How many epidurals does it take.......

[Pete495]

to become proficient?

I was recently listening to an anesthesiologist list reasons why his group did not want to teach student anesthetists at one of my clinical sites. One of my colleagues had a discussion with an MDA here at my hospital. My hospital recently became a clinical site for my srna program. The group of MDA's here is just that, a group not affiliated with the hospital. The group will not allow the students (2-4 per semester) to perform any invasive procedures (i.e. epidurals, central lines, etc), so the students attending this particular program will have to be sent out to other hospitals even though they could easily be learned at the hospital where the MDA's are allowing instruction for only general anesthesia cases. The reasons provided were lame, as one could predict. In no particular order, the reasons were:

1) someone elses mistakes requires more work for them

2) said hospital is not a teaching hospital, so patients don't expect to get treated by students.

3) students would not get the ample amount of cases they would at a primary teaching facility, and students need close to 500-1000 epidurals to become proficient because that is how long it took them while in school, and they had 4 years of residency!

4) they can't supervise a room and attend to a student putting a line in at the same time (one of the lamest).

5) the current CRNA's at this hospital are not doing said procedures, and if they let the students do them, everyone (including the older CRNA's) will want to (also very lame).

I got to thinking though that maybe Nurse Anesthetists are not performing enough procedures, and how can SRNA's in rural to medium sized hospitals convince their superiors to teach it?

My other question however is how many epidurals, IJ's, central lines was it before one can become comfortable performing them, and is this while in school, or in the work place? and how many are supervised doing procedures while in the workplace to start out, and in general?

Sorry bout the long rant. it's just become an issue to me.

[athomas91]

Pete - if you don't mind me asking (you can pm me) what program/hospital are you in...

i think it is a bunch of bunk that an -ologist is perpetuating to maintain control over the anesthesia reigns...

my primary site is not a "teaching hospital" - and although they don't teach 1 semester students things like that - they are wonderful instructors as far as lines/epidurals etc...and if they profess you are not proficient until you have completed 500-1000 whatevers - BULL.

i hope to be constantly learning and getting better even after 5000 whatevers-

i guess they would rather you learn after you are a CRNA...yeah - that is great for patients... ugh...

[WntrMute2]

I believe that it takes soemwhere around 50 epidurals and a similar number of central lines before one becomes comfortable doing them. I did about this many during school. This doesn't mean your proficient, just that the straight forward procedures should be handled without difficulty and you should recognize you are getting into trouble. After placing a couple of hundred central lines and probable a similar number of epidurals, I don't hesitate to call for someone to assist (that may well be a CRNA rather than a DR.) if I can't locate the vessel or the epidural space after a couple of attempts. At our hospital, it is possible you are the only provider evenings, weekends, holidays so there may be no backup. But knowing when to stop is an important thing to learn.

The rationals that MDA gave you is plenty lame. I have to say, many MDA groups encourage regional/line placement/independant practice if you work for them. They make money whoever does the procedure. The conflict raises its head if the CRNAs are paid by the hospital. It is mostly about control - IMHO.

[Skytrane]

There are several research articles on this very issue, unfortunately I don't have the citations for you. I am sure you could easily find them by doing a pubmed search.

Most of these articles say that the "magic" number is between 50 - 80 repititions of whatever you are trying to master.

Good luck!

Franklin

[lifeLONGstudent]

omg!! what an a$$.

as students, do you encounter this type of "strong personality" very often and what is your advice on successfully dealing with it?

lifelongstudent

[Pete495]

Yes it happens a lot. My advice: suck it up, deal with it, and don't take it personally.