... I was not allowed to do 2 months of regional and 2 months of acute pain because it "violated RRC guidelines" since you can only do 6 months total of Regional/Pain over 3 years, and that would have made it 7 months.
That is an incorrect interpretation of the RRC requirements. Here is the relevant section of the
RRC Revised Common Program Requirements regarding the allowable number of months in each subspecialty, and it is pretty clear. In Introduction B.2.b (5) it says
Additional subspecialty rotations are encouraged, but the cumulative time in any one subspecialty may not exceed six months during the CA-1 through CA-3 years.
However, in the Common Program Requirements, the RRC clearly distinguishes pain medicine from postoperative management from regional anesthesia as separate "subspecialty" rotations.
from section IV.A.5.a
(k) 40 patients undergoing surgical procedures in whom peripheral nerve blocks are used as part of the anesthetic technique or perioperative analgesic management
(l) 20 new patients who are evaluated for management of acute, chronic, or cancer- related pain disorders. Residents should have familiarity with the breadth of pain management including clinical experience with interventional pain procedures;
(p) Patients immediately after anesthesia. There must be a postanesthesia care experience of 0.5 month involving direct care of patients in the postanesthesia-care unit...
So by the letter of the law you should be able to do six months in all 3 categories if you could somehow fit that in with all of the other requirements into your 36 months of training.
Your program may lump regional and pain into one combined rotation, and that may be why they are saying that you are hitting the 6 month mark. I don't think that combining the two subspecialties into one rotation is really kosher with the RRC definitions. They may have similar modalities, but they are clearly separate subspecialties. If you want to pursue this, I would highlight the relevant sections of the
RRC Revised Common Program Requirements and take it to your PD to discuss the issue.
It really doesn't matter how it is done at other institutions since it is your institution that you have to deal with to comply with RRC requirements. I am just glad my institution hasn't been paying close attention to how many months of regional that I have done.
How do electives work at your institution? I feel like I got screwed -
I am pursuing a fellowship in Regional
Seriously, if you are doing a fellowship in regional, why would you want to do a lot of regional in your residency. You should concentrate your time buffing up all of the other areas of anesthesia that you will not be doing for an entire year right out of residency.
I suspect that the first year out of residency/ fellowship has the steepest learning curve of the multitude of learning curves that we have experienced in our training over the last 8 plus years. My biggest concern in doing the CT fellowship is that I will have to face this and my orals with the vast majority of my non CT anesthesia experience being more than 12 months old.
Also, Recovery Room was not considered an advanced elective ...don't feel comfortable with treating acute post-op pain at this point . I have not spent a lot of time in the post-op period. Any thoughts?
Recovery room IS TOTALLY a junior level rotation. If you feel uncomfortable managing patients in the postoperative period, I suggest you pursue the opportunity to manage them like an anesthesiologist in the real world. Tell the PACU nurses to page you directly with any issues that arise. You can then telephone triage them from the OR while you are working on your next case. It is tough trying to figure out how to approach problems in this manner, but that is real world and you are a senior resident so you should be able to "step up to the Mic." Practice doing this while still in residency and while you still have the safety valve of an assigned PACU resident and multiple attendings. I always make certain that the PACU nurses have MY pager number and know to call it FIRST if there are any issues with my patients. It can be pretty eye opening and it can help you hone your anesthetic technique.
- pod
. I have not spent a lot of time in the post-op period. Any thoughts? how does your institution handle CA-3 electives?
