Rigorous CRNA education!

[sebsvenmdc]

Wow, so as a future anesthesiologist, I have to say that I'm very annoyed by the perception that CRNAs and anesthesiologists are two of the same thing! What a joke! To apply to CRNA schools, I looked at a few programs. Baylor requires a whole 1000 on its GRE and a 3.0 GPA. TCU requires a stellar 1100 and 3.0. Baylor described interviewing a whole 130 applicants for ONLY 15 spots...wow, so selective! Seriously, this is just embarrassing. A 1000 on the GRE is probably similar to 145 on the Step 1. I could make an 800 on the quantitative alone. It's just pathetic that these people are paid so much money for such an easy trajectory. They should get no more than 30-40% of a MD salary. Do anesthesiologists frequently bail CRNAs out of trouble? So much so that the public has no idea that there is a distinction between our job performance? Or is the job rarely that risky and perceived differences in quality of care only surface during such non-every day events?

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[polkadotcap]

Most people have no clue what the anesthesiologist does. I have had many people tell me that they thought we roll them back to the room, put a breathing tube in, and leave.

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

2. Wear your WHITE COAT into and out of the hospital. Wear it when you pre op, and when you post op. Make sure it is CLEAN and pressed. Your surgical colleagues are doing it, and like it or not, it sends a message.

3. Explain to your patients in the AM that you will be with them the whole time during surgery (applicable to residents), explain what you will do (give pain medicine, watch carefully over heart and lung function, monitor fluid balance and blood loss). Make it personal - hx of CAD?- mention that it is YOUR job, while the surgeon focuses solely on the surgery, to carefully monitor their heart function and work to prevent untoward events such as intraop MI. PATIENTS DO NOT KNOW WHAT WE DO, EDUCATE THEM!

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist?"

5. Follow up with your patients- this is KEY- when you go by to see them, re-introduce yourself as Dr. X, your anesthesia resident who took care of you in the operating room. Chat with them about how they did during surgery. Give a damn about their pain, offer to contact the primary team if they are hurting or get their nurse to get them their pill, ASK what you can do for them before you leave. Tell them you would be more than happy to take care of them should they unfortunately require a trip back to the OR. People DO remember this!!

 

[sebsvenmdc]

Most people have no clue what the anesthesiologist does. I have had many people tell me that they thought we roll them back to the room, put a breathing tube in, and leave.

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

2. Wear your WHITE COAT into and out of the hospital. Wear it when you pre op, and when you post op. Make sure it is CLEAN and pressed. Your surgical colleagues are doing it, and like it or not, it sends a message.

3. Explain to your patients in the AM that you will be with them the whole time during surgery (applicable to residents), explain what you will do (give pain medicine, watch carefully over heart and lung function, monitor fluid balance and blood loss). Make it personal - hx of CAD?- mention that it is YOUR job, while the surgeon focuses solely on the surgery, to carefully monitor their heart function and work to prevent untoward events such as intraop MI. PATIENTS DO NOT KNOW WHAT WE DO, EDUCATE THEM!

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist?"

5. Follow up with your patients- this is KEY- when you go by to see them, re-introduce yourself as Dr. X, your anesthesia resident who took care of you in the operating room. Chat with them about how they did during surgery. Give a damn about their pain, offer to contact the primary team if they are hurting or get their nurse to get them their pill, ASK what you can do for them before you leave. Tell them you would be more than happy to take care of them should they unfortunately require a trip back to the OR. People DO remember this!!

Thanks for sharing the advice! I'm catching on to this...I don't use MDA anymore. I think the idea about introductions with title and white coat are "clutch" too. Let the CRNAs try to be friends with the patients, we need to be the epitome of professionals. How do react to overhead pages of "anesthesia"...that's different from a one-on-one ability to ignore and correct other staff that use the terms interchangeably.

 

[jetproppilot]

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[rsgillmd]

Most people have no clue what the anesthesiologist does. I have had many people tell me that they thought we roll them back to the room, put a breathing tube in, and leave.

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

2. Wear your WHITE COAT into and out of the hospital. Wear it when you pre op, and when you post op. Make sure it is CLEAN and pressed. Your surgical colleagues are doing it, and like it or not, it sends a message.

3. Explain to your patients in the AM that you will be with them the whole time during surgery (applicable to residents), explain what you will do (give pain medicine, watch carefully over heart and lung function, monitor fluid balance and blood loss). Make it personal - hx of CAD?- mention that it is YOUR job, while the surgeon focuses solely on the surgery, to carefully monitor their heart function and work to prevent untoward events such as intraop MI. PATIENTS DO NOT KNOW WHAT WE DO, EDUCATE THEM!

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist?"

5. Follow up with your patients- this is KEY- when you go by to see them, re-introduce yourself as Dr. X, your anesthesia resident who took care of you in the operating room. Chat with them about how they did during surgery. Give a damn about their pain, offer to contact the primary team if they are hurting or get their nurse to get them their pill, ASK what you can do for them before you leave. Tell them you would be more than happy to take care of them should they unfortunately require a trip back to the OR. People DO remember this!!

👍👍

Fortunately I don't have to worry about #4. I do all of the rest and 100% agree with your post.

 

[Frank Rizzo]

Most people have no clue what the anesthesiologist does. I have had many people tell me that they thought we roll them back to the room, put a breathing tube in, and leave.

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

2. Wear your WHITE COAT into and out of the hospital. Wear it when you pre op, and when you post op. Make sure it is CLEAN and pressed. Your surgical colleagues are doing it, and like it or not, it sends a message.

3. Explain to your patients in the AM that you will be with them the whole time during surgery (applicable to residents), explain what you will do (give pain medicine, watch carefully over heart and lung function, monitor fluid balance and blood loss). Make it personal - hx of CAD?- mention that it is YOUR job, while the surgeon focuses solely on the surgery, to carefully monitor their heart function and work to prevent untoward events such as intraop MI. PATIENTS DO NOT KNOW WHAT WE DO, EDUCATE THEM!

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist?"

5. Follow up with your patients- this is KEY- when you go by to see them, re-introduce yourself as Dr. X, your anesthesia resident who took care of you in the operating room. Chat with them about how they did during surgery. Give a damn about their pain, offer to contact the primary team if they are hurting or get their nurse to get them their pill, ASK what you can do for them before you leave. Tell them you would be more than happy to take care of them should they unfortunately require a trip back to the OR. People DO remember this!!

If, as a resident, you're doing this already, I applaud you! Stick to it!

 

[DScully]

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

👍👍

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

This is so true - I had a great attending once who just introduced himself as "John Smith" and I could just see how patients had no clue why he was even in the room.

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist"

Quick question about this...what does you actually say when a nurse (who is in the same room with you) says something like this? Do you ignore her? Do you correct her on the spot?

As a soon-resident-to-be, I can just imagine being in the room with a patient who complaints about something related to pain, and the nurse would just point to me and say, "well, we leave that decision to anesthesia" or something like "well, you have to talk to anesthesia." Do I still say "oh, you must have meant the anesthesiologist"?? 😕

 

[polkadotcap]

👍👍



This is so true - I had a great attending once who just introduced himself as "John Smith" and I could just see how patients had no clue why he was even in the room.



Quick question about this...what does you actually say when a nurse (who is in the same room with you) says something like this? Do you ignore her? Do you correct her on the spot?

As a soon-resident-to-be, I can just imagine being in the room with a patient who complaints about something related to pain, and the nurse would just point to me and say, "well, we leave that decision to anesthesia" or something like "well, you have to talk to anesthesia." Do I still say "oh, you must have meant the anesthesiologist"?? 😕

Okay, so in my mind there is a difference here. If someone is referring to "anesthesia" to a patient or to a colleague, sometimes they are doing it in a way that is non-derogatory and in a way that is just generally identifying them. I don't mind this usage. For example:

On rounds, you say to your attending, "Cardiology came by and said to go ahead and restart the Plavix"

This is okay.

If you are walking into your patient's room and see the cardiologist outside the room looking at the chart, it is rude to say "Oh, hey, Cardiology, glad you're here". You would say, "Oh, Hi, are you Dr. So-and-So with cardiology? Thanks for dropping by"

In preop, the nurse may say to another nurse, "anesthesia wants to send a preop potassium". This is not an egregious error in my mind, they are simply identifying the team that wants the lab.

It's when I hear, "Hey, ANESTHESIA, what's the EBL?" that I get my back up.

So to answer your question, you have to be kinda choosy about when you "correct" people, or when you take offense to how they are referring to you. I generally don't make a huge thing about it, especially in front of a patient, unless it's really out of line. Patients pick up on weirdness and it just makes you look like a d-bag. Point it out later, in private (and remember you will have more clout when you are not a resident, or at least a few years along- don't appear to be "pulling rank" as a CA-1 🙂)

 

[DScully]

So to answer your question, you have to be kinda choosy about when you "correct" people, or when you take offense to how they are referring to you. I generally don't make a huge thing about it, especially in front of a patient, unless it's really out of line. Patients pick up on weirdness and it just makes you look like a d-bag. Point it out later, in private (and remember you will have more clout when you are not a resident, or at least a few years along- don't appear to be "pulling rank" as a CA-1 🙂)

Thanks for the reply!!

I will definitely keep your advice in mind as I progress through this process! 🙂

 

[CVRN]

Wow, so as a future anesthesiologist, I have to say that I'm very annoyed by the perception that CRNAs and anesthesiologists are two of the same thing! What a joke! To apply to CRNA schools, I looked at a few programs. Baylor requires a whole 1000 on its GRE and a 3.0 GPA. TCU requires a stellar 1100 and 3.0. Baylor described interviewing a whole 130 applicants for ONLY 15 spots...wow, so selective! Seriously, this is just embarrassing. A 1000 on the GRE is probably similar to 145 on the Step 1. I could make an 800 on the quantitative alone. It's just pathetic that these people are paid so much money for such an easy trajectory. They should get no more than 30-40% of a MD salary. Do anesthesiologists frequently bail CRNAs out of trouble? So much so that the public has no idea that there is a distinction between our job performance? Or is the job rarely that risky and perceived differences in quality of care only surface during such non-every day events?

As far as the minimum requirements for CRNA school admission go, it's just an accepted reality for anyone aspring to become a CRNA that only having the minimum GRE, GPA, years of experience, etc. wouldn't even get you an interview. I would guess the schools set those requirements low to give them flexibility on who they accept and interview. If someone had 5 years experience as a paramedic, 5 as a flight RN, 10 as an ICU RN of multiple specialties, had a 4.0 math/science GPA, but an 1150 on their GRE then a school would want the flexibility to offer them an interview to see what kind of a candidate they may be since they sound like an outstanding candidate except for the mediocre GRE score. To play my own devils advocate I guess one could argue that this leaves the possibility of admitting and maybe even graduating a SRNA/CRNA who just barely snuck by with the bare minimum and is now practicing and with inadequate knowledge and skills. Keeping in mind that no system is perfect the same could probably be said of a few anesthesiologists.

 

[Apollyon]

This is so true - I had a great attending once who just introduced himself as "John Smith" and I could just see how patients had no clue why he was even in the room.

In the ED, had the same thing when I was a resident. I was in the white coat, with a shirt and tie. I identify myself as "Dr. Apollyon", and wear my nametag. My attending comes in, no nametag, wearing scrubs, and says, "Hi, I'm John."

Who's this guy?

 

[sebsvenmdc]

In the ED, had the same thing when I was a resident. I was in the white coat, with a shirt and tie. I identify myself as "Dr. Apollyon", and wear my nametag. My attending comes in, no nametag, wearing scrubs, and says, "Hi, I'm John."

Who's this guy?

I think the John dude is trying to project a positive image by appearing humble and not aloof, but NOTE, I'm not implying that your professionalism in appearance has a component of arrogance or aloofness! It's just that some of these docs probably have the mindset that they will build rapport with the patients if they appear informal and down-to-earth. The weak aspect of this introduction though is that it is prone to a compromise of professionalism and it allows for ambiguity regarding the role of physician, namely an anesthesiologist. I will wear my white coat and use your approach.

 

[Impromptu]

I'm currently in the intern year doing some ambulatory clinic at a VA (sweet month), and I introduce myself as, "Hi, I'm [first name], one of the doctors here today." I haven't decided how I'll introduce myself come June when I start hitting the OR's. I have great German last name, but that makes it difficult for most patients to remember. I'll have to think about how I introduce myself.

 

[Licoricestick]

I'm currently in the intern year doing some ambulatory clinic at a VA (sweet month), and I introduce myself as, "Hi, I'm [first name], one of the doctors here today." I haven't decided how I'll introduce myself come June when I start hitting the OR's. I have great German last name, but that makes it difficult for most patients to remember. I'll have to think about how I introduce myself.

We don't have midlevels confusing things, but nonetheless most patients don't realise that we anaesthetists are doctors. So I introduce myself (both in clinic and in OT) by saying "Hi, I'm Licorice Stick, one of the anaesthetic doctors here" or "...the anaesthetic doctor who will be looking after you today".

Calling myself Dr Licorice Stick as a trainee would also make me sound rather obnoxious as it's really on the surgical consultants who insist on introducing themselves in that way.

And white coats are generally out on the basis of infection transmission risk.

 

[funkyfaroh]

Most people have no clue what the anesthesiologist does. I have had many people tell me that they thought we roll them back to the room, put a breathing tube in, and leave.

It is OUR JOB to do our own PR, people. It is OUR generation that is up to try to change things.

1. Introduce yourself every morning as DOCTOR. Don't do that stupid thing I see many of my colleagues doing, both in and outside anesthesia, and using your first name or full name without your title.

2. Wear your WHITE COAT into and out of the hospital. Wear it when you pre op, and when you post op. Make sure it is CLEAN and pressed. Your surgical colleagues are doing it, and like it or not, it sends a message.

3. Explain to your patients in the AM that you will be with them the whole time during surgery (applicable to residents), explain what you will do (give pain medicine, watch carefully over heart and lung function, monitor fluid balance and blood loss). Make it personal - hx of CAD?- mention that it is YOUR job, while the surgeon focuses solely on the surgery, to carefully monitor their heart function and work to prevent untoward events such as intraop MI. PATIENTS DO NOT KNOW WHAT WE DO, EDUCATE THEM!

4. Never EVER answer to "anesthesia". I have stopped answering to "anesthesia provider". I am the anesthesiology resident. When people say "MDA", I give them a blank look like I have no idea what the hell they are talking about, and say, "Oh, you mean the attending anesthesiologist?"

5. Follow up with your patients- this is KEY- when you go by to see them, re-introduce yourself as Dr. X, your anesthesia resident who took care of you in the operating room. Chat with them about how they did during surgery. Give a damn about their pain, offer to contact the primary team if they are hurting or get their nurse to get them their pill, ASK what you can do for them before you leave. Tell them you would be more than happy to take care of them should they unfortunately require a trip back to the OR. People DO remember this!!

This month I have been working in the Anesthesiology clinic seeing patients and I followed #4 very carefully. You have no idea what an impact it had on the patients and our interactions. I could sense a huge sigh of relief from my patients today after particularly emphasizing to them that a PHYSICIAN would be taking care of them every second they were asleep in the OR. The gratitude was both vocal and implicit.It was a huge wake-up call and I will surely be incorporating it into my daily practice. The coat was starched and crisp too. The patients weren't the only ones that noticed.

 

[Mman]

As far as the minimum requirements for CRNA school admission go, it's just an accepted reality for anyone aspring to become a CRNA that only having the minimum GRE, GPA, years of experience, etc. wouldn't even get you an interview. I would guess the schools set those requirements low to give them flexibility on who they accept and interview. If someone had 5 years experience as a paramedic, 5 as a flight RN, 10 as an ICU RN of multiple specialties, had a 4.0 math/science GPA, but an 1150 on their GRE then a school would want the flexibility to offer them an interview to see what kind of a candidate they may be since they sound like an outstanding candidate except for the mediocre GRE score. To play my own devils advocate I guess one could argue that this leaves the possibility of admitting and maybe even graduating a SRNA/CRNA who just barely snuck by with the bare minimum and is now practicing and with inadequate knowledge and skills. Keeping in mind that no system is perfect the same could probably be said of a few anesthesiologists.

Surely you jest.

We have a CRNA school at our hospital and I work with all their students. I am also friends with several recent grads and students from 2 other schools nearby.

I am well aware of what the average CRNA knows and I know exactly what it takes to get an interview at these schools (it isn't much).


As for saying the same thing about anesthesiologists that just met the minimum requirement, you are correct. However, the minimum requirement is several orders of magnitude beyond the minimum requirement to finish CRNA school. Off the top of my head...

Requirements to get into CRNA school:
- HS graduate with some minimum GPA to get into undergrad nursing school (if you are a man, this is quite easy in some places aiming for diversity)
- 1+ year of "critical care" nursing that is a very broad definition and could include an ICU that might have 1 patient on a vent per month
- a GRE score

That's about it in terms of minimum requirements to get in as far as I can tell.

Requirements to get into an anesthesia residency program:
- HS graduate with a minimum GPA to get into college
- a large number of prereqs including lots of advanced science classes
- minimum MCAT score
- 4 years of medical school
- USMLE Step 1
- USMLE Step 2
- USMLE Step 3

Then you get 4 years of residency (including internship).

This doesn't even begin to cover the extreme differences in the actual amount of education residents get beyond what CRNA students get. I mean CRNA students average about 3-4 days of clinical work for somewhere between 18-24 months. Residents work 5-6 days per week for 48 months. The case volume and acuity you are exposed to is infinitely more than CRNA students could ever dream of getting. The CRNA students at our program take a single overnight shift (in two years!!!!) and never work a weekend shift. I'm pretty sure I put in more hours in undergrad than they do currently.


While I doubt I could find any CRNA that could pass the ABA written and oral board exams, I'm pretty sure the CRNA boards would be a piece of cake for any anesthesiologist.

 

[Eta Carinae]

Surely you jest.

We have a CRNA school at our hospital and I work with all their students. I am also friends with several recent grads and students from 2 other schools nearby.

I am well aware of what the average CRNA knows and I know exactly what it takes to get an interview at these schools (it isn't much).


As for saying the same thing about anesthesiologists that just met the minimum requirement, you are correct. However, the minimum requirement is several orders of magnitude beyond the minimum requirement to finish CRNA school. Off the top of my head...

Requirements to get into CRNA school:
- HS graduate with some minimum GPA to get into undergrad nursing school (if you are a man, this is quite easy in some places aiming for diversity)
- 1+ year of "critical care" nursing that is a very broad definition and could include an ICU that might have 1 patient on a vent per month
- a GRE score

That's about it in terms of minimum requirements to get in as far as I can tell.

Requirements to get into an anesthesia residency program:
- HS graduate with a minimum GPA to get into college
- a large number of prereqs including lots of advanced science classes
- minimum MCAT score
- 4 years of medical school
- USMLE Step 1
- USMLE Step 2
- USMLE Step 3

Then you get 4 years of residency (including internship).

This doesn't even begin to cover the extreme differences in the actual amount of education residents get beyond what CRNA students get. I mean CRNA students average about 3-4 days of clinical work for somewhere between 18-24 months. Residents work 5-6 days per week for 48 months. The case volume and acuity you are exposed to is infinitely more than CRNA students could ever dream of getting. The CRNA students at our program take a single overnight shift (in two years!!!!) and never work a weekend shift. I'm pretty sure I put in more hours in undergrad than they do currently.


While I doubt I could find any CRNA that could pass the ABA written and oral board exams, I'm pretty sure the CRNA boards would be a piece of cake for any anesthesiologist.

That statement should read, "the minimum requirement for becoming an anesthesiologist is several orders of magnitudes beyond the MAXIMUM requirement for a CRNA"

I wouldn't even compare the two. They just do NOT exist on the same plane.

 

[droopy1592]

Wow, so as a future anesthesiologist, I have to say that I'm very annoyed by the perception that CRNAs and anesthesiologists are two of the same thing! What a joke! To apply to CRNA schools, I looked at a few programs. Baylor requires a whole 1000 on its GRE and a 3.0 GPA. TCU requires a stellar 1100 and 3.0. Baylor described interviewing a whole 130 applicants for ONLY 15 spots...wow, so selective! Seriously, this is just embarrassing. A 1000 on the GRE is probably similar to 145 on the Step 1. I could make an 800 on the quantitative alone. It's just pathetic that these people are paid so much money for such an easy trajectory. They should get no more than 30-40% of a MD salary. Do anesthesiologists frequently bail CRNAs out of trouble? So much so that the public has no idea that there is a distinction between our job performance? Or is the job rarely that risky and perceived differences in quality of care only surface during such non-every day events?

Everyone with a 3.0 is accepted, right? I'm sure it's that simple. Hell, every program I've seen let's everyone in with a 1000 no matter what, even if they don't have the seats available.