supervising residents

[Jeff05]

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for attendings -
how do you guys keep your cool supervising residents? especially with procedures...

 

[Noyac]

Just leave the room.

That's what malpractice is for.

 

[DrBrown]

I enjoy supervising residents most of the time. The camraderie can be great....The residents who are really willing to learn and are eager make it worth while. Every once in a while they will screw up. If I am so mad that I would say something offensive, I just leave the room until I cool off. I try to remember what is was like to do something new or mess up something myself. It is difficult sometimes to watch them struggle and not take the procedure away. I have been forcing myself to wait until repeated attempts would hurt the patient OR the resident asks me to take over. For alines the residents get one arm to try as often as they like but they can't move to the other side once they mess it up. For intubations I let the CA-1s try once and the upper levels try twice before I look.

 

[militarymd]

I don't know how I did it for 5 years....and frequently I did leave the room.

 

[Fastrach]

I find supervising residents to be pretty fun as well, as just being a resident last year I still know exactly what they're going through and can relate, making it all the more fun to kid around and jokingly chastise when things don't go 100% as planned.

On the flip side, supervising CRNA's is a little more of a challenge. I feel like I need to be more diplomatic when dealing with them than with residents. I have no problem saying to a resident "Why the *&!@ would you do something as amazingly stupid as that?", whereas with the CRNA's I feel the need to tiptoe around 'questionable' decisions, like pulling that tube out while I wasn't looking when the Des was only down to 2... putting the patient immediately into wicked laryngospasm... and reaching for a nasal trumpet while i'm jaw-thrusting/cpap'ing the crap out of the guy. Yeah, definitely tested my diplomacy that day.

Should I feel this way about CRNA's, or should I not be worried about letting them have it when they deserve it?

 

[causeican1968]

If you are refeering to SRNA's they are paying for education give them the best you can, as for a practicing CRNA if you saw a colleuge doing somthing stupid and you had to bail them out I am sure you would have a word with them later, particularly if it were a pattern, no different spare no ego allow only the best care possible.

 

[EternalMD]

If you are refeering to SRNA's they are paying for education give them the best you can, as for a practicing CRNA if you saw a colleuge doing somthing stupid and you had to bail them out I am sure you would have a word with them later, particularly if it were a pattern, no different spare no ego allow only the best care possible.

this implies that we're on equal footing - I beg to disagree with said assumption. SRNAs should go ahead and learn from their CRNA superiors IMO.

 

[kazuma]

I'm only a 3rd year and I haven't done my Anesthesiology rotation yet, but they Anesthesiologists have been nice enough to let me help out between surgery cases. Usually the patient is sedated with propofol, then they coach me through the process of LMA, ET placement etc. I haven't made any mistakes (yet), so I haven't seen what they would do if things went bad.

 

[drmwvr]

for attendings -
how do you guys keep your cool supervising residents? especially with procedures...

It's definitely an art. Your presence can change their performance for the worse as easily as for the better. Goes for CRNA's as well.

 

[Jeff05]

It's definitely an art. Your presence can change their performance for the worse as easily as for the better. Goes for CRNA's as well.

how do you change it for the better?

 

[tucker27705]

I don't think I could work as an attending with residents, it would drive me crazy. So "thanks" to my attendings you current attendings.
I now work at a pvt hospital and do most of my own cases, but about once / week I supervise 3 or 4 rooms of mostly AA's.
As the newbie, many of them seem to think they know more about anesthesia than I do. I do learn some things from some of them, but overall their knowledge is lacking--and we don't need to get into that discussion here.
My beef is that they don't take direction well from me. I have heard from the other jr docs that they have the same issue. This never happens with the more sr guys. I ask them to do things and they don't get done. Eg use a phenylephrine gtt to maintain pressure and avoid fluid overload in a prone pt. 30 mins later, pressure of 85/40, no gtt. wtf?
If you call them on it, it builds up even more resistance. And then they talk among eachother about the docs who "micromanage".
I am far from that. But there are some things I want done.
I hate supervising.
Anyone else having these issues?

 

[urge]

how do you change it for the better?

First of all, I would start with identifying the problem you are having? Are you too anxious? Rightfully so, or do you have a personality disorder?

 

[drrosenrosen]

First of all, I would start with identifying the problem you are having? Are you too anxious? Rightfully so, or do you have a personality disorder?

He only has a little bit of a personality disorder. 😀

 

[geauxg8rs]

I think it is false to assume that SRNAs are paying for their education and resdents somehow are not. As one of our GME deans put it on orientation day as an intern. You are here for 80 hours a week (wink wink). 40 of em are education and 40 of em are work. I differ on the breakdown but get the overall gist of what he was saying. He was trying to soften the blow for making less than the janitorial staff on an hour/hour basis.

So I would say that residents are paying for their time in the OR.

 

[arentyoutiredye]

No one denys that residents are not paid generously for thier time, cause they are not. The point being is that as SRNA the 80 hrs a week were work and school with NO pay instead we paid to be there.

As for AA's if I am to train them I will it could be my life or my loved one that they take care of.

I did not state any equivilence, just that both should care for the patient and that should be what drives clinical situations not political BS.

 

[deleted50478]

this implies that we're on equal footing - I beg to disagree with said assumption. SRNAs should go ahead and learn from their CRNA superiors IMO.

Yeah. And they should use nursing textbooks based on nursing research.

 

[Jeff05]

please stop hijacking thread with srna/crna related topics.

 

[obviouslynot]

Should I feel this way about CRNA's, or should I not be worried about letting them have it when they deserve it?

Yes I can see answering this question was hijaking the thread... Oh wait were you talking to Fastrach?