As anesthesia providers, we operate in high-stress, high-stakes environments. But if we are being completely honest with ourselves, the hardest part of clinicals isn't always the physiology or the pharmacology. It's the culture. It's how we treat each other — specifically, how we treat our students.
The clinical crucible: surviving the "Type A" paradox
Think back to your time as an SRNA. The pressure to constantly prove yourself to your preceptors was immense. The unspoken rule in many clinical settings is that you have to prove you are "good enough" to be there, despite the fact that you are literally there to learn how to be good enough.
We are a profession of Type A personalities, and that often translates to preceptors demanding things be done in their exact, specific way. But step into any hospital with 20 or 30 different CRNAs, and you'll find 20 or 30 different "right" ways to do the exact same thing.
For a student just getting their bearings, this is incredibly confusing. They feel like a fish out of water, desperately trying to please the specific preceptor of the day rather than focusing on the actual principles of anesthesia. One day they are praised; the next day, doing the exact same thing for a different CRNA, they are reprimanded.
The cost of a hostile learning environment
When learning becomes a tense, high-stakes game of preceptor roulette, the environment becomes counterproductive.
I'll never forget catching one of my classmates in the parking lot, completely broken down and ready to quit the program. Not because the medicine was too hard, but because a preceptor had relentlessly picked on him, making his life miserable. He was at his breaking point. Thankfully, he didn't quit. He went on to become an excellent CRNA and has been practicing successfully for over ten years now.
How many brilliant, capable clinicians has our profession lost simply because someone decided to make them feel small?
The psychology of the "tough" preceptor
Why do some preceptors act this way? Over time, I've realized it rarely has anything to do with the student's actual performance.
Often, people bring their own personal insecurities — whether from home or from their own past traumas as a student — into the hospital. When a student is vulnerable, it becomes an easy outlet for a preceptor to project those insecurities. Once I realized this as a student, I stopped taking it personally. I actually started feeling sorry for the preceptors who felt the need to bring others down just to build themselves up.
But recognizing the psychology behind it doesn't excuse the behavior. It creates a toxic atmosphere that hinders learning and shatters confidence.
It doesn't stop in the OR
Unfortunately, this culture of tearing each other down isn't confined to the hospital walls. Take one look at some of the CRNA Facebook groups or online forums. A provider will ask a genuine clinical question, and instead of receiving peer support, they are jumped on, belittled, and made to feel stupid.
When did we stop treating each other with basic human dignity? When did we forget that every single one of us is on a continuous journey of growth and learning?
A call for a better clinical culture
When I became a CRNA and started precepting, I made a promise to myself to break this cycle. When a new student walks into my OR, the first thing I do is try to give them a sense of relief.
I tell them: "Listen, the first time you do this, you're going to be bad at it. I don't expect you to know it all. I expect you to make mistakes, and more importantly, I expect you to learn from them."
We need to stop using the OR as a place to "weed people out." The reality is, the rigor of the job and the demands of the program will naturally filter out those who don't want to put in the work. We don't need to be condescending or artificially harsh to achieve that.
Our job as preceptors is to build competent, confident colleagues. Let's make our clinical settings conducive to actual learning. Let's give our students the grace to make guided mistakes, the confidence to ask questions without fear of ridicule, and the support they need to become the next generation of exceptional CRNAs.
It starts with us. Let's do better.