Krafty

15+ Year Member
Jul 13, 2003
138
0
Philly
Status
OK, so one of my classmates has a father (not a big surprise...read on) who is the PD there. Dr. Kushins that is.

He used to be chair of Robert Wood Johnson (UMDNJ) in New Brunswick, New Jersey. He personally told me on the interview, that he left because he wantedt to move the education of the department in certain directions (regional among others). But the machinations of the institution (surgeons, other attendings) basically became tons and tons of red tape.

As a result he was offered a position at SLR and a free hand. From what I gathered from the residents who knew him back at Robert Wood he was a great resident advocate. He would make sure that the residents got out at 5 pm flat, to be relieved by attendings (out of all people). This naturally created some friction between him and the attendings.

Apparently when he left RWJ, the residents told me that their attendings yelled 'Yippee' and got the hell out of dodge at like 10am. Which left the residents pretty much in their rooms upwards of 7-8 o'clock.

He was able to recruit one of the anesthesia attendings from HSS (Hospital of Special Surgery - Cornell - #2 ranked ortho hospital in the country after Mayo) where 85% of cases were regional. As a result he was able to create regional experiences for the residents, that they would not have imagined (or so I was told). In addition he has put together a month of "Difficult Airway" rotation where residents spend isolated time in lab and going in on cases to do difficult airways (things I haven't heard of - high pressure 02 bursts into the cricothyroid...type suff). As a result I felt that this made for one of the two best programs (Sinai) in the city from the education perspective - this guy is pretty much it in anesthesia education.

Now I know people will say what about Cornell and Columbia...my experiences there were that with big names like that people didn't care so much about regional, difficult airway, or even trauma (Columbia). Again its a personal preference in terms of the "NAME" stuff, but with a highest paycheck in the city (51K - 53K - 55K Ca-1,2,3 respectively) it becomes the true diamond in the rough...nobody really knows much about. It seems to me the reputation will spread once more people go on the interview circuit.

Bottom line is when your business partners in the private same day surgery hubs want you to do Carotid Endarterectomies under regional, or you got a lady with amyloidosis and c-spine injury...chances are 1/1000, but I'm not so sure coming out of Cornell or Columbia I would be able to handle such difficult cases. Again my subjective opinion.

Now IN DEFENSE OF RWJ:
The place is not horrible from a resident standpoint. The impression I had there was that the call system that was adopted spreads the workload reasonably, and what really impressed me was the comraderie of the residents (probably the coolest, and least toolish people I've seen on my interview tour). Dept is relatively strong.

Cheers and good luck with ROLs.

P.S. 3 top gems in NYC area : Sinai, SLR and UMDNJ-NJMS all cause of great leadership, PDs and Chairs. Those programs should surge in the next few years.


And please pardon my double post. I spent considerable time typing this thing up. I would like people to at least glance at it.
 

earpiece

New Member
15+ Year Member
Feb 21, 2004
4
0
NYC
Visit site
Status
stuff you talk about: jet ventilation, regional for CEAis very basic anesthesia....we do jet vent in ENT all the time. both Cornell and Columbia have difficult airway rotations that involve playing w/ lots of toys and slowing down OR start times because of the setup.
 

Krafty

15+ Year Member
Jul 13, 2003
138
0
Philly
Status
Actually you bring up an EXCELLENT point.

How do you NEVER LEARN any regional or difficult airway during your residency?
-Slow down the surgeons.

My exact question to Dr.Kushins on the interview was, how the hell do you get the surgeons to let you do all you claim to do?

He said you have to organize and streamline it. Apparently they don't have problems with slowing down cases (like every other institution I've been to) because they have a separate block room. And they do some sort of a rotation - start a bunch of blocks pretty much at off/times, so that the surgeon doesn't have to wait 30 mins to take hold. Get somebody to relieve you early (temporarily) so you get out of the room, do a block, go back to your room, they close...guess what, you got another case waiting and the surgeon doesn't want to rip all of his and yours hair out.

I think that is one of the most basic problems with current anesthesia training. ORGANIZATION. Here's the party line about regional:

- Well...we have lots of it in ortho, but just the first case...cause the surgeons get pissed.
- Difficult airway...ya we have it...but you have to bring all the equipment and show up and hour early.

At the more progressive programs (SLR) This sort of administrative bull#(*&% is under direction of some people that know what they're doing.

How do you sell it to the surgeon? 2 points:
1) Better post-op pain control (pt won't be pagin you at ungodly hours for refill of morphine)
2) Faster Case turnover - more cashola. That's why many private practices increase their regional cases (especially ortho).

Why you ask? NO induction, NO emergence, NO such thing as too much isoflurane/pancuronium.

None of the other institutions had anything sembling organization of those two difficult areas...this includes Columbia. Actually their regional guy, Dr.Brown was surprised when I asked him whether residents ever get skimped out on blocks (when a Ca-3 wants to do a Regional Block rotation). He thought one of their residents told me to ask it. Apparently that's something they're trying to work on.

Bottom line, organization, good workload spread (not too many resident run cystos and T&As) and innovative OR management. The only place like that I've seen was SLR...maybe Sinai.

I got nothing against other programs...you'll get adequate training everywhere...remember most of your education will be dependent on you. If you want to show up 30 mins early for the knee replacement or ENT nasal intubation and set up the stuff...more power to you. People at better organized programs will probably sleep in longer and focus on more important educational questions (US guided Regional blocks perhaps?)
 
About the Ads