Sajedr Posted June 1, 2010 Share Posted June 1, 2010 I recently took a job in neurosurgery. While I'm not a new PA anymore, I'm new to surgery and haven't had any OR exposure since school. My surgeon's don't think I need a class, and are willing to teach what I need to know, but the Hospital has as a requirement of my priviledges that I need to take a 3 credit first assist class. Anyone know of a worthwhile class? There are some local community colleges with some courses, but none of which seem appropriate. Resources would be greatly appreciated! Link to comment Share on other sites More sharing options...
delco714 Posted June 1, 2010 Share Posted June 1, 2010 I can't help, but id like to say I am jealous ;) Link to comment Share on other sites More sharing options...
just_me Posted June 1, 2010 Share Posted June 1, 2010 http://www.caahep.org/Find-An-Accredited-Program/ you can find surgical first assist programs here Link to comment Share on other sites More sharing options...
andersenpa Posted June 1, 2010 Share Posted June 1, 2010 This is ridiculous. You are a trained PA and have first assist clinical education from school. PLUS, your surgeons are willing to teach you "their way". The first thing I would do is ask the surgeons to talk to credentialling and have this requirement WAIVED. And yes, they should have the power to make that happen. Link to comment Share on other sites More sharing options...
Contrarian Posted June 2, 2010 Share Posted June 2, 2010 This is ridiculous. You are a trained PA and have first assist clinical education from school... That's one dangerous assumption... Doing a surgical rotation and having "first assist clinical education" aren't necessarily the same things at MOST PA programs. Lots of PA students get to scrub in... then have the pleasure of being pimped while hypoxic, but DO NOT have any real "Surgical First Assist" training/skills. Since most preceptors for PA students are volunteers, its really rare that a volunteer physician and hospital and malpractice carrier is gonna jump through all of the hoops required to let a 1 month PA student, who likely has NO previous surgical experience, function at/on the level of a "first assist." Just thoughts... Contrarian Link to comment Share on other sites More sharing options...
andersenpa Posted June 2, 2010 Share Posted June 2, 2010 All PA education is standardized to the extent that it can be. You need to know how to scrub/gown/glove and not contaminate the sterile field. MOST surgical programs will have a new PA walk through this with "Nurse Ratchet, CNOR" to make sure they know the specifics of THEIR operating room. After the basics stated above, it is the discretion of the surgeon to determine how much training the PA needs-and then provide it or ship the PA elsewhere. A cred committee who knows not one thing about the PA is not in the position to make that determination. My humble surgical opinion, thanks for this interesting consult. Link to comment Share on other sites More sharing options...
Contrarian Posted June 2, 2010 Share Posted June 2, 2010 All PA education is standardized to the extent that it can be.You need to know how to scrub/gown/glove and not contaminate the sterile field. MOST surgical programs will have a new PA walk through this with "Nurse Ratchet, CNOR" to make sure they know the specifics of THEIR operating room. After the basics stated above, it is the discretion of the surgeon to determine how much training the PA needs-and then provide it or ship the PA elsewhere. A cred committee who knows not one thing about the PA is not in the position to make that determination. My humble surgical opinion, thanks for this interesting consult. For sure anytime... We are in agreement that it should be at the discretion of the Attending/SP... My ONLY contention was that a non-standardized surgical rotation with a volunteer Surgeon in PA school somehow equals Surg First Assist training. You know as well as I do that some PA students get to do all kinds of really cool stuff in the OR and some do not... it varies by surgeon, hospital, patient, location, etc. I was with a really cool surgeon during my 30 day Surg rotation. This guy was the Director of Surgery and we were in the OR standing over a patient at 0545 every M-T-W and in the office doing procedures by 1300 M-Th for 4 weeks. While I did learn a lot... it didn't qualify me to do your job... or even get me close to being a Surgical First Assistant. YEMV... Contrarian Link to comment Share on other sites More sharing options...
andersenpa Posted June 2, 2010 Share Posted June 2, 2010 Well, on that we agree. The difference (I think) is what we (people who have been around an OR) consider a FA- facile, multispecialty or extremely proficient in one area (neuro, ortho, cardiac), etc.....vs the introductory FA exposure PAs get in school. Sterile technique Suction Cut sutures keep your head out of the surgeon's way etc If you can handle these basics, you're good to go with your OJT in a surgical practice that known they're getting a clean slate. I still think it's bogus that they hired the OP and are making him take (?pay for) a class to the job he has already been hired for! Link to comment Share on other sites More sharing options...
jer_sd Posted June 2, 2010 Share Posted June 2, 2010 Rather than fight medical staff I would just suck it up and take a course. Finding a 3 credit course that might teach you something possibly usefull is better in my mind than making enemies in the medical staff office. www.nifa.com has suture workshops or even surgical assistant program. They use to have an agreement with community colleges for credits when I did the RNFA course years ago. The surgical assistant program is under 3k which should be covered or clsoe to covered by your CE reinbursement. A quick google seach for online courses also found many other options. http://www.lorainccc.edu has three courses you might be able to just take one. http://www.lorainccc.edu 5k price www.madisonville.kctcs.edu http://meridian-institute.com Jeremy Link to comment Share on other sites More sharing options...
andersenpa Posted June 2, 2010 Share Posted June 2, 2010 The OP's SURGEONS should be talking to med staff, not the OP who has no pull. Also, it is insulting to make this PA waste his entire first yr of CME funds on what the hospital/practice is going to teach him w/ OJT. The whole concept is demeaning to PA education. Link to comment Share on other sites More sharing options...
Contrarian Posted June 3, 2010 Share Posted June 3, 2010 it is insulting to make this PA waste his entire first yr of CME funds on what the hospital/practice is going to teach him w/ OJT. The whole concept is demeaning to PA education. Why is this insulting...??? He is a NEW GRAD who just passed a General Medicine exam (PANCE) after spending the last 2 yrs studying general medicine. I am of the opinion that the first 2 yrs CME allowance SHOULD be spent in its entirety on leaning as much as a new grad can about the new specialty they have entered... especially so if the new grad isn't going to a residency or into primary care. As a new grad who's first job was in a Cardiology Practice, I spent my entire first 2 yrs CME allowance on 40 hr American College of Cardiology Physician board review courses to help me get up to speed on my new specialty. This along with meeting my primary SP in the clinic at 7am every Thursday morning for an hour to discuss a chapter out of Mayo Clinic Cardiology Board Review until we finished that entire big a$$ed text. Also I'm confused as to ... Why is requiring a new grad to attend a specialty focused class "demeaning" but if this same student attends a residency its not...??? Personally, if I was to take a job in a specialty I have no experience in... say... Nephrology, I wouldn't have a problem being paid to sit in a dialysis class to get up to speed. I'd actually prefer to have a consistent structured curriculum as a base that my SP could build upon because I realize that even in the best of practices with the best of intentions, mentors get busy and things get missed/rushed. But hey that's just me... Contrarian Link to comment Share on other sites More sharing options...
andersenpa Posted June 3, 2010 Share Posted June 3, 2010 IF the goal is to learn neuro OR, he should be in a NEURO OR with his NEURO surgeons. Not a generic course on the basics of first assisting. Our CME funds AND allowed professional time off for those events is precious, an should be spent for maximum benefit. The reason it's not worth his time (IMO) is that it isn't specialty specific. Specific to surgical FA is a world of difference from neurosurgery training (which the OP can get OJT....get paid for it....not waste CME funds which he could use to attend the AANS conference......not waste CME time which he could use for neurosurg workshops....etc)......... A FA course is not a good use of time or resources for this new grad. Link to comment Share on other sites More sharing options...
Contrarian Posted June 3, 2010 Share Posted June 3, 2010 Hmmm... ok. I guess we will have to agree to disagree with your premise. The earlier stages of teaching technical skills should take place outside the operating room; practice is the rule until automaticity in basic skills is achieved. This mastery of basic skills allows trainees to focus on more complex issues, both technical and nontechnical, in the operating room. To return to the example of knot tying, the learner who still has to think about how to tie a square knot is much less likely to pick up on other teaching that transpires in the operating room than is the learner who has mastered this simple skill. Ericsson has helped to elucidate the acquisition of expertise.13,14 Expert performance represents the highest level of skill acquisition and the final result of a gradual improvement in performance through extended experience in a given domain. According to Ericsson, most professionals reach a stable, average level of performance and maintain this status for the rest of their careers. In surgery, "experts" have been defined by Ericsson as experienced surgeons with consistently better outcomes than nonexperts. An extensive literature on the relationship of operative volume to clinical outcomes supports the hypothesis that practice is an important determinant of outcome15; the literature also provides support for Ericsson's contention that many professionals probably do not attain true expertise. However, volume alone does not account for the skill level among practitioners, since variations in performance have been shown among surgeons with high and very high volumes. Deliberate practice is a critical process for the development of mastery or expertise. Ericsson argues that the number of hours spent in deliberate practice, rather than just hours spent in surgery, is an important determinant of the level of expertise.13 Deliberate practice calls for the individual to focus on a defined task, typically identified by a teacher, to improve particular aspects of performance; it involves repeated practice along with coaching and immediate feedback on performance. The attained level of expertise has been shown to be closely related to time devoted to deliberate practice in the performance of expert musicians, chess players, and athletes. In the current model of surgical training, based primarily on apprenticeship, the opportunities for deliberate practice are rare. Operations are complex, and it is difficult to focus on one small component of the procedure. In our opinion, in order to better plan instruction and assess the efficacy of curricular interventions, valid and reliable assessments of technical skills are needed. Evaluating performance in the operating room is difficult,16 and most efforts have focused on techniques that standardize the assessment process outside the operating room. One such method is the Objective Structured Assessment of Technical Skills (OSATS),17,18 in which candidates perform a series of standardized surgical tasks on inanimate models under the direct observation of an expert. Examiners score candidates using two methods. The first is a task-specific checklist consisting of 10 to 30 specific surgical maneuvers that have been deemed essential elements of the procedure. The NIFA course listed above by Jer_sd is basically OSATS... But hey... what do I know... I'm not a surgical PA. Just thoughts Contrarian Link to comment Share on other sites More sharing options...
Sajedr Posted June 6, 2010 Author Share Posted June 6, 2010 Hey everyone, thanks for the input. I have asked my surgeons to speak with the credentialling board and we will see what happens. Honestly, I wouldn't mind some more specific clinical training, but the courses I've seen locally are not structured in a way which make them reasonable to attend as I hold a full time position. Thus, the look for other options. I'll check out some of the above options if it looks like the requirement will not be waived. I have CME funds available, but I would be reluctant to spend them on a general first assist course, not specific to my specialty because I'm in dire need of CME that IS specialty specific. I'm not a new grad - 2 years family practice in a tribal clinic,and 2 years in a midsize ER. But, no specialty specific education- other than my outside reading etc. My assumption is that my practice will pay (not making me use my cme) but they are reluctant as it will take time and money that they feel could be better used in other ways while they train me themselves. My Surgical rotation was with Ortho, and I never technically first assisted with the exception of a few hand cases. I was more a second assist. I was in the OR 3-4 days a week, and saw lots, but again >4 years ago for one month. I'm fast on my feet, and am fitting in quickly, but have a long way to go. Also, my surgeon's were well aware that I was a "clean slate" as I addressed this in my interview and was told they prefer it this way, so that they can provide the training they feel is appropriate. They are all quite understanding in the OR and instructive (and occasionally I get the sighs, emphatic "NO!"'s or such when I make a mistake deserving of such) :) At any rate, I appreciate the discussion as well as the course options. Saje Link to comment Share on other sites More sharing options...
autumn_george Posted September 20, 2010 Share Posted September 20, 2010 To the OP Sajedr: I have accepted a job as a neuro surg PA too. I haven't started yet but I am a new grad and I have a couple weeks before I start. Any book you recommend and any you can't live without. I am terribly bored at home and would like to start brushing up and learning things since PA school doesn't go into depth here. I would love to take any info you're willing to give me :) Thanks Autumn Link to comment Share on other sites More sharing options...
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