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Peer Assistance

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Recently I have been in contact with Heather Wilson of Peer Assistance Fame, a National Speaker of Note and good friend. I asked her to send something for the web site and she chose to discuss a little Q and A. Here it is and if any one further questions about Peer Assistance please do not hesitate to call her or anyone involved.

Q: I am a CRNA in the CA BRN Diversion Program. My contract requires me to attend a variety of 12 step program meetings. I don’t feel like they are helping me because I don’t believe in God. In fact, this is exactly why I do not want to attend anymore.

A: You raise an interesting point, and you are certainly not alone. There are some key points to consider here. First, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) do not mandate anybody to believe in God. Twelve step programs also have 12 Traditions, necessary for the cohesiveness and effectiveness of the group.

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Resources For CRNA Board Prep

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For the senior class members that will be graduating soon, board preparation is on everyones mind or else it should be. I have been doing a little searching around the web for resources for the nurse anesthetist board candidate and found a couple of interesting web sites. Listing these sites does not confer endorsement by me or anyone here. However, I think that checking these things out could prove helpful to you. Not everyone learns, studies or needs the same things. These various resources offer a range of products and services that if they suit your style then will help you to reach your goal of getting that Pass letter in the mail.

The first place to start is to narrow down your reading material. The large text books like Barash and Miller are great for general study and case preparation during your clinical years. When it comes down to the wire and time is getting pinched look for other reading material to help you prepare for boards. I suggest a couple of books. The Basics of Anesthesia, 5th ed edited by Stoelting and Miller is a great start as well as Morgan and Mikhail. Anesthesia Reivew by Faust is really top notch as well as the question and answer books like Anesthesia Secrets. Two books that I feel really are essential are Anesthesia and Co-existing Diseases by Stoelting and Review of Medical Physiology by Ganong. What I suggest is to read these two texts again during the last 6 months of clinical rotations. There is an amazing amount of physiology on the board test as well as stuff found in the Co-existing book.

Other review material and courses are listed below that I have found.

Valley Anesthesia review is a long time standby for board prep offering both review courses and valuable study material. Highly recommended.

Core Concepts Anesthesia Review On line course. I just ran into these folks the other day and they seem legitimate. I poked around their web site and found some interesting stuff like the Question of the Day. Recommend checking their service out.

Prodigy Anesthesia Review is an interesting web site presence. Like the Core Concepts place, here you can find pracitce exams that look very close to the real thing. Check them out and let me know what you think.

CRNA Secrets is another one that I need info on. Please check it out and let me know what you think of this guy!

Good luck and keep me informed about your progress.

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Anesthesia Question Of The Day

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I just found a link to an on line review course that publishes on line an anesthesia Question Of The Day.  The course at Core Concepts Anesthesia Review is something that I am going to check out in the near future.


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Get To Work Old Man!

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David Avitar ArrowheadWell – it’s been several months now since passing boards and vacation time is over. Since November 1st 2006 the gainful employment thing has been happening in full stride. I could not be happier as a nurse anesthetist! All of the hard work and struggle is worth it more than double. There was a running joke about the last year of clinical rotations that goes something like this. “If you can make it through this gauntlet still standing you are a winner.” Let me explain.

Most graduate education is difficult. I should know, this last effort was a second post graduate degree. However, in nurse anesthesia education the stakes are higher and many people feel its their duty and privilege to make life difficult for the prospective candidate for the Certifying Nurse Anesthesia exam. The gauntlet that the student runs is like a small alley way lined on both sides with angry frustrated preceptors that are wielding long bamboo sticks. Any unworthy student trying to run down the alley is beaten from both sides as they try to make it through. You think I am kidding – well maybe the allusion is too graphic but the idea still holds. In the words of one old timer mentor, “Yup, we love to cull the herd!” So its taken me a little time to recuperate from the last two years of very hard work getting through clinical residency. All of the bruises are healed but the scares still remain.

Now I am one! One what you ask. Well now I am one of the mentors and the bamboo is put away.  You’re laughing I am hoping, yes? Actually I have been very fortunate and have been appointed to a faculty position at a leading Medical School that houses a nurse anesthesia program. Just little over six months ago I was a student and now I hold a faculty position with my own students to ed-u-ma-cate. I am humbled by the position I am in and having the time of my life. Love it! The perspective from the other side is of course different but I try to hold on to the kindness for others that suffering produces.

One of the questions that was asked of me during my interview process for the faculty position at the University of Southern California was how I would deal with a difficult student one who is not progressing or one that is not safe clinically. To be honest I do not feel that I am ready to deal with this case scenario and told them so. I can handle the new student and the ones that are a quick study. Maybe next year I will have a bit more experience to handle the difficult student. Just as an aside I do have many years of as a preceptor in another capacity so teaching and mentoring is not new for me.

So whats it like to be in practice now as a nurse anesthetist. Wonderful – I love my job and what I do. In our practice setting we work in a team collaborative practice with anesthesiology. The joint practice is great when the Staff are good. Every day is another learning experience which I can talk about in the future. For now I just wanted to touch bases with you and let you know that the web site is still going strong. I will be recruiting new writers in the months to come and adding links that should prove helpful to the prospective CRNA or clinical resource for the practicing nurse anesthetist.

Your feedback is always encouraged so let me know what your ideas or concerns are. Thanks for reading.

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Passed Board Exam!

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Well its official. I passed boards. The notice of board results can be seen at the AANA web site under Certification Verification. After taking that crazy board exam I was perplexed as to how I actually did on the exam so its been a long ten days checking for results each morning at the AANA web site. We are precluded from discussing the exam itself but I can tell you that the board exam from the CCNA is very probing and examines your knowledge and understanding of physiology and the anesthetic implications at very sophisticated levels. My exam shut off at 90 questions. From what I have heard from other people this is either very good or very bad. The board exam is a test that learns from your answers what questions to give you tailoring each test individually selecting questions out of the very large pool. Each test is different if I understand this correctly. This has been a long and difficult road climbing this mountain but the view from the other side is terrific. Just take a look at the view.

Currently Jennifer and I are in Shanghai visiting her parents for the Chinese Moon Festival. Each morning I would get up first thing and turn the computer on and go to the AANA web site looking for the board exam results. I know that sounds nuts but I just could not wait for the mail and the end of our trip overseas to find out the results of the board exam.

So what can I now recommend as study preparation for the board exams you ask. First I would not put off any review for the board exam but to study daily the entire time while doing clinical rotations. A through review of medical physiology is a must. My choice is the LANGE publication by Ganong, “Review of Medical Physiology” as a must read. This is not a large text but dense and will require several months of careful reading and rereading to gather the appropriate understanding of the specific anatomy and physiology that is required knowledge to do well on the nurse anesthesia board exam. Maybe I could give you a general example of how specific the board exam is.

One of the favorite subjects on the board exam has been the endocrine system and the interactions with anesthesia. The pituitary glad as you may recall is located in the Sella Tursica, a cave like bony structure and is histologically divided into three sections. In humans the intermediate lobe section is underdeveloped and rudimentary. The posterior pitutiary or neurohypophysis is the site of excretion of ADH (vasopressin) and oxytocin which are structurally similar. It is interesting to note that oxytocin has antidiuretic qualities because of the structural similarity of these two hormones. I digress. The point I am getting to is that the source of the posterior pituitary hormones in from higher structures in the hypothalamus, specifically the supraoptic and paraventricular nuclei. Nerve axons project from these structures and descend out of the “Blood brain barrier” down to the posterior pituitary where they are released when physiologically stimulated. A full review of this and all of the physiology surrounding these structures and the actions of all of the hormones along with the anesthesia implications is highly suggested. Ganong’s Review of Medical Physiology and the Anesthesia and Co-existing Disease book by Stoelting are both highly recommended.

Brother, that was a mouth full. So which part of this do you need to know to pass boards? I am afraid that this is just a small example of the detail between structure and function that is requried. Its been overwhelming and the more that I study the more I realize that I know very little.

Good luck to all that are preparing for the board exam and don’t forget the small details. I guess it would be correct to say that knowledge at a superficial level will leave you really perplexed when you take boards while knowing the fine details will help you navigate your way through the questions. Again good luck.

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CCNA Board Exam Prep

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“OH NO MR. BILL the CCNA exam is coming in a few days and even after years of study and preparation I do not feel ready”, the little voice whispers in the back of my head. What to do about those voices.

Just as all others that have come before and for those that follow there no way around this mountain except to climb each day a little further. I have kept a picture of K2 on my wall for many years and I keep whispering to myself that one day I will be over the crest. That day is so soon approaching that it is almost too much to comprehend.
Here is a plan for CCRN board exam preparation that I have used:

Attend a Review Course. I did the Valley Anesthesia Review, there are others?
Select a few concise books for reference.

  • Morgan and Mikhail Clinical Anesthesiology
  • Barash Handbook
  • Sota Omoigui’s Drug Handbook.
  • Valley Review Course material. The Sweat Book, the Memory Master and the Mixed Reviews.
  • Anesthesiology Review by Ronald Faust

I have read through the Sweat Book twice and the Memory Master a couple of times and The Mixed Reviews from Valley anesthesia I keep with me all the time. I read through these frequently.

The Faust Anesthesiology Review is a great one to look stuff up quickly for refresher. These past three weeks since graduation I have spent 6 to 10 hours a day reading and reviewing questions and looking stuff up quickly that I needed clarification on. I feel that I am ready for the exams but still have so much to learn. I just found out about another on-line review that could be helpful. It is called Prodigy Anesthesia. This is an on-line review and workbook type thing. I checked it out and it seems very good. Highly recommended for someone that has more than a couple of days before the scheduled exam. Another board prep on line I found is CRNA Secrets. If you do check it out let us know if it helped or not with boards.
Thanks to everyone for the well wishes. Our class will get together for a big party once these exams are over so every one will know about our success.

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The University of Southern California program of nurse anesthetist awarded Bob Naruse, M.D. the faculty award this year. Dr. Naruse is staff anesthesiologist at Cedars Sinai Hospital where many of us do our neuro rotations. It is here that I met Dr. Bob and became acquainted with the low opioid techniques for craniotomy surgery that are routinely used there. Today several of our classmates were able to present the award to him in person. Unfortunately I was not able to attend but sent my best wishes and called him on the phone as a follow up.

Our lives have been enriched by his mentorship and example of excellence in patient centered anesthesia care. Thank you Dr. Bob Naruse and we will all make you proud. What follows is a letter I received from him after today’s presentation.

Dear ‘SC Class of 2006,I must admit that I am truly touched by your award. Working with such a distinguished group of anesthetists made my job easy and fun. I can’t remember a class that I’ve enjoyed more than yours. I know that each of you will be outstanding anesthetists for years to come and I want to congratulate each of you for the great achievement of completing graduate school. I am proud of you.

Please pass along your knowlege, especially that which is not in the textbooks. I know that eventually your colleagues will be impressed with your airway management skills as am I. We owe it to our patients to provide the best care possible.

Take care and best wishes in the future. Fight On!!!

Yours truly,
Bob Naruse
Da cedarsgasman

So there you have it. This week many of us are studying for CCNA board exams. My test date is the 20th of this month. Pressure, a little, confidence, a lot. I will let you all know how our class does.

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Graduation At Last

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The Keck School of Medicine program of Nurse Anesthesia has graduated the class of 2006 this past Saturday. I am so proud to be a part of this class of winners and overcomes. We have all struggled with difficulties to one degree or another but this past Saturday we all stand together as graduates. What a blast that is!
The program for the graduating class took place at the Town and Gown on the University of Southern California main campus in East Lost Angeles. We were privileged to have Elizabeth Visco from the University of Washington as our Key Note speaker. Her credentials are too long to discuss. She was wonderful.

Awards to faculty went to Robert Naruse, M.D. as faculty of the year and Tracy Valdez, CRNA as clinical instructor of the year. Dana Grogan received a well-deserved recognition for her didactic instruction. Lifetime achievement awards from the Nurse Anesthesia program at the University of Southern California were awarded to Janette Peter and Dr. Vladimir Zelman. Student awards went to Robert Olson for Leadership as well as the Agatha Hodgins award while the other leadership award went to Karyn Embrey and the scholarship recognition went to David Godden.

After the festivities at the Town and Gown we all went our separate ways to celebrate with family and friends. Douglas Brannan and his family and I spent the evening together with our families at a little Greek restraraunt in Manhattan Beach. Douglas has been a great friend and fellow traveler on this road with me.

To view all of the pictures you can go to the flickr web site here. Follow along with me on this journey to see how this graduating class of 2006 soldiers on.

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Last Clinical Day

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Its all finished folks. After two years and a lot of hard work the class of 2006 from the Keck School of Medicine department of Anesthesia has graduated the next group of nurse anesthetists. The University of Southern California program for nurse anesthetists has been terrific but I am so glad to be finally finished with this step in education.

After this weekend I will buckle down to several weeks of intensive study for board examinations. Following this Jennifer and I will take some time for ourselves before I start work November 1st. Isn’t life great!

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Out with the old and In with the new

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This Saturday evening Douglas and I had an early dinner together at the famous Irish Pub in Pasadena, Lucky Baldwins. We are winding down now from our clinical rotations with only eight days left to go before our graduation celebration September the 2nd. The University of Southern California program of Nurse Anesthesia has been a wonderfully difficult experience. The graduating class of 2006 is just about finished with course work and will be stretching our wings shortly. Pictures of the class can be perused at flickr.

Friends of Douglas joined us at Lucky Baldwins. What made this interesting is that Sonny and Dianne will be starting “The Program” this coming Monday and are part of the Class of 2008 program of nurse anesthesia at USC. During our early dinner at the Irish Pub we discussed and rehashed the trials and tribulations of being an anesthesia resident. All of the usual subjects came up that new students have. Its great now to be on the other side of this mountain. Douglas and the girls went off for an evening of “Pub Hopping” while I happily traveled home to be there when Jennifer came home from a long day at work.

Douglas and I have been having our study sessions and dinner now on Saturday evenings for the past several months now but I always make sure that I am home to greet wifey when she arrives home from work. This past evening we finally got around to talking about future work related things. No matter where we both end up we agreed to continue to meet regularly for bicycle riding and “Pub Hopping”. Next year Douglas his mother and I are planning on riding the RAGBRAI. For those that do not know, this is one of the oldest sponsored group rides in America. The ride across Iowa will be its 35 next year and I am looking forward to this get away 7 day trip. Douglas and I have planned this now for the past year and come next July we will be flying across those rolling Iowa hills. More to follow on this one.

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