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.

Enjoy!

Well – 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 NurseAnesthetist.org 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.

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.

“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.

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.