Procedures average

[Henle]

Hello,
I haven't found any info on this issue here so far:

Based on your experience as residents, how many
-Intubations
-Laryngeal masks
-Epidurals
-Spinal an.
-Regional blocks
-central lines
are roughly done in an average residency year? The ABA doesn't post minimum numbers. Are you keeping a procedure log?
(Background- one anesth resident told me about bad programs with a lot of resident abuse with 'stand-by')
Are the new work hour recs decreasing the number of procedures significantly?

Any input welcome...

---

Members don't see this ad.

 

[UTSouthwestern]

Hello,
I haven't found any info on this issue here so far:

Based on your experience as residents, how many
-Intubations
-Laryngeal masks
-Epidurals
-Spinal an.
-Regional blocks
-central lines
are roughly done in an average residency year? The ABA doesn't post minimum numbers. Are you keeping a procedure log?
(Background- one anesth resident told me about bad programs with a lot of resident abuse with 'stand-by')
Are the new work hour recs decreasing the number of procedures significantly?

Any input welcome...

Just out of curiosity, what is "stand-by"?

The new work hour recs are not decreasing the number of procedures significantly and the ABA's future changes in the minimum case load requirement and procedure requirements will reflect changes in anesthesia since the original numbers were decided upon (example: decreasing the number of required cases of C-sections done under epidural reflecting the change from previously more popular single shot epidural techniques to intrathecal techniques. The number of CPB cases needed to graduate will increase from 20 to probably 40 or 50).

I will hazard some estimates (over a 3 year period) for your question as:
Intubations: 1200+
LMA's: 400+
Epidurals: 400+ (maybe less at other institutions but we do almost 10,000 epidurals a year just on the OB service)
Spinals: 400+ (see above)
Regional: 100-200+ (depends largely on your motivation and eagerness to use these techniques)
Central lines: Good lord a ton.

 

[Henle]

Just out of curiosity, what is "stand-by"?

The new work hour recs are not decreasing the number of procedures significantly and the ABA's future changes in the minimum case load requirement and procedure requirements will reflect changes in anesthesia since the original numbers were decided upon (example: decreasing the number of required cases of C-sections done under epidural reflecting the change from previously more popular single shot epidural techniques to intrathecal techniques. The number of CPB cases needed to graduate will increase from 20 to probably 40 or 50).

I will hazard some estimates for your question as:
Intubations: 1200+
LMA's: 400+
Epidurals: 400+ (maybe less at other institutions but we do almost 10,000 epidurals a year just on the OB service)
Spinals: 400+ (see above)
Regional: 100-200+ (depends largely on your motivation and eagerness to use these techniques)
Central lines: Good lord a ton.

thank you for the quick reply. The person who told me this story is an FMG, 'stand-by' meaning not providing general anesthesia but merely baby sitting surgeons or radiologists performing procedures. I guess: bad program= more scut.
In any event - 2600+ procedures in 365 days sounds pretty good. Must be busy doing 8 cases a day?!?!

 

[DrDre']

I think UT meant his numbers to encompass an entire gas residency...

 

[bubalus]

http://www.acgme.org/acWebsite/downloads/RRC_progReq/040pr703_u804.pdf

See page 15

Not quite what you wanted to know, but some info there.

 

[Tenesma]

MGH has a caseload website with comparisons to averages...http://etherdome.org/Education/ResiInfo/Caseload.html

 

[DenRock]

My CA-1 year totals (approximate):

Epidural - 300
SAB - 150
Central lines - 50
A-lines - 50
Nerve blocks - 20
LMA - 50
Total cases - roughly 750

We don't track intubations except for some special cases like double-lumen tubes, fiberoptic intubations, etc.

The numbers will be significantly different for the CA-2 year for me since I am doing different cases/subspecialties. More blocks, lines this year. Hope this helps.

 

[MDEntropy]

My CA-1 year totals (approximate):

Epidural - 300
SAB - 150
Central lines - 50
A-lines - 50
Nerve blocks - 20
LMA - 50
Total cases - roughly 750

We don't track intubations except for some special cases like double-lumen tubes, fiberoptic intubations, etc.

The numbers will be significantly different for the CA-2 year for me since I am doing different cases/subspecialties. More blocks, lines this year. Hope this helps.

I find these numbers quite interesting and even a bit perplexing for a few reasons.

A-lines and CVP's are equal. I would expect A-lines to be a multiple of CVP's. Doesn't have to be that way though.

Only a hand full of nerve blocks but 300 epidurals with only 750 cases? 40% of your cases got an epidural, and 20% got a spinal. There could be some overlap with CSE but that is still a MAJORITY of cases getting a neuraxial block. And you are expecting MORE blocks this year? Did you do a considerable amount of OB as a CA-1? These numbers just don't look quite right to me although they could be explained by your case mix.

Please tell use about your instiution's philosophy on neuaraxial anesthesia.

 

[UTSouthwestern]

I think UT meant his numbers to encompass an entire gas residency...

Thanks for the heads up. I corrected the original post.

One of our residents was a transfer from the Colorado program and as I understand it, he did 11 months of general and one month of pain as a CA-1. No OB. Lots of Bier blocks. Some trauma. Lots of skiing.

 

[DenRock]

I find these numbers quite interesting and even a bit perplexing for a few reasons.

A-lines and CVP's are equal. I would expect A-lines to be a multiple of CVP's. Doesn't have to be that way though.

Only a hand full of nerve blocks but 300 epidurals with only 750 cases? 40% of your cases got an epidural, and 20% got a spinal. There could be some overlap with CSE but that is still a MAJORITY of cases getting a neuraxial block. And you are expecting MORE blocks this year? Did you do a considerable amount of OB as a CA-1? These numbers just don't look quite right to me although they could be explained by your case mix.

Please tell use about your instiution's philosophy on neuaraxial anesthesia.

L+D is a large part of CA-1. In general, epidural for vaginal delivery, SAB for C-section; CSE counted as epidural in our numbers.

As a CA-1 we only got to do blocks on random cases. This year I have actually completed a "regional" month where I did somewhere around 100 blocks in holding area without actually doing the case in OR.

Philosophy on neuraxial anesthesia - don't know exactly what you're asking. We do epidurals for post-op pain in a lot of lower extremity ortho. SAB for many foot/ankle, cysto cases. Epidurals for most thoracotomies.

 

[sbmed100]

DenRock,

I have a hard time believing you did 300 epidurals as a CA-1. I am in a program that offers an insane regional experience and some OB in our first year and I maybe did 100 epidurals, if that, in my CA-1 year. Unless your CA-1 year consisted of a fellowship in OB anesthesia I doubt you did three hundred epidurals...at my program at least, laparoscopic surgery requires an endotracheal tube!

 

[Tenesma]

denrock... i hate to knock your experience, and even though i believe you have an awesome exposure to neuraxial anesthesia - i find it hard to believe that you can do 450 epidurals/spinals in your first year....