Concerning issue

[Sam212]

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The hospital where I am at is a county style hospital. Today I saw a 3rd med student who was following a "CRNA Resident" on his anesthesia rotation. This was very concerning to me. I pulled the guy aside to ask him what's up. He told me that Anesthesia chair told him to follow CRNAs in the hospital. These CRNAs refuse to teach him unless there is also an SRNA around, just to "protect the trade". Apparently he discussed this with Anesthesia chair and not a single **** was given. I asked him about the general attitude of anesthesiologists he's worked with. He told me he barely ever sees them unless **** hits the fan and they are mostly hangin in the lounge.

Now I know anesthesiolgists are a hard working bunch as a group but what is up this? I just wanted to bring it up here for discussion to see if this was the norm in anesthesiology, i.e students following CRNA. I don't know if it's unique to my hospital because its county style or if its prevlant at other places too.

 

[urge]

The hospital where I am at is a county style hospital. Today I saw a 3rd med student who was following a "CRNA Resident" on his anesthesia rotation. This was very concerning to me. I pulled the guy aside to ask him what's up. He told me that Anesthesia chair told him to follow CRNAs in the hospital. These CRNAs refuse to teach him unless there is also an SRNA around, just to "protect the trade". Apparently he discussed this with Anesthesia chair and not a single **** was given. I asked him about the general attitude of anesthesiologists he's worked with. He told me he barely ever sees them unless **** hits the fan and they are mostly hangin in the lounge.

Now I know anesthesiolgists are a hard working bunch as a group but what is up this? I just wanted to bring it up here for discussion to see if this was the norm in anesthesiology, i.e students following CRNA. I don't know if it's unique to my hospital because its county style or if its prevlant at other places too.

You just have extra lazy people at your hospital. You can get away with a lot of stuff in BFE land.

 

[lushmd]

Unfortunately it happens. This reminds me of my MS3 anesthesiology rotation which was at a small community hospital (site for my surgery rotation, which the anesthesiology rotation was part of). Like the student you mention, I was put in rooms with CRNAs (who, to their credit, did teach to an extent) and had little interaction with the anesthesiologists. Needless to say, doing an anesthesiology rotation at our main university hospital was an entirely different (and much better) experience.

 

[IlDestriero]

We try to put the medical students with sitting faculty, that way they can get some quality 1:1 time, otherwise they go with a resident. Never a CRNA. PICU fellows, transport nurses, etc. usually get CRNAs as they are there for IV and intubation experience, and we don't want to take that away from the trainees.
You guys have a crappy system and they're probably driving students away from the field. You should bring it up with the Dean, maybe you can rotate somewhere else. And the Chair should wake up and get his/her priorities in order. I'm guessing there are no residents there and it's a shady pseudo academic CRNA mill.

 

[DRJ37]

Unfortunately, this can happen anywhere. Went to med school in a mid-sized city with a well-respected university hospital. Made it clear during my rotation that I was interested in the specialty, and was paired with a CRNA who up front told me that she hated working with med students, and would not teach or let me do anything. Told the scheduler that I would rather be with a resident or solo attending the next day, and was paired with the SAME CRNA. Decided to ditch my "schedule" from there on and find my own pairings. Could have easily lost interest in the field over that one.

 

[amyl]

when i was a med student doing an away rotation at a program I was assigned some days to a crna. they didn't ever really teach even tho I relentlessly asked questions but they did let me do procedures.
at my hospital now that NEVER happens. med students are only with residents. and as a resident they are very careful to slant things in a way that the crna is there to help YOU -- and they do... for example, they will come in the cards rooms in the morning and hook up the lines to the swan as you float it.
in the main ORs they will come in as an extra set of hands in an unstable ruptured AAA or for a sick icu transport. i have to say they are often very PC about it and approach even junior residents with respect or at least a very good pretense of respect 🙂

 

[Doctor4Life1769]

when i was a med student doing an away rotation at a program I was assigned some days to a crna. they didn't ever really teach even tho I relentlessly asked questions but they did let me do procedures.
at my hospital now that NEVER happens. med students are only with residents. and as a resident they are very careful to slant things in a way that the crna is there to help YOU -- and they do... for example, they will come in the cards rooms in the morning and hook up the lines to the swan as you float it.
in the main ORs they will come in as an extra set of hands in an unstable ruptured AAA or for a sick icu transport. i have to say they are often very PC about it and approach even junior residents with respect or at least a very good pretense of respect 🙂

I agree with this. Spent time there, the med students were always with residents. Had a great time there.

My 3rd year rotation was in BFE. IM only program in the styx. Had an awesome attending. He was the only anesthesiologist. Staffed ~ 5 or so CRNAs (very good, very friendly group). They would teach and allow me to intubate and extubate, push drugs, etc. Especially in the evenings when the attending and SRNA would peace out. Yes, SRNA. It was also an SRNA teaching site. Fortunately, I had a cool SRNA who was pretty much finishing up and had no qualms allowing me to intubate on 90% of the cases, do pre-op assessments, attempt lines (still not my strong point). The anesthesiologist was there for each of my assessments and critiqued them. Was there for each of my intubations. Pulled me aside for daily hour-long didactics. Had end of week quizzes on readings. We did epidurals for patients in labor. Also participated in pain clinic and a few procedures all with his supervision. Great guy. Very friendly. Wrote me a great letter. Solidified my interest in anesthesia. It's unfortunate that the OP's BFE county hospital does not provide such opportunities to their medical students.

 

[Sam212]

Just to let ya'll know, I am not in anesthesiology, I am an intern in another field. We don't have anesthesiology residency at our hospital, but we do have SRNAs from a neighboring CRNA schools. I actually saw this M3 with a "CRNA resident" and then saw him coming out of a room and just standing in the hallway. He told me that CRNA told him to leave as SRNA wasn't there for that epidural. I was shocked to say the least and investigated further and that's when he told me all other details. I just thought it was unfortunate that anesthesiologists at our place don't care about med student education at all and let the CRNAs run the show like this. Apparently the chair already knows this happens, yet looks the other way and pairs this guy with CRNAs. I'd have been pissed is I was an anesthesia attending at my hospital and would have worked with the student. Guess guys over here are too lazy to care. Unfortunate, thats all.

 

[cfdavid]

This is obviously all to common, and completely unacceptable. Unreal. But, I've seen it too. Fortunately there are strong leaders elsewhere, but these situations are a big part of our image problem.

 

[RxBoy]

Said it, and will say it again. Old timers need to go. Not all old timers are like this, but enough to make me ashamed. Its always the old timers that pull this ****. Lounge lizards who haven't picked up a book in ages.

Once the motivated young blooded anesthesiologists take hold, the landscape will change. I already see it with the younger attendings at my hospitals. They'll play the nice PC card here and there, but they'll NEVER let a CRNA come before a resident/medical student's education. There have been some major changes in the last 2 years since the new attendings came in.

These old timers lived during the roaring 20's (fast cash with no worries) and we're living in the great depression with world war 2 on its way. The only difference is we know it and they could care less.

 

[Doctor4Life1769]

WW II came and went... However, the point is clear.

I hope we don't have a WW III in our future.

👍

 

[cfdavid]

Said it, and will say it again. Old timers need to go. Not all old timers are like this, but enough to make me ashamed. Its always the old timers that pull this ****. Lounge lizards who haven't picked up a book in ages.

Once the motivated young blooded anesthesiologists take hold, the landscape will change. I already see it with the younger attendings at my hospitals. They'll play the nice PC card here and there, but they'll NEVER let a CRNA come before a resident/medical student's education. There have been some major changes in the last 2 years since the new attendings came in.

These old timers lived during the roaring 20's (fast cash with no worries) and we're living in the great depression with world war 2 on its way. The only difference is we know it and they could care less.

We need more in this field with some "attitude". The right kind, mind you, but dudes/dudettes whom actually have a pair. Seriously.

As for the newer generation, I'd agree as a whole, it's going to be up to us to right this ship as far as image is concerned.

It's IMPERATIVE for us to increase the perception of the value we all know anesthesiologist are capable of providing. CRNA's can NOT be seen as virutally the only "provider" in the room except during induction and hopefully (though not always from what I hear at some places) emergence. I've seen first hand how the image is distorted to some extent with nobody seeing exactly how busy attendings in ACT practices can indeed be, BUT nonetheless, during down time I see no reason whatsoever for an MD/DO not to stroll into any of their rooms, sit down, draw up some drugs, f.cking hang out for a while, chart, change some vent setting, whatever. Even if this pisses the CRNA off. Instead of the lounge, waiting for "**** to hit the fan", what about picking a room or two as "home base"? The OR, in an ACT model, need NOT be the "territory" of a CRNA even during "auto pilot" for a 5 hour robotic surgery. (I know this would be a big "culture shock" in some practices and for sure with some CRNA's whom are used to pretty much running the show at some hospitals)

***I'd be interested in hearing more about ideas for improving the image of our field. Because the above is TOTAL BS and will end up killing our profession if we don't do something about it.

I'm not saying stay out of the lounge (hell, everybody needs a break once in a while), but clearly there are attendings whom are more hands on and this image earns them the respect, IMHO, of the surgeons which should not be underestimated from a business perspective.

Also, this doesn't take much. All it takes is some strong leadership and a group which is willing to go the extra mile, which will require more work, but which is also crucial to our future success.

I know of groups which are very financially successful, yet do ALL epidurals, ALL lines, ALL other regional, and do ALL emergent intubations in the SICU. They work harder but they are respected in the hospital. AND they are profitable. So, it can be done.

 

[Tuohy]

Said it, and will say it again. Old timers need to go. Not all old timers are like this, but enough to make me ashamed. Its always the old timers that pull this ****. Lounge lizards who haven't picked up a book in ages.

Once the motivated young blooded anesthesiologists take hold, the landscape will change. I already see it with the younger attendings at my hospitals. They'll play the nice PC card here and there, but they'll NEVER let a CRNA come before a resident/medical student's education. There have been some major changes in the last 2 years since the new attendings came in.

These old timers lived during the roaring 20's (fast cash with no worries) and we're living in the great depression with world war 2 on its way. The only difference is we know it and they could care less.

You mean the same "old timers" who are "grandfathered" for lifetime board certification-total bull****! These are the people that need to stay current the most!!!! Those dudes need MOCA bigtime!!!

 

[scudrunner]

The hospital where I am at is a county style hospital. Today I saw a 3rd med student who was following a "CRNA Resident" on his anesthesia rotation. This was very concerning to me. I pulled the guy aside to ask him what's up. He told me that Anesthesia chair told him to follow CRNAs in the hospital. These CRNAs refuse to teach him unless there is also an SRNA around, just to "protect the trade". Apparently he discussed this with Anesthesia chair and not a single **** was given. I asked him about the general attitude of anesthesiologists he's worked with. He told me he barely ever sees them unless **** hits the fan and they are mostly hangin in the lounge.

Now I know anesthesiolgists are a hard working bunch as a group but what is up this? I just wanted to bring it up here for discussion to see if this was the norm in anesthesiology, i.e students following CRNA. I don't know if it's unique to my hospital because its county style or if its prevlant at other places too.

My feelings about that situation:

I'd be writing to everyone I could. Expose the problem.

 

[leaverus]

Med students were NEVER in a CRNA's room where i trained and frankly i think this is unacceptable for this to happen anywhere. For a several hundred thousand dollar tuition you'd better be getting a several hundred thousand dollar education and you aint gonna get that from an RN. Students to whom this is happening need to COMPLAIN to the Dean of their school.

 

[jwk]

You mean the same "old timers" who are "grandfathered" for lifetime board certification-total bull****! These are the people that need to stay current the most!!!! Those dudes need MOCA bigtime!!!

Although I'm all in favor of it, a lot stay current without MOCA, particularly the docs that are actually doing anesthesia and not just supervising.

Med students were NEVER in a CRNA's room where i trained and frankly i think this is unacceptable for this to happen anywhere. For a several hundred thousand dollar tuition you'd better be getting a several hundred thousand dollar education and you aint gonna get that from an RN. Students to whom this is happening need to COMPLAIN to the Dean of their school.

Flip side - we occasionally had med students rotate through my previous small-hospital gig where anesthetists did all the cases. The students would pop in for an intubation, go next door for a CVP, maybe try an epidural - basically just following the anesthesiologist around. They NEVER actually did a case - pushing drugs, masking, intubating, managing the "they're getting tight, son" complaints from the surgeon, emergence, extubating, etc. I would have been more than happy to let them do it all - had they actually stayed in the room more than two minutes.

 

[cfdavid]

Although I'm all in favor of it, a lot stay current without MOCA, particularly the docs that are actually doing anesthesia and not just supervising.



Flip side - we occasionally had med students rotate through my previous small-hospital gig where anesthetists did all the cases. The students would pop in for an intubation, go next door for a CVP, maybe try an epidural - basically just following the anesthesiologist around. They NEVER actually did a case - pushing drugs, masking, intubating, managing the "they're getting tight, son" complaints from the surgeon, emergence, extubating, etc. I would have been more than happy to let them do it all - had they actually stayed in the room more than two minutes.

This is why it's important for a med student to do rotations at institutions where they actually train residents. The above may be fine for non-anesthesia residents-to-be, but if you have interests in this field you need to be in the room, and preferably not with a CRNA.

 

[Idiopathic]

lets not forget that in some cases, especially at places similar to those described above, you may actually learn more about the delivery of anesthesia from the CRNA than the attending. I teach at an academic center, so I constantly challenge the students on a variety of topics, but our med students do rotations through here as part of their surgical sub-I, only about 10-15% want to do anesthesia.

This sounds like an isolated event of a student at a smallish med school wanting to get some anesthesia experience, and this place probably NEVER has students rotate through.

I also did a month at a community hospital as a MS4, where it was divided between surgery and anesthesia, and most all my anesthesia interaction was with the in room CRNA. This being "unacceptable" is often a projection of personal biases, but I learned just as much from the 10-20 year CRNAs I spent time with as I did from the attendings. All you are really learning at that time is intubation/IV tricks, rote material re: volatile, etc.

 

[Idiopathic]

Is it common for MS3s to do an anesthesia rotation? I didn't do one. I thought this was exclusively a 4th year elective rotation for students?

i would imagine it was part of the surgery rotation, possibly elective for the student. clearly they dont appear to have a formal rotation set up.

 

[MTGas2B]

Is it common for MS3s to do an anesthesia rotation? I didn't do one. I thought this was exclusively a 4th year elective rotation for students?

At my med school, a few years back, we had a six week block in 3rd year we could use for whatever we wanted. Some people did research, some did electives, some did nothing.

 

[RemyMcswain]

I did my anesthesia rotation in June.

The CA-1s that I was paired up with wouldnt let me do anything. In their defense, a lot of students at my school would take a 2wk anesthesia elective to just to intubate and would care little about the actual anesthetic being delivered. That would prob piss me off as well.

When I was in a room with a crna, I got to manage the airway, do IVs, a few a-lines, etc.

 

[cfdavid]

lets not forget that in some cases, especially at places similar to those described above, you may actually learn more about the delivery of anesthesia from the CRNA than the attending. I teach at an academic center, so I constantly challenge the students on a variety of topics, but our med students do rotations through here as part of their surgical sub-I, only about 10-15% want to do anesthesia.

This sounds like an isolated event of a student at a smallish med school wanting to get some anesthesia experience, and this place probably NEVER has students rotate through.

I also did a month at a community hospital as a MS4, where it was divided between surgery and anesthesia, and most all my anesthesia interaction was with the in room CRNA. This being "unacceptable" is often a projection of personal biases, but I learned just as much from the 10-20 year CRNAs I spent time with as I did from the attendings. All you are really learning at that time is intubation/IV tricks, rote material re: volatile, etc.

I see where you're coming from. It's a big mistake to assume that you can't learn a lot from a good, experienced CRNA. It seems that the big picture, though, is that they should not be the sole teaching resource for any med student or resident (non-anesthesia) for that matter.

Also, once again, I don't see why an attending can't just park it in one of his/her rooms, politely tell the CRNA to scoot over, and stool sit for a while. If they get called out for a preop or to another room, so be it, rather than going back to the lounge, they can go back to that same room and pick up where they left off. I think the major reason why this is NOT done more often (despite the yearning that I feel many supervising attendings have to get back into the OR anyway) is that there has become a culture of territorialism where the CRNA's feel that aside from induction, emergence, and problems, the anesthesiologist "shouldn't be there". Well, maybe it's time for some groups to begin reasserting themselves.

 

[ssmallz]

As a 3rd year med student, I did a week long anesthesia rotation because of some last minute changes to my schedule. I knew I was interested in anesthesia but never had any real exposure to it yet. They put me in there w/a CRNA because it was a supervisory model and there was no residency program. I learned a lot b/c my knowledge base was zilch but it became pretty clear to me that during my 4th year I needed to be shadowing residents to get a true feel for what it's like to be an anesthesiologist and to really expand my knowledge. I don't feel it's wrong to have a 3rd year med student shadow a CRNA b/c most of them have no interest in anesthesia and even the ones that do have so little knowledge about it that any input can be helpful.

CRNAs do have some knowledge and for the level that a 3rd year med student has, it's certainly enough to teach him/her something. As a 4th year med student doing an audition rotation or trying to truly learn anesthesia, it would be absolutely unacceptable to be shadowing a CRNA.

 

[soon2b]

You can learn something from everyone, be it an anesthesiologist or a CRNA. I'm currently on an anesthesia rotation and I will follow either. I usually will go into whatever OR has the most interesting cases, or cases I have never seen before.

 

[Foodie]

My university program does not allow CRNA's to teach medical students. CRNA's are also strongly against teaching medical students. They want to only teach SRNA's, which is fine, IMHO. There is one truly cynical, jaded, depressed, diligent CRNA at this one hospital. We call her the Eeyore. She also has come to embrace this fond nickname.

Whenever I am paired with med students, I teach and let them do as much as I feel comfortable letting them do. Unless they are disinterested and only want to intubate. They are then shown the door out of the OR.

 

[Stank811]

I agree with cfdavid...just out of principle medical students should not be paired up with CRNA's. Any 3rd year medical student could learn something from an experienced CRNA, AA, PA, NP etc but in no way should they be the person they learn from the majority of the time on a medical school rotation. Ridiculous! All that is doing is diluting the education experience of that medical student. Even if the majority of the medical students at that institution want nothing to do with anesthesia they can still be taught a **** load about medicine. Teach them stuff they can use in every field of medicine.