CRNA's training residents

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San Marzano said:
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.
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Which program was this out of curiosity? So I can avoid applying there...
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Sounds like you’re at a terrible program
 
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Thanks for your input everyone. I'm not a troll though I don't blame people for thinking it. I made a new account for the purposes of this post because I'm fairly certain people can tell who I am from my other account. Sorry if that's against the rules, if so I apologize. I purposely didn't make any additional posts because I wanted to see the conversation unfold and to get as many points of view as possible.

Sounds like the chiefs are fighting this thing about as hard as they can. I guess we'll see what happens.
 
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My program does a month of anesthesia July of PGY-1 and 2 more months of anesthesia during intern year. During that first month, I ended up with a CRNA 2/3 of the time I'd say. I appreciate that I know some of them now because they're cool people, but there was a big difference when I worked with them vs with a resident. They were more likely to sit back and let you run things, and show you some of their favorite little gimmicks and things having to do with room setup or other random things. Being paired with a resident, you learned a lot more about your role as a resident and what was expected of you. For whatever reason, when with a crna you hardly saw an attending during the day, but if paired with a resident you got a lot more teaching and from both the attending and the resident.

I expressed in our review of the rotation the experiences I had and how I thought it was far more beneficial to work with a resident and I think future classes should be paired with a resident. We'll see if anything changes.
 
Major fail. Are we trying to be the laughing stock of all physicians...
 
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There is a specific avenue at the ACGME level to report this kind of behavior. I would have this program cited immediately. On the ACGME survey there is a specific section asking if other learners, members of health care teams, etc compromise resident education.
 
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You let the genie out of the bottle in the US letting nurses give Anaesthesia.
Getting them to teach future anaesthesiologists is doing it all over again.

This will bite you in the a$$ big time in the future.
Stop it.
 
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All of our problems stem from laziness and money. Too many hands in our pockets and no one is willing to put in the time. Looking at the current cohort, the future looks to be the same.
 
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Outside the ACGME, the ABA should be involved in stamping this out. It' bad enough that we train our potential replacements ( in the minds of militant CRNAs anyways) but now you have them teach our trainees. Better have the janitor scrub in and teach craniotomies to the incoming neurosurgery residents for the first few months.
 
TheLoneWolf said:
Outside the ACGME, the ABA should be involved in stamping this out. It' bad enough that we train our potential replacements ( in the minds of militant CRNAs anyways) but now you have them teach our trainees. Better have the janitor scrub in and teach craniotomies to the incoming neurosurgery residents for the first few months.
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The scrub techs know the names of the instruments and what approach Dr. Patel likes. We could save a lot of time for the neurosurgery attendings by having them teach the surgical interns.
 
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TL;DR

At our program our attending physicians are 1:1 in the room with two ca1s in the same room for the first two weeks. Then 1:1 with one ca-1 in the same room for two more weeks. They start flying on their own supervised 1:2 (1 attending two rooms) after that.

Our program does this despite less efficient billing, lost academic days (we don't get any in July), and increased cost of attending physician coverage.. Because our program places an emphasis on resident education.

Any program that decides to put the emphasis on billing, staffing, or anything else over resident education is failing their academic educational mission, in my opinion.

I'd run from that program like the plague and encourage everyone that interviews not to come there. They've lost the forest for the trees.

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Psai said:
All of our problems stem from laziness and money. Too many hands in our pockets and no one is willing to put in the time. Looking at the current cohort, the future looks to be the same.
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That's truth too.
 
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The Physician Philosopher said:
TL;DR

At our program our attending physicians are 1:1 in the room with two ca1s in the same room for the first two weeks. Then 1:1 with one ca-1 in the same room for two more weeks. They start flying on their own supervised 1:2 (1 attending two rooms) after that.

Our program does this despite less efficient billing, lost academic days (we don't get any in July), and increased cost of attending physician coverage.. Because our program places an emphasis on resident education.

Any program that decides to put the emphasis on billing, staffing, or anything else over resident education is failing their academic educational mission, in my opinion.

I'd run from that program like the plague and encourage everyone that interviews not to come there. They've lost the forest for the trees.

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An issue here is that a lot of these programs that you say to run away from (and i'm not mad at you for that) are big name programs that people want on their resumes for future employment.
 
The Physician Philosopher said:
TL;DR

At our program our attending physicians are 1:1 in the room with two ca1s in the same room for the first two weeks. Then 1:1 with one ca-1 in the same room for two more weeks. They start flying on their own supervised 1:2 (1 attending two rooms) after that.

Our program does this despite less efficient billing, lost academic days (we don't get any in July), and increased cost of attending physician coverage.. Because our program places an emphasis on resident education.

Any program that decides to put the emphasis on billing, staffing, or anything else over resident education is failing their academic educational mission, in my opinion.

I'd run from that program like the plague and encourage everyone that interviews not to come there. They've lost the forest for the trees.

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If you are at Emory which I think you are, they only started doing that this past academic year.
 
JobsFan said:
You let the genie out of the bottle in the US letting nurses give Anaesthesia.
Getting them to teach future anaesthesiologists is doing it all over again.

This will bite you in the a$$ big time in the future.
Stop it.
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It has already bit US. The one who will get bitten in the a$$ in the future is YOU.
 
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I'm alright with the only "learning" I get from cRNAs being the stuff I notice and change when taking over their cases to get them out at 3pm and 7pm.
 
FFP said:
It's a matter of principle. Nurses do not get to train doctors, period!
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Let me clear up something: I learn new things from various non-physicians (including CRNAs) all the time, and I am grateful. But I find it completely inappropriate to be taught medicine by them. Why? Because bad habits die hard. There is a huge difference between an attending picking up new tricks and pearls of wisdom, and a "newborn" being "primed".
 
FFP said:
It has already bit US. The one who will get bitten in the a$$ in the future is YOU.
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Several other countries are acting arrogantly and look down on the U.S. health care system a lot. But it's not like they don't have their own big problems. One example I have heard is that the NHS is doing very badly now. And don't U.K. doctors use something similar to CRNA's too? Regardless, the U.K. might have it worse than us - maybe we have to "compete" with nurses, but they are literally losing tons and tons of their younger doctors. Unless they can do something to fix that soon, a nation's health care system that is being bled dry of future attendings is probably not going to do very well!
 
pocafx said:
8/10 places I interviewed the residents relieved crnas at 3 on most days
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That's insane. People have lost their priorities. I mean if you are on CT or peds or it's an educational case, by all means stay til the room is finished that day. I did that multiple times.

If you are waking up your fourth lap chole of the day as a CA3 at 6pm, then your program has missed the point.

So much of Anesthesia is knowledge based. You can't get that if you don't have time for lectures and reading. The breadth is so wide that you probably won't see everything once until you are 5 to 7 years out of training.

I always tell every med student... Your number 1 priority when you interview is to make sure that the programs you rank highly priortize and place an emphasis on resident education. Not on being part of the workforce.

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W19 said:
I hate to say it but there is a reason why gas is no longer a competitive specialty...
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I was going to say I thought you were wrong on this one but then looked at charting outcomes of the match from the NRMP and the scores are right at the national average.

I guess it's average in how competitive it is now. On par with EM and gen Surg.

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The Physician Philosopher said:
I was going to say I thought you were wrong on this one but then looked at charting outcomes of the match from the NRMP and the scores are right at the national average.

I guess it's average in how competitive it is now. On par with EM and gen Surg.

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It's not on par with EM and gen surg. Of course average score (s) might be same but that does not tell the whole story... ~20 US seniors failed to match in 2016; I like to to think half of the applicants who did not match had board failure(s) and the other half had probably professionalism issues. Essentially, one just needs to be an allo student to match gas somewhere ...
 
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W19 said:
It's not on par with EM and gen surg. Of course average score (s) might be same but that does not tell the whole story... ~20 US seniors failed to match in 2016; I like to to think half of the applicants who did not match had board failure(s) and the other half had probably professionalism issues. Essentially, one just needs to be an allo student to match gas somewhere ...
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That's true because of the number of spots and number of applicants. I admittedly know less about the Gen surg and EM match rates. I am sure many other factors play into that

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The Physician Philosopher said:
That's insane. People have lost their priorities. I mean if you are on CT or peds or it's an educational case, by all means stay til the room is finished that day. I did that multiple times.

If you are waking up your fourth lap chole of the day as a CA3 at 6pm, then your program has missed the point.

So much of Anesthesia is knowledge based. You can't get that if you don't have time for lectures and reading. The breadth is so wide that you probably won't see everything once until you are 5 to 7 years out of training.

I always tell every med student... Your number 1 priority when you interview is to make sure that the programs you rank highly priortize and place an emphasis on resident education. Not on being part of the workforce.

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I agree that a lot of anesthesia is knowledge based, but i think getting real experience in difficult situations is far more important. Weirder stuff happens after 3pm. If something stresses you out, you need to do more of it until it doesn’t anymore.

The problem with the assumption that going home at 3pm gives you more time to “study” is that the best bang for your buck time wise is spent on qbanks for the ITE, the measuring stick of somewhat clinically irrelevant knowledge. Just as the step 1 scores keep going up, the ITE bell curve also continues to be shifted to the right. This makes it harder to spend time reading about technical aspects of your cases that make you a better anesthesiologist.

It is much more meaningful reading, discussing, and reflecting on real situations than theoretical ones in a book. You can’t just read about someone’s neck exploding a few hours after a carotid when you happen to be walking by in the PACU. What equipment and back up do you actually have when it really matters? What is your actual next step when it’s just you and a nurse for the next minute. You have 3 years to train. The only way you encounter these situations is by being in the hospital.
 
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The Physician Philosopher said:
I was going to say I thought you were wrong on this one but then looked at charting outcomes of the match from the NRMP and the scores are right at the national average.

I guess it's average in how competitive it is now. On par with EM and gen Surg.

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Actually general surgery and EM look like they are more competitive than anesthesiology now. Results and data from the 2017 main residency match:

http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf
 
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SnapperRocks said:
I agree that a lot of anesthesia is knowledge based, but i think getting real experience in difficult situations is far more important. Weirder stuff happens after 3pm. If something stresses you out, you need to do more of it until it doesn’t anymore.

The problem with the assumption that going home at 3pm gives you more time to “study” is that the best bang for your buck time wise is spent on qbanks for the ITE, the measuring stick of somewhat clinically irrelevant knowledge. Just as the step 1 scores keep going up, the ITE bell curve also continues to be shifted to the right. This makes it harder to spend time reading about technical aspects of your cases that make you a better anesthesiologist.

It is much more meaningful reading, discussing, and reflecting on real situations than theoretical ones in a book. You can’t just read about someone’s neck exploding a few hours after a carotid when you happen to be walking by in the PACU. What equipment and back up do you actually have when it really matters? What is your actual next step when it’s just you and a nurse for the next minute. You have 3 years to train. The only way you encounter these situations is by being in the hospital.
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I agree with everything you are saying, with a caveat. I saw a ton of stuff on call as a resident. And as a CA-3 carrying the bag we got an unbelievable amount of autonomy.

In your example, though, I don't think the resident sitting the case is gonna be around in the PACU for that exploding carotid anyway. You either went home or are sitting your next case. Unless you are talking about the resident covering the PACU rotation. Our on call CA-3 residents cover the PACU at night as well with us covering as back up for anything that they might need. They go home at 3pm on general OR days for lectures, pre-op evals, or work-life balance. So, they still have the opportunity to be in the hospital to see this stuff.

There is certainly a balance to be had here, and I am not going to disagree that you need experience as much as knowledge. They are synergistic, really. You cannot have a valid conversation about something that just happened by using your experience alone. CRNA's love to tout that logic. You won't have the knowledge if you only have experience from being in the OR. And you won't have the knowledge if you don't have time to read and study on your own outside of the OR. They both must exist.

All I am implying is that when a residency places the importance of relieving CRNA's over resident education, that's a massive issue, IMO. It seems to be happening more and more frequently.

If a program has round a way to accomplish both placing a large emphasis on resident education and making the rest of the staff happy, then I am all about it. But the priority should be on resident education.
 
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spacegun said:
Actually general surgery and EM look like they are more competitive than anesthesiology now. Results and data from the 2017 main residency match
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Yeah, I admitted as much above (not being all too familiar with other specialty matches. I guess I was looking at it from a Step exam competitiveness issue. There is certainly more to it.
 
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The Physician Philosopher said:
I agree with everything you are saying, with a caveat. I saw a ton of stuff on call as a resident. And as a CA-3 carrying the bag we got an unbelievable amount of autonomy.

In your example, though, I don't think the resident sitting the case is gonna be around in the PACU for that exploding carotid anyway. You either went home or are sitting your next case. Unless you are talking about the resident covering the PACU rotation. Our on call CA-3 residents cover the PACU at night as well with us covering as back up for anything that they might need. They go home at 3pm on general OR days for lectures, pre-op evals, or work-life balance. So, they still have the opportunity to be in the hospital to see this stuff.

There is certainly a balance to be had here, and I am not going to disagree that you need experience as much as knowledge. They are synergistic, really. You cannot have a valid conversation about something that just happened by using your experience alone. CRNA's love to tout that logic. You won't have the knowledge if you only have experience from being in the OR. And you won't have the knowledge if you don't have time to read and study on your own outside of the OR. They both must exist.

All I am implying is that when a residency places the importance of relieving CRNA's over resident education, that's a massive issue, IMO. It seems to be happening more and more frequently.

If a program has round a way to accomplish both placing a large emphasis on resident education and making the rest of the staff happy, then I am all about it. But the priority should be on resident education.
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Sure, but I still go home and study, have a social life, and have hobbies outside of work. I am not going to be convinced that I’d be better off going home at 3. I am sure it is comfortable to have a lot of time to preop your next days assignment and read. I agree that you shouldn’t be kept late every day, but there is a lot of value in doing sick add ons efficiently, taking over cases you didn’t preop the night before, and taking over cases that aren’t going quite as planned. When you’re a senior and get sent to a room that by all means is a complete **** show, it is your time to shine, take on the role you’ve been training for, and clean it up.
 
If a flock of CRNAs come in at 3pm to relieve the residents, like at one well respected program in the South, it is for one reason and one reason only. To increase supervision ratios so more attendings can go home also. You can say it’s for ‘education’ all you want but I’m a non-believer. It also sends a horrible message to your surgical co-residents.
 
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FFP said:
Let me clear up something: I learn new things from various non-physicians (including CRNAs) all the time, and I am grateful. But I find it completely inappropriate to be taught medicine by them. Why? Because bad habits die hard. There is a huge difference between an attending picking up new tricks and pearls of wisdom, and a "newborn" being "primed".
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That's why I made the point of saying July is more "orientation" than "training". You're not learning anesthesia in the first month of CA-1. This is why I have no problem having CRNAs help show CA-1s how to set a room, draw up drugs, and place IVs. Those are the very very very basics of how to be useful in an OR as a brand newbie, and I wouldn't classify that as "training".
 
Twiggidy said:
That's why I made the point of saying July is more "orientation" than "training". You're not learning anesthesia in the first month of CA-1. This is why I have no problem having CRNAs help show CA-1s how to set a room, draw up drugs, and place IVs. Those are the very very very basics of how to be useful in an OR as a brand newbie, and I wouldn't classify that as "training".
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Does this really take a month to teach? Seems like something that takes a weekend.
 
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I disagree with July being just an orientation month. Those basic tasks were generally taught during the med school rotation or the month in the OR as an intern where I trained. July was very important from a resident education standpoint. We went through all of Baby Miller in morning lecture during our first month, and were regularly questioned by our staff on the basics of anesthesia during our period of closest supervision. It ensured that we had a solid base and shared language on which to build for the coming months. Being paired with a nurse and just learning how to set up a room, start IVs, and intubate would have been a huge disservice.

Regarding being relieved at 3pm vs staying, yes there are benefits to both. While staying late and picking up sick add-ons is very beneficial, staying late and finishing a room of ASA1 lap choles is less so. I had staff that tried to use the argument that we needed to stay late to see more pathology, but really, they just wanted to keep us sitting stool late into the evening, rather than make sure we were relieved to prepare for the next day's cases or read. Not all time in the hospital is equal, and my education would have been better served if I had been able to leave a couple hours early those days and go home to read.

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Your first months in the OR are where you understand why we do the things we do. CRNAs are good at responding to certain events but terrible at explaining what caused it or why they chose their treatment of choice. Their fundamentals are severely lacking and there's no reason they should be teaching fundamentals (CA1 July) to us doctors.
 
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Ronin786 said:
Your first months in the OR are where you understand why we do the things we do. CRNAs are good at responding to certain events but terrible at explaining what caused it or why they chose their treatment of choice. Their fundamentals are severely lacking and there's no reason they should be teaching fundamentals (CA1 July) to us doctors.
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But it literally takes MONTHS (even years) to be a vigilant anesthesiologists, that's why I'm saying month ONE is orientation more than anything. A July CA-1 will probably barely know how to make a Neo drip if needed or let alone know where to find the materials, especially if they're in OR 1 today and OR 6 next week. By October likely, they'll be in a groove, no July 20th. If you're trusting July 20th CA-1s like that, then more power to you.

Also, CRNA are bad teachers because overall, nurses are bad teachers. I cringe when nursing students come to my hospital because they're being taught habits by all the nurses that aren't completely skillful in the first place and they're just bad INSTRUCTORS. We can be part of the problem too because nurses have a hard time being taught by physicians so I'm sure the Anesthesiologist - SRNA dynamic is probably interesting. Or do CRNAs teach SRNAs which makes the problem worse?
 
W19 said:
It's not on par with EM and gen surg. Of course average score (s) might be same but that does not tell the whole story... ~20 US seniors failed to match in 2016; I like to to think half of the applicants who did not match had board failure(s) and the other half had probably professionalism issues. Essentially, one just needs to be an allo student to match gas somewhere ...
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Look, you're a 4th year medical student going into psych. Your opinion is irrelevant as always and off track for the thread.

Anyway, as we shouldn't have anesthesiologists teaching srnas, we shouldn't have crnas teaching residents. The whole thread is absurd and I thought my program was bad until I saw these shenanigans happening elsewhere. Now I'm grateful for the training I'm getting.
 
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It’s not what CRNAs can contribute (very variable), it’s what this training says: you are learning a nursing trade that can be done by nurses. It says it to the whole room: the surgeon, the circulator, the scrub tech, the surgical resident. It says when the CRNA is managing a patient about to code they know what they’re doing, after all they trained the anesthesiologist. This is some shameful s***. The all star PAs, NPs and first assists offer advice to residents (surg/med) but don’t spend more time with them than the attendings. And as they advance the listen to them because they know they will be their future bosses. You should reflect your dissatisfaction in the ACGME survey and tell everyone else to, it’s the best way to get things changed in a residency that sounds like it needs changing. Will your attendings be there, sure likely with their 3/4:1 ratio, just enough time to reassure you how great your nursing mentor is
 
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GandalfTheWhite said:
Wouldn't they make even more mistakes if you transition their education from an MD to a CRNA?
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I think many are misinterpreting that i'm saying it's cool for CRNAs to train CA2 and CA3s. That's not what I'm saying. I'm saying July 1st is busy at many programs because there are a lot of "green" people running around the ORs and having an experienced CRNA teach the July 1 basics isn't the end of the world. If the CRNA is that bad that July 1 basics can't be taught then that CRNA probably shouldn't work at that institution.

Residents making mistakes late in the year or late in residency has nothing to do with "MD vs CRNA instruction"....that's just residents being residents. Never think you don't need to supervise a resident. You'll learn which resident you can lengthen the leash on and which you literally have to stand at the door watching. (Same can be said for CRNAs)
 
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Psai said:
Look, you're a 4th year medical student going into psych. Your opinion is irrelevant as always and off track for the thread.

Anyway, as we shouldn't have anesthesiologists teaching srnas, we shouldn't have crnas teaching residents. The whole thread is absurd and I thought my program was bad until I saw these shenanigans happening elsewhere. Now I'm grateful for the training I'm getting.
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Going into IM--not psych... I was not commenting on the dynamic of MD (CA1) vs. CRNA etc... I was sharing my opinion regarding gas competitiveness based on charting the outcomes.

I guess med students should have no opinion in SDN... 'Look, you are a medical student.' Aren't you tired of using that same phrase over and over?
 
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W19 said:
Going into IM--not psych... I was not commenting on the dynamic of MD (CA1) vs. CRNA etc... I was sharing my opinion regarding gas competitiveness based on charting the outcomes.

I guess med students should have no opinion in SDN... 'Look, you are a medical student.' Aren't you tired of using that same phrase over and over?
Click to expand...

it's not "gas"......it's anesthesiology
 
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