. Seriously.

I have nothing new to add, but i'll "talk" anyway.

Probably 90+% of anesthesiologist don't do SC lines, and never ever will again. don't sweat that.

Academic places put in A-lines way more than private practice jobs. I bet there are a ton of anesthesiologists that haven't done an a-line YEARS. They just aren't used that much in private practice because surgeons are fast, and they don't loose blood. As a resident, rotating at other hospitals including Kaiser, I was always shocked at the cases they would do without lines. My staff would always say (with reference to central access and A-line on what I thought where BIG cases like whipples and stuff) "put it in if you want, we usually don't for that."

But having said that, I have never regretted having an A-line. This year, have a very LOW threshold to put in an A-lines. Tell your staff you will do it after the drapes come up as to not delay anything. I can't imagine your staff having heart burn about that because it doesn't slow the room down, and it is pretty darn safe. Of the things you mentioned, A-lines are important to get comfortable with. Doing an ALIF? Put in an A-line. Doing a cercival fusion with myelopathy? do an aline? Belly case >4 hours? A-line. Someone fat >3 hours? Easily justifiable to do an A-line because a BP cuff every 3 minutes can cause nerve damage, make horrible looking marks and bruises, cause post-op pain, etc - have a low threshold for A-line. You can find them if you push for them.

Practice with ultrasound. If you get good at putting in an A-line with ultrasound with an in-plane technique, you are unknowingly improving your regional skills, AND your central - line skills. I never do central lines, but I don't fear them because I feel very confident that I can - with direct visualization - put a tip of any needle in any point in the body with great control.

Central lines...eh. I can't think of a real reason you need one ever. Seriously...why is a central line ever really needed? 14 gauge flows faster. With CardioQ or flowtrac, you get good enough data and makes a CVP useless. All of us have given vasoactive stuff peripherally - maybe it is risky, but so is putting in a central line. Practice putting in a RIC or two - that should get your seldinger technique down. (next case that turns 180, put a RIC in the saphenous - good practice.....and bloody as all get out.)

First line I learned to do as an intern was the subclavian. I did a bunch of them. So easy and so elegant.

Ever since I started anesthesia I stopped doing them, because we don't do them. I can say I did more subclavians during my internship than I have done in anesthesia all my years.

 

[Mac4]

Somehow, I do not feel OP the only CA-3 who might feel the same way. Glidescope and U/S have taken away many training opportunities for the residents.

 

[Random Anesthesiologist]

Sad that this thread is being used as an example on nurse-anesthesia.org as "evidence" they are training better than us.

 

[IlDestriero]

Sad that this thread is being used as an example on nurse-anesthesia.org as "evidence" they are training better than us.

They're delusional.


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Il Destriero

 

[Man o War]

Sad that this thread is being used as an example on nurse-anesthesia.org as "evidence" they are training better than us.

Oh you mean the same people who have devoted an entire thread to debating whether simulations can/should be counted toward case counts? Good grief.
I'm also a bit suspicious of some of these threads that are posted here and then immediately used as fodder on the CRNA websites.
Just saying.....

 

[RK.md]

I'm also a bit suspicious of some of these threads that are posted here and then immediately used as fodder on the CRNA websites.

Lol, those nurse-anesthesia.org posts are great for a good laugh and reminder of the insecurity held by some of our mid-level counterparts. I'm as collegial and inclusive as the next guy, but come on... quoting SDN posts? Those admins are making fools of themselves.

 

[Psai]

Sad that this thread is being used as an example on nurse-anesthesia.org as "evidence" they are training better than us.

A lion doesn't concern itself with the opinion of sheep

 

[IlDestriero]

$1000 says this guys "inadequate" partial training is better than any of theirs already.
The Navy SRNAs used to double up on their cases for numbers. I always thought that was shady. Sims as cases is ridiculous.
P.S. Some may wish it was, but it's not a lie. I was there and watched it happen with my own eyes. Their CRNAs pulled them out of cases to do it. I don't think that it happened, I'm certain it happened.
I don't know what the rules were then for them, or what they do now, nor do I care. I don't train SRNAs anymore and the Navy is ancient history.
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Il Destriero

 

[deleted171991]

They don't know what they don't know. The OP does. Just with that, he should run circles around most of them, as fresh grad.

I am never afraid or disrespectful of people who know when to ask for help.

 

[vector2]

Sad that this thread is being used as an example on nurse-anesthesia.org as "evidence" they are training better than us.

The main issue is that they equate procedural competency with medical knowledge and decision making. A nurse may be able to technically perform an ISB after a weekend workshop, but I would wager he is also more likely to order a CT and activate a stroke code because he's unaware of the incidence of Horner's (or for that matter what Horner's even is).

 

[Robotic Wis-Hipple]

SRNAs thinking their training is comparable, little lone superior, is the definition of delusional. Places that train SRNAs can only do so because the residents are getting numbers that would make their heads spin (not that I think this is ok even then...).

But I second all the others that are encouraged by the fact the OP is cognizant of potential inadequacies.

The truth of knowledge is the realization that the more you learn, the less you know.

 

[BLADEMDA]

I feel that a good response to the concerns of the OP is due to set the record straight:

1. Anesthesiologists at good residency training programs receive both education and hands-on experience in all aspects of this specialty. This means the Resident should be exposed to all types of cases, especially ASA 3 and 4 patients which results in invasive monitoring from time to time.

2. A senior resident in a good residency program should be competent in all basic skills sets; this includes General anesthesia, difficult airway management, basic Peds, Basic Cardiac and common regional/neuraxial blocks.
3. Basic competency in invasive line placement is a core requirement for a CA-3 in a good program.

Please notice I stress "basic competency" as opposed to "expert level competency" which is usually obtained 1-5 years post residency training.

Any program not delivering on 1-3 is a blight on the profession and should be closed immediately; or, at least put on probation until all the issues are corrected. A residency program must deliver on education and competency in the practice of Anesthesiology and those programs which fail to do so are an anomaly. These types of programs should be exposed for what they really exist for which is cheap labor. These types of threads which disparage the profession do a great disservice to the Medical Specialty of Anesthesiology and all those in good residency programs. These "bottom-feeder" programs which are likely the worst 5-10 residencies in the nation should be shut down.

There simply is no comparison between the training Anesthesiology residents receive vs the civilian CRNA programs. One is the major leagues while the other is AAA ball at best.
Those Anesthesiology Residencies which can't play in the major leagues must be brought up to speed or shut down.

 

[Carbocation1]

 

[Timeoutofmind]

Sounds like your program is complete crap. Of all the things you listed, you definitely need more regional exposure. Anyway you can fix asap this will likely help a lot with job searching...i don't think I would hire someone who can't even do a block, trauma, and sucks at lines...

I would strongly consider a CV fellowship if you can get a spot...would help in all of these areas except regional.

You owe it to everyone who is or will be at that program to contact ACGME, insist on them keeping you anonymous, and lay out in detail the deficits there.

Keep your chin up! Not a deficit that is beyond repair, but honestly, it is going to be critical to choose a first job where you are exposed to these things and work hard to supplement your own education online and on the job. Sorry you have to deal with this situation...so many POSs in academics...

 

[urge]

Please notice I stress "basic competency" as opposed to "expert level competency" which is usually obtained 1-5 years post residency training.

I would argue expert level is reached 10 years after graduation.



When you are ready, you won't have to [dodge bullets].

 

[IlDestriero]

This guys program is an example of why I think you need either trauma or liver transplant in residency, and a decent cardiac program. You would likely cover all of these deficiencies with that.
Someone asked me years ago if they should do a trauma fellowship, my suggestion was to get a job at a real trauma center, find the greyest hairs there, and ask for all their tips. When you have questions or concerns, call them. Then you will learn.
Instead of making ~70k for a year of abuse, you make 300k+ and get a couple years of experience at a big center kicking ass and taking names. Then you market that experience to score the good job. Maybe that's something to consider. Or sell out to a GI center and hope CRNAs don't go independent there. I'd probably take option 1.
There's plenty of time for the OP to get experience, 12 months!, BUT he/she has to be aggressive about seeking out opportunities, pushing the faculty, and not taking "next time" as an answer.


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Il Destriero

 

[DrN2O]

i'm shocked at this post...are residency training so weak these days we need fellowship to feel confident with our skills...?
maybe you should have done a surgical internship, i logged well over 20 central lines this year and i can't even begin to count the number of alines that i did. Most of them in the surgical ICU, it was a closed unit ran by us residents....hated the 4 hour morning rounds tho.

Ha, I cringe every time the CT guys try to place the femoral a-lines. They methodically search for the artery by blindly fanning their needles, often after they make me give heparin. The surgeons these days are no better at lines than my resident. And god helps them if they need to pick up an ultrasound.

 

[vector2]

Ha, I cringe every time the CT guys try to place the femoral a-lines. They methodically search for the artery by blindly fanning their needles, often after they make me give heparin. The surgeons these days are no better at lines than my resident. And god helps them if they need to pick up an ultrasound.

One of our CT surgeons used to do so much deep, blind, angulated fanning that I'm surprised the syringe never returned a liquid that was brown, yellow, or clear.

 

[deleted171991]

One of our CT surgeons used to do so much deep, blind, angulated fanning that I'm surprised the syringe never returned a liquid that was brown, yellow, or clear.

Beats me why people are dumb and don't use the ultrasound when it's already in the room.

 

[2Fast2Des]

I feel that a good response to the concerns of the OP is due to set the record straight:

1. Anesthesiologists at good residency training programs receive both education and hands-on experience in all aspects of this specialty. This means the Resident should be exposed to all types of cases, especially ASA 3 and 4 patients which results in invasive monitoring from time to time.

2. A senior resident in a good residency program should be competent in all basic skills sets; this includes General anesthesia, difficult airway management, basic Peds, Basic Cardiac and common regional/neuraxial blocks.
3. Basic competency in invasive line placement is a core requirement for a CA-3 in a good program.

Please notice I stress "basic competency" as opposed to "expert level competency" which is usually obtained 1-5 years post residency training.

Any program not delivering on 1-3 is a blight on the profession and should be closed immediately; or, at least put on probation until all the issues are corrected. A residency program must deliver on education and competency in the practice of Anesthesiology and those programs which fail to do so are an anomaly. These types of programs should be exposed for what they really exist for which is cheap labor. These types of threads which disparage the profession do a great disservice to the Medical Specialty of Anesthesiology and all those in good residency programs. These "bottom-feeder" programs which are likely the worst 5-10 residencies in the nation should be shut down.

There simply is no comparison between the training Anesthesiology residents receive vs the civilian CRNA programs. One is the major leagues while the other is AAA ball at best.
Those Anesthesiology Residencies which can't play in the major leagues must be brought up to speed or shut down.

How does one achieve expertise post residency if the future is supervision only and hands off while running around like a headless chicken?

 

[GA8314]

I'll say this. If you lack higher volumes of large cases etc. then you need to make the most of every one you do. Make them a little rocket science project. Preop and read the sh.t out of those cases. If you don't place lots of big lines, then break open a kit and familiarize yourself with the contents before hand. Review the plan with staff.

Get greedy with procedures. If you are assigned a mundane room and a senior has another, ask to put the lines in for him/her. Start IV's.

I know it can be more limiting, but it's totally possible. You don't need super high volumes of those types of cases to burn a memory such that you feel comfortable with them in the future, in practice. Surely, there is a minimum but you must be meeting those or your program would be on probation or nonexistent.

During ICU, be the first to volunteer or assert that you will place the lines. I see/hear a lot of excuses from residents when it's, frankly, their own fault. It's true that a large place with loads of those procedures/cases makes it easier, but this is your career. Make the most of your training.

Also, don't take breaks during critical portions of the surgery. Don't miss out on ANY procedures until you are 100% deft at them. This is what it means to be greedy. I see so many residents lose that critical "continuity" of a case by taking breaks at the wrong times. Yes, I've been there. I know you either take it or lose it. Sometimes, however, you just have to go without aside from maybe some bathroom breaks and a quick bite. But, taking 30 minutes and letting the other guy come off pump is totally unacceptable if you are in one of these programs.

 

[deleted171991]

How does one achieve expertise post residency if the future is supervision only and hands off while running around like a headless chicken?

One finds a post-residency job that involves at least 50% solo work, for the first 2-3 years, regardless of pay.

 

[confusingleaf]

the job i am starting is academic, but they have taken over a couple of surrounding private practice groups and i have volunteered to go do my own cases as much as needed and if they are ever short of residents at the main center i am happy to do my own. nothing makes you learn faster than figuring out how to troubleshoot the lines/problems yourself with no attending looking over your shoulder.

 

[BLADEMDA]

How does one achieve expertise post residency if the future is supervision only and hands off while running around like a headless chicken?

Do all the lines your first 2 years out even if the CRNA requests it. Second, Do all your own blocks and spinals on your assigned rooms. How can you not get proficient this way? I still do about 1/2 the central lines and 1/4 of the neuraxial blocks even at my experience level just out of time constraints or to bail out the CRNAs.

What you really can't get skilled at without 2-3,000 cases under your belt is fast wake-ups and dealing with intraop issues. I believe the best supervisor is someone with thousands of personally performed cases under his/her belt.

 

[Arch Guillotti]

Do all the lines your first 2 years out even if the CRNA requests it. Second, Do all your own blocks and spinals on your assigned rooms. How can you not get proficient this way? I still do about 1/2 the central lines and 1/4 of the neuraxial blocks even at my experience level just out of time constraints or to bail out the CRNAs.

What you really can't get skilled at without 2-3,000 cases under your belt is fast wake-ups and dealing with intraop issues. I believe the best supervisor is someone with thousands of personally performed cases under his/her belt.

Why are you letting the nurses do central lines and blocks?

 

[BLADEMDA]

Why are you letting the nurses do central lines and blocks?

Our CRNAs do get to do some central lines and spinals/epidurals. The use of U/S has made central line placement relatively safe and CRNAs have a long history of doing Neuraxial blocks.

 

[2Fast2Des]

Our CRNAs do get to do some central lines and spinals/epidurals. The use of U/S has made central line placement relatively safe and CRNAs have a long history of doing Neuraxial blocks.

at a certain program, you have to ask the crna for permission to do lines for your pt, or if you have a bit of a lower threshold for lining a pt up for a case, the surgeons and CRNA will throw a hissy fit because its not the way they do it.

 

[pgg]

at a certain program, you have to ask the crna for permission to do lines for your pt, or if you have a bit of a lower threshold for lining a pt up for a case, the surgeons and CRNA will throw a hissy fit because its not the way they do it.

I'm sure the ACGME would like to hear about that.

 

[Arch Guillotti]

Our CRNAs do get to do some central lines and spinals/epidurals. The use of U/S has made central line placement relatively safe and CRNAs have a long history of doing Neuraxial blocks.

Are you letting them do u/s guided peripheral nerve blocks?

 

[IlDestriero]

at a certain program, you have to ask the crna for permission to do lines for your pt, or if you have a bit of a lower threshold for lining a pt up for a case, the surgeons and CRNA will throw a hissy fit because its not the way they do it.

Our CRNAs do zero lines, if they ask, they might get an A line from some of the faculty. Most of the time they don't even put in IVs. They mask the patient, we line and push the induction drugs, they intubate, we place additional lines, blocks, etc. while they prep the patient and chart. If they don't like the arrangement, they can find a better place to work. My area tends to have either solo MDs, tight supervision jobs, or very minimal 4:1 supervision with the MDs running and gunning for the loot. There's not much middle ground from what I hear.
I cannot imagine a high turnover 4:1 job. As it is I can't always keep a good eye on the CRNAs covering 2:1 on a busy day. I give an instruction, like give some fluid for the hypotension, come back ~10 minutes later after an induction or extubation elsewhere, and the pressure still sucks but is up a bit and they think the 10% improvement was good enough. GD! WTF? I swear they are slowly killing me one grey hair at a time. Then they look at me sideways when I'm pushing a pressor, slamming in 20/kg LR, cutting down the gas, etc.
Serenity now, Serenity Now!


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Il Destriero

 

[IlDestriero]

at a certain program, you have to ask the crna for permission to do lines for your pt, or if you have a bit of a lower threshold for lining a pt up for a case, the surgeons and CRNA will throw a hissy fit because its not the way they do it.

"That's not the way they do it."
Lol!
"They" don't do ****. It's always your patient.
Pick your battles, of course, but don't compromise what you consider the best plan because a couple whiners want to get out 10 minutes early.


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Il Destriero

 

[deleted171991]

Our CRNAs do zero lines, if they ask, they might get an A line from some of the faculty. Most of the time they don't even put in IVs. They mask the patient, we line and push the induction drugs, they intubate, we place additional lines, blocks, etc. while they prep the patient and chart. If they don't like the arrangement, they can find a better place to work. My area tends to have either solo MDs, tight supervision jobs, or very minimal 4:1 supervision with the MDs running and gunning for the loot. There's not much middle ground from what I hear.
I cannot imagine a high turnover 4:1 job. As it is I can't always keep a good eye on the CRNAs covering 2:1 on a busy day. I give an instruction, like give some fluid for the hypotension, come back ~10 minutes later after an induction or extubation elsewhere, and the pressure still sucks but is up a bit and they think the 10% improvement was good enough. GD! WTF? I swear they are slowly killing me one grey hair at a time. Then they look at me sideways when I'm pushing a pressor, slamming in 20/kg LR, cutting down the gas, etc.
Serenity now, Serenity Now!


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Il Destriero

You're peds. Different rules, different reality.

 

[IlDestriero]

The rules are what the partners/chief says they are.
Though it's easier when you employ them.


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Il Destriero

 

[B-Bone]

The rules are what the partners/chief says they are.
Though it's easier when you employ them.


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Il Destriero

Agree. We don't let our CRNAs do any blocks, neuraxial, or invasive lines. We do employ our CRNAs, but it was this way even when we didn't. The medical staff is in charge of who is credentialed for what procedures, and CRNAs aren't credentialed for these things.

 

[confusingleaf]

where i am, typically residents do any case that requires a line. SD did a case with a CRNA that required a line and of course she wanted to do it and insisted she could. he almost called a fellow to come take over it was so awful.

now SRNAs, that's a whole 'nother can of beans. we (unfortunately) havea crna training program and SRNAs rotate through cardiac. without fail, each and every one of them comes on demanding to do a lines and central lines and saying they're there to "get lines." it is really f*&cking infuriating. if it is a junior resident i absolutely forbid the srna doing the lines--the resident needs the experience. if it's a senior, it really depends on how i am feeling and how much BS i feel i can tolerate that day, but my inclination is to not let them do any lines. and if there's any indication that they didn't know the patient, help set up, etc.--they are sitting in the corner the whole case. they also routinely will come to the heart room without knowing anything about the patient, thinking that their 6 am preop is adequate, as they do for all their other patients. sigh.

 

[BLADEMDA]

where i am, typically residents do any case that requires a line. SD did a case with a CRNA that required a line and of course she wanted to do it and insisted she could. he almost called a fellow to come take over it was so awful.

now SRNAs, that's a whole 'nother can of beans. we (unfortunately) havea crna training program and SRNAs rotate through cardiac. without fail, each and every one of them comes on demanding to do a lines and central lines and saying they're there to "get lines." it is really f*&cking infuriating. if it is a junior resident i absolutely forbid the srna doing the lines--the resident needs the experience. if it's a senior, it really depends on how i am feeling and how much BS i feel i can tolerate that day, but my inclination is to not let them do any lines. and if there's any indication that they didn't know the patient, help set up, etc.--they are sitting in the corner the whole case. they also routinely will come to the heart room without knowing anything about the patient, thinking that their 6 am preop is adequate, as they do for all their other patients. sigh.

The bottom line is that you do allow SRNAs to do central lines from time to time.

 

[BLADEMDA]

 

[BLADEMDA]

FYI, I received that propaganda piece by the AANA from the Florida State Society of Anesthesiologists (FSA) about 2 years ago when they were pushing hard for independent practice.

 

[confusingleaf]

The bottom line is that you do allow SRNAs to do central lines from time to time.

you're right. i do. mostly because it is GREATLY ENCOURAGED by powers that be and i was a fellow this past year. i can tell you that the number of lines i allow them to do is going to go down significantly in my or.

 

[loveumms]

I personally think we need to refuse to train SRNAs anymore. I get that it is a huge money maker for many hospitals but, we should not be training anyone who thinks they can do our job with 2 years of 'school'.

And Blade - I have a bunch of those propaganda flyers that just make me so infuriated. The ASA needs to step it up and we need to start educating our patients about the difference. The ASA did post a really interesting post about the studies the AANA claims prove they provide the same care. Well, they actually don't. Not even the Cochran review they spout all over the place (it actually found that the evidence was not robust enough to make a decision but the AANA apparently doesn't understand the study).

 

[Carbocation1]

Another favorite propaganda piece by the aana:

 

[criticalelement]

Look around at your weekly conferences. Are Nurses at those conferences? If they are are... disallow it? Stop inviting your enemy to the meetings.. Let them have there own meetings, their own patients and train their own without me teaching them how to do central lines.. I wont do it. For GP... but also my coronaries cant handle it.

 

[Arch Guillotti]

Our CRNAs do get to do some central lines and spinals/epidurals. The use of U/S has made central line placement relatively safe and CRNAs have a long history of doing Neuraxial blocks.

Are you letting them do u/s guided peripheral nerve blocks?

 

[Planktonmd]

He does whatever his AMC bosses want him to do hoping they would keep him around a few more years!