What is up with CRNA/AA/MDA politics.

[dreatx]

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 they deserve it after all the hard work they put in. I see AAs saying that they get a better education, though how they come up with that i don't know.

Why are people, who are supposedly well educated and claim to be adults, so monstrously disrespectful of the work others have done or are doing.

What's the deal here? and if i successfully complete a program, am i gonna have to hear that kind of nonsense from people in my professional life?

[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.

[deepz]

........

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

[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...

[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

[CougRN]

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..

actually this is what "valley review" has done for years and it was ignored until someone made it totally obvious and the council had no choice but to issue a statement on it. you may be appauled but it has been going on in many professions for years.

[Trauma Tom]

Deepz,

I always cringe a little when I see topics like these come up on the board because you can usually predict where they will end up going. As a current SRNA I always try to maintain my professionalism and hope that other SRNAs and CRNAs will do so as well. Whether as a CRNA, SRNA, MDA or AA we all at some time, more likely than not, be working together in a team environment or perhaps independently at the same hospital. In those situations hopefully we will work together collaboratively to deliver the best anesthesia care we can for our patients. As for the comment about the curdle zone:

Anesthesia is, after all, the Curdle Zone, where the cream of nursing rises to mingle with the dregs of medicine.

I feel that this does nothing to promote our collaboration and only serves to inflame one another. Deepz, I am not trying to pick on you, however I am only trying to use your comments as an example. As to comments like;

(Nothing personal, Doctor.) I do not know how you can take those comments as anything but personal. I think it is much more beneficial to us all when we get on with professional discussions concerning the practice of our trade, not who is better, who spends more time in the OR, or who brings more practioners in from a foreign country. IMHO. I am climbing down off my soapbox now.

Trauma Tom

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

[Brenna's Dad]

Although it is my understanding (from informal conversations only), that Anesthesiology historically has attracted the so called dregs.... I no longer believe this to be the case. Many of the newly graduated MDAs I work with are top notch practitioners and I imagine this will continue to be the case for the anticipated future.

Thank you very much for Tenesma's post regarding Anesthesiology residencies.

Obviously the approach between physcian and nurse anesthetist education is very different. I can't help but imagine that it must be more difficult for a physician to learn the mechanical aspects of anesthesia, than a professional critical care nurse who has been doing many of these skills in the ICU.

[alansmith52]

this puts a name on what I 've been thinking about.

I just couldn't fomulate what I see going on with the CA1's that I work with. Iam making a top 10 list of funny things I hear attendings say. here are a few.

1. the apex gets far more ventilation that the base (my personal favorite)

2. "oh oh, wait I see a buble in the line we got get that out so we don't give an air embolism.

3. whenever you attach a needle to a syringe don't touch this part (pointing to the threads) with your finger"

4. "desflurane step change? I ve never heard of such a thing"

anyway its a work in progress, I am gonna make T shirts

and don't argure about the apex deal. we where talking about an upright sv patient.

[Tenesma]

mechanical aspects of anesthesia: intubation, extubation, IVs, a-lines, central lines, epidurals, spinals, regional blocks, nerve block catheters.... i wasn't aware that these were skills that professional ICU nurses were doing in the ICU... i do agree that most graduates from medical school only have minimal exposure to performing some of those skills.

alan... what is your point? how are those things funny? and by the way, the apex does get more ventilation in the upright spontaneously ventilating patient...

[versatile_kat]

mechanical aspects of anesthesia: intubation, extubation, IVs, a-lines, central lines, epidurals, spinals, regional blocks, nerve block catheters.... i wasn't aware that these were skills that professional ICU nurses were doing in the ICU...

Well, I can't say much for the epidurals, spinals and blocks ... but we always did our own IV's, extubated the patient and even inserted a-lines on my open heart unit. I didn't think those things were such a big deal. Granted, I'm obviously not talking about femoral a-lines ...

[loisane]

and by the way, the apex does get more ventilation in the upright spontaneously ventilating patient...

This is an issue of constant confusion to students of all ages (even us with experience are still students)

Barash 4th ed, p. 801 "Despite the smaller alveolar size, more ventilation is delivered to dependent pulmonary areas". In the upright person, the bases are more dependent.

There are actually two different issues to be answered here, with two different solutions, which confuses us all so much.

In the upright person, which part of the lung gets more volume of ventilation, apex or base? Answer-base, see above.

In the upright person which part of the lung gets more volume of blood perfusion, apex or base? Answer, also base.

Here is where it gets fun. In the bases, is there relatively more ventilation or perfusion? Answer-more perfusion than ventilation (shunt).

In the apex, is there relatively more ventilation or perfusion? Answer-more ventilation than perfusion (dead space).

So in answering the question, you have to be very careful which question is being asked. Are you comparing apples to apples? (Ventilation in the apex compared to ventilation in the base). Or are you comparing apples and oranges together, and asking which location has a greater percentage of apples?

The old respiratory phys instructor in me couldn't resist getting in on this, sorry it is so off topic.

loisane crna

[Tenesma]

thanks loisane - but i was being facetious... (i was hoping to prove alan's point that MDs are useless :) ) here is the reason why the bases get more ventilation:

The base of the lung is at a less negative pleural pressure and its alveoli are at a lower relative volume. Thus, alveoli at the base are more compliant.

The apex of the lung is at a more negative pleural pressure and its alveoli are at a higher volume. Thus, alveoli at the apex are less compliant.

The pressure change due to inspiration will be roughly the same in all lung zones and thus more compliant alveoli will change their volume more.

During each breath the alveoli at the base will change volume more than those at the apex and thus they will ventilate more than those alveoli at the apex.