The Real Stonybrook Anesthesiology

[xselsior4]

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.

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[surfdevl02]

You're probably going to get an unsatisfactory when your program director reads this and figures out who it is.....

 

[Mac4]

It sounds like you may have to adjust your expectations of being a resident.

Yes, you have to study and do well in ITE. You can not take as many breaks as CRNA. You may have to do cases when you are on call. The PD may want to meet you during your non-clinical time when your performance is not good....I mean, it sounds like every other program in the country.

 

[pgg]

CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.

I don't doubt your account that the program is malignant, but I'd readjust my perception of the above bit.

If you wanted a CRNA schedule of shifts and breaks, you shoulda become a CRNA.


And this -

As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is.

is an institutional problem, not a residency problem per se. If the institution and your department have decided to do any case any time any surgeon wants to, and there may be a dozen lamentable reasons why they've chosen to **** that chicken, that has little or nothing to do with the residents. You're just collateral damage in that regard.


Residency is a grind. This too shall pass.

 

[norwood]

an institutional problem, not a residency problem per se. If the institution and your department have decided to do any case any time any surgeon wants to...

Not limited to Stonybrook, either.

Back in the day, my med school's hospital had an insanely busy OR and it was not unusual to see things like an elective lap chole at 3 in the morning.

 

[surfdevl02]

As an attending now I see why many times I will prefer a CRNA than a resident. If I'm running 4 rooms and were busy I'd much rather have crnas in the room many times, they are less maintenance and some are MUCH more experienced than the residents. As much as our profession loves to trash the CRNAs, they make our lives easier on many days. We get a lot of VIPs at my hospital and generally we have senior attendings and seasoned CRNAs in those rooms, that's just the reality of it. Don't think just because we're MDs that things will be handed to us, especially in residency.

 

[IlDestriero]

Sounds like a crappy place to work.
Just put your head down and keep on grinding.
When your salary goes up 7-10 fold, you can literally laugh all the way to the bank.
BTW, taking the competencies very seriously, w/ remediation, extension, dismissal, etc. will be much more common across the board. He sounds more like a douche than an early adopter, but you never know.

 

[kazuma]

As an attending now I see why many times I will prefer a CRNA than a resident. If I'm running 4 rooms and were busy I'd much rather have crnas in the room many times, they are less maintenance and some are MUCH more experienced than the residents. As much as our profession loves to trash the CRNAs, they make our lives easier on many days. We get a lot of VIPs at my hospital and generally we have senior attendings and seasoned CRNAs in those rooms, that's just the reality of it. Don't think just because we're MDs that things will be handed to us, especially in residency.

This makes me sad, but I guess there is a wide spectrum of programs. At my program they cut the cord pretty early, in some cases even during July of CA1 year and definitely after your first month of hearts. For the most part, my attending involvement consists of me pushing drugs/tubing while their back is turned to me as they sign the attestation on the computer. I rarely see them again unless someone drops in to take over and sign the chart. On OB I usually have the epidural in before they get off the elevator. After taking over cases or giving breaks at our place, I can say for sure that I'd rather have any of our CA2/3's and most CA1's take care of me than the majority of our CRNA's.

 

[norwood]

For the most part, my attending involvement consists of me pushing drugs/tubing while their back is turned to me as they sign the attestation on the computer. I rarely see them again unless someone drops in to take over and sign the chart.

Reading this really makes me sad.

As a resident, I learned so much from attendings who cared enough to visit me during the case. It was rare that they needed to make any significant change to my management, but it happened a few times, and I learned greatly from it. Those visits were also when a lot of teaching took place.

As an attending, I will sometimes simulate what your attendings are doing, by saying "I'll be your tech for this. You tell me what you need and I'll get it for you. I will only intervene if you try to do something unsafe." - but I'm still around.

 

[sleepallday]

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.

Wow! I actually find this hard to believe. This program director was my attending at a different institution when I was a resident. He was one of best attendings I had. Extremely intelligent, kind of thought of him as a renaissance man. Wrote multiple books on anesthesia and also outside of medicine. Hope he hasn't changed.

 

[kazuma]

Reading this really makes me sad.

As a resident, I learned so much from attendings who cared enough to visit me during the case. It was rare that they needed to make any significant change to my management, but it happened a few times, and I learned greatly from it. Those visits were also when a lot of teaching took place.

As an attending, I will sometimes simulate what your attendings are doing, by saying "I'll be your tech for this. You tell me what you need and I'll get it for you. I will only intervene if you try to do something unsafe." - but I'm still around.

Our attendings will have more presence in big cases like CT/vascular/traumas or sick peds/pedi hearts etc. but the above applies for most straight forward cases. However about 25% of our attendings will do intraoperative teaching in basic cases and our ICU attendings teach on ICU rounds and I the OR. It's a problem common among many programs. While we can read and score high on exams, it's the tricks of the trade and subtleties that aren't published in books that we miss out on with lazy academic attendings. My point was that I figured most residents were pretty self sufficient after about the first 6 months of CA1 year, definitely by CA2 year.

 

[norwood]

It's a problem common among many programs. While we can read and score high on exams, it's the tricks of the trade and subtleties that aren't published in books that we miss out on with lazy academic attendings. My point was that I figured most residents were pretty self sufficient after about the first 6 months of CA1 year, definitely by CA2 year.

I do agree it's a common problem. Depending on the program and the individual day, it's possible that a doc who wants to teach may not have much time free during cases - it isn't automatically just laziness. But regardless of the reason, if that's happening regularly, the residents are still losing out.

Leaving aside residents who had been attendings in other countries and who are only doing residency here to satisfy the requirement, there is a notable difference between the CA1's, 2's, and 3's I've seen. Honestly, it's not just subtleties and tricks of the trade, although it's that too. First of all, many residents feel the power differential between themselves and surgeons acutely, and it's not unheard of for surgeons to take advantage of this - hence the attg needs to check and make sure his trainee hasn't been buffaloed into doing something unsafe. This improves with time, as residents gain confidence. Secondly, there's the danger of "they don't know what they don't know" - early in training, residents often don't realize the full meaning of a situation and respond (even if just by calling for help) in time. This also improves with time, and with surviving a few bad calls. And third, just being honest, but a lot of residents get cocky - which kinda ties in with the second point. "I can handle this, I don't need help..."

On a totally different note, I take it from your avatar that you're into oldschool Toyotas?

 

[Maverikk]

What I want from an attending as a resident:
1) Inform me of your expectations
2) Make me feel comfortable asking questions (even stupid ones)
3) Quibble over the details that matter, make understand why they matter (eg 'that's just how it's done' is not an explanation, it's an excuse)
4) I understand you're busy too, just hit the important points
5) explain why we do something, and when to do it differently

I know these are broad generalizations but I think they help. The worst thing you can have is pressure outside of the job. Pressure to do well during the workday is OK and is just expected when I know I'm not experienced, but 'unsatisfactories' and interfering with your outside-of-work schedule is unacceptable if you pass your exams, extra exams are ok, but shouldn't be held against you as long you bass your ites/boards. This sounds like a real loser of a residency, just make sure that it's known on your acgme reviews so your program doesn't get 5 year accreditation, last year it had a 5 year accreditation which was surprising given what I've heard from med students who have rotated there

 

[jeffblue]

What I want from an attending as a resident:
1) Inform me of your expectations
2) Make me feel comfortable asking questions (even stupid ones)
3) Quibble over the details that matter, make understand why they matter (eg 'that's just how it's done' is not an explanation, it's an excuse)
4) I understand you're busy too, just hit the important points
5) explain why we do something, and when to do it differently

I know these are broad generalizations but I think they help. The worst thing you can have is pressure outside of the job. Pressure to do well during the workday is OK and is just expected when I know I'm not experienced, but 'unsatisfactories' and interfering with your outside-of-work schedule is unacceptable if you pass your exams, extra exams are ok, but shouldn't be held against you as long you bass your ites/boards. This sounds like a real loser of a residency, just make sure that it's known on your acgme reviews so your program doesn't get 5 year accreditation, last year it had a 5 year accreditation which was surprising given what I've heard from med students who have rotated there

I appreciate this post.
People don't how certain staff/attendings can make or break your day, week, residency.
Anesthesia residency is about to become exceedingly more stressful since they have instituted on more written test that you have to pass before you graduate from residency. This is an additional 700 bucks or so and I imagine you would have to study your butt off for it. I also imagine there will be many people redoing years of residency which is what I am sure they want.

 

[Stellar Clouds]

I appreciate this post.
People don't how certain staff/attendings can make or break your day, week, residency.
Anesthesia residency is about to become exceedingly more stressful since they have instituted on more written test that you have to pass before you graduate from residency. This is an additional 700 bucks or so and I imagine you would have to study your butt off for it. I also imagine there will be many people redoing years of residency which is what I am sure they want.

I'm trying to understand this post. Who exactly wants people to redo years of residency?

 

[IlDestriero]

Trust me, we want you the F out. Especially if your marginal.
Good luck, god bless, don't ask for a recommendation.

 

[jeffblue]

I'm trying to understand this post. Who exactly wants people to redo years of residency?

I would imagine the program. More warm bodies to get the schedule done for cheap. If you have to pass that exam prior to graduating residency there will be some people (20 % who fail) which is historically the number of people who fail. The pass rate is nowhere near as high as the USMLE. That's 20 percent of residents doing some sort of remediation. S0 doing quick math about 300 people per year will be either repeating a year or graduation delayed until the next opportunity to pass that written exam

 

[norwood]

I would imagine the program. More warm bodies to get the schedule done for cheap. If you have to pass that exam prior to graduating residency there will be some people (20 % who fail) which is historically the number of people who fail. The pass rate is nowhere near as high as the USMLE. That's 20 percent of residents doing some sort of remediation. S0 doing quick math about 300 people per year will be either repeating a year or graduation delayed until the next opportunity to pass that written exam

You're missing something big, which is that each program has a maximum number of residents set by ACGME. Programs can't just keep all their residents while adding new ones. This leads to oddities like programs taking over other programs and not unifying the residencies, because it would lose resident slots for them. ACGME can (or at least historically could) approve exceptions for things like providing spaces when a program closes.

In any event, unless your anesthesia program is either (a) not accredited, or (b) unbelievably malignant, you'll fill all available slots with people still wanting to come in. So unless you are deliberately not filling available slots (which I've never seen), you're already at max capacity and the last thing you'd want is for a resident to fail.

 

[kyan sleeve]

It’s about time the truth came out and I thank the person who started this thread. All the residents admit to each other that we are unhappy and that a new program director would be a positive change. Our PD often says, “I don’t want any complaints about you. I want all of you to make me look good.” Then he points to his phone on his belt and says, “remember your future is on my hip.” It’s residency, it’s not supposed to be fun, we’re supposed to work hard and study hard, we know all that, but threatening residents day after day isn’t right. This program needs a director that, in addition to fulfilling all of the ACGME requirements and ensuring a proper resident education, actually looks out for the residents and protects them from all the other problems and political drama in this place and doesn’t use fear as a motivator.

 

[IlDestriero]

It sounds like you need a new chair as well if they accept that kind of behavior. Education is one of the 3 pillars of academic medicine. They're ignoring 1/3 of their stated principles. I assume you've discussed these concerns with the chairman.
I'm sorry that you are struck training there.

 

[jeffblue]

It sounds like you need a new chair as well if they accept that kind of behavior. Education is one of the 3 pillars of academic medicine. They're ignoring 1/3 of their stated principles. I assume you've discussed these concerns with the chairman.
I'm sorry that you are struck training there.

Talking to the chairman will do NO GOOD. You work for the chair, he doesn't work for you. It should be reversed. The best thing is to suck it up and move on. They know you have zero political clout and that's why they dont treat you correctly. When you have a chairman who understands that he works for you, that's when you know you have a chair that has some leadership skills.

 

[Maverikk]

Talking to the chairman will do NO GOOD. You work for the chair, he doesn't work for you. It should be reversed. The best thing is to suck it up and move on. They know you have zero political clout and that's why they dont treat you correctly. When you have a chairman who understands that he works for you, that's when you know you have a chair that has some leadership skills.

I think this depends. The chair is there to make the department run smoothly, balance everyone's interests, which in many cases means leaving some people a little unsatisfied. Your situation sounds like the residents are very unsatisfied. A good department has the chair and the program director in close communication. The priority of the chair is clinical considerations and balancing staff, including resident, interests. Some program directors and chairs are just out of touch, they found a cush, albeit lower paying, academic job where they can thumble-twiddle/research all day in an office or not working with their residents to know what actually goes on. More clinical-based programs have the PD working alongside residents from when they start as CA1s. For prospective candidates out there ask on your interview: how often do you talk to your PD or work with them in the OR before you're a CA-3 (ie just about to be out the door). My best friend matched into a program where the PD does pain med management all day, basically no contact with residents where it matters, not a good situation because ultimately your PD is the decision maker.

 

[D P356]

Is this the individual you guys are speaking about?

 

[nycitygas]

Didn't Stonybrook get a new chairman who just started?

 

[Liz Lemon 1985]

The OP brings up several valid points, but she seems to paint a much bleaker picture than perhaps the rest of us would have you believe. As with any program this one has its strengths and weaknesses. Certainly threats were made and acted out against residents for trivial things, but the majority of the other faculty were very approachable. I was on a first name basis with many of my attendings there.
Some of the frustration comes from the fact that the PD is evaluated based on the residents' performances on in-service tests and board exams. So in an effort to raise residents' grades he pushed so many homework assignments on them perhaps not realizing what they need is not more written work as they have more than enough practice questions already, but rather time out of the OR to go do those questions.
And yes surgeons are allowed to take non-urgent cases to the operating room at all hours with abandon, but this is beyond the ability of our PD to change. It is a politically charged decision made by department chairs which comes down to money. And since the anesthesia residents are often the only ones in the OR who have been working 24 hours, they feel the brunt of those decisions more strongly and become especially frustrated. But the coordinators did seem to make a good faith effort to get non-call residents out at a decent time and to take into consideration whether they were there late the day before.
Not a perfect system, but it got us to where we needed to be.

 

[sevoflurane]

Are you guys talking about Dr. Chris Gallagher? Never had him as a program director, but he's always seemed like a cool dude. He actually offered my wife and I a position outside of the match when we interviewed at the U of Miami. We declined, but had a great interview with him. You want to get on his good side? Talk tennis to him. He's a tennis nut, and I think he's even gone as far as written some tennis books. I've see him from time to time at conferences and he really seems to like resident related material (poster boards, etc.) He seems genuinely interested in resident education. Take all of this with a grain of salt… I don't know him as a resident.

 

[McCram]

Disclosure: I am a recent graduate of the anesthesiology residency at Stony Brook. Class of 2013. I have no financial ties to this institution. I currently work as an attending in another academic hospital with an anesthesiology residency.

I heard about this post and thought additional information should be reported while the faceless masses of this forum throw their opinions around and pass premature judgement on the training that takes place within the Anesthesiology Department at Stony Brook and the program director, Chris Gallagher.

Generally speaking, it is the pervue of any program director to be concerned about anesthesiology board pass rates. The goal is to have a 100% of residents passing on the first attempt. This is no different at Stony Brook. As for the program director at Stony Brook, he is already a full professor which implies both job security and that somebody higher-up must have thought he was a good clinician / educator / administrator. Having worked with the program director closely last year, the motivation behind a lot of what he does is to make sure all his residents pass the boards like a coach who wants his players to succeed.

The yearly in-training exam (ITE) is a predictor of how well one will do on the boards (http://www.ijme.net/archive/3/predictors-of-success-on-a-board-certification-exam.pdf) so it is fair that those who do poorly on the ITE become the focus of the program director. The in-house written tests mentioned in the original post are a recent development so I cannot comment on them but since the ITE is administered only once per year this may be the best way to guage the core competency of "medical knowledge" and to motivate residents to stay on top of their studies and at least stay off the program director's radar by doing well on exams.

As for the infringement on free time for extra "study hall", I don't think it's anyone's idea of a good time away from the grueling hours of being in the ORs for both the residents and the program director. I rather think it is commendable that the program director would dedicate extra time on the weekends (unpaid, I am sure) to make certain residents come in to see them study and provide some strucuture. Residency is not like your typical job. It is more like an apprenticeship and sometimes the responsibilities of your training and demands on your time exceed what is considered normal. Again, residents who have done well on the yearly ITE and demonstrate a good fund of medical knowledge are not likely to be bothered by the program director about this issue. Laslty, I think I would want to be reminded that I am lacking in the "medical knowledge department" by my program director and that I am at risk to fail the written boards instead of having this be a non-issue and progress through residency thinking that everything is going well. The fact that the program director spends this extra time tells me that he thinks its important enough to disrupt residents during their "off-hours".

Currently, there is an interim chairman for the department so this may be a consideration for medical students considering Stony Brook anesthesiology for their training. But six months is hardly a long period of time to find and select the next chairperson. I would submit that while having a nationally-recognized chairperson is helpful for networking purposes and to obtain a quality fellowship or job post-residency, it is the program director who is more involved in your training and knows you best as a resident. This is the person fellowhip program directors and private practice employers call to get the scoop on a certain resident, knowing that most anesthesia chairpersons lack any profound knowledge about the strengths and weaknesses of each resident. Chris Gallagher tells you at the residency interview, the first day of intern year, and throughout the residency that you are "working for his phone call." While this could be misconstrued as a threat like a prison warden to a parole board, I think he means that he is going to tell it like it is when it comes to a recommendation since his reputation is also on the line. So long as you are satisfying the responsibilites and demands of your training, he will go to bat for you and support your post-residency aspirations. And that's all you really ever want from your program director.

As mentioned in another post, there are numerous aspects of residency that the program director cannot control such as the work habits of the CRNAs and 24-hour call schedules. Stony Brook is likely one of the few residency programs to have residents take true 24-hour in-house calls and I recall many sleepless calls doing cases until the morning or starting cases randomly in the early morning hours to seemingly accomodate a VIP patient or a surgeon's schedule but I also recall many calls where I slept for a good chunk of the call after scheduled cases were completed. Ironically, I am writing this post on-call now and feel that this 24-hour call experience from residency has prepared me well for the rigors of being an attending anesthesiologist on call at a big inner-city hospital.

Also, you know who often brought in donuts at 5:00 AM for the call team and came in on Thanksgiving and Christmas call to deliver donuts for the lucky residents on call during the holidays? The program director. But I digress.

Yes, it is busy in the Stony Brook ORs but this is likely the case at many residency programs and it is always an ongoing struggle to balance clinical training / service with protected time to study and read to shore up one's medical knowledge. But no anesthesiology program is perfect, without a blemish, and all its residents being happy. It's unfortunate that someone compiled all the warts of a residency program into an anonymous internet post and associated it with a program director who has dedicated a significant portion of his professional career to residency education.

To reiterate, the Stony Brook residency is NOT "malignant" nor the program director a "douche" as menionted by other participants in this "discussion".

I encourage any applicants considering Stony Brook for residency to look beyond the original and subsequent posts and recognize that there are many positive aspects of training at Stony Brook such as the lack of fellows to compete with for interesting cases, great sub-specialty exposure, good support staff (i.e. nursing and anesthesia techs), opportunities to go on medical missions and provide anesthesia, good clinician educators, and the program director who may go to extremes but with good inentions. The list goes on and is too lengthy for this already ridiculously long post.

If you want to say that Stony Brook is a 2-hour drive from New York City and in the middle of suburbia or that the residents are occassionally overworked or that the program does not allow for moonlighting or overtime resident pay then this would be accurate. But I can honstly say that I am happy and satified with my residency experience at Stony Brook and consider myself lucky to have trained with some great anesthesiologists there including Chris Gallagher.

Mark Kim, MD

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.

 

[ruralsurg4now]

I just stumbled upon this thread and wanted to comment that it demonstrates how a shared experience can be perceived in two different ways, both of which are completely valid. The OP views getting pulled into meetings or to study during weekends off or vacation as ridiculous, while the most recent poster thinks it reflects concern for the resident. Now, I personally think it's ridiculous to schedule a meeting during someone's vacation, regardless of why you're meeting with them, but that's just me. But regardless, it seems to me that the OP's claims of what the PD does are correct and you can go from there to decide whether or not you feel it's acceptable behavior or not. True? Also, for the record, if some PD told me that I was "working for his phone call," I'd consider him a douche. Realistically, as a PD, you should be going to bat for anyone who you graduate. If not, what does that say about you? That you don't mind churning out trash?

 

[ruralsurg4now]

And yes surgeons are allowed to take non-urgent cases to the operating room at all hours with abandon, but this is beyond the ability of our PD to change. It is a politically charged decision made by department chairs which comes down to money. And since the anesthesia residents are often the only ones in the OR who have been working 24 hours, they feel the brunt of those decisions more strongly and become especially frustrated. But the coordinators did seem to make a good faith effort to get non-call residents out at a decent time and to take into consideration whether they were there late the day before.
Not a perfect system, but it got us to where we needed to be.

You know, I've always felt that this is like Stockholm Syndrome. People are trapped in a sucky environment so they start to make excuses for the environment. Like, if your surgeons are taking non-emergent cases to the OR at all hours and the decision was made "up on high," then guess what? After a certain period, it should just be the attendings covering that non-emergent case since they're the ones who agreed to it and they're they ones getting paid for it. We had tons of that going on in surgery residency, where it would be like like "oh, they put on a wound vac, but they don't manage it, surgery does." And I'd be like "wtf?" And I'd be told "sorry, but that's the decision made by the attendings." Fine, then the attendings should manage the other service's wound vacs. Capiche? Residents too often accept that their role is to be used like pawns. I had to do patient transport for the sole reason that "it's faster than if you wait for the transporters." So, let me get this straight, I went to med school so that I could do the job of a high school kid who isn't motivated just because it saves the hospital some time? That's a really sh**ty excuse for that practice.

 

[ruralsurg4now]

First of all, many residents feel the power differential between themselves and surgeons acutely, and it's not unheard of for surgeons to take advantage of this - hence the attg needs to check and make sure his trainee hasn't been buffaloed into doing something unsafe.

This is true, but it goes both ways. I've had it occur where when I was closing as a resident, the anesthesiology attending would just start waking up the patient and say "that'll teach you to close faster" or "time's up." I was like "wow, this will go well for the patient." As an attending, believe it or not, some CRNAs also try to pull this on me, where they start waking the patient before I'm done and then pretend they don't know what's going on. As an attending, I can just stop and say "yeah, I'll wait until you're ready then, let me know" and just start taking a stroll around the room. As a resident, there's no way I could do that.

 

[somedumbDO]

This is true, but it goes both ways. I've had it occur where when I was closing as a resident, the anesthesiology attending would just start waking up the patient and say "that'll teach you to close faster" or "time's up." I was like "wow, this will go well for the patient." As an attending, believe it or not, some CRNAs also try to pull this on me, where they start waking the patient before I'm done and then pretend they don't know what's going on. As an attending, I can just stop and say "yeah, I'll wait until you're ready then, let me know" and just start taking a stroll around the room. As a resident, there's no way I could do that.

Well did you learn to close faster?

 

[ruralsurg4now]

Well did you learn to close faster?

Nope. I learned to close at my own speed. I also learned that I'm in charge of the OR.

Oh, and while I realize that's a rude response, your question was also rude. So don't anyone complain that I started a flame war.

 

[Gasworks]

Yes that was rude.. but funny nonetheless. I'm glad there is always someone willing to step up and be "in charge of the OR", makes my life significantly easier. Personally I would never wake a patient up until I see the dressing about to go on, I don't know who people think they are helping by screwing up the closure or slowing down the surgeon with a moving target. On a related note, I interviewed at stonybrook many many moons ago and learned everything I needed to know when the nurses in the ambulatory center turned their backs on us during the tour. After 15+ interviews you get a sixth sense for places where the culture of medicine is fundamentally rotten. This plus a life of mind numbing boredom in the arse end of suffolk county landed this program second to last on my rank list. The only program I ranked lower was westchester, where the charming PD offered to backhand residents if they didn't read. At least stonybrook put me up in a nice hotel, gave us an awesome pre-interview dinner and had strawberry fields bring us breakfast. Westchester wouldn't even validate parking, so I pocketed a couple of sandwiches and jumped the curb to get out of the lot.

 

[kazuma]

Westchester wouldn't even validate parking, so I pocketed a couple of sandwiches and jumped the curb to get out of the lot.

Lol, if that really happened, then that was awesome.

 

[IveGotTwins]

I don't understand complaining about consequences for poor performance on ITEs. You are either smart enough to do well enough without studying to fly under the radar or you are not. So these consequences only come into play if you fail. So you want to be not smart, not study and not pass all without repercussions? If you are studying and still failing well maybe you need some extra structured time with someone around who can help. You can say you study at home but if the results are poor what choice does a program have but to supplement your ineffective attempts?

Soy muy confusado.

 

[ruralsurg4now]

I don't know who people think they are helping by screwing up the closure or slowing down the surgeon with a moving target.

It's not even that. I explained to the anesthesiologist, if the patient is straining (as they do when they wake up), then I can't get the closure tight. All you're doing is increasing the risk for a hernia and then guess what, we're going to be right back here doing another case. Let's just do what's right for the patient, even if it takes a little longer. He ignored me and kept doing it, so whatever. I tried.

 

[norwood]

I don't understand complaining about consequences for poor performance on ITEs. You are either smart enough to do well enough without studying to fly under the radar or you are not. So these consequences only come into play if you fail. So you want to be not smart, not study and not pass all without repercussions? If you are studying and still failing well maybe you need some extra structured time with someone around who can help. You can say you study at home but if the results are poor what choice does a program have but to supplement your ineffective attempts?

Soy muy confusado.

OP was talking not only about ITEs but also about the residency's own exams. Depending on how the residency does those exams, that could be a good or a bad thing.

 

[pgg]

It's not even that. I explained to the anesthesiologist, if the patient is straining (as they do when they wake up), then I can't get the closure tight. All you're doing is increasing the risk for a hernia and then guess what, we're going to be right back here doing another case. Let's just do what's right for the patient, even if it takes a little longer. He ignored me and kept doing it, so whatever. I tried.

It's certainly bad form for an anesthesiologist to try to hurry up a surgeon by waking the patient early. Not to mention unkind to the patient.

But, you've got to understand something: anesthesia isn't an on-off switch. If you want fast wakeups and short room turnovers so you get to your next case, you need to accept the fact that the closer you get to the skin, the lighter the patient will be. It's OK if the patient moves as you're suturing the skin. Instead of stopping to gripe, think "this is great the patient will be in PACU in 5 minutes and my next case will go sooner" ... just pretend you're in the ER stitching up a drunk.

If your hernia repair can't handle even a violently coughing or bucking patient at wakeup, the problem is your repair, not the anesthesia. We strive for smooth wakeups as a matter of style and pride, but recurrent hernias are a surgical failure, not an anesthetic failure.

 

[ruralsurg4now]

It's certainly bad form for an anesthesiologist to try to hurry up a surgeon by waking the patient early. Not to mention unkind to the patient.

But, you've got to understand something: anesthesia isn't an on-off switch. If you want fast wakeups and short room turnovers so you get to your next case, you need to accept the fact that the closer you get to the skin, the lighter the patient will be. It's OK if the patient moves as you're suturing the skin. Instead of stopping to gripe, think "this is great the patient will be in PACU in 5 minutes and my next case will go sooner" ... just pretend you're in the ER stitching up a drunk.

If your hernia repair can't handle even a violently coughing or bucking patient at wakeup, the problem is your repair, not the anesthesia. We strive for smooth wakeups as a matter of style and pride, but recurrent hernias are a surgical failure, not an anesthetic failure.

I'm quite aware anesthesia isn't an on-off switch. I also know the more experience anesthesiologists try to time wakeups so that the patient wakes as we finish (which is why I always try to communicate with them where I am in the surgery). I also don't think that hernias occur because the patient is moving as I'm suturing the skin, although it certainly could make the final scar look bad, depending on how much of a moving target I have to work with. I also am not in the stage of working where I have ever bothered a team about turnover time (unless they're blatantly just standing around and doing nothing), as I'm only a little over a year out. So first of all, no need to be hostile.

Second thing is, you don't seem to know what I was saying. I'm not talking about a hernia repair holding up under stress. I'm talking about closing a laparotomy primarily where the patient's abdomen is tensed because once it relaxes again the closure isn't tight. And you can talk about it being a surgical failure, but it's really not. It's a failure due to you, if that's how you want to view it. By the way, I highly doubt you tell your surgical attendings that a violently bucking patient is their problem. If you do, that's rather poor form.

 

[pgg]

I'm not talking about a hernia repair holding up under stress. I'm talking about closing a laparotomy primarily where the patient's abdomen is tensed because once it relaxes again the closure isn't tight.

Oh, I agree, until the fascia is closed the patient ought to be non-tense, either via enough remaining muscle relaxant, or deep enough anesthesia. Our job is to provide good operating conditions for you, to facilitate your work. Good anesthesia should make your job easier. I'm not arguing that bad anesthesia doesn't make your job harder.

I'm arguing that a light patient during closure is not by-definition bad anesthesia.

By the way, I highly doubt you tell your surgical attendings that a violently bucking patient is their problem. If you do, that's rather poor form.

You would be correct in your high doubts that I would tell a surgeon that 'violent bucking' was their problem. Of course I wouldn't, and that's not what I wrote.

What I was implying was that if a hernia repair fails because a patient coughs while he's asleep, it's going to fail the first time he coughs when he's awake, or if he sneezes in the BK drive-thru on the way home from the hospital. And that is a lousy repair, or possibly a patient that wasn't completely fixable in the first place. Not bad anesthesia.

Regardless, you sound like a surgeon I'd like to work with, because you seem to value communication and taking responsibility for how the OR functions.

 

[ruralsurg4now]

I wouldn't blame a bad repair on Anesthesia. We all have to be honest with ourselves and own up to our mistakes.

 

[somedumbDO]

Nope. I learned to close at my own speed. I also learned that I'm in charge of the OR.

Oh, and while I realize that's a rude response, your question was also rude. So don't anyone complain that I started a flame war.

Really you are in charge?!? It's this type of attitude that gets you surgeons in trouble. It's a team thing. I greatly value GOOD surgeons, I go out of my way to get the case started, even let them operate in non ideal conditions/pts. It's the arrogant/hubris/inexpirenced aka one yr out surgeon... That i usually have to watch out for. Do you think its a coincidence that your pt routinely come out intubated, in icu, w mult lines and blood hanging? Oh and I bet you also think its a coincidence that your senior surgeon colleague happened to step into or suite when you are flailing... Don't worry I was texting him to give ya a hand. Leaders know when they are such, they don't have to tell themselves or the OR staff....

 

[ruralsurg4now]

Do you think its a coincidence that your pt routinely come out intubated, in icu, w mult lines and blood hanging?

They do? I guess you need to a better job then, huh? Chop, chop.

Oh, by the way, you're clearly one of the worse anesthesiologists. Your view is that waking patients early should "teach" people things and you clearly asked a question with that attitude. When I didn't accept your poor contention, you immediately marked that up to me being young and then started confabulating about my patients, none of whom you know.

Stick to reading magazines, I'll deal with professional anesthesiologists like pgg, kid. I don't have time to tell you how to do your job while I'm working.

 

[ssmallz]

Really you are in charge?!? It's this type of attitude that gets you surgeons in trouble. It's a team thing. I greatly value GOOD surgeons, I go out of my way to get the case started, even let them operate in non ideal conditions/pts. It's the arrogant/hubris/inexpirenced aka one yr out surgeon... That i usually have to watch out for. Do you think its a coincidence that your pt routinely come out intubated, in icu, w mult lines and blood hanging? Oh and I bet you also think its a coincidence that your senior surgeon colleague happened to step into or suite when you are flailing... Don't worry I was texting him to give ya a hand. Leaders know when they are such, they don't have to tell themselves or the OR staff....

ruralsurg seems like a good dude.....snarky comments get snarky responses, he even admitted that fact in his response. Don't take it personal. In the OR, there are 2 leaders but the key is figuring out who should lead when. Doing so requires good communication and the ability for each to be professoinal

 

[MD911]

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.[/qu

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.

What about Associate Director of Residency Training Program????

 

[gascopper]

I would have to agree with the older posts. Nothing has changed since those other posts...the PD continues to be malignant, concerned more with his image than the betterment of the residents. So many times we were pulled out of our lectures so that an attending can SINGLE cover and he never stood up for us. Most of the lectures are very weak and only 1 or 2 attendings care to engage the students. He has so much non-clinical time, he could easily give better lectures himself, but he chooses not to. He needs to go. I would not come here again.

 

[urge]

I am a current anesthesiology resident at stony brook and feel that an accurate and honest description of our program is well overdue…

The best feature of the program?
-that everyone who applied to a pediatric fellowship matched

The worst feature of the program?
-the PROGRAM DIRECTOR

Our program director constantly threatens residents to create the illusion that we have a strong program in order to promote his job security. Because we’re all scared of getting fired nobody speaks up. How would we get fired? He uses any and every excuse to give residents an “unsatisfactory” in any of the ACGME core competencies and he says that two unsatisfactories are grounds for dismissal from the program. If we score below 20% on an in-training exam we get an unsatisfactory. We get written tests at the end each rotation that are graded A,B,C, or F and if we get two C’s then we get an unsatisfactory (we rarely see the answers to any of these tests, just the final letter grade). If he gets any complaint about a resident from an attending in our department or another department he’ll give an unsatisfactory for professionalism or whatever category he feels is appropriate. He has made residents come in on weekends during our free time for supervised study sessions without any notice because he “feels our medical knowledge is not where it should be.” He meets with residents on his own time without any respect for our time whatsoever, it doesn’t matter if we’re on vacation, post-call, or in an interesting case.
Our last chairman retired in July of this year and since then we have had an interim chairman who was already a member of our department. They have been interviewing candidates for a permanent chairman position…for 6 months
CRNAs always receive priority over residents when it comes to being sent home at the end of each day whether their shifts are over or not. CRNAs get a 30 min breakfast break and 45 min lunch break, residents get 15 min breakfast break and 30 min lunch break.
Most of the time 24 hour call is exactly what it sounds like…doing cases in the OR for 24 hours straight because the hospital does not treat emergency and elective cases any differently. As long as there is an anesthesiology attending and residents, any case can go at any time no matter how trivial it is. If an elective case is scheduled to start at 7:30 am, a surgeon can call and ask for the case to start at 6:30 am and if the 24 hr call team is not busy at 6:30 am, then that elective case will start at 6:30 am instead of 7:30 am. Even if the anesthesiology call team has been awake and working for 23 hours, they have to start the elective case early.

I’m not sure how residents at other programs feel, but the residents at stony brook are not happy.

Edit. Didn't realize this is an old thread.


Sounds just like every other anesthesia program I know.

Perhaps your expectations are unrealistic. Seems like your PD does not want to graduate sub par residents.

20% is pretty low. Would you want one of those taking care of your wife and children?

 

[repititionition]

Anyway, some dude just left Duke to be Vice-Chair of Research at Stony Brook.

 

[Doctor4Life1769]

Anyway, some dude just left Duke to be Vice-Chair of Research at Stony Brook.

What's your point?
He went from a huge pond to a smaller one.

 

[nimbus]

Anyway, some dude just left Duke to be Vice-Chair of Research at Stony Brook.

TJ Gan

Years ago Peter Glass left Duke to be chair at Stony Brook.

It's a small world. People are connected.