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More Shadow Days
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Recently I have been very busy with the new students operating room rotations. We are now coming to the place I really look forward to in the development of the SRNA’s clinical skills and awareness. This new class has been in the OR’s now for a little over 6 months and are starting to really shine. Now is the time to back off as clinical instructors and let the little fledglings fly a bit and see what its like to take care of patients with less direction and more watchful care from the instructors. I have been really pleased to see how far the students have come in their skills and judgment of basic anesthesia care. My greatest pleasure now is in seeing the developing SRNA’s taking the reigns and allowing me to back off to more of a watchful position. Off course I am always there to rescue or to discuss different management systems for the cases we do. All in all I think that as instructors of clinical anesthesia we are very hands on. Now is the time to back off a bit.
The clinical days with the students amount to four days a week and my schedule lines up pretty well with theirs for the most part. I choose it this way. But I did have a Monday or two over the last couple of months where potential students have shown up for “Shadow Days”. These days are another of the great pleasures I have being associated with the Keck School of Medicine in the Anesthesia department. Mostly I just take care of the patients while the shadow person observes. We discuss the anesthesia care and the surgical cases. What I do is to lead the candidate into a discussion of what it takes to be a nurse anesthetist, the background and individual talent that is needed to succeed in any rigorous anesthesia program. We also discuss the various program options that are available now including the DNAP and the DNAP degrees that are just around the corner. More on that in another post to come.
After our day in the OR I always ask the participant to write back to thank the administration and to submit a little description of their experience in the operating room to me. This helps me get better at seeing what the candidate has identified as important to them and clues me into a better tailoring of the experience for those that are scheduled to come to the OR next. This has been a work in progress. Frankly, the Shadow Program has been extremely successful in introducing new candidates to USC and helping the faculty here to get to know the persons that are planning on applying to the program in the future. I think it saves a lot of time for the candidates preventing wasted effort for the potential students. By receiving a couple key clues they are able to better prepare, study and present their application in the best light.
What I tell the candidates is based on the individual but in general there are a couple of tips that any wise potential nurse anesthesia student will take to heart. I always recommend studying for the CCRN exam prior to application as this demonstrates a commitment to excellence and is a land mark indicator for a baseline degree of knowledge. The achievement of the CCRN certification is a laudable achievement and comes highly recommended. If a candidate goes through an application process and is not accepted for what ever reason one of the things that is told to that individual is that if they wish to apply again the CCRN certification will help them to be more successful with the next interview process. Enough said about the CCRN certification. You can check the requirements to sit for this exam with the American Association of Critical Care Nurses.
One of the other tips I give out is to get the book, “Watchful Care” by Marianne Bankert. This book chronicles the history and nurse anesthesia in America and is a great inspiration for nurses wanting to go into the field of anesthesia. This is important background information that is critical to know if you want to sound like a candidate that has done their homework and knows what they are getting into. Another book I highly recommend is Paul Marino’s great text, “The ICU Book“. I find that too many candidates coming in to either shadow or to interview do not have enough experience or the base knowledge that will ensure their success in a rigorous nurse anesthesia program. The information in Paul Marino’s book is fundamental prerequisite knowledge. There is just too much to learn about anesthesia while in graduate education to try and catch up with the basics that are contained in The ICU Book. A word to the wise should be sufficient! As a guide for studying for the CCRN exam, the Core Curriculum for critical care is highly recommended as well.
OK, enough for now. What follows are a couple notes form recent Shadow days.
New Students in the OR
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It is a new year and a new group of first year SRNA’s are starting in the OR. Now the “Art and Science” begins. The end of January starts the clinical rotations for the Students in “The Program”. After the first four months of didactic theory its hands on time now.
Its one thing to have a book understanding of concepts and basic science theory about anesthesia; it is another matter to deliver anesthesia care for a live breathing patient. I guess that is what makes what we do so much fun. The clinical rotations now are in addition to continued class room work. I want to discuss more about what its like to start clinical rotations but first.
Here is a little digression.
There are basically two types of Nurse Anesthesia programs out there. There are those that “Front Load” with all of the didactic and class room work up front and then put the clinical rotations at the end. These programs are usually longer because the clinical applications and specialty rotations take at least 18 months of solid work. Then there are programs that start some clinical rotations immediately combining class room study and clinical rotations. The USC approach is to give at least one semester of didactic then start the clinical rotations. What we have been doing for the past two years now is to expose the new students to the operating room environment through the use of “Shadow” experiences and now “Simulation” during the first semester to ease the transition to the Clinical sites. This seems to be working really well.
Simulation work is the frontier for learning new skills and crisis training. There are some programs that have really jumped on the Simulation Bandwagon. The University of Pittsburgh Nurse Anesthesia program has one of the largest Simulation Laboratories in the country. I was fortunate to visit their fabulous institution during my search for a program for myself. Pittsburgh or just plain “PIT” is an awesome program. Fortunately, we have one of the former clinical professors from Pit now as part of our department. One of his passions is to get the LAC + USC simulation room up and functional. We have all the equipment but the whole simulation package here is improving with Lou’s help. Last month we had an all day event with the first year students in the simulation room. We all learned a lot about what it takes to make it “real”. One of the “patients” died during the simulation. It was real “Art”.
Samuel Merritt University has a simulation center as well. A couple of our faculty here went up to visit their facility to see how they are progressing in their simulation work. You can read about Sam’s Health Science Simulation Center here. Samuel Merritt University is one of the great Nurse Anesthesia programs here in California. They are our San Francisco cousins, sort of.
First Year Nurse Anesthesia Students in the OR
Combining physiology and pharmacology in a hands on application is what the practice of anesthesia is all about. I have heard it said that anesthesia is an Art and a Science. For the first year student nurse anesthetists here at LAC + USC in their first clinical rotation it’s more like Effort and Guidance. The Art comes later maybe way later.
For me as a clinical instructor, watching the growth of the students over the first several months during their clinical trials is like watching your first born learn to crawl then stand. Crawl mostly, the standing is a little shaky right now. The first walking steps with minimal if any assistance will come later in the second year of clinical rotations, hopefully.
Airway management is on every one’s mind and developing the needed skills to maintain an airway is something that takes time effort and practice. Eventually the skills in assessment improve to the point where surprise is a rare occurrence. For the First Year SRNA’s, just Hand Mask Ventilation can be a challenge, depending on the patient. I think its important to note that the students are 
never left in a position where there is any risk to a patient. A fully trained licensed CRNA or anesthesiologist is with the patient at all times during the first year of nurse anesthesia training at our institution.
Here is a former USC student during anesthesia training. He was late to a very early mandatory student meeting. He was setting up his room when he should have been in conference. We work them hard.
After passing his board exams recently, Geoff is now part of the USC anesthesia team. We are glad to have him.
Nobel Peace Prize
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In an unexpected announcement this morning, sitting President Obama was elected the Nobel Peace Prize winner for 2009. Wow!
The New York Times Opinion section had a great statement today concerning this announcement,
“Mr. Obama has bolstered this country’s global standing by renouncing torture, this time with credibility; by pledging to close the prison camp at Guantánamo Bay, Cuba; by rejoining the effort to combat climate change and to rid the world of nuclear weapons; by recommitting himself to ending the Israeli-Palestinian conflict; and by offering to engage Iran while also insisting that it abandon its nuclear ambitions.”