In my fall newsletter, I described our "21st Century Flexner Moment," in which artificial intelligence (AI) is forcing us to reimagine medical education by doubling down on uniquely human skills like complex decision-making, ethical reasoning, and empathetic communication. As AI masters data and pattern recognition, our core value will increasingly be found in our ability to lead, collaborate, and connect. But this raises a critical question: can we cultivate these essential human skills in clinical learning environments that are too often compromised by incivility and psychological distress?
While we champion better teamwork and communication, our workplaces are frequently fraught with behaviors that undermine them. Research demonstrates that healthcare teams exposed to just “mild rudeness” show significant declines in diagnostic performance, procedural skills, and team collaboration. A 2023 review by Lewis found that incivility is directly associated with increased stress, declines in team performance, compromised patient safety, and poor quality of care, with junior staff more affected (1). In simulated anesthesia crises, residents exposed to incivility performed dramatically worse on critical management steps, with only 64% of the "rude environment" group performing at expected levels compared to 91% of controls (2). Cooper et al. reported that patients of surgeons with higher numbers of unprofessional behavior reports faced a 14% increase in complications (3). In the ASA Monitor, Swerdlow and colleagues identify harassment, incivility, and disrespect as the primary drivers of burnout, with anesthesiologists reporting the highest intent to leave academic practice compared to other specialties (4).
We know what healthy culture looks like. A 2025 review by Rafi'i and colleagues identified six key themes predicting provider work satisfaction: continuous communication, supportive leadership, teamwork, employee involvement in decision-making, recognition, and autonomy (5). These are the same cultural elements that Braithwaite and colleagues found consistently associated with positive patient outcomes, including reduced mortality rates and increased patient satisfaction (6). Competency‑Based Medical Education (CBME) itself hinges on such an environment. It requires a culture that prioritizes growth, encourages vulnerability, and offers psychological safety (7). A culture of incivility directly contradicts the learning atmosphere needed for CBME to thrive.
While our first challenge is integrating AI as a collaborative tool, our second, equally critical challenge is redesigning clinical learning environments where human skills of leadership, empathy and teamwork can flourish. Cultivating civility demands more than teaching communication; it requires accountability, conflict‑management training, and leaders who champion psychological safety.
The Society for Education in Anesthesia recognizes this imperative. Our upcoming Spring Meeting, themed "Beyond the Anesthesia Machine: Finding Your Professional Purpose," directly addresses these challenges. The meeting tackles culture and well-being head-on with a keynote from Dr. Yue Yung Hu on "Wellness in Training and Beyond" and a fireside chat with former Surgeon General Dr. Jerome Adams on finding professional purpose. Practical workshops include: "From Surviving to Thriving: Coaching Skills for Professional Well-being and Purpose," "Finding the Right Words: Preparing Trainees for High-Stakes Conversations," "Integrating Trauma‑Informed Care into Anesthesiology Training," and "Beyond Balance: Work‑Life Integration." Each offers concrete strategies to nurture the six cultural themes that are essential for both clinician well‑being and patient outcomes.
In the era of AI, we must stop competing with machines on tasks they'll always do better and double down on what only humans can do: build trust, communicate with empathy, and create safe spaces where every team member can contribute. By fostering a culture of respect and support, we not only enhance well‑being and retention but also lay the groundwork for the next generation of compassionate, collaborative anesthesiologists.
I invite you to join us in St. Louis from April 24‑26, 2026, to shape that culture together. Together, we can build a future for anesthesia education where the human heart of medicine thrives alongside technological advancement, and where the culture we create is as safe and effective as the care we provide.
References:
- Lewis C. The impact of interprofessional incivility on medical performance, service and patient care: a systematic review. Future Healthcare J. 2023;10(1):69.
- Katz D, Blasius K, Isaak R, et al. Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Qual Saf. 2019 Sep;28(9):750.
- Cooper WO, Spain DA, Guillamondegui O, et al. Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients. JAMA Surg. 2019;154(9):828.
- Swerdlow B, Klopman MA, Mani JM. The relationship of harassment, incivility, and disrespect to burnout in anesthesiology. ASA Monitor. 2025;89(11):14.
- Rafi'i MR, Hanif SAM, Bin Daud F. Exploring the link between healthcare organizational culture and provider work satisfaction: a systematic review. BMC Health Serv Res. 2025;25(1):904.
- Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G. Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ Open. 2017;7(11):e017708.
- Lomis KD, Mejicano GC, Caverzagie KJ, et al. The critical role of infrastructure and organizational culture in implementing competency-based education and individualized pathways in undergraduate medical education. Med Teacher. 2021;43(sup2):S7.
