What is up with CRNA/AA/MDA politics. - page 4

I am way not in it but long term, i am aspiring to be a CRNA so i hang out on various boards and i am amazed at what i see. I see MDAs to be talking about having nurses do the mundane work becasue... Read More

  1. by   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...
  2. by   jwk
    Quote from 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...
    I'd still like to see where that stat comes from. And if an anesthesia resident only does one, how many does a CRNA do? And where does that stat come from?

    The number of general C-Sections done is going to be a function of how busy the OB service is. If you're doing a very low percentage of general C-Sections, there simply won't be that many numbers to do, and it will have nothing to do with whether you're a CRNA or AA or MD. At my training hospital, it was kind of funny, but it was whoever got to the head of the bed first when they paged overhead for a STAT section was the one that actually stayed and did the case.

    I don't know our exact numbers, but I would guess it's less than 5% general C-Sections, and most of those will be for walk-ins in active labor with bad heart tones, prolapsed cords, moms who have HELLP syndrome or some other coagulopathy or contraindication to a regional, and EXIT procedures which require a general C-Section.
  3. by   Brenna's Dad
    I would be interested in learning more about anesthesiology residency education. Specifically, hours spent in didactic per week and level of supervision during cases.

    Also, do physician anesthetists typically count all their OR time and time on call as hours, or only their actual "bag-time" as we are told to do? Using Tenesma's post of over 10000 hours in a physician residency, this amounts to a little over 10 hours a day, five days a week for four years. Definetly possible, but resulting in pretty long days if you aren't counting turnover time, pre-oping patients, A-lines and central lines out of the OR, sitting around in OB, sitting around waiting on call or in the OR etc. In a big teaching hospital with longggg cases of course, this might be easier to achieve.

    Also, what is the culture in physcian residency programs concerning reading during cases? In my....(I hesitate to use the term).....residency (internship, studentship, slave labour camp....please insert whatever you feel most comfortable with), reading non-anesthesia material during a case results in immediate expulsion. It seems the anesthesiologists I work with do not have this same cultural norm.
  4. by   Tenesma
    brenna's dad - i can't answer for all anesthesia residencies but i can tell you about my experiences

    1) didactics (meaning lecture/class-room setting - includes grand rounds) is about 3-4 hours/week.... the first month or two of anesthesia residency you might get about 6-10 hour/week.

    2) OR time of 10,000 hours is about an average of 75 hours of OR time/week for 11 months for a total of 3 years (instead of 12 months, since one month is usually non-OR related stuff the residents do: pain clinic, ICU, vacation, etc.)... the 75 hours is an average since OR time is usually 7am to 6pm and then the residents take 1 to 2 24 hour shifts during the week. So this isn't "bag-time" by definition, but includes all pre-op activity/lines/regionals etc...

    3) reading-material: you can ONLY have patient related reading material in the room - if there is an article on intra-aortic balloon pumps while you are doing a breast case that is big TROUBLE. However, i am sure quite a few people cheat with those crazy palm pilot thingies everybody has... but if you were caught being non-vigilant (ie: surfing the web, reclining in the corner) you went straight to the chairman's office.... i don't think anybody has ever been expelled, but they have been banished to some ****** ORs instead ....

    plus i think it is very disrespectful/unprofessional to everybody in the room, ESPECIALLY the patient to be reading --- if i am not sure, I always ask myself: "what would the patient think if he/she knew what i was doing right now?".
  5. by   deepz
    [QUOTE=Tenesma].......OR time of 10,000 hours is about an average of 75 hours of OR time/week for 11 months for a total of 3 years ..... and then the residents take 1 to 2 24 hour shifts during the week. ......


    Anyone else see anything wrong with this math? Counting days on call, then counting the hours more than once? Duh.

    Remember the past President of the A$A who told a congressional committee IN SWORN TESTIMONY that he had *personally* performed over 300,000 anesthetics?

    deepz
  6. by   Tenesma
    first of all nobody can perform 300,000 anesthetics...

    but my math is correct:
    monday: 7am - 6pm 11 hours
    tuesday: 7am - 6pm 11 hours
    wednesday: 7am - 6pm 11 hours
    thursday: 7am-6pm 11 hours
    friday: 7am - 7am 24 hours
    saturday: 7am-7am OFF
    sunday: 7am to 7am (but i will only count the first 17 hours until sunday night)

    total: 85 hours - now that is a crappy week but we averaged that week once a month

    the easiest week:
    monday: 7am - 6pm 11 hours
    tuesday: 7am- 6pm 11 hours
    wednesday: 7am-7am 24 hours
    thursday: 7am-7am off
    friday: 7am 6pm 11 hours
    saturday: 7am 7am 24 hours

    total: 81 hours - is a bit more average...

    the average of 75 hours comes from non-clinical time in the OR/meetings/average sickdays, etc.... at least for my former institution...
    so where is my math wrong?
  7. by   alansmith52
    I was with a very cool senior resident today. he is likeable and gets along with most of the RRNA's he got a new book to study for boards. we went through some of the questions together.
    he told me that the book he had was a great one becuase the service that made the book recruited people who had just taken the written boards to "regurgitate" questions from the writen. immeaditly my mind flashed back to a letter I had received from the AANA about how apauling they felt that was.
    he told me that it goes on with alot of medical board exams
    hmmmmm.....
    i do know for a fact that durring medical school they are given "sample" questions for tests..
  8. by   alansmith52
    furthermore. we have let see..... about 6 MDA attendings mabye 8 and I think 3 or 4 are board certified. I take that back there maybe 5
  9. by   jwk
    Quote from alansmith52
    furthermore. we have let see..... about 6 MDA attendings mabye 8 and I think 3 or 4 are board certified. I take that back there maybe 5
    So "maybe" 5 out of 6?

    And let's get real - the memorizing of test questions goes on with CRNA's, MD's, biology students, nursing students, psychology students, yada yada yada. Don't pretend it only happens with anesthesiologists.

    And of course every professional organization professes their abhorrence and disgust with the idea. What do you expect them to do?
  10. by   Tenesma
    alan

    almost all professional exams provide sample questions (believe it or not, that applies for the certification of CRNAs as well - just look at the brochure by the council on CRNA examination)

    i think it is illegal to publish such a book as it is a copyright violation to copy or paraphrase those copyrighted questions.
  11. by   deepz
    Quote from Tenesma
    ........
    so where is my math wrong?

    Looks like you count hours on call (sleeping, eating, TV, etc.) as hours of clinical experience. Rather bogus. But, as noted previously, typical of MDAs' characteristic mode of exaggeration. 10,000 hours, 300,000 cases.

    Further, the implication that two news stories in '95 somehow led to a sudden influx of FMGs in anesthesia residencies is laughably off-base. Non-English-speaking and poorly educated FMGs have flocked to anesthesiology since the '60s, for all the obvious reasons.

    Anesthesia is, after all, the Curdle Zone, where the cream of nursing rises to mingle with the dregs of medicine. (Nothing personal, Doctor.)

    deepz
  12. by   Tenesma
    deepz...

    you are right... as residents we got 2 15 minute breaks and 1 30 minute lunch break every day - and on call we got a 30 minute break every 6 hours (on average)... so you are right, you can deduct 10 hours a week for breaks ...
    by the way, the ACGME passed a rule a year or two ago that limits the amount of hours worked in the hospital to 80 hours a week - probably because too many residents were sleeping, eating and watching TV.... Just curious, when was the last time you worked 80 hours a week?

    my statement wasn't off-base - it was based on fact... the class of US-medical school trained residents starting in 1996 was only 300!!! out of 1200 or so spots!!! that was a huge drop based on the wall street journal scare and the JAMA scare... Almost all specialties except for the most competitive (ophtho, derm, urology) have a 20-40% of FMGs. I find your comment to be off-base somehow correlating dregs of medicine with FMG.... I think there are many fantastic doctors who happen to be FMGs. But I can say with certainty based on board results, atttrition rates, etc, that the years of 1996-1998 were filled with FMGs that were scraped from the bottom of the barrel....


    while i agree that the cream of nursing can be found among CRNAs - i find your comment that the dregs of medicine to be somewhat pathetic... I truly am very, very sorry that your exposure to MDs has been so horrible...
    Last edit by Tenesma on Jan 20, '05
  13. by   gaspassah
    we all are aware of deeps feeling as have been posted before i wish these wouldnt get so personal.
    however i will debate tenes about your hours. while your experience may have actually been like this i have trained in intitutions where as a srna i "relieve" the residents at 3 pm so they can leave. it's not because they were there longer than me we all got there the same time everyday, they just got to leave. yeah they may pull a weekend shift but never both days and they got the day after call off. so as it is most institutions, training is different everywhere not everyones' experience is the same.
    d

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