Thoughts on residency programs with SRNA training programs?

[26B]

A number of the programs I've applied to have SRNA training programs on the same sites as the residency training programs. Having talked to residents and attendings about it, I've heard opinions on both sides of the fence and wanted to get some additional input from the experienced members here. What are your thoughts about going to a residency program which also has a SRNA training program at the same location?

If two programs were otherwise similar, would you rank the residency without the SRNA training program higher?

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[Mman]

as far as you should be concerned, the only question worth asking is how daily room assignments are made. We had an SRNA training program at my residency, but 90% of their students were rotating at other hospitals at any given point. Our daily assignments were made by the chief resident assigning residents to rooms and then the CRNAs filled in whatever the residents didn't take. So literally every "good" case went to a resident.

 

[deleted126335]

Depends on the local power politics dynamic.

 

[Man o War]

A number of the programs I've applied to have SRNA training programs on the same sites as the residency training programs. Having talked to residents and attendings about it, I've heard opinions on both sides of the fence and wanted to get some additional input from the experienced members here. What are your thoughts about going to a residency program which also has a SRNA training program at the same location?

If two programs were otherwise similar, would you rank the residency without the SRNA training program higher?

CRNAs and srnas should always get the leftovers. If cases are assigned any other way, I wouldn't rank that program.

 

[partydoc]

It depends on how many there are and what cases they do. We have the occasional srna but they follow around the crnas- so no big deal we residents get all the big cases. I have a friend who said that the srnas were taking cranis from them, eff dat

 

[Psai]

It depends on how many there are and what cases they do. We have the occasional srna but they follow around the crnas- so no big deal we residents get all the big cases. I have a friend who said that the srnas were taking cranis from them, eff dat

lol "taking"?
That's a residency that shouldn't exist.

 

[partydoc]

yeah, exactly. so applicants, beware of those programs

 

[Robotic Wis-Hipple]

So, I'll bite, obviously there are political and philosophical oppositions to the idea of shared training programs.... while I agree that in a vacuum you'd rather SRNAs weren't at your program (or exist at all..), but you could look at it the same way you look at programs with fellowships. Are fellows "taking"cases from residents? Certainly. But the fellowship program wouldn't be allowed if there weren't enough cases for the residents to easily hit their numbers. And the fellows ideally are doing the more complex cases in a given subspecialty area. The same with SRNAs, they couldn't be there if the residents weren't hitting numbers easily, and the residents likely get the more complex cases between the two trainees.

The bigger issue, which is more difficult to tease out is the political side of it. It implies that the hospital system/admin/program is ok with SRNAs and/or that the CRNA group has power. That can potentially be bad. Who makes assignments? Who runs the breaks/relief? Do SRNAs have "numbers" they are required to hit? If so that implies that they could potentially take a case from you, say last day of neuro for SRNA X and they're 1 crani short while you have >20, the SRNA will get that case etc.

Lastly, programs with SRNAs are likely large, with far more ORs than residents can run alone therefore CRNAs are used and residents are not "the workforce". This is a much larger debate but in general means more of a lifestyle program and may also mean residents get the best cases and aren't sitting lap appys as ca-3's, but again the debate of lifestyle/case selection vs workforce program will rage for eons but I think SRNAs tend to imply a particular side.

 

[Nivens]

We have an SRNA program, and while there are minor annoyances (them coming into cardiac room occasionally just to do a central line to "get their numbers"), overall having them around doesn't seem to impact us much.

 

[Libertas]

We have an SRNA program, and while there are minor annoyances (them coming into cardiac room occasionally just to do a central line to "get their numbers"), overall having them around doesn't seem to impact us much.

Seriously? Like they took your line from your case? I would not call that a minor annoyance..... that is not legit

 

[Psai]

We have an SRNA program, and while there are minor annoyances (them coming into cardiac room occasionally just to do a central line to "get their numbers"), overall having them around doesn't seem to impact us much.

? Why do they have "numbers"? Why are they touching any of your procedures or your patients?

 

[Man o War]

CRNAs shouldn't be taking lines from residents. I'd rather a resident do one more line than any CRNA doing it. They shouldn't be doing central lines at all IMO.

 

[G-Man82]

We have an AA training program at my institution, but it doesn't interfere with the Residency at all. I think we may also get an SRNA training program, but they'll probably rotate through outlier satellite hospitals. We have maybe 2-3 CRNAs and the rest are all AAs


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[AdmiralChz]

We have an SRNA program, and while there are minor annoyances (them coming into cardiac room occasionally just to do a central line to "get their numbers"), overall having them around doesn't seem to impact us much.

That's completely unacceptable in my opinion. We get a ton of central lines in my program, but I would be lit the F up if this ever happened to me.

Sometimes I scrub in with NP/MD/PA students in the ICU for central lines. Only place I'll allow it, and I feel like I'm building my instructional skills.

 

[WholeLottaGame7]

We have an SRNA program, and while there are minor annoyances (them coming into cardiac room occasionally just to do a central line to "get their numbers"), overall having them around doesn't seem to impact us much.

Awww hell naw. That's f'd up.

OP, that's the kind of thing you should be asking about. Do SRNAs take cases or procedures to "get their numbers"? If so, run far far away.

Nivens, did you say anything (to anyone?) about that?

 

[Hoya11]

Awww hell naw. That's f'd up.

OP, that's the kind of thing you should be asking about. Do SRNAs take cases or procedures to "get their numbers"? If so, run far far away.

Nivens, did you say anything (to anyone?) about that?

Their number should be 0. 0 blocks. 0 fiberoptic intubations. 0 central lines.

 

[Nivens]

Awww hell naw. That's f'd up.

OP, that's the kind of thing you should be asking about. Do SRNAs take cases or procedures to "get their numbers"? If so, run far far away.

Nivens, did you say anything (to anyone?) about that?

I haven't, as it wasn't my case. I start cardiac next week- if and when it becomes an issue, I will for sure speak up.

 

[2Fast2Des]

Their number should be 0. 0 blocks. 0 fiberoptic intubations. 0 central lines.

At my place C/Srna's do everything that residents do (procedures/cases/difficult airways, etc). I think I'm wasting my time in residency if these guys can come out of their training and in less than 2 years basically do what we do and also tell attendings to basically shove it when it comes to management. Our attendings / department have no backbone so this is a great place to be a noctor. For example even if cases get switched around to another room, they won't let us keep the cases that we preop'd for the night before and do the low yield cases instead because it would upset the crna's/Srna's. Even in one of the hospital we rotate at we're supervised by Crna's and if the Srna makes a request for a certain room and cases and they beat me to asking for it, then I will be stuck in a more non educational room and attending will say sorry they got it first..
I'm coming to the realization that med school and residency is a total scam compared to the accelerated track of becoming a physician wannabe, and if this is the future, shouldn't we scale back our rigorous track we do if all ends up being equal ?

 

[Psai]

At my place C/Srna's do everything that residents do (procedures/cases/difficult airways, etc). I think I'm wasting my time in residency if these guys can come out of their training and in less than 2 years basically do what we do and also tell attendings to basically shove it when it comes to management. Our attendings / department have no backbone so this is a great place to be a noctor. For example even if cases get switched around to another room, they won't let us keep the cases that we preop'd for the night before and do the low yield cases instead because it would upset the crna's/Srna's. Even in one of the hospital we rotate at we're supervised by Crna's and if the Srna makes a request for a certain room and cases and they beat me to asking for it, then I will be stuck in a more non educational room and attending will say sorry they got it first..
I'm coming to the realization that med school and residency is a total scam compared to the accelerated track of becoming a physician wannabe, and if this is the future, shouldn't we scale back our rigorous track we do if all ends up being equal ?

That's completely unacceptable and you should out your program.

 

[Carbocation1]

At my place C/Srna's do everything that residents do (procedures/cases/difficult airways, etc). I think I'm wasting my time in residency if these guys can come out of their training and in less than 2 years basically do what we do and also tell attendings to basically shove it when it comes to management. Our attendings / department have no backbone so this is a great place to be a noctor. For example even if cases get switched around to another room, they won't let us keep the cases that we preop'd for the night before and do the low yield cases instead because it would upset the crna's/Srna's. Even in one of the hospital we rotate at we're supervised by Crna's and if the Srna makes a request for a certain room and cases and they beat me to asking for it, then I will be stuck in a more non educational room and attending will say sorry they got it first..
I'm coming to the realization that med school and residency is a total scam compared to the accelerated track of becoming a physician wannabe, and if this is the future, shouldn't we scale back our rigorous track we do if all ends up being equal ?

Wow.

 

[Noyac]

Op, do yourself a favor and avoid the srna locations. You will never know how things really work until it's too late.

 

[AdmiralChz]

Huh, interesting to see that perspective. The CRNA/AAs/AA students at my program don't do anything behind simple intubations and a-lines, and they at least appear to be totally OK with it. Attendings do any additional work if needed.

 

[Nivens]

Huh, interesting to see that perspective. The CRNA/AAs/AA students at my program don't do anything behind simple intubations and a-lines, and they at least appear to be totally OK with it. Attendings do any additional work if needed.

That's mostly how it is at my program. I think they need like 3 or 5 IJs or some nominal amount. I certainly don't feel threatened- like I said, it's more annoying than anything else. The entire department shares a lounge and we get along just fine. I was taking over a case from one of the more senior CRNAs the other day (a DIEP- kill me), and he was talking to me about how he doesn't understand all the fighting on the internet. Claimed he never wanted to take care of a sick person ever, and that almost every CRNA he knew felt the same way.

Want to hear something totally twisted though? We rotate through a pre-op clinic a few weeks a year to satisfy the ACGME requirement. It's staffed mostly by NPs who see the patients and present to one of two attendings (most of whom are involved in our "periop medicine" fellowship). Except one of the "attendings" is a CRNA who has been at our institution for decades. So there are instances where you as the resident are presenting to this CRNA, who is then attesting your note. One can easily see a situation where you are questioned in court as to why a nurse was overseeing you, the physician.

All of this being said, I think you'd be insane to let any of this scare you away from our program. It's just the way things are going.

 

[Psai]

That's mostly how it is at my program. I think they need like 3 or 5 IJs or some nominal amount. I certainly don't feel threatened- like I said, it's more annoying than anything else. The entire department shares a lounge and we get along just fine. I was taking over a case from one of the more senior CRNAs the other day (a DIEP- kill me), and he was talking to me about how he doesn't understand all the fighting on the internet. Claimed he never wanted to take care of a sick person ever, and that almost every CRNA he knew felt the same way.

Want to hear something totally twisted though? We rotate through a pre-op clinic a few weeks a year to satisfy the ACGME requirement. It's staffed mostly by NPs who see the patients and present to one of two attendings (most of whom are involved in our "periop medicine" fellowship). Except one of the "attendings" is a CRNA who has been at our institution for decades. So there are instances where you as the resident are presenting to this CRNA, who is then attesting your note. One can easily see a situation where you are questioned in court as to why a nurse was overseeing you, the physician.

All of this being said, I think you'd be insane to let any of this scare you away from our program. It's just the way things are going.

Wait so not only do they take your lines, you're presenting to them? And then this nurse signs your note as an attending? hahahahahaha

 

[Nivens]

Wait so not only do they take your lines, you're presenting to them? And then this nurse signs your note as an attending? hahahahahaha

I just always make sure to present to the other attending that day, which is always an anesthesiologist.

To the OP, you need to find the best situation for YOU. People on this board will insist you have to martyr yourself to further a political agenda. This, I feel, is misguided advice. My program is a top 5 shop. If you get the opportunity to go to a great place, you go, regardless of petty crap like this. Now if you are fighting day-in, day-out for cases because of a major SRNA training program, that's a different story.

 

[Psai]

I'm sure your program is just fine but if your education is being negatively affected by people who are supposed to be there to support you, something is wrong. It's not about a political agenda, it's about being the best doctor you can be. Can you imagine if a surgery pa stepped in front of a general surgery resident to first assist? Or a cardiology np was reading the echos and doing the caths instead of the cardiology fellow? It's unthinkable in other fields and yet in anesthesiology seems to be more common than I thought. It's not petty at all. Just like MD students should be in front of midlevel students for everything, our residents should be in front of their students for everything.

The residents should be doing all the toughest cases, not waiting in line because a nursing student "asked first" (I know it was the other guy who said this). If there are left over cases with educational value but no residents to take them then maybe they can get a shot. Otherwise, physicians should be the priority no questions asked.

Supervised by a CRNA? Can you imagine a pulm/cc fellow being "supervised" by an icu midlevel? I can't.

 

[WholeLottaGame7]

I just always make sure to present to the other attending that day, which is always an anesthesiologist.

To the OP, you need to find the best situation for YOU. People on this board will insist you have to martyr yourself to further a political agenda. This, I feel, is misguided advice. My program is a top 5 shop. If you get the opportunity to go to a great place, you go, regardless of petty crap like this. Now if you are fighting day-in, day-out for cases because of a major SRNA training program, that's a different story.

It's good that y'all have a familial relationship at your place, but that is not the end-all be-all. I can tell you that there are a huge number of residencies where SRNAs will not take your lines, nor do you present to them in pre-op clinic.

The fact that you think stuff like this is "petty" just tells me that "they" have already gotten to you. You should be reading all of our reactions who are aghast and thinking, "hey, maybe this isn't so cool, after all..."

 

[Nivens]

Mispost

 

[2Fast2Des]

Lot of my co-residents don't seem to mind the working under/with crna's/Srna's, some even say that since they've been doing it a lot longer than us that we should accept our place... it's been like that for a while so we've accepted that this is how anesthesia is... Except for the few of us that just bite our tongues and bide the time until hopefully better pastures . .

 

[Nivens]

It's good that y'all have a familial relationship at your place, but that is not the end-all be-all. I can tell you that there are a huge number of residencies where SRNAs will not take your lines, nor do you present to them in pre-op clinic.

The fact that you think stuff like this is "petty" just tells me that "they" have already gotten to you. You should be reading all of our reactions who are aghast and thinking, "hey, maybe this isn't so cool, after all..."

I never said "petty", first of all.

Second, I truly don't believe my education is impacted at all because a CRNA does an occasional line, just like I don't think it's impacted if an intern does one in the ICU over me. The reason they have to be a "guest" for lines is that we don't allow them to do their own cardiac cases.

I can't really defend the pre-op clinic thing. It's odd, but I get around it by simply refusing to present to her. Hasn't been an issue.

I still think I attend an amazing program. I'll be set for life once I graduate. Sorry man, but if you're telling me I should let my ego drive me to a different residency, I'll pass. But to each their own.

 

[criticalelement]

I'll be set for life once I graduate..

LOL!!

 

[Nivens]

LOL!!

Oh good, you're here. I'm surprised it took you so long.

 

[WholeLottaGame7]

If you get the opportunity to go to a great place, you go, regardless of petty crap like this.

Sure you never said "petty"?

It's nothing personal, you go to the best place you get in, I get it. And your support for your program is admirable. But even you know it's f'd up. You already said you would protest if they came in to your room and tried to take your line. And that you never present to the CRNA in pre-op.

But not everyone is going to react that way. You're going to have residents who just go with the flow, and think that kind of s**t is normal. And then they turn in to attendings who tell their residents to let the SRNA just sneak in and take their line.

 

[Ronin786]

Some of the things in this thread are frightening. That's what ACGME surveys are for. Those things should be brought up and they will be changed.

 

[rakotomazoto]

If you choose to go to an institution that trains SRNA's, you can choose to swallow that pill however you like by telling yourself that they are happy in their place, but the reality is that many of them are eager to replace you and sincerely believe they are superior to physicians in every way. They don't know what they don't know and they are dangerous. Blurring lines and sharing cases and procedures is a slippery slope to be walking on and the presence of CRNA's and/or SRNA's is something to seriously consider in the context of the other strengths and weaknesses of a program. These types of issues were common at my medical school and I specifically wanted to minimize CRNA/SRNA drama so I ranked accordingly and avoided them like the plague.

It seems reckless to teach people to do a procedure when they don't understand when and why it is appropriate to place a central line. Just like intubating, you could train a monkey to do it through muscle memory and sheer repetition. Imagine what it will feel like when you walk into a CRNA room that you are supposed to be supervising where the carotid has been dilated or the patient has a pneumothorax and they didn't even mention that they were going to place a line because they already met their numbers as a SRNA and resent your mere presence. If they know how, they are going to try and do it.

 

[Psai]

If you choose to go to an institution that trains SRNA's, you can choose to swallow that pill however you like by telling yourself that they are happy in their place, but the reality is that many of them are eager to replace you and sincerely believe they are superior to physicians in every way. They don't know what they don't know and they are dangerous. Blurring lines and sharing cases and procedures is a slippery slope to be walking on and the presence of CRNA's and/or SRNA's is something to seriously consider in the context of the other strengths and weaknesses of a program. These types of issues were common at my medical school and I specifically wanted to minimize CRNA/SRNA drama so I ranked accordingly and avoided them like the plague.

It seems reckless to teach people to do a procedure when they don't understand when and why it is appropriate to place a central line. Just like intubating, you could train a monkey to do it through muscle memory and sheer repetition. Imagine what it will feel like when you walk into a CRNA room that you are supposed to be supervising where the carotid has been dilated or the patient has a pneumothorax and they didn't even mention that they were going to place a line because they already met their numbers as a SRNA and resent your mere presence. If they know how, they are going to try and do it.

Maybe you missed the part where they get 3-5 at this illustrious program, that's more than enough.

 

[Nivens]

Sure you never said "petty"?

Well would you look at that

I guess I feel as secure as I can in that there is more that separates me from a CRNA than the ability to do a central line.

Anyway, I think my position has been stated. See you all at the next episode of Outrage Porn.

 

[AdmiralChz]

Maybe you missed the part where they get 3-5 at this illustrious program, that's more than enough.

Top 5! Presenting to a supervising CRNA! Periop medicine fellowship!

Oy... well, the northeast personality doesn't exactly include humility I suppose.

 

[Nivens]

Top 5! Presenting to a supervising CRNA! Periop medicine fellowship!

Oy... well, the northeast personality doesn't exactly include humility I suppose.

Personal attacks on an anonymous board? Really?

 

[BLADEMDA]

Top 5! Presenting to a supervising CRNA! Periop medicine fellowship!

Oy... well, the northeast personality doesn't exactly include humility I suppose.

Chill out. Nivens does attend a top 5 program. The program he attends is in the top 5 of 99% of all those willing to rank programs. Like it or not, even the top programs may have issues with CRNAs/SRNAs over-stepping their bounds.

 

[POW16]

Is it Hopkins?

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[WholeLottaGame7]

Chill out. Nivens does attend a top 5 program. The program he attends is in the top 5 of 99% of all those willing to rank programs. Like it or not, even the top programs may have issues with CRNAs/SRNAs over-stepping their bounds.

It's almost worse that this is happening at a Top 5 program. I'm not a doom-and-gloomer by any stretch of the imagination, but it's stuff like this that at least lets me see their perspective.

 

[deleted171991]

It's almost worse that this is happening at a Top 5 program. I'm not a doom-and-gloomer by any stretch of the imagination, but it's stuff like this that at least lets me see their perspective.

This is the ASA perspective. Reminds me of when US computer programmers had to train their offshore replacements to get severance pay back in the early 2000's.

 

[pjl]

Maybe you missed the part where they get 3-5 at this illustrious program, that's more than enough.

At our program, where residents did well over 100 central lines, the SRNAs had to do them on cadavers to get their numbers. Apparently, that counted for them.
Unless they are working completely independently, there really is no reason a CRNA needs to know how to do a central line. Even if they are independent the surgeon can just do it anyways, and a surgeon that only chooses to work with CRNAs can put up with that small sacrifice.
Out in the real world, the number of central lines you do outside of the cardiac room is pretty low anyways.

Training programs with SRNAs dont have to decrease the level of education that residents get. In fact, doing supervision of SRNAs as a resident was a good way to practice your supervision skills with the one group of people in the department who were actually lower than you on the totem pole. It was better than "supervising" the CRNAs who had been there for 20 years that didnt care what you said.


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[Noyac]

I still think I attend an amazing program.

But you have no point of reference. It's the only program you really know. Until you get out into the real world and see that your program either set you up to be an equal with a nurse or it prepared you to be the best person in the OR. You are green and have a lot to learn.

 

[Noyac]

Lot of my co-residents don't seem to mind the working under/with crna's/Srna's, some even say that since they've been doing it a lot longer than us that we should accept our place... it's been like that for a while so we've accepted that this is how anesthesia is... Except for the few of us that just bite our tongues and bide the time until hopefully better pastures . .

This is a new level of low.

Back when I trained, yeah it was pretty long ago, we didn't have a srna program at my institution but we did have crna's. The residents would do their cases all day and on lecture days the crna's would relieve us. Crnas did the lesser cases and there were plenty of cases to go around. After lectures we would divy up the next days cases and do the pre-op's. The call people would return to the OR. I was a CA-1 and I ran into a crna at the end of the day. I told her," hey I did the pre-op on your first case tomorrow." She looked at me and clearly stated that she didn't accept pre-ops from residents. The next day she veered from my anesthetic plan and things didn't work out so well. She definitely had to eat crow. I don't know what ever happened to that bitch but I'm sure she is out there touting her expertise to anyone who will listen. From that point on she had to do her own pre-ops.

The point of my story is that they are a necessary evil. Your interaction with them must be professional but you don't need to be pushed aside for procedures or presenting to them. I can see presenting to a seasoned vet crna in the pre-op clinic as a CA-1 just to get ready for the "real" presentation to your "real" attending. But that's it. My program used the crnas appropriately, they freed us up for lectures and they covered the leftover workload. We never sat in a conference or lecture with them. They did cases. Period. We did share sleep rooms though but that's for a different forum.

 

[jonessoda1212]

Is it Hopkins?

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Sounds kinda like Duke.

 

[Pixiwoman]

It depends on how many there are and what cases they do. We have the occasional srna but they follow around the crnas- so no big deal we residents get all the big cases. I have a friend who said that the srnas were taking cranis from them, eff dat

That shouldn't happen, the cases should be for residents, MDs, our field is being harassed

 

[Man o War]

That's mostly how it is at my program. I think they need like 3 or 5 IJs or some nominal amount. I certainly don't feel threatened- like I said, it's more annoying than anything else. The entire department shares a lounge and we get along just fine. I was taking over a case from one of the more senior CRNAs the other day (a DIEP- kill me), and he was talking to me about how he doesn't understand all the fighting on the internet. Claimed he never wanted to take care of a sick person ever, and that almost every CRNA he knew felt the same way.

Want to hear something totally twisted though? We rotate through a pre-op clinic a few weeks a year to satisfy the ACGME requirement. It's staffed mostly by NPs who see the patients and present to one of two attendings (most of whom are involved in our "periop medicine" fellowship). Except one of the "attendings" is a CRNA who has been at our institution for decades. So there are instances where you as the resident are presenting to this CRNA, who is then attesting your note. One can easily see a situation where you are questioned in court as to why a nurse was overseeing you, the physician.

All of this being said, I think you'd be insane to let any of this scare you away from our program. It's just the way things are going.

@Nivens I know you're catching a lot of grief here, I'm not being a dick, but next time you see that CRNA ask him if he belongs to the AANA . If he does (a vast majority of them do), he's full of crap. The only reason that organization exists is to attempt to make anesthesiologists obsolete with a lesser trained and woefully unprepared substitute.

 

[WholeLottaGame7]

Sounds kinda like Duke.

Def not Duke. NYC or BOS program?