A Double Edged Sword: How Technology is Shaping Anesthesiology Residency

Anesthesiology has evolved significantly since the days of chloroform induction and the copper kettle. Technological advancements have given us the ability to gather real time intraoperative data to provide personalized, safe and effective medical care. The emergence of the electronic medical record (EMR), paging systems, and ultrasound particularly affect anesthesiology trainees given frequent use of these technologies to provide anesthetic care and I want to spend some time reflecting on the implications for the modern trainee. While beneficial in many regards, the hardware and software technology we rely upon to provide anesthesia daily is not without fault, and has subtle negative consequences that are often overlooked or hard to appreciate.

The EMR and web based, two-way paging systems have exponentially improved medical care. A modern EMR allows for seamless, concise, and efficient record keeping. It also facilitates sharing of information about patient care across specialties and disciplines. Also, providers can easily evaluate prior anesthetics and anticipate potential complications in upcoming surgeries without needing to visit medical records to pull paper charts. Paging systems accelerate communication between trainees and members of the care team such as attending physicians, nurses, and pharmacists. Attending physicians are more rapidly notified of intraoperative events due to the use of EMR and paging systems as well.

A Discussion of Evolving Modalities in Medical Education for Anesthesiology Residents

Rahul Kukreja

Jeremy Tang M.D.

Benjamin Landgraf M.D.

Alopi Patel M.D.

The field of education in anesthesiology has undergone significant changes in recent years. Anesthesiology trainees now engage in many different learning styles and use a multitude of educational resources. Understanding and incorporating these various learning modalities is important not only for effective residency training but also for improving patient outcomes, quality of care, and clinical revenue.^1,2

Welcome to another addition of the SEA newsletter!

It’s been a wildly productive year from SEA on many fronts. While all committees have been amazing, I’ll hit just a few highlights here and invite you to peruse the newsletter.

First a shoutout to Bryan Mahoney and Dave Stahl, the masterminds behind the PD’s at SEA podcast. This series has been tackling several key issues in our specialty with intelligence, wit, and humor. I strongly suggest that you check it out if you have not yet.

Sukhman Shergill, MD

In the realm of medicine, I see a myriad of heroes don invisible capes as they strive relentlessly to improve lives. Their stories of compassion, humility and resilience stirred me as I took a front row seat to these chronicles during medical school in India and residency training in the United States. They inspired me to be part of something greater, a purpose that transcended hospital walls and touched lives far and wide. When the opportunity of the SEA-HVO global health traveling fellowship presented itself, I felt that perhaps this could be what I had been looking for. With anticipation and excitement, I prepared for the journey. However, a lingering question remained in the back of my mind – how much of a difference could one person really make?

My adventure was off to a rocky start. While navigating through connecting airports in Vietnam, I almost lost my luggage due to a miscommunication. Thankfully, I avoided having to repeat outfits through the skills learned in residency, of keeping calm while my brain was flooded with adrenaline, helped along by the immense kindness of strangers in this new land. Exhausted yet brimming with enthusiasm, I finally reached my destination, ready to wholeheartedly embrace whatever adventures the next four weeks had in store.

Natalie Koons, DO

Rachel Moquin, EdD

This infographic was creating using survey data gathered from medical students, recently matched residents, and anesthesiology program leadership regarding advisement on the use of signaling in the Match. We hope that it inspires improved communication and transparency in the anesthesiology application cycle.

Dr. Koons is a current PGY1 anesthesiology resident at Stanford's Department of Anesthesiology, Perioperative and Pain Medicine and Dr. Moquin is currently an Assistant Professor and Director of Learning and Development at the Department of Anesthesiology, Washington University School of Medicine in St. Louis.

Dr. Monica Arndt

Review submitted by Dr. Monica Arndt, PGY4 resident in the Department of Anesthesiology at Yale School of Medicine

With the proposition of ‘what we should know about the people we don’t know’, Malcolm Gladwell invites us to approach strangers with humility and caution on his best seller “Talking to Strangers”.

Coach Training for Leaders and Educators in HealthCare (CFLinHC): Coming to the SEA in January 2024.

Karen Souter, MBBS, FRCA, MACM

Flying back to the West coast in March 2018 I noticed the man in the window seat gazing out of the window for a very long time. Eventually he turned to me and said, “what a day, huh?!” I smiled and nodded and asked, “what do you do?”. He said uneasily I’m the CEO of a company that builds automatic software for vehicles. I nodded again a little more knowingly – this week a bad accident had occurred involving a self-drive car. He asked me “what do you do?”. “I’m an executive coach” I said simply. He rolled his eyes and said rather loudly “Coaches, coaches, coaches. Everyone’s a coach these days!”. For a moment I thought about defending the honor of coaches and coaching leaders everywhere and then I decided to behave like a coach. “I know there are more of us around than there used to be... Are you headed home?”. He nodded.
“What are you heading into?
My team is freaked out” he said, quietly.

“(The)pristine path (to publication) does not usually exist in the real world of assembling a journal. It is strewn with boulders and potholes called politics, ethics, conflict of interest, tardy review, and, worse, incompetent review.”
-Stuart J. Salasche, MD
Editorial in Dermatologic Surgery

Becoming a peer reviewer is an important role taken on by a scientific professional. Peer review allows for the creation of new knowledge and its dissemination to the wider academic and research communities through publication. This contribution by the scientist is a critical component of the overall publication process and confers added value to a submitted paper. Because academic careers depend on being published in high-quality journals, peer review is both a privilege as well as a great responsibility. The diligent peer reviewer must function as both an “Author Advocate” as well as a “Journal Advocate.”

We are pleased to report the Society for Education in Anesthesia (SEA) Spring Meeting was both well attended and successful, despite unintentionally running concurrently with the 2023 AUA/IARS/SOCCA meetings. There was considerable positive feedback about the meeting location and hotel chosen, most notably that all sessions were held on the same floor thus encouraging mingling among attendees. Thank you to the SEA Meeting Planning Committee for this fantastic hotel choice.

The theme “Going Up! Making Your Case and Supporting Colleagues Through Promotion” was chosen to target younger members and increase involvement within the society, with the thought that senior department leadership may be attending AUA/IARS/SOCCA, and this would ensure meeting success. Our goal was to support educators within the field of anesthesiology in documenting and showing off their successes, as well ask making promotion to associate or full professor achievable by all members.

Let’s keep this short & sweet! We want to provide SEA members with quarterly newsletters that contain educational, inspiring, and interesting pieces. If you have an idea for a submission, or an author, and want to share, please email [email protected]. Feedback is always appreciated. We will continue to issue longer summer and winter editions, and shorter fall/spring pre-meeting editions. Thank you in advance for your attention. Enjoy!

-Michael Majewski, MD
Chair, Publications Committee

Our Iceberg is Melting: Changing and Succeeding Under Any Conditions
John Kotter

Review by Nicholas Cormier, MD, Current CA3 and Chief Resident, Yale Anesthesiology

Growth and Renewal in 2023

As SEA President, I am grateful for the opportunity to share stories of our Societies growth and renewal that is underway in 2023.

The first half of 2023 has been tumultuous but leaves me filled with optimism for the future. On a personal note, I limped away from a serious car accident in at the end of January but was lucky enough to make a full recovery. Much like the pandemic itself, it left me battered, but not broken. I emerged more grateful and committed than ever to wellbeing, both for myself and our organization. I look around each day and see so much to be thankful for that I am determined to share my good fortune with others, starting here in SEA. Should you need any support, professional or personal, please do not hesitate to reach out to me. Please indulge me now in some “greatest hits” and “coming attractions” that perhaps presage other articles but are meant to augment their impact and celebrate our successes and goals.

The Society for Education in Anesthesia (SEA) Fall Meeting was a great success. With very few open seats at the start, this was the first in-person fall conference since the COVID-19 pandemic and was also paired with the SAAAPM meeting. The theme was “Professional Identity Formation”, a topic that encompasses many of the most urgent issues in anesthesia education today. Conceptually we chose to approach professional identity formation in a two-fold manner. On one hand, your professional identity is, of course, shaped by your personal background and experience, while on the other, our collective identity as a profession is molded by the environment to which we are exposed which is in turn influenced by political, social, and economic (not to mention technological) factors impacting medicine in general and anesthesiology in particular.

The meeting opened with an incredible McLeskey lecture featuring Dr. Jo Shapiro, Associate Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, Principal Faculty for the Center for Medical Simulation in Boston, and a consultant for the Massachusetts General Hospital Department of Anesthesia, Pain, and Critical Care. Her talk, “Fostering Psychological Safety: A Key Driver of Patient Safety and Physician Wellbeing,” inspired our attendees through her personal and profound take on fostering an environment in which we can maintain and elevate our profession for the betterment of both patients and practitioners.

As 2022 draws to a close and I am charged with writing my first President's message for the SEA. At this time of year, I find it best to express gratitude, do a bit of reflection, and set some resolutions for the new year.

First, I want to thank all our members, both new and established, for helping to keep this society vital, inclusive, and welcoming through the long first act of COVID. We came to together to utilize all our creativity and skill to exchange ideas during one of the darkest times in modern history. Dr. Stephanie Jones deserves special recognition for her stalwart leadership and resolute commitment to our core values. Members of the board and committee leaders and active members all played critical roles in keeping our organization going strong through this difficult period. While we still live under the shadow of this pandemic, we have entered a new phase that allows us to travel and meet again and I am truly grateful for that. The supportive energy that we transfer to each other is unmatched and priceless.

 “FROM THERE TO HERE”
MEMBERS INTERVIEW IN THE SEA
Dr. Karen Souter, Previous SEA President 

What made you join SEA?

OXYGEN by Carol Cassella

As we move from the short days of winter to the longer and warmer days of summer, it also seems that time has expanded and this may be the perfect time to check out some good fiction. The book is written by a physician and the plot is something to which we can all relate. The story is set in Seattle and follows the emotional roller-coaster of an anesthesiologist who loses a young ‘special needs’ patient to an intraoperative catastrophe. The author narrates in great detail the legal and emotional issues associated with the death of a patient. Dr Marie Heaton, the protagonist, who is at the top of her game as an anesthesiologist, a brilliant and caring physician, is forced to take a look at her own insecurities as a physician. Something goes terribly wrong during a routine pediatric case and forces her to re-evaluate her life, her truths, her friends, family and her world. The story gives the reader an understanding of the conflict she feels between empathizing with the mother of the patient while at the same time coming to terms with what this incident means to her career as a physician. 

1. When and why did you join SEA?
It’s been longer than I’d care to admit. Over ten years now. I have always been interested in teaching skills to small groups or individuals, not so much in the lecturing part. A mentor of mine sent me a note informing me about the Seattle meeting in 2009 and suggested I should attend. I had been a member of SEAUK before I moved across the Atlantic to Colorado.

2. What skills do you have that you use to contribute to this organization?
Skills…hmm. I get things done. Is that a skill or a superpower?

Throughout 2022 we will be celebrating the fifth anniversary of when The Journal of Education in Perioperative Medicine (JEPM) became archived on PubMed Central (PMC). This could not have happened without the support of you, the SEA members, and we want to celebrate this landmark achievement with you the entire year. Landing on PMC was significant for the Journal in so many ways. For starters, the recognition of the Journals new status began a growth trajectory of manuscript submissions that has surpassed one hundred manuscripts in 2021. That’s up from fewer than ten in 2015! Our published articles get significant viewing. One of our most popular published articles is “How to Write Well-Defined Learning Objectives,” by SEA member Debnath Chatterjee, MD & Janet Corral, PhD. This piece has had over 32,000 total requests including more than 2,700 full-PDF downloads; it has also been cited in twelve other peer-reviewed articles including five in 2021 alone! None of this growth would have been possible without our incredibly talented and hard-working team of associate editors including Phillip S. Adams, DO; Eric Heinz, MD, PhD; Ryan Keneally, MD; Timothy Long, MD; Susan M. Martinelli, MD; Annette Mizuguchi, MD, PhD, MMSc, FASE; Deborah A. Schwengel, MD, MEHP; Jed Wolpaw, MD, MEd; & Lara Zisblatt, EdD, MA, PMME. On the administrative side, we owe a great debt of gratitude to Megan Sage, our coordinator in the SEA office, and Heather Chaney, our new Managing Editor with Allen Press.

So what can you do to join the celebration of the anniversary? First, we are always looking for talented reviewers. Giving your time and talents as a peer-reviewer is a tremendous service to the society, the Journal, and of course, our specialty. Second, you can submit your high-quality education manuscripts to the Journal. Many are published, but if not, our talented reviewers and associate editors will provide you with thoughtful feedback that you can incorporate when you resubmit elsewhere. Your education research manuscript will have been reviewed by some of the most talented minds in the business, setting them up for success down the road. Last, you can celebrate with us by attending the SEA spring and fall meetings. The Journal will be featured in a number of venues at each of our meetings including a reappearance of our “reviewing workshop”, which was so well received in the past.