Pairing CA-1s with CRNAs???

[Crash cart]

Just want to get some input on this one. I just learned that one of the programs I am considering ranking number 1 pairs CA-1s with either a CRNA or a senior resident for the first month. Before I make too big of a deal about this, can anyone speak to the prevelance of pairing up CA-1s with CRNAs and/or residents in lieu of an attending? How big of a deal do you think this is? Would this make you think twice about training at a program? why?

Thanks!

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[TofuBalls]

My program has CA-1's with a senior resident for their first month. For about the first two weeks, the senior is right beside the newbie but after that, the leash gets progressively longer. Although I am biased, I think it is a good idea.

As far as the CRNA supervision, we would sometimes have them supervising us during big cases on our VA rotation (i.e. crani's, AAA, etc.). This maybe happened once or twice. I didn't mind, I will try to learn from everyone.

I have heard of some places just throwing you in cold... wow, I just hope the attending's pager has fresh batteries!

 

[InGasWeTrust]

O' Hells No


CRNA's are cool and all, but I would not want to get a foundation for my CA-1 year from a CRNA, especially new or older ones.

 

[VolatileAgent]

CRNA's are cool and all, but I would not want to get a foundation for my CA-1 year from a CRNA, especially new or older ones.

ditto. the only time i see them is either in the lunch room or when they are giving me a lunch break. not to start a **** storm, but it's just an entirely different style/perspective on the field. no value judgment on the nurse-anesthetist profession here, but remember that you're training not only to be just passing gas but also to practice medicine. i would strongly re-consider any program that hasn't made that clear and crucial delineation and, more importantly, commitment to your future.

 

[MacGyver]

This is not new, many MDA residency programs do this, if you arent being outright supervised by a CRNA, then you are splitting cases with them.

Hell, some programs give CRNAs FIRST CHOICE on the cases.

ABsolutely ****ing ridiculous. Tell your MDA program directors to quit whoring out the profession

 

[BubbleHead]

I think this is huge. I rotated at CCF and experienced a junior attending work his way through me, then the CA-3 asking questions about everything we did, were about to do, and had done. It was a pimp-fest, but more than that it was a Clinic in the Socratic Method of Anesthesia education. Even if I or the senior resident knew the answer and why the answer was right, this junior attending would continue on with papers, the history behind the topic, and clinical situations where all of it was relevant. And this was a junior attending; the senior attendings were as good or better at stretching the residents' knowledge every time they came in the room.

These were not questions about: what do you do now? What next? What do you do if this happens? I will not concede that a CRNA could match the experience of learning from an attending; you'll have too many questions beyond their skill set and knowledge depth too soon. You're learning way beyond you do this and this and this or this and this if this happens. My rotation preceptors have specifically told me not to go in with CRNAs as an MS-4, so why go in and learn from one as a PGY-1?

 

[bullard]

Could somebody tell me where the ignore button is?

gasguy06, I would run like hell from a program like that. Seems to me the first couple of months of anesthesia residency are critical -- better to spend that time around a pro rather than a CA-3 or a CRNA.

 

[davvid2700]

This is not new, many MDA residency programs do this, if you arent being outright supervised by a CRNA, then you are splitting cases with them.

Hell, some programs give CRNAs FIRST CHOICE on the cases.

ABsolutely ****ing ridiculous. Tell your MDA program directors to quit whoring out the profession

I agree

would not even rank a program like that..

You should receive instructions from the best and the brightest.. and even if the crna is the best and the brightest. they are still nurses... they dont have the training of a physician and they dont think like physicians so...I would not rank that place.. or if you desperately wanna go there ask for further clarification

 

[toughlife]

and let us know in general terms where this program is located so that we stay far away from that program.

At least, it would be good to know what state it is in so I make sure my ranking list does not have that state.


thanks,

 

[militarymd]

Future Navy SEAL officers go through Basic Underwater Demolition/Survival training to learn the basics of becoming leaders of Naval SpecWarfare Operators.

They are trained by enlisted men...men who they will lead after completion of the training.

 

[toughlife]

My program has CA-1's with a senior resident for their first month. For about the first two weeks, the senior is right beside the newbie but after that, the leash gets progressively longer. Although I am biased, I think it is a good idea.

As far as the CRNA supervision, we would sometimes have them supervising us during big cases on our VA rotation (i.e. crani's, AAA, etc.). This maybe happened once or twice. I didn't mind, I will try to learn from everyone.

I have heard of some places just throwing you in cold... wow, I just hope the attending's pager has fresh batteries!

what state are you in? I don't want no god damn stinking CRNA supervising me for shizznit.

 

[toughlife]

This is not new, many MDA residency programs do this, if you arent being outright supervised by a CRNA, then you are splitting cases with them.

Hell, some programs give CRNAs FIRST CHOICE on the cases.

ABsolutely ****ing ridiculous. Tell your MDA program directors to quit whoring out the profession

woudl you care to list some of the programs that do this?

 

[TofuBalls]

what state are you in? I don't want no god damn stinking CRNA supervising me for shizznit.

Wow! I think you may be over reacting a little...

The instances I was talking about happened like this:

VA with 4 running OR's (one eyeball, one AAA, one lap chole, and one cysto).

M.D. in charge says, "Hey CA-1 (in my second month), would you like to do the cysto room by yourself or do you want to do the AAA with Mr. CRNA?"

Well I chose the AAA instead of the cysto hell and learned a lot both from the attending and the CRNA. The CRNA was there as an extra set of hands while I did the lines and fun stuff. I definitely was glad he was there when we unclamped!

Today, as a senior resident when I am running the board at night I am telling him what to do, not bragging, just the facts. We both have respect for each other which is the way it should be.

So be careful how you judge programs and other people's experience. Although you may be a seasoned MS4, you will soon learn that for a short time the CRNA's will be able to swim laps around you while you are barely treading water.

 

[toughlife]

Wow! I think you may be over reacting a little...

The instances I was talking about happened like this:

VA with 4 running OR's (one eyeball, one AAA, one lap chole, and one cysto).

M.D. in charge says, "Hey CA-1 (in my second month), would you like to do the cysto room by yourself or do you want to do the AAA with Mr. CRNA?"

Well I chose the AAA instead of the cysto hell and learned a lot both from the attending and the CRNA. The CRNA was there as an extra set of hands while I did the lines and fun stuff. I definitely was glad he was there when we unclamped!

Today, as a senior resident when I am running the board at night I am telling him what to do, not bragging, just the facts. We both have respect for each other which is the way it should be.

So be careful how you judge programs and other people's experience. Although you may be a seasoned MS4, you will soon learn that for a short time the CRNA's will be able to swim laps around you while you are barely treading water.

Thanks for the advice. I would still, however, like to know what state that is.
Senior resident running the board?? could you be in NY?

 

[toughlife]

I think this is huge. I rotated at CCF and experienced a junior attending work his way through me, then the CA-3 asking questions about everything we did, were about to do, and had done. It was a pimp-fest, but more than that it was a Clinic in the Socratic Method of Anesthesia education. Even if I or the senior resident knew the answer and why the answer was right, this junior attending would continue on with papers, the history behind the topic, and clinical situations where all of it was relevant. And this was a junior attending; the senior attendings were as good or better at stretching the residents' knowledge every time they came in the room.

These were not questions about: what do you do now? What next? What do you do if this happens? I will not concede that a CRNA could match the experience of learning from an attending; you'll have too many questions beyond their skill set and knowledge depth too soon. You're learning way beyond you do this and this and this or this and this if this happens. My rotation preceptors have specifically told me not to go in with CRNAs as an MS-4, so why go in and learn from one as a PGY-1?

That's the way it should be. to CCF for that.

 

[BubbleHead]

Future Navy SEAL officers go through Basic Underwater Demolition/Survival training to learn the basics of becoming leaders of Naval SpecWarfare Operators.

They are trained by enlisted men...men who they will lead after completion of the training.

We all saw GI Jane. I even knew a couple SEALs when I was active and heard many stories , guy busted both femurs in a bike accident and lost his place in Teams, so went to boats. That doesn't make me an authority on their training. If you didn't go through that training, I think your comparison is weak. If you did, I think your comparison is weak. If the Senior Chiefs and Master Chiefs leading those courses drop an LDO package, then they're O-2s and O-3s no questions... in a time frame of weeks. That isn't the same as a CRNA going to med school, at all.

Your an MD? So, tell us why learning from a CRNA during our CA-1 year would be the same as learning from you... nobody wants to hear about SEALs training.

Well... OK, that's a lie! Everyone wants to hear about SEALs all the time, but tell us about learning Anesthesia from a CRNA anyway... as an attending sees it. You couldn't do a better job than a CRNA???

I never saw a wild thing
sorry for itself.
A small bird will drop frozen dead from a bough
without ever having felt sorry for itself.
- DH Lawrence

 

[nitecap]

Think we had this discussion the other night and people agreed that one with far superior training(level of training) was more effective. So what a CRNA with 10 years experience has no valuable knowledge to share with the CA-1, esp. in the CA-1's 2nd month in the OR. I suppose we just let the ego take over and let the inexperienced practitioner possibly screw up and cause harm. Of course there is a schooling gap no doubt, but in this case the experience gap is larger. Now what you guys think about the program doing that is another thing. To say a CA-1 with 2 months OR time doesnt have anything to learn from a CRNA with far more experience is ignorant. Better deflate those heads guys. The patient comes first here.

That attending probrably keeps it real and sees that NO the CA-1 with 2 months OR time probrably cant do a better job than the more experienced CRNA.

 

[militarymd]

All I'm saying is that one should not let your title go to your head....DO, MD, etc.

If you, as a CA-1, think that you have nothing to learn from a CRNA, ward nurse, CCU nurse, or ICU nurse, then you have a problem.

 

[BubbleHead]

Point taken.

Now that we've reached common ground on the fact that a CRNA has an experience level that a CA-1 in month one could learn something from...
I'm sure you as attendings could also learn something from a CRNA, nurse, tech, etc... The question becomes: Where do you draw the line?

I'm not interested in learning Anesthesia from a CRNA during my whole residency. I want the person in the Attending's position to be my mentor. They are the people who understand the end game of your residency training, they have an idea of where best to start you, how best to progress you, where you need to be a various stages of learning, where you need to end up to complete a residency.

Ego? Ignorance? OK, call it what you will, but a CRNA isn't going to provide complete training to MDs in residency and that is the bottom line. They do have a role. When they do what they're good at, I'm sure it contributes the whole team. That doesn't mean they can play every position on the team. So, why substitute? Why put them in on a temporary basis? Manpower issues... that is the sign of a less than ideal situation.

Don't assume we're all bursting at the seams with pride and ego. All I care about is learning everything about my chosen profession and I'm not confident that a CRNA can provide that, but I am confident that an MD can provide that for me.

 

[sleepwithme]

Point taken.

Now that we've reached common ground on the fact that a CRNA has an experience level that a CA-1 in month one could learn something from...
I'm sure you as attendings could also learn something from a CRNA, nurse, tech, etc... The question becomes: Where do you draw the line?

I'm not interested in learning Anesthesia from a CRNA during my whole residency. I want the person in the Attending's position to be my mentor. They are the people who understand the end game of your residency training, they have an idea of where best to start you, how best to progress you, where you need to be a various stages of learning, where you need to end up to complete a residency.

Ego? Ignorance? OK, call it what you will, but a CRNA isn't going to provide complete training to MDs in residency and that is the bottom line. They do have a role. When they do what they're good at, I'm sure it contributes the whole team. That doesn't mean they can play every position on the team. So, why substitute? Why put them in on a temporary basis? Manpower issues... that is the sign of a less than ideal situation.

Don't assume we're all bursting at the seams with pride and ego. All I care about is learning everything about my chosen profession and I'm not confident that a CRNA can provide that, but I am confident that an MD can provide that for me.

okay i agree with both sides of the argument, but as someone entering a residency program, i want 95% of my training to come from anesthesiology.
if a Crna teaches me things in my first few months (first 4) then i dont mind. but in the end, i want to be taught by the person who suffered through OB/Gyn doing pelvics, had to sweat out step 1s and 2s, went through all the crap that I am going through, took his anesthesia boards, took orals, went through 4 years of hell, came out on the other side, and sees me as a potential to do the same if not better as they did. You want Michael Jordan teaching you to shoot free throws, not an ex-NFL linebacker. CRNA is a different profession than anesthesiology. different roles, different jobs, although very slightly overlapping.
so give me the anesthesia program that teaches exclusively with anesthesiologists. I dont mind the tokens of wisdom that everyone in the hospital can probably offer, but at the end of the day, i want to learn anesthesia from an ANESTHESIOLOGIST.
IMHO

 

[bell412]

sorry pal. but when your dumpin pee and chartin vital signs your job is no different than the CRNA.

 

[toughlife]

sorry pal. but when your dumpin pee and chartin vital signs your job is no different than the CRNA.

Nurse, go get me some coffee.

 

[bell412]

I'd love to get you some coffee Doctor. Right after I show you how to dump this pee.

 

[Lizard1]

I think it's foolish not to rank a program because you might be paired up with a CRNA at the start of your residency. Like many others have said, there is a wealth of info to be learned from nearly everybody in the hospital. The second you get stuck on yourself because of the initials after your name is when you fall behind and make yourself look like a jack-ass.

I do not for one second think CRNA's should be able to practice unsupervised but I do realize that they(especially the experienced ones) can be just as valuable as an attending. In my residency, your first 3 wks you were either paired up with an experienced anesthetist or a senior resident. When I say experienced, I mean like 30+ yrs of on the job. Your first month of training, you're struggling to remember all the things to do. A CRNA can certainly help you with that. Of course, an attending oversees the case.

Now, I do not agree with placing a green CA-1 in a room with a fairly new CRNA/PA. Talk about the blind leading the blind

 

[sleepwithme]

sorry pal. but when your dumpin pee and chartin vital signs your job is no different than the CRNA.

you know you are arguing with a Crna when they fail to mention "resuscitate pt with ACLS, do critical care rotations, manage pain in postop setting, take care of chronic pain managment pts, and moonlight in an ER to make more $" as part of the job.
can crna's moonlight as nurses in an ER? pure curiosity

 

[toughlife]

I'd love to get you some coffee Doctor. Right after I show you how to dump this pee.

I know how to do that already. I just want you to get me some coffee.

 

[bell412]

no you don't doctor. nor do you know how to turn the bed, draw up the drugs, turn the gas on, chart the vital signs, put tube in, take tube out. so doctor, after were done with our little tasks i'll get you a big ol mocha

 

[Noyac]

no you don't doctor. nor do you know how to turn the bed, draw up the drugs, turn the gas on, chart the vital signs, put tube in, take tube out. so doctor, after were done with our little tasks i'll get you a big ol mocha

I see where you are coming from and I understand. Others will eventually and then some won't.

 

[sleepwithme]

isn't this a graduate MD/DO forum?
why don't you make a nurses-r-us forum.. and i guarantee none of us will be there..
oh and can you get a warm blanket for bed 6, nurse

 

[toughlife]

no you don't doctor. nor do you know how to turn the bed, draw up the drugs, turn the gas on, chart the vital signs, put tube in, take tube out. so doctor, after were done with our little tasks i'll get you a big ol mocha

The one thing you mentioned I did not get to do during my rotation was taking a tube out. Everything else I got to do.

During my 3rd year rotation, I got to intubate many old guys shriveled up like pretzels, do some a-lines, place a DLT, and was even fortunate enough to work in a trauma case one-on-one with an attending (with no resident around) where we had a guy with a hct of 6, bp 30s/10s, hr 170s, running epi infusions, transfusing like mad, all hell breaking loose, etc. That was some good shizznit.

So even though I am only a med student, I am not that naive as to what goes down in the OR, dude.

None of the above makes me an expert, but it won't be too long before I get to know how to do all that and more.

 

[bell412]

naw sleepwithme, i kinda like watchin you and toughlife grease up in front of the mirror.

 

[nitecap]

you know you are arguing with a Crna when they fail to mention "resuscitate pt with ACLS, do critical care rotations, manage pain in postop setting, take care of chronic pain managment pts, and moonlight in an ER to make more $" as part of the job.
can crna's moonlight as nurses in an ER? pure curiosity

Dude first thing is that how many anesthesiologists are certified in critical care. Not that many though the numbers may be rising. I spoke to a CA-3 that had not once coded a pt in his entire residency so far. Sure thats not with all. If you think that ICU RN's dont resus. pt's with ACLS you obviously have no ICU experience. THe average ICU RN will participate in more codes than your average private practice physician anesthetist. If you do a critical care fellowship then of course you are the critical care man no doubt. But if your CC rotation consists of 1 month in the ICU during your residency than sorry man thats not respectable. I have worked with a ton of residents doing their 1 month and the nurses in the unit end up teaching them a ton of stuff, though all my experiences have been extremely positive with them. they are very eager to learn the day to day functions of the ICU and ask for help all the time in how to fast track their pts so we could turn the bed over. Sorry when you go from the OR to writing orders for tubefeedings, bowel care, TPN, diets, wound care antibiotics (not just 1 gm ancef or vanc) ect it does take adjustments and they admittingly dont know it all. Whether you are a MD or not when thrown in a new arena taking care of pts of a different level you automatically dont know it all.

AS far as CRNA's moonlighting in the ER no we dont work in the ER but 9 times out of 10 in your average community hospital it will be the in house on call CRNA that is paged to intubate in ER or on the floor when the MD is at home hopefully getting a little poontang.

AS well in rural hospitals that only use CRNA's they can manage post-op pain as long as consulted by that pt's attending. Chronic pain is a more confusing issue and recently a large topic of debate but few CRNA's practice in though it is not unheard of. However the CRNA will always need to order from an attending (not have to be anesthesiologist) to do what ever it is necessary.

And again how many anesthesiologist out there are really moonlighting in the ER, come on now be realistic. As well from what I hear from my ER peeps there is a big push to not let non ER trained MD's work in the ER. They said the future will hold drastic changes for those MD's with no official ER training as far as what they will be allowed to do ect. Thats just what they tell me.

Look no doubt the MD scope of practice is larger. Thought this whole issues was whether its right or not for the CA-1 with 2 months exp to learn from the more exp. CRNA.

As far the coffee Ill get you one but Im getting one also and putting it one your tab. If youd rather dump pee then fine Ill so get the caffiene. freqly however esp in private practice its the CRNA that will "dump the pee" (run the case), while the MD goes on that coffee break. peace out.

 

[Noyac]

Dude first thing is that how many anesthesiologists are certified in critical care. Not that many though the numbers may be rising. I spoke to a CA-3 that had not once coded a pt in his entire residency so far. Sure thats not with all. If you think that ICU RN's dont resus. pt's with ACLS you obviously have no ICU experience. THe average ICU RN will participate in more codes than your average private practice physician anesthetist. If you do a critical care fellowship then of course you are the critical care man no doubt. But if your CC rotation consists of 1 month in the ICU during your residency than sorry man thats not respectable. I have worked with a ton of residents doing their 1 month and the nurses in the unit end up teaching them a ton of stuff, though all my experiences have been extremely positive with them. they are very eager to learn the day to day functions of the ICU and ask for help all the time in how to fast track their pts so we could turn the bed over. Sorry when you go from the OR to writing orders for tubefeedings, bowel care, TPN, diets, wound care antibiotics (not just 1 gm ancef or vanc) ect it does take adjustments and they admittingly dont know it all. Whether you are a MD or not when thrown in a new arena taking care of pts of a different level you automatically dont know it all.

AS far as CRNA's moonlighting in the ER no we dont work in the ER but 9 times out of 10 in your average community hospital it will be the in house on call CRNA that is paged to intubate in ER or on the floor when the MD is at home hopefully getting a little poontang.

AS well in rural hospitals that only use CRNA's they can manage post-op pain as long as consulted by that pt's attending. Chronic pain is a more confusing issue and recently a large topic of debate but few CRNA's practice in though it is not unheard of. However the CRNA will always need to order from an attending (not have to be anesthesiologist) to do what ever it is necessary.

And again how many anesthesiologist out there are really moonlighting in the ER, come on now be realistic. As well from what I hear from my ER peeps there is a big push to not let non ER trained MD's work in the ER. They said the future will hold drastic changes for those MD's with no official ER training as far as what they will be allowed to do ect. Thats just what they tell me.

Look no doubt the MD scope of practice is larger. Thought this whole issues was whether its right or not for the CA-1 with 2 months exp to learn from the more exp. CRNA.

As far the coffee Ill get you one but Im getting one also and putting it one your tab. If youd rather dump pee then fine Ill so get the caffiene. freqly however esp in private practice its the CRNA that will "dump the pee" (run the case), while the MD goes on that coffee break. peace out.

You still don't get it do you!

 

[sleepwithme]

Dude first thing is that how many anesthesiologists are certified in critical care. Not that many though the numbers may be rising. I spoke to a CA-3 that had not once coded a pt in his entire residency so far. Sure thats not with all. If you think that ICU RN's dont resus. pt's with ACLS you obviously have no ICU experience. THe average ICU RN will participate in more codes than your average private practice physician anesthetist. If you do a critical care fellowship then of course you are the critical care man no doubt. But if your CC rotation consists of 1 month in the ICU during your residency than sorry man thats not respectable.

I stopped listening right there.
you mad a perfect point about CRNA's and how they dont belong in this conversation nor in this forum: ACGME requires more than just 1 month, but you wouldn't know you are a nurse. and most programs are anticipating a possible move to possibly more than 4 months required..
that is why i ignored the rest of your talk. you are generalizing all MDs based on your experience with a CA-3 that had not coded once.
in the end, u make less money because you have less knowledge in skills. in the end, there are no pharm rep dinners aimed at nurses, no top tier students striving to enter nursing schools over medical school, and DEFINITELY no tv programs glorifying nurses wiping up ****..
and it is like comparing optometrists to ophthalmologists.. they are thinking about letting optometrists use a scalpel.. umm who would u go to for LASIKs, "top of their med school" grads or optometrists?
similarly, i was speaking with some family friends about anesthesia, and MDs out there, educate the masses.. half of them did not even know that nurses can be in charge of their anesthesia, so now they will be requesting anesthesiologists only. this awareness needs to be made before optometrists are performing surgery and CRNAs do more than TAKE ORDERS

 

[MacGyver]

I do not for one second think CRNA's should be able to practice unsupervised but I do realize that they(especially the experienced ones) can be just as valuable as an attending.

If they are "just as valuable" as an attending then you have lost your case against them getting independence. After all if you are going ot argue they are just as good as an attending, then how in good conscience can you not allow CRNAs the same job duties as an attending?

 

[bell412]

thats right sleepwithme. you need to tell the whole world. tell em all. no, ORDER them all.

 

[bullard]

isn't this a graduate MD/DO forum?
why don't you make a nurses-r-us forum.. and i guarantee none of us will be there..
oh and can you get a warm blanket for bed 6, nurse

I get warm blankets for my patients all the time. Why is that below you?

 

[bullard]

Anyway, the bottom line is this. Can a totally green CA-1 learn something from an experienced CRNA? Of course. Is it a good idea to go to a program that can't muster up experienced attendings to show CA-1s the ropes? Don't think so. If they can't do that, they're probably deficient in some other categories too. Why settle?

Man, this thread turned into MD vs CRNA really fast. Might be a new record.

 

[brisk80]

thats right sleepwithme. you need to tell the whole world. tell em all. no, ORDER them all.

This is ridiculous. I feel like no matter which forum thread I go to I am stuck reading about one group versus another. I am a current MS4 and its amazing how much maturity most of you posters still need to obtain in life. In the beginning of your CA-1 year numerous programs place you with a senior resident or a CRNA and sometimes with an attending. For a newbie resident to say or think that they can learn nothing from an experienced CRNA is a joke. Vice Versa for a CRNA to claim they have an equal ground of training from nursing and anesthetist school to that of a physician is also a joke.

It is the pride in your initials or submerged insecurity that prevents most of you from realizing your own limitations.

 

[toughlife]

This is ridiculous. I feel like no matter which forum thread I go to I am stuck reading about one group versus another. I am a current MS4 and its amazing how much maturity most of you posters still need to obtain in life. In the beginning of your CA-1 year numerous programs place you with a senior resident or a CRNA and sometimes with an attending. For a newbie resident to say or think that they can learn nothing from an experienced CRNA is a joke. Vice Versa for a CRNA to claim they have an equal ground of training from nursing and anesthetist school to that of a physician is also a joke.

It is the pride in your initials or submerged insecurity that prevents most of you from realizing your own limitations.

Nothing wrong with a senior resident or fellow teaching you anything. I think the point is that once that trend develops in a program, who says it will not progress any further?

 

[toughlife]

This is ridiculous. I feel like no matter which forum thread I go to I am stuck reading about one group versus another. I am a current MS4 and its amazing how much maturity most of you posters still need to obtain in life. In the beginning of your CA-1 year numerous programs place you with a senior resident or a CRNA and sometimes with an attending. For a newbie resident to say or think that they can learn nothing from an experienced CRNA is a joke. Vice Versa for a CRNA to claim they have an equal ground of training from nursing and anesthetist school to that of a physician is also a joke.

It is the pride in your initials or submerged insecurity that prevents most of you from realizing your own limitations.

Nothing wrong with a senior resident or fellow teaching you anything. I think the point is that once that trend (CRNA teaching residents) develops in a program, who says it will not progress any further?

 

[brisk80]

Nothing wrong with a senior resident or fellow teaching you anything. I think the point is that once that trend (CRNA teaching residents) develops in a program, who says it will not progress any further?

Good point. I should have been more clear in my post. I would not recommend nor would I go to a program that consistently paired CA's with CRNA's beyond the initial introductory training period to the OR. Personally I have not spent much time doing showcase rotations in Anesthesiology nor do I plan on spending my electives during my transitional year in the anesthesia department. I believe my time will be better spent with pulmonology, cardiology, critical care, etc. So with this said, my first few months in the OR as a CA-1 will be for the most part getting oriented to the equipment, protocols etc. of the hospital. During this period for a CRNA to take me under their wing and show me what they know will be greatly appreciated. Once my skills progress I will expect someone with more knowledge and training to stand behind the curtain with me to optimize the education with the patient encounter. The dilemma now stands at when should a resident no longer be paired with a CRNA? and that will be dependent on the progression of each individual resident.

 

[Noyac]

Just want to get some input on this one. I just learned that one of the programs I am considering ranking number 1 pairs CA-1s with either a CRNA or a senior resident for the first month. Before I make too big of a deal about this, can anyone speak to the prevelance of pairing up CA-1s with CRNAs and/or residents in lieu of an attending? How big of a deal do you think this is? Would this make you think twice about training at a program? why?

Thanks!

I would want to know why I was being put with a crna. Is it b/c there are not enough cases, too many trainees, or lazy attendings. There are things that can be learned from crna's (not all good either) but putting an impressionable resident in with a crna this early on had better have some damn good reasons. There is a definite practice difference IMHO. I have learned many things from crna's and some of them were good but all were helpful. So ideally you would be paired with a senior resident or an attending but if not possible, you will learn from the experience.

PS: not all programs pair the two. Mine didn't. Unless it was the resident training the crna. And this is a tough position to be in as a resident. I think this is a good thread with a lot of valuable info for some new residents. Unfortunately, you will have to weed through the bullsh*t.

 

[nitecap]

I stopped listening right there.
you mad a perfect point about CRNA's and how they dont belong in this conversation nor in this forum: ACGME requires more than just 1 month, but you wouldn't know you are a nurse. and most programs are anticipating a possible move to possibly more than 4 months required..
that is why i ignored the rest of your talk. you are generalizing all MDs based on your experience with a CA-3 that had not coded once.
in the end, u make less money because you have less knowledge in skills. in the end, there are no pharm rep dinners aimed at nurses, no top tier students striving to enter nursing schools over medical school, and DEFINITELY no tv programs glorifying nurses wiping up ****..
and it is like comparing optometrists to ophthalmologists.. they are thinking about letting optometrists use a scalpel.. umm who would u go to for LASIKs, "top of their med school" grads or optometrists?
similarly, i was speaking with some family friends about anesthesia, and MDs out there, educate the masses.. half of them did not even know that nurses can be in charge of their anesthesia, so now they will be requesting anesthesiologists only. this awareness needs to be made before optometrists are performing surgery and CRNAs do more than TAKE ORDERS

Last I heard there werent to many TV programs glorifying you guys either. And sorry your family is not educated about hlth care, im sure at least a few of them have had their anesthesia administered by a CRNA and did fine. Maybe they have lengthened the CC requirements but you said its not 1 but maybe will be "as long as 4" so what do you get now 2 to 3 months. Seems rather short being you guys spend 3 or more years in the OR. Guess a ER doc could go work in OR for a few months and be able to moonlight their No?

As well you are generalizing that all anesthesiologist can work critical care and ER which is not the case. you also generalize rather incorrectly and unintelligently about a CRNA's scope of practice. We have been through this b/f so I will let you be nieve for now. Your immaturity shows when you comment about TV programs depicting "assssssses whiping" and comments of not getting free diner from pharm reps. Please dude one if thats why you went into this profession then I dont even know what to think, maybe your obese or something with an addiction to free food. Also everytime the pharm reps come to my training facilities we get just as much free food. Their objective is to increase use of the drug and in the real world many times it is the CRNA who is giving that drug even though they may be medically directed.

Again the topic of this thread was if a CA-1 should learn from a CRNA and I see that although the egos here are big a couple of you old timers (posters ) have agreed that the CA-1 could learn from the experienced CRNA, although you followed it up with I wouldnt go to that program. So I rest my case based on what these old wise ones have said.

 

[davvid2700]

Last I heard there werent to many TV programs glorifying you guys either. And sorry your family is not educated about hlth care, im sure at least a few of them have had their anesthesia administered by a CRNA and did fine. Maybe they have lengthened the CC requirements but you said its not 1 but maybe will be "as long as 4" so what do you get now 2 to 3 months. Seems rather short being you guys spend 3 or more years in the OR. Guess a ER doc could go work in OR for a few months and be able to moonlight their No?

As well you are generalizing that all anesthesiologist can work critical care and ER which is not the case. you also generalize rather incorrectly and unintelligently about a CRNA's scope of practice. We have been through this b/f so I will let you be nieve for now. Your immaturity shows when you comment about TV programs depicting "assssssses whiping" and comments of not getting free diner from pharm reps. Please dude one if thats why you went into this profession then I dont even know what to think, maybe your obese or something with an addiction to free food. Also everytime the pharm reps come to my training facilities we get just as much free food. Their objective is to increase use of the drug and in the real world many times it is the CRNA who is giving that drug even though they may be medically directed.

Again the topic of this thread was if a CA-1 should learn from a CRNA and I see that although the egos here are big a couple of you old timers (posters ) have agreed that the CA-1 could learn from the experienced CRNA, although you followed it up with I wouldnt go to that program. So I rest my case based on what these old wise ones have said.

Ill repeat.. IF im ever working with you I will severely restrict your practice.. No spinals No epidurals.. no central lines.. Just monitor the patient .. Thats if you graduate from baylor.. You are a dangerous man and you need to get off of this board..

 

[VolatileAgent]

as i did earlier in this thread, i'll simply state it again (and hope this thread soon closes hereafter):

i would be very leery about going to a program, as a new resident, where CRNAs are put in a direct supervisory/teaching role over anesthesia residents. period.

i think the degradation of this thread amply speaks - on many different levels - as to exactly why.

 

[toughlife]

as i did earlier in this thread, i'll simply state it again (and hope this thread soon closes hereafter):

i would be very leery about going to a program, as a new resident, where CRNAs are put in a direct supervisory/teaching role over anesthesia residents. period.

i think the degradation of this thread amply speaks - on many different levels - as to exactly why.

wouldn't it be important then for us to know which programs do this?

I'll start: one is a program located in a popular city known for its great skiing and proximity to the rockies.

 

[VolatileAgent]

wouln't it be important then for us to know which programs do this?

all i can tell you for certain is it doesn't happen (and never will so long as current management stays in place) at penn st.

 

[Noyac]

all i can tell you for certain is it doesn't happen (and never will so long as current management stays in place) at penn st.

 

[BubbleHead]

no you don't doctor. nor do you know how to turn the bed, draw up the drugs, turn the gas on, chart the vital signs, put tube in, take tube out. so doctor, after were done with our little tasks i'll get you a big ol mocha

Actually they did go over all those things during my rotations. I don't have years of experience doing it, but then again who really needs years of experience to do those things? So, if you're getting Mochas I like mine with whipped cream.