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 2023As 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.
Every once in a way you come across a book that has so much heart that it takes you by surprise. Dr. Wesley Ely’s book Every Deep Drawn Breath is one such book. As we struggle to come to terms with the aftermath of COVID both for our patients and for us as medical professionals, the book serves as a testament to the power of medicine to unearth truths regarding health and disease.
What if the very medications and technology that were helping to keep patients alive in the ICU also rob them of the essence of who they were? The author, Dr Wesley Ely, is an internist, pulmonologist, and critical care physician at Vanderbilt University Medical Center. He describes his journey as an intensivist who started off with the very best of intentions and whose observations of the effect of ICU stay on his patients made him question the protocols of modern medicine. The very real struggles of patients after they are discharged from the intensive care unit are painstakingly described and the reader can identify with the existential crisis that patients face when they can no longer live a meaningful life due to the effects of prolonged intubation and ventilation on the brain and other organs. Relating human stories, Dr. Ely outlines the Post Intensive Care Syndrome (PICS) that affects ICU patients, often the result of the treatment they receive to keep them intubated and sedated. The reader is brought along as a spectator through Dr. Ely’s professional and personal journey as he struggles to understand and provide comfort to his patients grappling with an unknown disease. Many face skepticism regarding their symptoms and stories. The book underscores the importance of believing the patient when we cannot understand what they are going through.
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.
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Applications for the 2023 Society for Education in Anesthesia (SEA) – Health Volunteers Overseas (HVO) Traveling Fellowship are being accepted as of November 15, 2022. All applications must be received by close of business on February 13, 2023.
2022 SEA Spring Meeting Highlight
After two years of COVID-hiatus, we were finally able to meet like-minded colleagues at the SEA Spring Meeting. The 2022 Spring meeting was successfully held between April 8-10, 2022, in Pittsburgh, attracting 180+ registrants. The meeting Co-Chairs were Dr. Viji Kurup (Yale), Dr. Susan Martinelli (UNC), and Dr. Phillip Adams (UPMC). Dr. Adams also served as the chair of the extremely well-organized social program.
“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.
It was an honor to host SEA’s 2021 Fall Meeting on Advocacy in Education and Academic Departments. This meeting has taken on several different forms over the past two years and endured the challenges of the pandemic. I hope you all enjoyed and benefited from our excellent speakers and workshop presentation.
Dr. Alan Schwartz opened the meeting with the McLeskey lecture and gave us a broad overview of the Politics of Medical Education. Who are the key players? How are scarce resources managed? What are the political interest of each stake holder? How do we apply this in our everyday interactions within our residency? Dr. Schwartz is an incredibly engaging and innovated educator, and we are grateful to have had him as our keynote speaker.
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.
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?
Thrive: Ariana Huffington
This year has been unlike any other! For those of us working in healthcare the stress from the job as well as keeping ourselves and our families safe has led to unprecedented levels of burnout. It also led many of us to re-examine our lives to define what is meaningful and what is not. This book by Ariana Huffington offers insights that could help us on this journey.
I think we all like to believe that anesthesiology training has changed by leaps and bounds over the last decades, but truthfully the essential core of our educational paradigm remains the same – the apprenticeship model. Yes, anesthesiology residents spend time learning about quality improvement, doing research, and treating rare complications in high fidelity simulators. But add up all the hours and days of a typical anesthesiology residency and the bulk of that time will be spent with a patient and the attending guiding their care. This relationship creates an environment where the influence of the attending physician can be of outsized importance. And this is true not just with respect to the development of clinical competence but also the modeling of professionalism and communication skills.
One of my favorite people to follow on social media is an ophthalmologist/comedian, Dr. Glaucomflecken. His TikTok videos expertly poke fun at a variety of medical specialty stereotypes, and anesthesiology is no exception. While exaggerated, most stereotypes have a kernel of truth. In Glaucomflecken’s world, the shower-capped anesthesiologist frequently hides behind the blue drapes and avoids meaningful conversation with the surgical team. A recent editorial published in Anesthesiology, “The Accreditation Council for Graduate Medical Education [ACGME] Special Report on Clinical Learners in Procedural Environments: Several Elephants in a Very Small Room,”1 sums up the not-so-funny reality: “Why are trainees communicatively inept? Because their teachers are. They are just mimicking what they see…. Anesthesiology, nursing, and surgery remain siloed communities…frighteningly so!” The potential impact of improved communication on patient safety and outcomes is regarded as self-evident. Closed loop communication, effective handoffs during transitions of care, and creating shared mental models can only serve to improve clinical care.
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Viji Kurup MD
Professor
Vice Chair for Medical Education Yale University
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When Breath Becomes Air: Paul Kalanithi
I came upon Paul Kalanithi’s When Breath Becomes Air through a community read program organized by Yale University. The title intrigued me, and I picked up the book. I was stunned by the sheer honesty and raw emotion that the author poured into this book. Kalanithi’s reflection on death and dying and his re-evaluation of life resonated in this year of the pandemic when we have done the same.
Kalanithi was a neurosurgeon who trained at Yale and Stanford. In the last year of neurosurgical residency, he was forced to confront a devastating diagnosis of lung cancer. Through his writing, we accompany him on that journey as we see through his eyes and bear witness to his inner turmoil when the doctor becomes a patient. In a culture that talks about death and dying in hushed tones, Kalanithi’s willingness to let the reader into his life and his mind is a gift that must be received with gravity. It highlights to the readers both the mortality of the subject as well as the immortality of his work.
The struggle that the author experiences when moving between the roles of doctor and patient is relatable. His story is similar to countless other medical professionals who ignore small signs and symptoms and chalk it up to fatigue. We put off medical visits for when we have more time. It was only when he could ignore his symptoms no longer that he went to seek medical help and found himself in a position that he had not expected. He moves between the point of views of the patient and doctor fluidly taking the reader with him. He talks about dealing with loss of control of your life when faced with the devastating diagnosis of Stage IV lung cancer. He also uses his illness to bridge his love for medicine and literature to describe his journey until the last phases where the book ends abruptly when his condition takes a turn for the worse.
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Stephanie B. Jones, MD
SEA President
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Happy summer! As we embark upon a new academic year, things are a little different than usual. The challenge of introducing new trainees to the perioperative environment remains our perpetual summer pastime. What has changed is the lens through which we view teaching and learning, having just emerged from the trying circumstances of the last year or so.
The degree to which individuals are underrepresented in medicine, and specifically in academic medicine, is significant and concerning. This representation gap is especially notable in leadership positions. This also holds true in the American Society of Anesthesiologists (ASA), as evidenced by the 2017 survey conducted by Toledo et al regarding diversity in the leadership of this organization.1 Another publication in Medscape, using US Census Bureau criteria, reports the vast majority (70%) of anesthesiologists identified as White/Caucasian, followed in prevalence by Asian Indian (7%), Chinese (5%), Hispanic/Latino (4%), and Black/African American (3%).2 Women are underrepresented among anesthesiologist among all these groups, with an exception noted in the Black/African American group.2 A recent review article from Kenevan et al reports a slow increase in the representation of women in anesthesiology from 22% in 2007 to 24.8% in 2013. However, this still lags behind the general medical workforce, comprising 38% women.3
As we reflect on this year, we are heartened by the verdict handed down in the George Floyd murder trial. It was a month prior to George Floyd’s death that SEA formed its Taskforce on Diversity, Equity, and Inclusion (DE&I). Both anniversaries speak of the work that remains to be done in order to live in a society where diversity is valued, equity is commonplace, and inclusion is the norm. Since its inception, the taskforce has been very busy – a testament to the times we live in.
The Taskforce on DE&I collaborated with multiple anesthesia component societies as well as freestanding organizations. In addition, we have reached out both to anesthesiology residents at multiple programs and to medical students through the Student National Medical Association who will be applying for residency in anesthesiology.
The SEA Spring Annual Business Meeting is scheduled for Saturday, April 17, 2021 at 4:50pm (Eastern) during the SEA Spring Meeting to be held via Zoom Webinar.
Items on the agenda include:
This year, the Society for Education in Anesthesia is commemorating its 35th anniversary. It was unfortunate we could not all be together in Washington, D.C. to celebrate. Nevertheless, we were so happy to see everyone who attended SEA’s Fall Meeting 2020 in its first ever virtual format. The meeting’s theme was “Educational Scholarship,” as we described how anesthesiology educators can create publications or other scholarly output from their curricular and educational efforts. We had an informative program full of amazing speakers this year, and we would like to share a summary of highlights from the meeting.
The first section of the meeting focused on “Why and Where to Publish Your Educational Work.” Dr. Grace Huang kicked-off the meeting by delivering the McLeskey Lecture, in which she encouraged us to make a habit of incorporating writing into our professional lives. She emphasized that scholarship is within everybody’s reach and that there are opportunities to publish in education beyond original research projects. Next, we had a panel session on non-traditional publishing venues, during which Dr. Jed Wolpaw described how podcast development can be incorporated into your curriculum vitae and assist with promotion. He also encouraged others, especially those in subspecialty practice, to develop their own podcasts. Dr. Fei Chen presented us with innovative methods for the peer review process and how such innovations address some of the challenges in traditional review and metascience. She left us with the hope that we will see the application of these innovations in anesthesiology journals in the near future. The final speaker on the panel, Dr. Steven Shafer, provided an editor’s overview of the ASA Monitor and introduced GitHub for non-traditional publication strategies. Dr. Shafer encouraged interested people to contact the editors of ASA Monitor with innovative ideas and expressed interest in a potential medical education column.
The speakers of the second section, Dr. Amy Miller Juve, Dr. Lara Zisblatt, and Dr. Amy DiLorenzo, described the numerous roles non-physician educational specialists can play in an anesthesiology department. Dr. David Zvara wrapped up the section, and first day of the meeting, with a chair’s perspective on how you can convince your chair to hire a non-physician educator.
We started the second day of the meeting discussing how to publish your educational work. Dr. Lara Varpio gave us several great pieces of advice on creating an educational research paper, including how to frame your paper in the context of existing literature and how to make good use of your cover letter. Next, we received some fantastic insights and perspectives from two journal editors, Dr. Ed Nemergut (A&A) and Dr. Jeff Berger (JEPM), regarding practical tips and common pitfalls in educational writing. They each discussed several attributes of high-quality educational manuscripts and emphasized how effective design and writing can facilitate publication.
To wrap up the meeting, we heard a very special presentation from Dr. Melissa Davidson and Dr. Stephen Kimatian, the SEA Duke Award Recipients for 2020. They both have been instrumental in the success of the SEA Workshop on Teaching and are extremely deserving of this prestigious award.
Overall, the first virtual meeting of the SEA was a success. The feedback from attendees regarding the content, speakers, and format of the meeting was highly positive. More than 100 SEA members participated in each day of the meeting, many of whom found the virtual format very accessible. Additionally, the mixture of pre-recorded videos, live presentations, and live Q&A made for a well-rounded variety of formats. Although we would have preferred to be together at an in-person meeting we were still able to have a well-attended meeting, where SEA members received valuable education and professional development.
