CRNA's training residents

[mad house]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

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[el_duderino]

That sounds inappropriate, and I can't imagine many on this forum will support such a plan.

 

[coffeebythelake]

To learn procedural skills I don't think it's a big deal. First few weeks maybe? The thing I don't understand is why don' they get paired with the senior residents. What do u mean by staffing shortage????

 

[MirrorTodd]

Sounds like an acgme violation in there somewhere.

 

[AdmiralChz]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

This happened super, SUPER rarely at my program. Like most other places, we were paired with senior residents at the beginning but occasionally there were just too many new CA-1s (or seniors were in low-yield cases for newbies like Peds hearts). Why aren't you paired with the upper levels at your place???

 

[zero0]

Where is this so I can not apply?

 

[anbuitachi]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

Wow. Awful. start applying for residency transfers

 

[Robotic Wis-Hipple]

Sounds like they don’t have the staff for 2:1

 

[pgg]

This is not OK, if the CRNA is the supervising staff member.

It's maybe OK if the responsible anesthesiologist is 1:2 and the CRNA is there to help orient the new CA1. It's a fine line to walk though and it should be the resident's case.

 

[Man o War]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

Never heard of this.
I would not trust a mid level with medical level education.
ACGME needs to know if this is true.
Transfer programs.

 

[Dr.whom]

I think I remember being in the OR a few times with CRNA for orientation as a CA 1 at a major academic program. We were never paired 1 on 1 with an attending. It was always 1 attending per 2 residents.

As long as its just orientation for the 1st couple weeks, it should be fine. The attending should still be in your room a lot and be the one teaching you how to do anesthesia. The CRNA can help with setting up the room, showing you how to draw up and label drugs, checking anesthesia machine, etc. If your attending is not the one teaching you and you are getting teaching from the CRNA, you should bring that up to your PD.

 

[deleted697127]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

This is unacceptable. The first few weeks of residency are some of the most important for building good habits, starting strong, and hitting the ground running. At my program, these first few weeks are generally considered mentorship positions for attendings. the attendings you get paired with are chosen for their interest in teaching, positive feedback from senior residents, and to make sure you don’t start off hating anesthesia and your program.

This is likely an acgme violation and if true risks creating an extremely toxic start of residency.

 

[Psai]

I can't imagine this happening anywhere and my only conclusion is that we're toasting in a roll bread.

mad house
Joined:Today
Messages:1

We see you trollin. We hatin.

 

[Robotic Wis-Hipple]

Not to mention it serves to perpetrate the idea that they can train us, I mean, do you think they’re telling their CRNA friends that they are merely teaching you the nursing tasks? Doubtful.

 

[narcusprince]

Op. Talk with your chief resident. Do not fight this head on. Learn what you can. Starting political fires early on can get you into major problems down the road. It sucks.... learn the monkey skills. Move on!

 

[Man o War]

I can't imagine this happening anywhere and my only conclusion is that we're toasting in a roll bread.

mad house
Joined:Today
Messages:1

We see you trollin. We hatin.

Same thought.
Probably the same CRNA that got banned yesterday.

 

[Arch Guillotti]

I can't imagine this happening anywhere and my only conclusion is that we're toasting in a roll bread.

mad house
Joined:Today
Messages:1

We see you trollin. We hatin.

Same thought.
Probably the same CRNA that got banned yesterday.

Unfortunately not a troll.

 

[Urzuz]

I remember being paired one on one with an attending for the first month or so (that attending only had that one room), but CRNAs (or sometimes other attendings) would occasionally break our attending out so the attending could eat, run to the restroom, etc (this is when we were too green to be left alone).

It is probably that the program doesn't have the staffing to accommodate 1 on 1 attending to new CA-1 ratios, so they pair a CRNA with the new resident and have the attending overseeing both. Additionally, if I need to dig deep and find some sort of justification for this, at the very least the CRNAs can teach the CA-1s the very basic, meaningless stuff (how to refill the vaporizer, how to chart, etc)

 

[Twiggidy]

Op. Talk with your chief resident. Do not fight this head on. Learn what you can. Starting political fires early on can get you into major problems down the road. It sucks.... learn the monkey skills. Move on!

This.

When you're a resident you're there to learn, not fight political battles. Leave that to the 1 or maybe 2 attendings that care. Get yours and move on and then in private practice when you've established yourself, then fight. As my man is saying, don't enter residency being "that guy". Seen it fail way to many otherwise very good residents.

 

[Robotic Wis-Hipple]

This.

When you're a resident you're there to learn, not fight political battles. Leave that to the 1 or maybe 2 attendings that care. Get yours and move on and then in private practice when you've established yourself, then fight. As my man is saying, don't enter residency being "that guy". Seen it fail way to many otherwise very good residents.

This is also very true. Quality advice.

 

[deleted171991]

Sounds like an acgme violation in there somewhere.

Let me tell you how they fix that: they make the respective CRNAs "instructors", which is even worse. I am serious.

 

[Iso4ane]

When you're a resident you're there to learn, not fight political battles.

As a brand new CA1 there is so much to learn; especially in the first four weeks, what one would learn from an attending and what one would learn from a CRNA would probably not be all to different. Sure the attending can and probably would go into more detail. But, at that point in time when you are still trying to figure out what end of a patient to stick a tube, how to pickup your drugs, the perioperative EMR, etc, the details are likely to fly over your head until you sit at home and read about it.

 

[deleted171991]

As a brand new CA1 there is so much to learn; especially in the first four weeks, what one would learn from an attending and what one would learn from a CRNA would probably not be all to different. Sure the attending can and probably would go into more detail. But, at that point in time when you are still trying to figure out what end of a patient to stick a tube, how to pickup your drugs, the perioperative EMR, etc, the details are likely to fly over your head until you sit at home and read about it.

It's a matter of principle. Nurses do not get to train doctors, period!

 

[Twiggidy]

It's a matter of principle. Nurses do not get to train doctors, period!

Trust me FFP, I get and respect what you're saying, but when can both agree to some extent that the first month of CA-1 year is more Orientation than Training. Should CRNAs show residents how to do epiurals, central lines, come off bypass, etc? Hell no. Can they show a resident how to setup a room, draw up drugs, do a pre-assessment? Sure, because if I'm that CRNAs attending that's all stuff they should know how to do. They may can even get away with showing an intubation, but again, I classify some of this as more "orientation" than training and if you're a busy academic center this can be helpful to an attending running two rooms where one room has a straight from internship newbie.

Now if it's December and this is happening, that program has some explaining to do. I mean it better be off the wall busy, and even in that case, hire more attendings.

 

[anbuitachi]

Trust me FFP, I get and respect what you're saying, but when can both agree to some extent that the first month of CA-1 year is more Orientation than Training. Should CRNAs show residents how to do epiurals, central lines, come off bypass, etc? Hell no. Can they show a resident how to setup a room, draw up drugs, do a pre-assessment? Sure, because if I'm that CRNAs attending that's all stuff they should know how to do. They may can even get away with showing an intubation, but again, I classify some of this as more "orientation" than training and if you're a busy academic center this can be helpful to an attending running two rooms where one room has a straight from internship newbie.

Now if it's December and this is happening, that program has some explaining to do. I mean it better be off the wall busy, and even in that case, hire more attendings.

Orientation should be maybe day 1 and thats it. There are residents who dont know how to put labels on syringes? Even if they dont, it should be a 3 second lesson. Learning setting up rooms also doesn't take long since the vast majority of CA1s have done anesthesia rotations. The first month of CA1 year is huge. You have to learn enough to be able to be double covered after the month. It's a lot of info!

 

[deleted171991]

Trust me FFP, I get and respect what you're saying, but when can both agree to some extent that the first month of CA-1 year is more Orientation than Training. Should CRNAs show residents how to do epiurals, central lines, come off bypass, etc? Hell no. Can they show a resident how to setup a room, draw up drugs, do a pre-assessment? Sure, because if I'm that CRNAs attending that's all stuff they should know how to do. They may can even get away with showing an intubation, but again, I classify some of this as more "orientation" than training and if you're a busy academic center this can be helpful to an attending running two rooms where one room has a straight from internship newbie.

Now if it's December and this is happening, that program has some explaining to do. I mean it better be off the wall busy, and even in that case, hire more attendings.

This is basically about a few attendings who don't want to give up their July vacations just to teach residents.

Oh, wait, isn't that their job?

 

[DrZzZz]

My program tried doing this during my CA-1 and I was vocal about/against it. They haven't done it again since, and it didn't hurt my standing in the program (I'm one of the chief residents). Those who are saying that the first few weeks are orientation, in terms of learning monkey skills like room setup and syringe labeling...why does it take a few weeks to learn that? We teach our green ca-1's that crap in a couple days before they even enter the OR as a resident. Putting naive residents with a CRNA is leaving the future of our specialty at a very impressionable time in their career with people who are hellbent on removing us from our specialty. New ca-1's deserve to be paired with at least senior residents, if not 1-1 with an attending.

 

[deleted875186]

This is basically about a few attendings who don't want to give up their July vacations just to teach residents.

Oh, wait, isn't that their job?

This is probably the main issue. That plus it’s easier for an attending to supervise a CRNA they already know well.

In all honesty, we’ve had many issues with nurses and residents gettin assigned certain cases, doing preops, etc. it’s a political issue. You won’t change anything, so don’t get on anyone’s bad side.

 

[rakotomazoto]

Is there any reason why you wouldn't just put the new CA1 with a CA3 (supervised by an attending, but CA3 is basically running the show and teaching the junior resident) and let the CRNA do their own case? Only time I was in this situation with a CRNA was as a medical student and it felt awkward then. I imagine this would only get worse the deeper into training you go.

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[2Fast2Des]

I've tried keeping up the good fight but in
Institutions where CRNAs and mid-levels have made a stronghold and attendings\leadership have no power or motivation to change status quo, I've learned now to just keep my mouth shut and avoid being "that guy." Ive ended up finding myself in more trouble when I try to defend us and have situations in which CRNAs caused issues turned on me since they have the power. The profession is reaching the dead horse status...

That being said, write up to acgme and rotation evaluations to get it in writing for sure. But just bide your time and be a yes man to the supervising attending CRNAs and do as they instruct.

 

[Noyac]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

I didn’t read all posts. But I think you need to seriously look into this. If this program has a staffing shortage then thee is something bad going on. They will play it off as no big deal but you don’t want to be there. And their plan to,deal with the shortage is just a sign of how bad it is.

 

[Twiggidy]

Is there any reason why you wouldn't just put the new CA1 with a CA3 (supervised by an attending, but CA3 is basically running the show and teaching the junior resident) and let the CRNA do their own case? Only time I was in this situation with a CRNA was as a medical student and it felt awkward then. I imagine this would only get worse the deeper into training you go.

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Because I’m sure the program doing this probably has a staffing issue. If you have an attending watching a CA-3 supervise a CA-1 you basically have one less room covered. A CA-3 in most institutions are covering an advanced case with an attending probably covering another less advanced case. A fellow can probably more likely do this although in July they’re focusing on fellowship.

Again, as was just said, it’s probably a staffing issue and that would say more about the program than CRNAs supervising CA-1s in July because that means for some reason you don’t have enough attendings (program too cheap or no one wants to work there)

 

[rakotomazoto]

If you have an attending watching a CA-3 supervise a CA-1 you basically have one less room covered.

Staffing issues are a separate issue than who covers the CA-1, got it. I guess I was focusing on who babysits the CA-1 and why you would put the CRNA and CA-1 in that situation together.

 

[Psai]

Great, not only will the new ca1s pick up crap nurse habits, they will likely pick up the lazy attitude and entitlement. If you can't support a rsidency program, you shouldn't have one.

 

[vector2]

I understand the point that some are making not to rock the boat from a political standpoint, but the idea that the 1st month is just for monkey skills is absurd. CA-1s need to learn basic anesthesia science as well- airway anatomy, apneic pco2 rise times, desaturation from frc, FA/FI of volatiles, age adjusted MAC, anesthesia machine pitfalls, opioid peak onset, NMB/NMB reversal idiosyncrasies, crystalloid vs colloid selection, transfusion rationale etc etc. Perhaps most importantly, they need to learn how a patient's existing medical conditions and co-morbidities interact with the delivery of anesthesia. A physician should absolutely be the one facilitating this knowledge (both in the OR and classroom) while simultaneously instructing on the nursing skills aspect.

 

[244913]

This was done routinely at my program until a few years ago. Attending would be 1:1 or 1:2, CRNA paired with the CA-1, attending supervising from the lounge, after a week CRNA supervising from the corner

We changed things around when I was a senior and started having the CA-2's and 3's supervise- it worked out better

 

[pgg]

This is basically about a few attendings who don't want to give up their July vacations just to teach residents.

Oh, wait, isn't that their job?

Not killing patients, publishing, teaching in that order. There is a subset who are on the clinical or teaching track, of course. I'd bet it's less an issue of vacation time than research time or administrative time.

I had an undergrad biochem professor tell me to hold my questions for a TA in the lab section because she was there to write grant proposals and run a lab, not teach me. It's not quite that bad in academic medicine, but there's a bit of it.

I'm fortunate to be at a program that is always 1:1 with our residents, but we don't have to concern ourselves with cost. Promotion is arbitrary and research production is not required (and largely not even possible).

 

[Notorious T.E.E.]

Just heard that there are plans for CRNAs to be involved in the training of my class (incoming CA-1s) at my program. They're supposedly going to be paired one on one with each member of our class in the ORs for the first few weeks. This was done by attendings up until now. Apparently there's a staffing shortage.

Thoughts?

Unfortunately not a troll.

There were a few thread around here a year or two ago about this happening at VCU, so I doubt if this is a troll. I can't see any reason for this to occur. Learn the ropes from a CA-2, CA-3, or even a fellow. If that doesn't work, hire a few locums for a month to free up staff for 1:1 supervision. Programs that do this need to be outed so medical students can make an informed decision about the nature of their training.

 

[San Marzano]

I can't imagine this happening anywhere and my only conclusion is that we're toasting in a roll bread.

mad house
Joined:Today
Messages:1

We see you trollin. We hatin.

Happened at my program. The head crna hired too many CRNAs and instead of giving all the residents cases they had to pair us with CRNAs some days due to excess staff. It was rare. If the CRNAs were assigned to a facilitator role they would whine and moan about it so they go what they wanted and we got sloppy seconds. I can only remember 3-4 times this happened to me personally but I’m just letting you know that it is in fact happening out there.

 

[DeadSpace]

I had this same issue with my program. I made a few benign statements in jest and realized quickly it wasn't received well. A few of the CRNAs even had the nerve to say nurse anesthetists have been training us since the beginning, quoting some anesthesia nurse (Alice Hunt?) who was a professor at Yale back in the day training anesthesia. Well, it's 2018 and I didn't come to this residency to not be trained by the attendings who run the program.

When your early training has CRNAs mixed in it makes you self-conscious when you're with your attending and you make a clinical decision. You wonder if this is how he would practice or is he thinking you're making poor decisions like a CRNA would.

Another annoying aspect of it is that the nurses have worked very hard to blur the lines between us. If they actually are playing a part in our training it makes it even worse, like we're being indoctrinated. For instance, I oddly want to wear compression hose underneath my scrubs and be a rep for Rodan & Fields.

 

[Psai]

No wonder we have such a crisis.

 

[anbuitachi]

You know what happens when that CA1 becomes an attending at that institution 3 years later? The CRNA will be like oh i trained that attending. if this picks up, next thing you know, CRNAs will be putting this stuff on their political posters.. "we train doctors!"

 

[Man o War]

You know what happens when that CA1 becomes an attending at that institution 3 years later? The CRNA will be like oh i trained that attending. if this picks up, next thing you know, CRNAs will be putting this stuff on their political posters.. "we train doctors!"

They will do that anyway.
They will show a resident around the OR one time and claim they trained them.
Look at their interpretation of studies....Cochrane being a great example.
Lie. Spin. Stretch. Repeat.
Donald Trump doesn’t have s@@t on many CRNAs.

 

[Aether2000]

This is appalling. It demonstrates the program considers CRNAs the equivalent of teaching anesthesiologists, is detrimental to the profession of anesthesiology, and denigrates residents as being equivalent to student nurses. Should not happen for a couple of weeks, one day, nor even one hour.

 

[Man o War]

If this happening at your program, report to ACGME however you feel comfortable. That’s the only way this gets rectified.
These programs need to have their anesthesia residencies removed if they can’t comply with requirements.
Nurses training you will not adequately prepare you for physician practice.

 

[AdmiralChz]

I’m inclined to agree with @Psai - joined yesterday, 1 post, never checks back in.

Looks like @mad house may not exactly be real news.

 

[Twiggidy]

Wow, The CRNAs really do threaten some people on here, don’t they?

Not one person is learning anesthesiology in one month of residency. First month CA-1 is

Set up a room correctly
Put on monitors correctly
Put in an IV (which for some can take all 3 years)
Induce the very basic anesthetic
Learn to intubate (again which gives many residents problems for their entire residency)
I don’t even expect a CA-1 to be remotely comfortable extubating
If you’re lucky you may get a spinal or epidural prior to OB rotation

All of these are basic that any seasoned CRNA should be well versed at. No problem with them helping, again ORIENT a July 1 CA1. July CA1 is not training. It’s very much so learning how to “anesthesia crawl” and you’re no where near walking

 

[Twiggidy]

You know what happens when that CA1 becomes an attending at that institution 3 years later? The CRNA will be like oh i trained that attending. if this picks up, next thing you know, CRNAs will be putting this stuff on their political posters.. "we train doctors!"

If a CRNA at said that to me, I’d just say “Let’s compare W2s”

 

[TheLoneWolf]

This has to be remediated. If not and becomes more widely accepted then the AANA will have add to their propaganda that "CRNAs teach the anesthesiologists". Ugh.

 

[Twiggidy]

This has to be remediated. If not and becomes widely accepted then the AANA will have add to their propaganda that "CRNAs teach the anesthesiologists". Ugh.

The best way to remediate it is to not train CRNAs