Thoughts on residency programs with SRNA training programs?

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Noyac said:
But you have no point of reference. It's the only program you really know. Until you get out into the real world and see that your program either set you up to be an equal with a nurse or it prepared you to be the best person in the OR. You are green and have a lot to learn.
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While I'll acknowledge that my clinical understanding of anesthesiology remains incomplete, I respectfully disagree with your assertion that my "green"-ness precludes me from reviewing the evidence available to me, including the national reputation of my hospital and residency, the job prospects of our graduates, and the resources available to me as a trainee, and concluding that I should be deeply satisfied with my good fortune and opportunity to train here. And that's all we can do as prospective residents, residents, and outsiders judging programs, right? What is a "rank list" other than a series of guesses, some more educated than others?

I am a bit confused as to how this thread became a concerted effort to convince me my program is crap (or that I don't know it isn't crap). I have shared the way things are done here, and my perspective on it. Any applicant to our program invited for an interview would be welcome to ask and engage us in a discussion about these issues on their visit. Then it would be up to them to make their decision about where to rank us accordingly. It seems apparent most of you would advise them to rank us towards the bottom of their list. And I would disagree with that advice. Is there really anything else to discuss?
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Not a personal attack at al (and I apologize if it came off like that), I just wasn't comfortable with an insinuation that presenting to a CRNA or having SRNAs take your lines was acceptable since you defended it with it being a "top 5 shop." This shouldn't be acceptable or standard anywhere, regardless of national reputation of hospital/residency/random faculty.

Nivens said:
I am a bit confused as to how this thread became a concerted effort to convince me my program is crap (or that I don't know it isn't crap). I have shared the way things are done here, and my perspective on it.
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I believe you misinterpret remarks here. I think most posting here are surprised or (like me) shocked to hear some of your experiences and reacted as such. You do have an n=1 (and so do I!) but given the reaction of many other posters, maybe such things should raise an eyebrow or some concerns.
 
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Pixiwoman said:
That shouldn't happen, the cases should be for residents, MDs, our field is being harassed:eek:
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If you mean almost the entire field of medicine... ;)

During my CCM fellowship, I had to tolerate a number of rounds with APRN students presenting cases (on APRN teams). And yes, they even placed lines. The sad thing was that none of my attendings seemed to be bothered by it; they didn't even realize they were training our replacements who, on top of it, refuse to admit that they are practicing medicine. I think physicians have given up swimming against the current, and just go with it, despite being pretty sure that they'll end up drowning regardless.

Young people who don't like this should go study/practice in another country. I am serious. In the US, a lot of people are working hard to dilute the role of physicians to homeopathic doses. One doesn't see paralegals practicing law, even if they were to call it "paralegaling", but we have tons of nurses practicing medicine advanced nursing. ;)
 
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Nivens said:
I guess I feel as secure as I can in that there is more that separates me from a CRNA than the ability to do a central line.
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This is a dangerous way to think. While you and I (and everyone else here) knows that "monkey skills" are not what separates us from the midlevels - rather it's our understanding of phys, path, pharm - you know, medicine - the "monkey skills" are far easier to quantitate and understand for the non-clinical suits that are running things. They look and see that complications are rare, so if they have to choose between an expensive MD or a cheaper midlevel, and they can both do things like blocks, central lines, etc. then why pick the pricier option. While its sad, we need to protect the monkey skills to preserve our place at the table even if that's not what's really important. You have to think like a suit that will never really understand what it is we do.

By highly ranking a program that trains SRNA's you are by default condoning this behavior. Stop it.
 
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SaltyDog said:
This is a dangerous way to think. While you and I (and everyone else here) knows that "monkey skills" are not what separates us from the midlevels - rather it's our understanding of phys, path, pharm - you know, medicine - the "monkey skills" are far easier to quantitate and understand for the non-clinical suits that are running things. They look and see that complications are rare, so if they have to choose between an expensive MD or a cheaper midlevel, and they can both do things like blocks, central lines, etc. then why pick the pricier option. While its sad, we need to protect the monkey skills to preserve our place at the table even if that's not what's really important. You have to think like a suit that will never really understand what it is we do.

By highly ranking a program that trains SRNA's you are by default condoning this behavior. Stop it.
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During one of my job interviews, I was told point blank that they would rather hire 2 CRNAs instead of an anesthesiologist, they just don't have enough good candidates.

I completely agree with @SaltyDog. For the uneducated layperson, most anesthetics don't benefit a lot from the presence of an anesthesiologist. Bean counters tend to think in numbers: if the probability of a $1M malpractice event is less than 5% per provider per year, it's much cheaper to just hire independent CRNAs and pay for the losses. Especially in states with malpractice caps. ;)
 
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FFP said:
If you mean almost the entire field of medicine... ;)

During my CCM fellowship, I had to tolerate a number of rounds with APRN students presenting cases (on APRN teams). And yes, they even placed lines. The sad thing was that none of my attendings seemed to be bothered by it; they didn't even realize they were training our replacements who, on top of it, refuse to admit that they are practicing medicine. I think physicians have given up swimming against the current, and just go with it, despite being pretty sure that they'll end up drowning regardless.

Young people who don't like this should go study/practice in another country. I am serious. In the US, a lot of people are working hard to dilute the role of physicians to homeopathic doses. One doesn't see paralegals practicing law, even if they were to call it "paralegaling", but we have tons of nurses practicing medicine advanced nursing. ;)
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SAD STORY:uhno:
 
I had SRNAs (from two different programs) training with us at several of the hospitals we rotated at. We occasionally bumped into AA students as well. There were some uncommon-to-rare occasions that I felt they got in the way of resident cases. Usually they were in bread and butter cases (lots of gen surg, eye and basic ortho). They got to intubate, do a-lines, labor epidurals/CSE/spinals. Not sure about central lines/DLTs. Definitely no regional (outside of ankle blocks) and no thoracic epidurals. There were only a few cases where they were in the right place at the right time to start a heart or something else that should have gone to a resident and that was b/c residents were at lecture or otherwise unavailable. The staff and residents both made active efforts to prevent that kind of thing.

Lots of talk about why to avoid programs with SRNAs going on in this thread but I'll put out a reason why I think I benefited from it. I now know what they can and can't do (regardless of what they tell you they can do). As a senior resident, we would run the board at night and on weekends while on call. We would supervise the junior residents and SRNAs and interact with them in STAT cases as well as urgent and elective cases. I got a lot of experience managing SRNAs (you can't really manage CRNAs as a resident without a license) in a variety of situations which definitely added to my toolbox. I honestly don't think it negatively affected my education, but I know it definitely added to it.
 
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We have one or two SRNAs floating around.

They in no way interfere with our program. What my attendings let them do in cases is up to that attending, and I know practices vary greatly.

But I will say to anyone applying is do NOT be afraid to ask about this on interview trail. If someone isn't comfortable answering or tries to hedge/cover up, huge red flag right there.
 
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Robotic Wis-Hipple said:
Maybe that's why they know they can get away with it. Plenty of people will sign up to be sold out in exchange for that gold star on their CV right?
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That is sad, people risk even mental health to get the stamp of the IVY league
 
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Pixiwoman said:
That is sad, people risk even mental health to get the stamp of the IVY league
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They won't risk their mental health but, unfortunately, they will put up with lesser training programs (especially fellowships) for the sake of the brand. And truth be told, it's the brand that opens the doors. Nobody has any idea how good actually one is clinically, but they take it as a mark of quality that one got into a highly competitive program, even if mediocre, vs a good hidden gem program nobody knows about.
 
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BLADEMDA said:
It's a top 5 program located in the Northeast. In fact, it's a top 3 program!
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Wow that's super awesome! On an unrelated note, the 11 programs I interviewed at all assured me that they were in the top 10.
 
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Psai said:
Wow that's super awesome! On an unrelated note, the 11 programs I interviewed at all assured me that they were in the top 10.
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Damn Psai, you on a rough rotation? Seems unlike you to be this confrontational.
 
Psai said:
Wow that's super awesome! On an unrelated note, the 11 programs I interviewed at all assured me that they were in the top 10.
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If a program needs to advertise that they are in the top 10, then they aren't.
 
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FFP said:
If a program needs to advertise that they are in the top 10, then they aren't.
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Meh they were all big name places that I actually do think are top whatever
 
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Psai said:
Meh they were all big name places that I actually do think are top whatever
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So true... I have done rotations in Ivy league places and the "ambiance" sucks! :oops:
 
Pixiwoman said:
So true... I have done rotations in Ivy league places and the "ambiance" sucks! :oops:
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I am sorry you had a rough go, but your generalization that all of the Ivy's must therefore be staffed with prestige ****** getting inferior training is a stretch, not to mention offensive.
 
Top 3, top 5, top 10, or any of the other descriptors do not really exist. If you got 100 people to list their top 10, each one would be different and it is likely that >50 programs would be mentioned at least once. As stated, everyone likes to brag that they are a top 10 program. If they say that, they are likely insecure. If outside people state that they are a top program, then that is much better than hearing it from someon within the program. But, in the end, no such list exists. Doximity tried to create a list, but there are so many huge problems with that list. The Society of Academic Anesthesiology Associations (academic chairs, program directors, fellowship directors) attempted to get Doximity to abandon that effort because their methodology is so flawed, but they did it anyway. There are a few top notch programs out there that also have srna training programs. It is unfortunate to say the least. Do not be lulled into thinking it will not have a negative impact on your experience. You just have to decide if the other positives outweigh the negatives associated with this issue. Politically, it is a ticking time bomb that could erupt and divide a department. The aana is a very militant group and the srna's are all dues paying soldiers in their efforts to undermine your profession and will stop at nothing to diminish the importance of your role in patient care.
 
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Nivens said:
I am sorry you had a rough go, but your generalization that all of the Ivy's must therefore be staffed with prestige ****** getting inferior training is a stretch, not to mention offensive.
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He wasn't talking about the training, but about the ambiance. I tend to agree that the bigger the place the worse the atmosphere tends to be.
 
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I wonder, is there an objective way to rate and rank residency programs?

Board pass rates, ITE percentile and/or score growth from one year to the next, percentage of residents that go into fellowship, an unofficial "prestige" factor, a combination of all those or others I'm missing?

Has any respectable rating system been compiled?
 
Fluffhead87 said:
I wonder, is there an objective way to rate and rank residency programs?

Board pass rates, ITE percentile and/or score growth from one year to the next, percentage of residents that go into fellowship, an unofficial "prestige" factor, a combination of all those or others I'm missing?

Has any respectable rating system been compiled?
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Short answer is no. Longer answer is who cares. Not everyone wants to do a fellowship, not everyone wants to do research, not everyone wants to have well defined rotations of cardiac, ob, peds, etc overseen or poached from by fellows (or SRNAs/CRNAs), etc. The guy that wants to do every case that comes his way for 3 years would be miserable, and likely less successful at the "Top" whatever hospital with crazy NIH funding that requires 3-6mo of research and pressures you into a fellowship for example.

Find out what you want, the style you are best in, and the location you want and go there. The gold stamps do help, nobody will say they don't at all, but if you hate it, don't do well, or quit, you aren't getting a letter of rec or the stamp anyway.
 
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While I agree no true "rankings" exist, I think most could agree on 10 or so of the most competitive/sought after programs by applicants, give or take. For example, Duke (which I do not attend), is on every list I've ever heard quoted as a "top" place to train. Of course there is going to be some minor regional variability. Of course there are lesser known programs that provide great training. Of course there are crappy docs that trained at these "selective programs". But to pretend that some sort of a heirarchy does not exist at all is ridiculous and serves little purpose other than to make those who didn't make the cut for one reason or another feel better.
 
BLADEMDA said:
It's a top 5 program located in the Northeast. In fact, it's a top 3 program!
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It wouldn't be my top 3. Or 5 or even 10 possibly. But I've mentioned more than once on this site what I wou,d look for in a program.
 
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Fluffhead87 said:
I wonder, is there an objective way to rate and rank residency programs?

Board pass rates, ITE percentile and/or score growth from one year to the next, percentage of residents that go into fellowship, an unofficial "prestige" factor, a combination of all those or others I'm missing?

Has any respectable rating system been compiled?
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In the end, the most objective ranking would be based on income, post-training and after 10-20 years. Anything else is BS and, to quote ICU studies, "doesn't change survival". :p
 
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Arch Guillotti said:
What was the attending's role in this?
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Crna's ignore when a supervising resident makes plans, and do their own thing until the attending pleads with them to follow what they want. One of the crna's who feels on top of the world huffs and puffs when an attending is helping with induction.. Especially when she's not mask ventilating properly... Although overall I keep hearing on the boards here that attendings having to rescue crna mishaps and whatnot, I have not really have seen that much...
 
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2Fast2Des said:
Crna's ignore when a supervising resident makes plans, and do their own thing until the attending pleads with them to follow what they want. One of the crna's who feels on top of the world huffs and puffs when an attending is helping with induction.. Especially when she's not mask ventilating properly... Although overall I keep hearing on the boards here that attendings having to rescue crna mishaps and whatnot, I have not really have seen that much...
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Because it's rare enough, thank God. But when it happens, it's not just bad, it's really bad, because it's usually a CRNA who didn't recognize the look, the smell, even the taste of ****, until it was all over the fan. Which makes one wonder what else they get away with on a daily basis.

In my n=1 experience, solo anesthesiologists tend to call for help or backup more frequently than CRNAs.
 
Nivens said:
While I agree no true "rankings" exist, I think most could agree on 10 or so of the most competitive/sought after programs by applicants, give or take. For example, Duke (which I do not attend), is on every list I've ever heard quoted as a "top" place to train. Of course there is going to be some minor regional variability. Of course there are lesser known programs that provide great training. Of course there are crappy docs that trained at these "selective programs".
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I would say there are likely 25 or so programs that most would agree should be considered top programs. However, everyone's top 10 will be a bit different. Many people would not list Duke as a top 10, but I think most would say it is in the running as a "top program." So, yeah, I think you are kind of correct. Conversely, there are a few programs that live off of name recognition alone that those close to the front lines know have major issues and should not be considered a top program. However, there they are, every year, discussed as a top 10 program...
The truth is, there are 130ish programs and most of them are pretty good. Each has strengths and weaknesses. The things that a candidate desires will be different for each person, so their "top 10" will differ greatly based on things such as geography, family needs, factors in the program that appeal to them, etc. If you are looking for a program that will optimally pad your CV, one with name recognition is good. If you are looking for the best diversity in preparing you to join a fast paced and diverse case mix private practice, maybe a smaller unknown program beats them hands down. If you are considering cost of living and family life, other programs may appeal more than the name recognition programs. Nobody's top ten will be the same, and that is why the system has continued to work and why many smaller, relatively less well known programs continue to attract top candidates. If a program fits your particular and unique needs, it may be your number one and someone else's number 50.
Nivens said:
"But to pretend that some sort of a heirarchy (sic) does not exist at all is ridiculous and serves little purpose other than to make those who didn't make the cut for one reason or another feel better"
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This statement only serves to further perpetuate the ivory tower mentality that is off putting to most anesthesiologists.
 
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though many CRNAs would like to have the same training as the MDs, there seems to be a general consensus that the more advanced cases should go to the residents and the basic work is for the SRNAs
 
We are in agreement that a general "ranking" of "the best places to train" is difficult to pin down, and that each individual applicant's "top 10" will vary based on personal circumstances/career goals, etc. I maintain that certain programs offer a better combination of clinical exposure/resources/opportunities, and in the absence of geographical limitations or specific career goals (which aren't worth much pre-residency anyways- best laid plans, after all) can and should be used to guide the formation of an individual rank list to maximize ROI down the road.

Gern Blansten said:
This statement only serves to further perpetuate the ivory tower mentality that is off putting to most anesthesiologists.
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And I'm sorry, it's difficult for me to take your "ivory tower" dig seriously given your use of (sic) to highlight my typo in your post. I find it very... off putting (sic).
 
Nivens said:
While I agree no true "rankings" exist, I think most could agree on 10 or so of the most competitive/sought after programs by applicants, give or take. For example, Duke (which I do not attend), is on every list I've ever heard quoted as a "top" place to train. Of course there is going to be some minor regional variability. Of course there are lesser known programs that provide great training. Of course there are crappy docs that trained at these "selective programs". But to pretend that some sort of a heirarchy does not exist at all is ridiculous and serves little purpose other than to make those who didn't make the cut for one reason or another feel better.
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There are about 5 or 6 programs that almost everybody would agree are "top 10". The order can vary, but people will generally agree on a handful as being truly elite. There are probably another 10 or 20 programs that will get plenty of consideration and mention for being in the "top 10" by people, but they might vary from "top 10" to "top 30" by various people.

For example, I think most people would agree MGH is a top 10 program. Is it #1? Is it #5? Is it #7? I don't know, but I'd bet if you asked 100 anesthesiologists around the country that at least 90% would place it in the top 10.
 
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FFP said:
He wasn't talking about the training, but about the ambiance. I tend to agree that the bigger the place the worse the atmosphere tends to be.
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So true, I did rotations in big places and the ambiance was malignant
 
Nivens said:
I am sorry you had a rough go, but your generalization that all of the Ivy's must therefore be staffed with prestige ****** getting inferior training is a stretch, not to mention offensive.
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I did not say all places, but most :eek::p
 
FFP said:
They won't risk their mental health but, unfortunately, they will put up with lesser training programs (especially fellowships) for the sake of the brand. And truth be told, it's the brand that opens the doors. Nobody has any idea how good actually one is clinically, but they take it as a mark of quality that one got into a highly competitive program, even if mediocre, vs a good hidden gem program nobody knows about.
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Thanks for your comment :)
 
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