Report of 15th Annual Fall Meeting of the Society for Education in Anesthesia. Orlando, Florida. October 16, 1998.
The 15th Annual Fall Meeting of the Society for Education in Anesthesia was held on October 16, 1998 in Orlando, Florida. The title of the program was "Innovations and Challenges in Anesthesiology Education."
The first speaker was Alexander Shysh, M.D., Clinical Associate Professor of Anesthesia at the University of Calgary, who discussed the application of education literature to teaching anesthesiology practice. He began by reviewing studies that evaluated the use of problem base learning (PBL) in medical education. Although the literature suggests that PBL seems to lead to increased retention of the learned material, PBL requires a longer time to cover the same amount of information covered in a traditional curriculum. Additionally, 4-20% of students do not thrive in a PBL format. He suggested that a plan that used PBL as a supplement to faculty-directed teaching might be the best approach. He also reviewed education studies involving the use of simulators as tools in anesthesiology education.
In concluding his presentation, Dr. Shysh provided a critique of education literature and the difficulties of performing research in this area. For example, it has been estimated that as many as 228 variables significantly influence learning in children from kindergarten through twelfth grade. He used this to emphasize the difficulty of performing an education study in which all confounding parameters were tightly controlled.
The second speaker was Barbara Guyer, Ed.D., Professor of Special Education at Marshall University. Dr. Guyer discussed the occurrence of dyslexia and attention deficit disorders in graduate level medical education. The student or physician with these problems is often someone with a high level of intelligence who has demonstrated difficulty with reading and test taking; they often confuse positively and negatively stated questions and may attempt to pick a response to a multiple choice question without reading it. Dr. Guyer described strategies that learning disabled students can be taught to help them succeed in passing standardized tests. She stressed that the passing scores on examinations should not be altered for these individuals; however, she thought it was reasonable for individuals with documented learning disabilities to be tutored on test-taking strategies and also for those with demonstrated dyslexia to be given additional time to take standardized multiple choice tests.
Kathryn King, M.D., Assistant Professor of Anesthesiology and Director of Medical Student Education at Duke University, discussed innovations to attract the best students to anesthesiology. She observed that contact with anesthesiologists during the entire continuum of medical school education was important in identifying to medical students the role and functions of anesthesiologists. Given the broad areas of medical knowledge necessary to practice anesthesiology, she suggested that anesthesiologists should be viewed as generalists, as well as specialists.
The operating room can provide an environment of discovery, especially for the application of basic physiologic and pharmacologic principals. She recommended that anesthesiologists work to become integrated into all phases of medical student education.
Catherine Lineberger, Assistant Professor of Anesthesiology and Director of Resident Education at Duke University, discussed the principles of organizing a substance abuse awareness education program. She stressed the need for the topic to be discussed openly and honestly and for the educational program to have the support of the leaders of the department. The dissemination of a clear, written policy to all members of the department helps to identify how problems with substance abuse will be handled. Involvement of the families of department members in the educational process is vital, both in helping to identify individuals with problems and in informing family members of the resources available. Educational formats that are particularly useful include first-hand accounts from recovering physicians, educational videotapes (e.g., Wearing Masks from the Society of Academic Anesthesia Chairs), and lectures from the medical director of the state physician health program.
David Waisel, M.D., Assistant Chairman for Resident Education at Wilford Hall Medical Center, discussed ethical issues involved in anesthesiology education. He identified two ethical theories underlying resident education. The mantle theory refers to the principle that by accepting the responsibility to educate residents, a department assumes certain obligations to these residents. The department owes the residents an education that will allow them to become consultant anesthesiologists. In contrast, the barrier theory refers to the obligation of the departmental faculty to produce quality anesthesiologists and to provide a barrier to prevent the graduation of substandard practitioners. He concluded by expressing his belief that training programs exist for the benefit of the residents and that, although institutions provide the environment in which education occurs, it is the individual anesthesiology faculty members who are responsible for accomplishing this and for measuring success or failure.
Lydia Conlay, M.D., Ph.D., M.B.A., Professor and Chairperson, Department of Anesthesiology at Temple University, discussed how to organize a curriculum for teaching medical students and residents about the economics of medicine. A new physician is stated to require 1 to 2 yr to learn how to practice in a managed care environment, and this increases the cost of patient care by $20,000-$30,000 for each new physician during this learning period. She stated that as educators we must ensure that our students learn the positive effects on cost and quality that can be achieved in the current managed care environment. Dr. Conlay also remarked that it is important to teach students and residents how to be successful in team-based interactions. As an example, she reported that some psychiatry residency educators teach residents how to interact with insurance reviewers for the benefit of their patients.
Denham Ward, M.D., Ph.D., Professor and Chairperson, Department of Anesthesiology at the University of Rochester, spoke about funding the educational mission of an academic department in an era of decreased reimbursement. He expressed his view that the era of the triple threat faculty member (skilled in clinical care, research, and teaching) had passed, but that the triple threat department would survive. He reviewed current proposals from the Health Care Financing Administration that will decrease the amount of support provided to teaching hospitals for resident education. These proposals include a cap on the total number of residents that will be included in an institution's funding formulas, and a recommendation to limit the total number of residency positions available nationally to 110% of the number of graduating American medical students. The limitation of federal funding for graduate medical education will not limit the number of residents that can be trained, but will limit the number that will be funded by the federal government. Dr. Ward concluded that the challenges for departments will be funding academic time, continuing to provide meaningful clinical education, and maintaining competitive faculty salaries. Furthermore, he noted that these difficult tasks will require innovations in departmental structure.
Charles McClusky, M.D., Professor and Chairperson, Department of Anesthesiology at Texas A&M University, concluded the lecture portion of the program by discussing the qualities of effective leaders. In his discussion, he included quotations about leadership from many great leaders from history. He set forth several maxims that were central to his vision of effective leadership. Dr. McClusky thought a leader should be visible to those he/she leads, should build strong alliances, and should persuade rather than coerce. Further, he expressed his belief that integrity and tenacity were essential attributes of a good leader, along with the ability to make decisions (even if they were subsequently proved to be wrong). He said that good leaders were result-oriented, encouraged innovation, and were good communicators. He concluded with Abraham Lincoln's observation that that, although leaders can face moments of great importance, more commonly leadership is demonstrated by "exerting quiet and subtle influence on a day-to-day basis."
The afternoon session of the program concluded with several workshops. Robert Lagasse, M.D., Associate Professor of Anesthesiology at the Albert Einstein School of Medicine, led a workshop entitled "Teaching Quality Assurance and Peer Review." During the workshop, he reviewed theories and techniques of performance improvement and quality management and then demonstrated how they can be taught in anesthesiology training programs. Meg Rosenblatt, M.D., Assistant Professor of Anesthesiology at Mount Sinai School of Medicine led a workshop entitled "Organizing a Faculty Development Workshop: Preaching to the Unconverted." During her presentation, Dr. Rosenberg reviewed the components of an effective faculty development workshop and discussed ways to implement them. The third workshop, led by Dr. Guyer was an interactive extension of her lecture about recognizing learning disabilities in medical students and graduate physicians and helping the students with these problems to succeed.
Also during this meeting, the second Society for Education in Anesthesia/Duke Prize for Excellence in Anesthesiology Education was presented to Robert Willenkin, M.D., Emeritus Professor of Anesthesiology at the University of Pittsburgh. Dr. Willenkin, who is a founding member of SEA, was honored for his contributions to the advancement of education in anesthesiology. The prize is made possible by a grant from the Department of Anesthesiology at Duke University.
Scott A. Schartel, D.O.
Associate Professor; Department of Anesthesiology; Temple University; Philadelphia, Pennsylvania 19140; firstname.lastname@example.org
(Accepted for publication February 3, 1999.)