Comprehensive Guide to Education in Anesthesia
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1 Comprehensive Guide to Education in Anesthesia
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3 Elizabeth A.M. Frost Editor Comprehensive Guide to Education in Anesthesia
4 Editor Elizabeth A.M. Frost Department of Anesthesiology Icahn Medical Center at Mount Sinai New York, NY, USA ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
5 To my sister and friend, Dr. Jean Margaret Handscombe, an educator
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7 Foreword Having recently completed my tenth board certification/recertifcation examination over the past 20 years, I have a few important thoughts. First, the education process and the manner in which we measure knowledge and competence in all fields, including in Anesthesiology and its subspecialties, are constantly changing. Who could have imagined tests on cadavers, computers, or simulators just a few years ago? Second, technology, medications, and procedures that were once considered small parts of our practice have evolved. Ultrasound, fluoroscopy-guided pain procedures, and transesophageal echocardiography are all very clear examples of changes which have significantly enhanced and changed the way we practice anesthesia in each of our specialty areas. Elaborate ultrasound-guided regional anesthesia techniques in all patient populations, transesophageal real-time views of the heart in cardiovascular surgery, and TAP blocks in obstetric anesthesia patients are improvements over how we practiced anesthesia just a few decades ago. Third, the development of electronic medical records and computer technology has dramatically changed our practices in all aspects. Fourth, newer boards and reconfigured tests have evolved. The American Board of Anesthesiology now offers is now an exam with three parts. Recertification sites for the American Board of Anesthesiology will now include simulation. In this regard, the last board examination that I recently completed, the relatively new American Board of Interventional Pain Physicians, having only been created a few years ago, involves four parts, a basic/clinic science portion, a substance abuse section, a coding and compliance section, and an oral/ practical section. This is reflective of changes in our practices and within each anesthesia subspecialty. This carefully constructed book by one of the great leaders in our field, Dr. Elizabeth A. M. Frost, M.D., provides an A Z user-friendly text from leaders in our field to describe all aspects of education. From its historic evolution, the book touches in detail on all topics of relevant interest. Some of these include closed claims analysis, residency and fellowship training and requirements, the board certification process, the role of simulation, research, and community/global outreach vii
8 viii Foreword and education. Medical students, health care professionals, and administrators may better understand the field of Anesthesiology after reading this book. Anesthesiologists at all levels will appreciate the many changes that have taken place in recent years. Dr. Frost, who has been a mentor to so many, including myself, has created a wonderful and important book for all to enjoy! New Orleans, LA, USA Alan David Kaye
9 Preface After a less than satisfying stint as a surgeon (no cures, just cut it out), I spent some time in internal medicine. There I found that arguments were the norm does the Lancet publish better studies than the New England Journal of Medicine or does the New England Journal of Medicine report more up to date data than the Lancet? This indecision was not for me. Still undaunted, I went on to obstetrics where I was appalled at women s inhumanity to women (come on, push it doesn t hurt that much!). Well it does hurt that much. At about this time it occurred to me that people expected essentially two things from their doctor: deliver the baby and take away the pain. Having conquered (?) the first part, anesthesia seemed the only career for me. And so, 50 years ago I started on what is still for me an amazing learning experience. I had no idea that this specialty could hold so much. From open drop ether and cyclopropane with a finger on the pulse as our only check that the patient was still alive to elaborate machines with a vast array of monitoring equipment, all the while caring for patients that may be so ill that their continued existence seems to hang by a thread, my education through these years has been monumental. And for that I have so many mentors to thank. From my first chair, Dr. Artusio, to my second appointment at the Albert Einstein College of Medicine with Drs. Orkin and Hershey, and later Dr. Goldiner, and now with Dr. Reich at Mount Sinai. I am grateful to all the educators who have helped others better understand the magic of anesthesia. And, of course, to all the contributors to the continuing education series in Anesthesiology News, now more than 30 years old and over 300 lessons long, thank you for making me continue to learn. In the Comprehensive Guide to Education in Anesthesia, educators from many different aspects of anesthesia have all given their time and expertise to review current practice of learning in our specialty. My special thanks to them all. Of course, as ever, extra thanks are due to the staff at Springer, to Shelley Reinhardt, Joanna Perey, and Kevin Wright, who have all worked hard to keep us on the right track. New York, NY, USA Elizabeth A.M. Frost ix
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11 Contents 1 Introduction and Historical Accounting... 1 Elizabeth A.M. Frost 2 Teaching by Example: Best Practices for Education in the Operating Room and the Lecture Hall Ethan O. Bryson 3 Learning from Incident Reporting and Closed Claims Analyses Julia Metzner, Karen L. Posner, and Karen B. Domino 4 Residency Training Daniel Katz and Alan Sim 5 Requirements for a Fellowship Sarah AbdelFattah and William Peruzzi 6 Teaching Clinical Science to Medical Students Chanannait Paisansathan and Verna L. Baughman 7 Mentorship in Anesthesia Monica S. Vavilala and Elizabeth A.M. Frost 8 The Process of Board Certification Ann E. Harman and Cynthia A. Lien 9 Maintenance of Certification in Anesthesiology Program Natalie F. Holt 10 Evaluation of Anesthesiology Residents John E. Tetzlaff 11 Giving Feedback to Superiors-Attending Evaluation Shara Steiner Brody, Julie Oppenheimer, and Michael C. Lewis xi
12 xii Contents 12 The Place for Simulation Teaching Judy G. Johnson 13 The Role of Continuing Medical Education Christina L. Jeng and Francine S. Yudkowitz 14 Multidisciplinary Teaching: The Interaction of the Specialties Michael Yarborough, Brian McClure, and Santiago Gomez 15 Research in Education Robert Fallar, Reena Karani, and Erica Friedman 16 The Place of Global Education in Anesthesia Angela Enright 17 Community Outreach Jordan Brand and Clifford Gevirtz 18 Substance Abuse Recognition and Prevention Through Education Ethan O. Bryson Index
13 Contributors Sarah AbdelFattah, M.D. Department of Anesthesiology, Perioperative Medicine & Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA Verna L. Baughman, M.D. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Jordan Brand, M.D. Department of Anesthesiology, San Francisco VA Medical Center, University of California, San Francisco, CA, USA Shara Steiner Brody, D.O. Department of Health Informatics, University of Miami Miller School of Medicine, Plantation, FL, USA Ethan O. Bryson, M.D. Department of Anesthesiology and Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA Karen B. Domino, M.D., M.P.H. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Angela Enright University of British Columbia, Royal Jubilee Hospital, Victoria, BC, Canada Robert Fallar, M.S. The Mount Sinai Medical Center, New York, NY, USA Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Erica Friedman, M.D., F.A.C.P. Sophie Davis School of Biomedical Education, City College, City University of New York, New York, NY, USA Elizabeth A.M. Frost, M.D. Icahn Medical Center at Mount Sinai, New York, NY, USA Clifford Gevirtz, M.D., M.P.H. LSU Health Sciences Center, New Orleans, LA, USA xiii
14 xiv Contributors Santiago Gomez, M.D. Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA Ann E. Harman, Ph.D. The American Board of Anesthesiology, Inc., Raleigh, NC, USA Natalie F. Holt, M.D., M.P.H. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA Department of Anesthesiology, VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA Christina L. Jeng, M.D. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Judy G. Johnson, M.D. Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA Reena Karani, M.D., M.H.P.E. Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA Daniel Katz, M.D. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Michael C. Lewis, M.D. University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA Cynthia A. Lien, M.D. Department of Anesthesiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA Brian McClure, M.D. Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA Julia Metzner, M.D. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Julia Metzner, M.D. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Julie Oppenheimer, M.D. Department of Anesthesiology, University of Miami Miller School of Medicine, Plantation, FL, USA Chanannait Paisansathan, M.D. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA William Peruzzi, M.D., S.M., F.C.C.M. Department of Anesthesiology, Perioperative Medicine & Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA Karen L. Posner, Ph.D. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA Alan Sim, M.D. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
15 Contributors xv John E. Tetzlaff, M.D. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA Monica S. Vavilala, M.D. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA Michael Yarborough, M.D. Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA Francine S. Yudkowitz, M.D., F.A.A.P. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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