Running 1:2 with residents on cardiac

[cowbydoc]

Does anyone here who works at an academic institution cover 1:2 with a senior resident on cardiac and another room with a stable and long case? We are investigating doing this but with some hesitation by some members of our team. Just curious if other groups out there do this or if we are heading in the wrong direction. If anyone is open to throwing out their institution it would be helpful. Thanks SDN crew.

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[pocafx]

when I was a resident. The attending would pick up a 2nd room after starting the heart.

 

[pocafx]

Very rare 1:1 besides 7am hearts. After that really never have 1 room. Unless liver txp

 

[Beeftenderloin]

I don’t work in academics, or supervise, but it was pretty common when I was a fellow for my attending to cover a second heart room with a CA2.

 

[abolt18]

Does anyone here who works at an academic institution cover 1:2 with a senior resident on cardiac and another room with a stable and long case? We are investigating doing this but with some hesitation by some members of our team. Just curious if other groups out there do this or if we are heading in the wrong direction. Thanks SDN crew.

Where I trained, heart rooms were always 1:1, even if there was a fellow doing the case or supervising a resident.

 

[rick roller pump]

As a resident our CV attendings essentially always had two heart rooms. Starts were 30 minutes apart. We had a 3 week training period with more hand holding though. After that, no choice except to get good. Our fellows did not sit cases, so they were often around to help if we had some monster case. They would have another attending cover if both rooms were coming off pump at the same time. We were not expected to do any TEE when sitting rooms (it was a weird system where there was a doc of the day who went around and did all the TEEs).

 

[JiPo]

Always 1:1

 

[Drwine]

Only 1:1 with a resident for their first 5-10 cases. Otherwise covering a second room. We moved 7 cardiac, neuro and major vascular cases to a separate building attached to the main hospital. When I girst started the rooms next to the heart room were either simple ortho or bread and butter general surgery.

 

[medicine2wallstreet]

Does anyone here who works at an academic institution cover 1:2 with a senior resident on cardiac and another room with a stable and long case? We are investigating doing this but with some hesitation by some members of our team. Just curious if other groups out there do this or if we are heading in the wrong direction. If anyone is open to throwing out their institution it would be helpful. Thanks SDN crew.

1 to 1 is an absolute joke. We always do 1:2 here.

I am shocked that this is even a question really. Just sit the damn case if it's 1:1.

 

[1halfMVsquared]

Usually 1:1, sometimes 1:2 if 2nd CV case is a non-CPB case.

 

[Beeftenderloin]

1 to 1 is an absolute joke. We always do 1:2 here.

I am shocked that this is even a question really. Just sit the damn case if it's 1:1.

The overwhelmingly most common arrangement I came across when interviewing for fellowships (n=15) was attending supervising 1:1, often even 2:1, meaning 1 attending covering a resident AND fellow in the same room. Nothing crazy about 1:2, but 1:1/2:1 is incredibly common in academics. But I guess you know best… 🙄

 

[AKMD_1984]

1 to 1 is an absolute joke. We always do 1:2 here.

I am shocked that this is even a question really. Just sit the damn case if it's 1:1.

?
It’s an academic place.
Why would you sit your own case?

 

[medicine2wallstreet]

?
It’s an academic place.
Why would you sit your own case?

I'm saying if you can't handle more than 1 to 1 then just quit!

 

[NVO]

Our institution does 2:1, CA1 on cardiac and second room could be anything from a crani, whipple, vascular, etc

 

[ambiturner]

I'm saying if you can't handle more than 1 to 1 then just quit!

It’s not fair to green residents, not to mention patients or surgeons to throw them into complex cases without direct supervision. In Canada attendings don’t supervise more than 1 resident, even for simple cases. Should they all quit?

 

[2buckchuck]

At my first job once had a redo AVR in one room and awake crani down the hall, both with residents. Thankfully none of the critical parts happened at the same time.

 

[BlueRug]

It’s not fair to green residents, not to mention patients or surgeons to throw them into complex cases without direct supervision. In Canada attendings don’t supervise more than 1 resident, even for simple cases. Should they all quit?

Really?

 

[triggermaster]

I'm saying if you can't handle more than 1 to 1 then just quit!

And there are probably lots of other attendings able to lend a hand in the second room if necessary.

 

[Gasville]

Have always done 2:1, out second room is usually with a seasoned Crna doing robotic general cases/longer cases with less turnover. If I can’t be there to start/wake up I’ll usually call our board runner to help or another colleague on the same floor and that always works. Having collegiality is critical.

 

[Iso4ane]

1:1 if they’re on their first 2-3 weeks of cardiac. Otherwise, 2:1. Our cardiac cases are in a separate pavilion, so the second room is either another cardiac room or something vascular (minor vascular like a BKA or tendon release if you’re lucky, AAA/TAAA repair if you’re not).

The ability to cover 2:1 really comes down to what and who is in the second room.

 

[kb1900]

We’re 1:1 most of the time until 4pm at which point if the cardiac attending is Comfortable with the resident or fellow they will take a second heart room typically so attendings can start to go home. Ideally one of those rooms is a cabg or something but sometimes it’s a reop or aorta or txp or offcab

 

[JiPo]

It is not necessarily about whether I have the ability to cover 2 cardiac rooms. I spend a lot of time teaching residents intra-op, and the quantity and quality of teaching is so much better when I am either 1:1 in cardiac room or covering 2 rooms with the second room being CRNA. Personally, covering 2 residents is a much busier day for me than covering 3 CRNAs because I am teaching intraop if I am not giving breaks/pre-oping/inducing/extubating.

 

[Iso4ane]

It is not necessarily about whether I have the ability to cover 2 cardiac rooms. I spend a lot of time teaching residents intra-op, and the quantity and quality of teaching is so much better when I am either 1:1 in cardiac room or covering 2 rooms with the second room being CRNA. Personally, covering 2 residents is a much busier day for me than covering 3 CRNAs because I am teaching intraop if I am not giving breaks/pre-oping/inducing/extubating.

Trying to be a good teaching attending is a lot of freaking work. It’s very easy being a lazy attending and letting your in room provider do all the work.