[deepz]

Originally Posted by ul239

[font=Arial]Tenesma, .....your comment re: RRNA's (cute) is offensive to many on this board. .........

At least she didn't ask Alan if he smoking crack!

deepz

And yes, 239, CRNAs do define themselves and their own profession -- and their own terminology. We don't define the A$A and they do not define us. Malign us, yes; define us, no.

[NGACRNA]

I don't know where you got that bad piece of info.

Boards, up unitl recently, were VOLUNTARY for anesthesiologists. And I know a WHOLE lot that either:

a) didn't take them, or
b) failed them

And as for residents getting good cases, I've seen too many lazy residents (of course they are slave labor for nights in some university med centers) duck out of cerebral aneurysm repairs, AAAs, etc.

Where I trained CRNAs and SRNAs did everything involved with the case: awake fiberoptic intubation, a-line, PA-cath, etc etc.

Oh, and did you know that the average anesthesiologist does only one (1) C-section under general anesthesia in their entire "4" year residency?

Add to that the fact that most can't do a simple machine check (because they're never taught). That last one's straight out of the ASA newsletter.

Lastly, SSEPs, and MEPs? Do them all the time.

(refer to yourselves as "Graduate Nurse Anesthetists")

[jwk]

Originally Posted by NGACRNA

I don't know where you got that bad piece of info.

Boards, up unitl recently, were VOLUNTARY for anesthesiologists. And I know a WHOLE lot that either:

a) didn't take them, or
b) failed them

And as for residents getting good cases, I've seen too many lazy residents (of course they are slave labor for nights in some university med centers) duck out of cerebral aneurysm repairs, AAAs, etc.

Where I trained CRNAs and SRNAs did everything involved with the case: awake fiberoptic intubation, a-line, PA-cath, etc etc.

Oh, and did you know that the average anesthesiologist does only one (1) C-section under general anesthesia in their entire "4" year residency?

Add to that the fact that most can't do a simple machine check (because they're never taught). That last one's straight out of the ASA newsletter.

Lastly, SSEPs, and MEPs? Do them all the time.

(refer to yourselves as "Graduate Nurse Anesthetists")

Interesting - virtually every anesthesiologist I know in the northern part of Georgia (probably >100) are board certified or fairly new out of residency and board eligible. If they are not on that track or already board certified, they won't last long in any of the major anesthesiology groups. Now they may find their way to smaller towns and hospitals, but they're not quite as selective - they can't afford to be, although I will be the first to agree that a bad anesthesiologist is most certainly NOT better than no anesthesiologist.

As for the average anesthesiologist only doing one general C/S during residency? That seems a little far fetched - where did you get your figure?

[mwbeah]

JWK,

You may find this interesting.

Both hospital characteristics and board certification of anesthesiologists affect patient outcomes

Patients undergoing surgery aided by experienced anesthesiologists who are not board certified suffer more deaths or failure to rescue (rate of death after complications) than patients of midcareer board-certified anesthesiologists. However, the poor outcomes associated with noncertified anesthesiologists may be a result of the hospitals at which they practice and not necessarily their manner of practice, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS06560 and HS09469).

The researchers found that noncertified anesthesiologists were more likely than those with board certification to practice at hospitals with fewer characteristics associated with quality care. Such factors include hospital size, nurse-to-bed ratio, percentage of board-certified surgical staff, presence of a trauma center, and others. These hospital factors play an important role in determining patient outcomes, explains Jeffrey H. Silber, M.D., Ph.D., of the University of Pennsylvania School of Medicine.

Dr. Silber and his colleagues analyzed Medicare claims records for nearly 145,000 elderly Pennsylvania patients who underwent general surgical or orthopedic procedures between 1991 and 1994. They compared the outcomes of 8,894 patients who had midcareer anesthesiologists (11-25 years after medical school graduation) who lacked board certification with all other cases.

After adjusting for other factors affecting patient risk of death, the odds of death and failure to rescue were both 13 percent greater when care was delivered by noncertified midcareer anesthesiologists. This corresponded to 3.8 excess deaths and 9.2 excess deaths following complications (failure to rescue) per 1,000 patients. Adjusting for international medical school graduates did not change these results. In addition, hospital characteristics often associated with improved quality were consistently less evident in the noncertified group.

In summary, the researchers note that the current study provides strong evidence that anesthesiologist board certification status is an important factor associated with surgical outcomes, but it must not be used in isolation. They conclude that midcareer anesthesiologists who lack board certification and the hospitals in which they are employed appear to be associated with worse outcomes for surgical patients.

See "Anesthesiologist board certification and patient outcomes," by Dr. Silber, Sean K. Kennedy, M.D., Orit Even-Shoshan, M.S., and others, in the May 2002 Anesthesiology 96(5), pp. 1044-1052.

[mwbeah]

Candidate Trends: The resident match articles in the ASA NEWSLETTER by Alan W. Grogono, M.D., regularly bring the ASA membership up to date on anesthesiology residency numerical trends. The smallest CA-1 entering class occurred in 1996 with the subsequent smallest CA-2 class, CA-3 class, ABA written examination cohort and ABA oral examination cohort following successively in 1997, 1999, 2000 and 2001, respectively. From 1994 to 1998, the overall pass rate on the ABA written examination varied from 61 percent-71 percent. In 2000, however, along with the lowest number of candidates, the written examination pass rate sunk to a nadir of 46 percent, climbing back to 55 percent in 2001 and then to 62 percent in 2002. Those who passed the written examination experienced similar overall oral examination pass rates to prior years — 70 percent-74 percent for the period between 1997 and 2002 with a consistent pass rate between 79 percent-83 percent for the subset of new American medical graduates.

[Kiwi]

Originally Posted by mwbeah

Candidate Trends: The resident match articles in the ASA NEWSLETTER by Alan W. Grogono, M.D., regularly bring the ASA membership up to date on anesthesiology residency numerical trends. The smallest CA-1 entering class occurred in 1996 with the subsequent smallest CA-2 class, CA-3 class, ABA written examination cohort and ABA oral examination cohort following successively in 1997, 1999, 2000 and 2001, respectively. From 1994 to 1998, the overall pass rate on the ABA written examination varied from 61 percent-71 percent. In 2000, however, along with the lowest number of candidates, the written examination pass rate sunk to a nadir of 46 percent, climbing back to 55 percent in 2001 and then to 62 percent in 2002. Those who passed the written examination experienced similar overall oral examination pass rates to prior years — 70 percent-74 percent for the period between 1997 and 2002 with a consistent pass rate between 79 percent-83 percent for the subset of new American medical graduates.

Was a new test administered in 2000? That number is down a couple standard deviations.

[jwk]

Obviously it wouldn't make sense if everyone passed. That would mean the exam is far too easy.

I wonder what the cumulative pass rate is after the 2nd or 3rd attempt? I know a fair number of docs that didn't pass the first time, especially on the orals, but made on the second try.

[Tenesma]

the story behind this is an interesting one.... in 1995 there were 2 news reports regarding a bad job situation for anesthesiologists... therefore anesthesia residency applications fell into the toilet and very few of the 1200 spots were filled by american graduates. The hospitals didn't have much of a choice, and were unfortunately forced to fill their anesthesia programs with residents from foreign countries who had 1) severe communication/language barriers 2) serious learning issues and 3) serious reliability issues. This was unfortunate on a whole, because those hundreds upon hundreds of residents were filling holes in residency programs to keep ORs running - but not necessarily in the interest of the patient A HUGE block of those weak/crappy/useless residents are responsible for the high board failure rate in the ensuing years. In fact, you don't see good quality medical students going back into anesthesia residency until about 1998/99 (those who would be taking boards in 2002/03) - and thus the changes in the board scores. The board exam itself hasn't been changed over that time period/nor has the grading system.... The good news financially is that for all the people who did pass the boards and who could communicate in the english language there was a huge SUPPLY of jobs because they had no competition from their colleagues when they graduated (part of the reason why there continues to be a shortage of MDs).

NGACRNA - you are right that the board certification process is voluntary - in the sense, that if a graduating resident doesn't feel like going through the process then he/she doesn't have to pass the boards or take the oral component. However it is a requirement of all anesthesia residencies that certify their residents as having completed the required years of residency, that they are signed up for the written boards that are administered in July. All groups that I know of require either Board certification OR Board eligibility with completion of board certification within one year in order to keep their job. The same thing applies for all university centers that I know of. Can somebody without board certification practice anesthesia - sure, but very few people would hire them!!!

ONE c-section during residency - give me a break... the ACGME requirement for graduation is 20 c-sections and the national average is 35-40. (here is a link to give you an idea of the averages: http://etherdome.org/Education/ResiInfo/Caseload.html

a simple machine check can't be done??? gimme the reference to that ASA newsletter - i would love to read it (because i searched their newsletters and couldn't find a reference)

[gaspassah]

ONE c-section during residency - give me a break...

i think the statement was one c section under general

As for the average anesthesiologist only doing one general C/S during residency?

at least that's how i interpreted it.
one c section for any anesthesia provider would be sad.
d

[Tenesma]

sorry - i misread about the GA part. you are right, those aren't very common... Most centers that do >3,000 deliveries per year would average 2-4 GAs per month (based on my readings). I don't know what the average c-sections under GA, but it wouldn't surprise me if some anesthesia residents never get to do a c-section under GA. which is sad...