CRNA's! Did your program have a strong clinical component?

allnurses Guide · Nov 24, 2011

I am in the Case Western/ Cleveland Clinic program. We have such a vast number of cases. We do have residents, but there are enough cases to go around. We rotate to an outpatient center to do all of regional/ peripheral nerve blocks. Our graduates have 2-3x the amount of case requirements upon graduation. During the OB rotation, it is not uncommon to have 80-100 spinals. We do mostly all ASA III-V. Therefore, we deal with a high level of acuity. I think just finding a well established program where the culture meets your needs is the most important thing. In my program, the majority of students stay after graduation, so the faculty is very interested in training you to become a competent colleague. The mentality is different. They would much rather teach you than haze you because most of the students stay. All programs have pros/cons. You just have to weigh them out.

I have to wonder about this program. CWRU has an AA program and one of the first classes listed for the NA program is for collaboration and consultation. This begs the question, does this program teach you to be an independent practitioner? Are there any CRNA only practice rotations? Do the graduates that stay at the main clinical site get to do their own pre-ops, CVLs, PNBs, always push their induction meds etc.? IMO any nurse anesthesia program that shares a site with anesthesiology residents is going to be inherently biased towards the residents.

Jasmere1 · Nov 25, 2011

Yes, I do acknowledge your point. The AAs practice at University Hospitals. Cleveland Clinic does not have AAs. The collaboration and consultation class is a generic MSN class that is a part of the core classes that every MSN student has to take. It is not specialized to anesthesia. This class is taken along with NPs from all different specialties. During one of our MSN courses, all independent practice CRNAs came in and contributed valuable information to us. The Cleveland Clinic main campus does have residents that do the PNBs. However, we rotated out to a different hospital and had great experience with PNBs. The cleveland clinic is in the process of transitioning to a different anesthesia model than what has been used historically. The cleveland clinic has both residents and srnas. The staff anesthesiology teach some of our lectures etc. It is a very integrated program. I personally enjoy both disciplines being involved in the learning process. It adds a different perspective to certain things. I'm sure there are other places where you can be completely and fully independent. All I'm saying is that we get a great vast amount of experience due to the volume of cases that we do. There are enough cases to go around for everyone. Not all grads stay at main campus. Even different hospitals within the cleveland clinic system have different cultures. Different specialties have different cultures for that matter. I'm not really into politics, but I do know that I am getting an awesome education. Our Crnas as well as MDs not only teach the chapter in the book, but some of them have written the chapters. They are the contributors to the most relevant research. Crnas have taught me some really great things, but so have some of your MDs. I do get your concern. Politics are involved in everything. I just think it's great to be able to work with this caliber of practitioners. They have trained all around the world. If I have a question about TEE/Echo, or fiberoptic, I don't have to email someone around the world. We have CRNAs/MD who specialize in it. I can just stop in their office and they know me by name and are happy to teach. As a student, I'm just like a sponge. I am willing to learn anything from anyone as long as it contributes to my practice. I don't know if I will stay there after graduation. It may not be the best fit for me. I just know that I am getting great training.

allnurses Guide · Nov 25, 2011

Yes, I do acknowledge your point. The AAs practice at University Hospitals. Cleveland Clinic does not have AAs. The collaboration and consultation class is a generic MSN class that is a part of the core classes that every MSN student has to take. It is not specialized to anesthesia. This class is taken along with NPs from all different specialties. During one of our MSN courses, all independent practice CRNAs came in and contributed valuable information to us. The Cleveland Clinic main campus does have residents that do the PNBs. However, we rotated out to a different hospital and had great experience with PNBs. The cleveland clinic is in the process of transitioning to a different anesthesia model than what has been used historically. The cleveland clinic has both residents and srnas. The staff anesthesiology teach some of our lectures etc. It is a very integrated program. I personally enjoy both disciplines being involved in the learning process. It adds a different perspective to certain things. I'm sure there are other places where you can be completely and fully independent. All I'm saying is that we get a great vast amount of experience due to the volume of cases that we do. There are enough cases to go around for everyone. Not all grads stay at main campus. Even different hospitals within the cleveland clinic system have different cultures. Different specialties have different cultures for that matter. I'm not really into politics, but I do know that I am getting an awesome education. Our Crnas as well as MDs not only teach the chapter in the book, but some of them have written the chapters. They are the contributors to the most relevant research. Crnas have taught me some really great things, but so have some of your MDs. I do get your concern. Politics are involved in everything. I just think it's great to be able to work with this caliber of practitioners. They have trained all around the world. If I have a question about TEE/Echo, or fiberoptic, I don't have to email someone around the world. We have CRNAs/MD who specialize in it. I can just stop in their office and they know me by name and are happy to teach. As a student, I'm just like a sponge. I am willing to learn anything from anyone as long as it contributes to my practice. I don't know if I will stay there after graduation. It may not be the best fit for me. I just know that I am getting great training.

Don't take this wrong way, because I am not picking on you or your program but I am pointing out a few things.

1. Consultation and collaboration is not an MSN core course. It is core course at your university, but is not a required course needed for accreditation.

2. If you shared equally with the residents then there would be no need to go elsewhere for a block rotation. Do you get to learn US and NS guided PNBs? Do you learn most blocks such as ISC, SC, IC, paravertebral, lumbar plexus, femoral, popliteal/lateral popliteal, TAP, inter coastal, AX etc.? I trained with residents too so I am aware of unequal aspects of clinical sharing. It may not be very apparent, but you can bet it is always there.

3. Does your clinical sites allow the CRNAs to do pre-ops, be the floor runner, PNBs, neuraxial anesthesia etc.? Are the CRNAs subject to the MDA plan or can they do their own plan even if they disagree with the MDA?

4. You may not be into politics, but it is central to everything in anesthesia. Politics effects billing, job duties, salaries, credentialing, ability to find jobs in certain geographic areas etc.

5. That is great that you don't have to email someone around the world, but I haven't really heard of school site having to do that anyway. Any academic institution that uses TEE and US should be able to explain it to you. The chances of you actually doing TEEs after graduation are slim though.

The ultimate question is always the same: Do you feel like you could function independently, work solo on call (no other anesthesia providers in house but you), as soon as you graduate? If you feel like you are being trained to do that then you are getting a great education.

AllieRice · Dec 30, 2011

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ssrhythm · Feb 14, 2012

Various schools seem to have a reputation for either strong or weak clinical components. Some give you the bare minimum to meet requirements and others provide an exorbitant amount of cases in open heart, neurosurg, and regional techniques.
While I know that experiences can vary between students in the same program, I'd like to get an idea of CRNA's opinions of the program they graduated from and what their clinical experience was like. This is a time to brag about the school you graduated from!!! Please share!

I'm coming down the homestretch in University of South Carolina School of Medicine's program in Columbia, SC. I'm going to give you a little more than what you asked for, because I LOVE almost every aspect of my program. The fact that it is based in a school of medicine is HUGE. The intense didatic portion of the program includes Phys and Pharm that are taught by veteran School of Medicine phDs that are guranteed to blow your mind...UP! And that is a GREAT thing. The curriculum is fantastic, and I cannot phathom it being taught any better. You will rise to the occassion and become a much better practitioner because of it. The CRNA courses are veteran taught and well done by a group of staff that truly care about YOU. They demand that you care about the program just the same way they care about you. You will find throughout the process, you will screw up, You will find out that you didn't screw up but someone said you did and therefore....you screwed up. You will then find wonderful staff that, while not pleased, will listen to you humbly tell them why you screwed up and will not let it happen again. They will be fair, and then they will use their wisdom to not let you get beat up clinically about that screwup whilst putting you in a position/positions to overcome said screwup and propell forward to where you know you belong. You will work in a busy OR at the main site and have ample opportunities to work traumas, cranios, emergency c-cections, healthy FAST paced peds, really sick peds, neonates, robotics, big neuromonitoring multi-level spine surgeries. You will have ample opportuniuty to do spinals and epidurals. We go through two months of heart rotation with with one being at a different facility that 95% of their cases are beating heart off pump- cases and the other being about 95% on pumpers. During the on-pump rotation, you will start every a-line and will insert the central cordis an float and secure a swan. There is also a rotation to a nearby site where you will learn and administer a host of regional blocks including popliteal, sciatic, ankle, mayo, fermoral and ultrasound guided intrascaline single shots as well as catheter placement. I've only described the tip of the iceberg as it pertains to our clinical training sites and what they each uniquely offer. My classmates have all met their clinical numbers and most did so long ago. This is a truly great program to aim for.

subee, MSN, CRNA · Feb 17, 2012

I think the Council on Accreditation has become lax when it comes to approving clinicals. Students are getting LESS experience in regionals, peds, working alone, etc. I know it's hard on the students but doing rotations in several places gets better numbers. That's the way the MDA's want it.....sigh.

k8thegr8 · May 2, 2012

i am applying for use columbia's crna program and have my interview june 6th. can you give me any guidance on clinical questions in the interview?

subee, MSN, CRNA · May 2, 2012

Yes, ask them if a Columbia instructor is available to you for clinicals. You are paying Columbia tuition and you deserve to have an on-site instructor. I'm very disappointed what this program has become.

goodknight44 · May 3, 2012

Bryan in Lincoln NE has great clinical. I did a lot of cases, especially good regional and rural anesthesia experience with independent CRNAs. It's a small program and hard to get into, but good clinical.