Front Loaded Program vs. Integrated

BigPappaCRNA · Aug 30, 2017

One of the biggest advantages to a front loaded program, is that the program can really send you to a lot of different sites, and get you much better clinical experiences, possibly preparing you to be a much more independent provider. An integrated program is limited in the clinical sites offered, to a couple of hour geographic range, due to the student still having to attend class every week. This works out fine for some programs, Kaiser comes to mind, where there are no end of local, close, clinical opportunities. Other programs, especially in the Northeast, have one or two clinical sites. You do not get nearly the well rounded, high variety mix of both preceptors, or cases. Front loaded programs will send you far and wide, which may suck at the time, but you are getting the cream of clinical experiences, full practice often times, as well as CRNA only, independent often times.

CCRN21 · Aug 30, 2017

Very intetesting.

jj224 · Aug 31, 2017

I can't really comment on a front loaded program, as I'm in an integrated one and have no personal experience otherwise. My first semester was all classroom, no clinical. Most of second semester was the same, but we eased into clinical, 2 days a week. As the second year progresses, your in class time drops to once a week and you're in clinical more / week. By the time you're in your 3rd year (when we start rural rotations), you're done with classroom stuff so we're not too limited on rural sites.. we have some 5-6 hours away, others closer as well.

One thing I like about this method - I took a peds anesthesia course and had a peds rotation immediately after the course ended. Trauma class, trauma rotation. I'd imagine it's different for a front loaded program. Also, the hard science classes are spread out, so your class load isn't too bad - I think the front loaded folks are truly beat down and worn out with the sheer amt of material they have to cover their first year (chime in if I'm wrong). I suppose that could be a con as well - you're in clinical late some days / nights before an exam, writing papers, etc..

Ultimately, I wouldn't let integrated vs front loaded be your deciding factor - I'd look for a program with great clinical sites that offer you plenty of opportunities for regional / neuraxial, lines, complex / high acuity cases, and some autonomy (to an extent - being left alone in a room). Look at 1st time board pass rates. Class size I think is important too - smaller programs tend to work with you / remediate if you're not doing well instead of kicking you to the curb... Plus it might make clinical placement easier if you have 10 students vs 50-60 that need to be placed at sites.

Just my 2 cents.. hopefully some other people chime in with their experiences.

CCRN21 · Aug 31, 2017

Wow that was extremely helpful. Thank you for that.

PresG33 · Sep 1, 2017

Agree with JJ. I'm in a front loaded and the first two semesters were all classroom. Was pretty intense with lots of class. However it was all the "basic" Chem/patho/etc. these are the foundations of all the advanced stuff you learn later. We really did t start talking about anesthesia until the end of 2nd semester after we had our basics. I would not have wanted to set foot in clinical before getting this foundational knowledge. Then we start clinical and have one day (3 classes) of class and 40 hrs of clinical a week. This gets pretty stressful because we are in class and clinical 50+ hrs a week not counting studying/care plans/commuting. Not sure if this is different with integrated. Choosing a front loaded program was important to me because I knew I didnt want to go to clinical before I had a decent didactic background. I guess it depends on the type of person you are? some people love integrated but it's not for me!

loveanesthesia · Sep 1, 2017

Front loaded can allow you to travel far for clinical, but that doesn't guarantee that the clinical experience is better, or even good. Depends if the program just takes whatever they can get for a clinical site. It also can be very costly and stressful as a student to find housing at distant clinical sites. Most integrated programs front load the didactic to a large degree, and then become clinical intensive toward the end. There are significant advantages to getting together with classmates/faculty as you progress through clinical. It's a safe place to ask questions about what you are seeing in clinical. Talking with classmates regularly is a huge stress relief. Another advantage is the program administration will often know your clinical preceptors, and can put things into context for you because of that. Communication all around is just easier. It can be more difficult to be admitted to an integrated program, because the class size it typically smaller.

CCRN21 · Sep 1, 2017

Great points. Thank you

PresG33 · Sep 1, 2017

Just as an addition to CCRN. My front loaded program only has 14 students, all our clinicals are within an hour of school, we all had classes together on Monday which includes a seminar where we talked about clinical... none of these are more or less likely to occur in an integrated vs front loaded program. A true integrated program starts clinical extremely early. There are more "hybrid programs" that are starting clinicals later than a true integrated and earlier than a true front loaded. These are probably a good mix of both and sound more like what the above poster is talking about. Best advice to OP is make a list of school options (class size, location, clinical sites, front loaded vs integrated) and rank them based on how important they are you you. Apply to schools based on this. And remember that the best school to go to is the one that accepts you; 90% of the education you get is based on your attitude and effort, not whether the program is front loaded or there are 100 people in your class. Good luck!!

CCRN21 · Sep 1, 2017

"And remember that the best school to go to is the one that accepts you; 90% of the education you get is based on your attitude and effort, not whether the program is front loaded or there are 100 people in your class"

So true!! Thank you for that reminder PresG33

Bluebolt · Sep 2, 2017

Many great points have been made here about integrated and front-loaded programs. I'm in my second year of a front loaded program, just beginning clinical rotations. It seems like most of the true integrated programs I know are masters level because it fully utilizes every month you have in the program to getting you valuable clinical experience. As you see more and more MSN programs changing to DNP you're seeing more front loaded structure or some of these hybrid types that call themselves "integrated" but don't start clinical for 9-10 months after exculsive didacitc. When selecting a program ask them when they actually start clinicals, if it's around 3 months or less of the program start, you're in a real integrated program.

While integrated may have the benefit of getting you in clinical fast, therefore enabling you to graduate in less time like in a masters program, it does have its disadvantages. After studying about 70 hours a week for an entire year I just now feel like I have enough safe Baseline knowledge to step into the OR and start performing anesthesia on patients. The local integrated masters program takes in 70-80 students grinds them for 6 weeks of classroom, then throws them into clinical. They have a substantial drop out rate because of the stress and unrealistic expectations. Not to mention this isn't safe for patients. They are changing to a doctorate, like everybody else, and getting a new program director so maybe they'll make positive changes soon.

Another point to consider is with front loaded or integrated your first year of CRNA school will be very tough and have plenty of didactic information that will overwhelm you. Would you rather be in the classroom and library studying all week and hammering the info to learn it with no distractions, or would you rather do class all day, study all night and be on your feet stressed in clinicals the next day? It's the decision you have to make when choosing what fits you best.

A front loaded program is set up much like medical school. You spend your first year completely in the classroom, with hard foundational sciences. Towards the end of the first year they start teaching some more complex topics and anesthesia sciences. 2nd year they usually have a couple specialty anesthesia sciences 1-2 days a week and maybe 3 days a week of clinical. It's like a 50/50 blend of specialty anesthesia and honing clinical skills. Third year is almost like a physicans residency where you don't have classroom work but are required to do research and prepare for your DNP project while also doing 40 hours a week of clinicals and running your own OR rooms. Occasionally you'll come to campus for meetings or conferences, etc. This is training you to be an independent practitioner and also researcher (this is for a doctorate program). You also spend your third year reviewing everything you've learned in the books and clinical over the previus two years and taking board prep programs.

As for clinical sites of a front loaded. We have 13 clinical sites within one hour of campus and they include everything from small critical access hospitals ran completely by CRNA only practices to prestigous 1000 bed university trauma centers. I think the quality and driving distance of your clinical sites will have more to do with the programs location and not the structure of the program.

This is all my opinion of course which is shaped by my experiences.

Liberation · Jan 26, 2019

please cont'd sharing your own experience .. Thanks