Residents being supervised by CRNA's

[twelvemonkeys12]

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I have noticed a disturbing trend at my institution of putting junior residents with CRNA's. Anyone know if this is violation of the ACGME and or ASA. Looking for specific language.

 

[Gern Blansten]

That is a big no-no. This is one of the big questions they ask about during program's site reviews. This practice is highly frowned upon. The ABA / RRC and ACGME are the ones who make the rules.

 

[Monty Python]

I have noticed a disturbing trend at my institution of putting junior residents with CRNA's. Anyone know if this is violation of the ACGME and or ASA. Looking for specific language.

CRNAs absolutely cannot officially supervise physicians. They can hang out in the room if asked, share tips or advice if asked, but there's no official supervisory relationship.

 

[OB1🤙]

This is ABSOLUTELY unacceptable.

From section D1 of the ACGME rules- http://www.acgme.org/acWebsite/downloads/RRC_progReq/040_anesthesiology_07012008_u03102008.pdf

"The integration of nonphysician personnel into a department with
an accredited program in anesthesiology will not influence the
accreditation of such a program unless it becomes evident that
such personnel interfere with the training of resident physicians.
Interference may result from dilution of faculty effort, dilution of the
available teaching experience, or downgrading of didactic material.
Clinical instruction of residents by nonphysician personnel is
inappropriate, as is excessive supervision of such personnel by
resident staff. Additional necessary professional, technical, and
clerical personnel must be provided to support the program."

 

[Arch Guillotti]

Interesting topic for one's very first post.

I wouldn't get too excited over this.

 

[radslooking]

Interesting topic for one's very first post.

I wouldn't get too excited over this.

curious indeed. i wonder if someone is trying to stir the pot.

 

[Arch Guillotti]

May be true, maybe not.

For now I am giving the OP the benefit of the doubt and would like to hear some more about this. And I hope the discussion can remain civil🙄.

 

[drccw]

I have seen this... When I was on staff at the Big House, I would be assigned a room sometime with a resident and a CRNA. I asked about this to the big boss and the response was that the CRNA was not supervising the resident (that was my responsibility) but given as I had another room and this particular resident was weak they thought it best to have another person in the room...

On their eyes it was akin to having a junior resident and a senior resident assigned to the same room.... The senior resident wasn't technically supervising the junior (that responsibility feel to the attending) but as always there was some teaching going on...

 

[periopdoc]

If there actually is a program where CRNAs are SUPERVISING then ACGME will have some stern words with the PD.

With a name like 12monkeys12, I am highly suspicious that someone is trying to stir up some mayhem.

- pod

 

[flashgordon]

When i was a 4th year med student at an away rotation, they frequently put me in rooms with CRNAs. Never saw residents paired with them though.

My suggestion: DO NOT APPLY TO THAT PROGRAM. If you're a resident, you guys as a GROUP need to RAISE HELL to your program director and/or chair. As a physician-in-training, you should be taught by a physician. I don't care how many DNPs said nurses have, but that is UNACCEPTABLE.

Your program should be reported to the ACGME.

 

[frank51]

When i was a 4th year med student at an away rotation, they frequently put me in rooms with CRNAs. Never saw residents paired with them though.

I don't even think med students should be paired with them, during one of my elective rotations, this CRNA was telling me how she just didn't believe that ventilators can cause barotrauma. I wasn't even sure how to respond, it's like somebody saying I don't believe in gravity.

 

[Gern Blansten]

I don't even think med students should be paired with them, during one of my elective rotations, this CRNA was telling me how she just didn't believe that ventilators can cause barotrauma. I wasn't even sure how to respond, it's like somebody saying I don't believe in gravity.

Don't dismiss the "no gravity" theory just yet. We need some randomized controlled studies.

 

[geogil]

And of course you need outcome studies, to prove that the same things happen regardless of who drops something. 🙄

 

[SleepIsGood]

The original poster is likely a CRNA. She wont even state the name of her program...

 

[Arch Guillotti]

The original poster is likely a CRNA. She wont even state the name of her program...

That was my first impression but now I am not sure sure this is the case. perhaps the OP can expound a bit.

 

[Josh L.Ac.]

Don't dismiss the "no gravity" theory just yet. We need some randomized controlled studies.

RCT's are fairly useless when applied to the real world.

A much more applicable type of study is a retrospective qualitative study where the patient's perception of gravity (and how it made them feel) is what's measured, not some cold objective type of measure.

 

[Colba55o]

I don't even think med students should be paired with them, during one of my elective rotations, this CRNA was telling me how she just didn't believe that ventilators can cause barotrauma. I wasn't even sure how to respond, it's like somebody saying I don't believe in gravity.

Maybe she was saying this in a "guns don't kill; people do" kinda way?
Giving her the benefit of the doubt. As a med student I got paired with quite a few CRNAs and learned a lot from them. Not to mention they let me do way more than residents did just because they didnt feel they needed the practice.

Of course the ideal is being one on one with an attending, but as far as getting to do stuff.. CRNA>>residents..sorry

 

[ASDIC]

I was involved in a surgery case as a medical student, it was a fairly long APR going on. 3 hours into the case, the surgeon noticed the patient not making any urine. He requested the CRNA to give an immediate bolus of IV fluids, but the CRNA refused stating that the patient needed a blood transfusion because the patient was anemic to begin with. There were some heated words exchanged for about an hour between the surgeons and the CRNA until the attending anesthesiologist stepped into the OR and instructed the CRNA to give an immediate bolus. The patient went into renal failure after the surgical case.

At the same hospital, I heard a CRNA pushed vancomycin extremely fast into a patient causing Red Man syndrome, so she could get out of there on time.

 

[Coastie]

I was involved in a surgery case as a medical student, it was a fairly long APR going on. 3 hours into the case, the surgeon noticed the patient not making any urine. He requested the CRNA to give an immediate bolus of IV fluids, but the CRNA refused stating that the patient needed a blood transfusion because the patient was anemic to begin with. There were some heated words exchanged for about an hour between the surgeons and the CRNA until the attending anesthesiologist stepped into the OR and instructed the CRNA to give an immediate bolus. The patient went into renal failure after the surgical case.

At the same hospital, I heard a CRNA pushed vancomycin extremely fast into a patient causing Red Man syndrome, so she could get out of there on time.

Reminds me of a case last night. Massive plastics/recon case, 10 hours, guy was 110 kg. CRNA had given him 2300 of LR total over 10 hours, guy had been full NPO. Told me he was "making good urine". Also gave 1000 mcg of fentanyl in the previous 2 hours before I relieved because of "blood pressure".

🙄

 

[Licoricestick]

RCT's are fairly useless when applied to the real world.

A much more applicable type of study is a retrospective qualitative study where the patient's perception of gravity (and how it made them feel) is what's measured, not some cold objective type of measure.

👍

Of course, even if you don't believe gravity exists, this sort of study still works because as long as the patient believes the gravity is real....

Sadly, the post modernist concept of "truth is what's true to you" seems to creep into areas where it makes absolutely no sense.

 

[Colba55o]

I was involved in a surgery case as a medical student, it was a fairly long APR going on. 3 hours into the case, the surgeon noticed the patient not making any urine. He requested the CRNA to give an immediate bolus of IV fluids, but the CRNA refused stating that the patient needed a blood transfusion because the patient was anemic to begin with. There were some heated words exchanged for about an hour between the surgeons and the CRNA until the attending anesthesiologist stepped into the OR and instructed the CRNA to give an immediate bolus. The patient went into renal failure after the surgical case.

At the same hospital, I heard a CRNA pushed vancomycin extremely fast into a patient causing Red Man syndrome, so she could get out of there on time.

What exactly is the point of posting these anecdotal stories of CRNA caused mishaps? You only need to peek at some other threads on this board even to see that MDAs and residents all f**k up on occasion.

Referring back to the OP, should crnas be teaching/supervising residents? Of course not. Does that mean they are incompetent overall and don't know basic physiology and how to handle common intra-operative events?

They get pretty good training in the science of anesthesia. They don't however have the training to practice medicine on their own, which is why the attending in the aformentioned situation should have been notified earlier, rather than bickering back and forth. The fact that they argued for a whole hour is the real problem. Re: the vanc story, anytime you hear something that starts out with "I heard..." is generally BS

I think its not such a bad idea to put med students with crnas only because the point of a med student rotation isn't really to learn how to be an anesthesiologist. Its to get exposure, meet people in the field, and get experience doing some cool procedures (hopefully).

 

[ProRealDoc]

What exactly is the point of posting these anecdotal stories of CRNA caused mishaps? You only need to peek at some other threads on this board even to see that MDAs and residents all f**k up on occasion.

Referring back to the OP, should crnas be teaching/supervising residents? Of course not. Does that mean they are incompetent overall and don't know basic physiology and how to handle common intra-operative events?

They get pretty good training in the science of anesthesia. They don't however have the training to practice medicine on their own, which is why the attending in the aformentioned situation should have been notified earlier, rather than bickering back and forth. The fact that they argued for a whole hour is the real problem. Re: the vanc story, anytime you hear something that starts out with "I heard..." is generally BS

I think its not such a bad idea to put med students with crnas only because the point of a med student rotation isn't really to learn how to be an anesthesiologist. Its to get exposure, meet people in the field, and get experience doing some cool procedures (hopefully).

And you are a CRNA, aren't you?

 

[236116]

I think its not such a bad idea to put med students with crnas only because the point of a med student rotation isn't really to learn how to be an anesthesiologist. Its to get exposure, meet people in the field, and get experience doing some cool procedures (hopefully).

Yeah, exposure to what they'd be doing as ANESTHESIOLOGISTS, not CRNAs.

 

[flashgordon]

Agree w/ pointless anecdotal stories.

Disagree w/ med students being paired w/ CRNA.

p.s. WTF is an MDA?

What exactly is the point of posting these anecdotal stories of CRNA caused mishaps? You only need to peek at some other threads on this board even to see that MDAs and residents all f**k up on occasion.

Referring back to the OP, should crnas be teaching/supervising residents? Of course not. Does that mean they are incompetent overall and don't know basic physiology and how to handle common intra-operative events?

They get pretty good training in the science of anesthesia. They don't however have the training to practice medicine on their own, which is why the attending in the aformentioned situation should have been notified earlier, rather than bickering back and forth. The fact that they argued for a whole hour is the real problem. Re: the vanc story, anytime you hear something that starts out with "I heard..." is generally BS

I think its not such a bad idea to put med students with crnas only because the point of a med student rotation isn't really to learn how to be an anesthesiologist. Its to get exposure, meet people in the field, and get experience doing some cool procedures (hopefully).

 

[frank51]

Does that mean they are incompetent overall and don't know basic physiology and how to handle common intra-operative events?

Unfortunately, while I was a med student I simply didn't like what I saw regarding CRNAs. Sure, I did meet some nice CRNAs, who minded their own business, but at the same time, looking back, there were many times, when CRNAs would argue with the attending about which drugs to push, the EKG reading, etc. What scares me is that many acted like they were an attending, while as a med student I knew that they were simply wrong, and obviously didn't have a sold foundation in medicine.

 

[Prodigal OU Son]

I have seen this... When I was on staff at the Big House, I would be assigned a room sometime with a resident and a CRNA. I asked about this to the big boss and the response was that the CRNA was not supervising the resident (that was my responsibility) but given as I had another room and this particular resident was weak they thought it best to have another person in the room...

On their eyes it was akin to having a junior resident and a senior resident assigned to the same room.... The senior resident wasn't technically supervising the junior (that responsibility feel to the attending) but as always there was some teaching going on...

I've worked several academic institutions over the last 10 years.....this is what I've seen....and it makes sense if you are suffering a temporary personnel crunch. If the CRNA can demonstrate some technical proficiency, then it can provide a service for the program....but it should remain purely technical.

 

[Saladin MD]

Can someone link me to this mysterious "CRNA Debates forum" I keep hearing about? I can't seem to find it.

I've been reading quite a few threads on this topic in the last couple days, and I must say that I am very disturbed by this CRNA militancy. What patient would opt for a nurse anesthetist as opposed to an anesthesiologist?! This is seriously something one could expect in some Third World country, not America. C'mon!

 

[wAyRadikull]

Can someone link me to this mysterious "CRNA Debates forum" I keep hearing about? I can't seem to find it.

I've been reading quite a few threads on this topic in the last couple days, and I must say that I am very disturbed by this CRNA militancy. What patient would opt for a nurse anesthetist as opposed to an anesthesiologist?! This is seriously something one could expect in some Third World country, not America. C'mon!

Bro, when you click on Anesthesiology, there is a sub-forum called "Midlevel Anesthesia Providers".
There is also a Private Forum on here, but I think you need to be part of the ASA in order to access that.

 

[Saladin MD]

Bro, when you click on Anesthesiology, there is a sub-forum called "Midlevel Anesthesia Providers".
There is also a Private Forum on here, but I think you need to be part of the ASA in order to access that.

Thanks. I just thought it was literally named the CRNA Debates Forum.