|LETTER TO THE EDITOR
|Year : 2017 | Volume
| Issue : 2 | Page : 96-97
Teaching in anesthesiology: Is it different from clinical medicine?
Vishal K Pai MBBS , Anil P Singh, Mridul Dhar, Atchya A Kumar
Department of Anaesthesiology and Critical Care, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
|Date of Submission||25-Dec-2015|
|Date of Acceptance||20-Mar-2017|
|Date of Web Publication||12-May-2017|
Vishal K Pai
Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh - 221 005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pai VK, Singh AP, Dhar M, Kumar AA. Teaching in anesthesiology: Is it different from clinical medicine?. Res Opin Anesth Intensive Care 2017;4:96-7
|How to cite this URL:|
Pai VK, Singh AP, Dhar M, Kumar AA. Teaching in anesthesiology: Is it different from clinical medicine?. Res Opin Anesth Intensive Care [serial online] 2017 [cited 2017 Sep 20];4:96-7. Available from: http://www.roaic.eg.net/text.asp?2017/4/2/96/206156
Anesthesiology is comparatively a new branch of medicine. Anesthesiologists rightly take pride in providing patient safety in the perioperative period. Growth of this medical specialty requires good-quality education. Training fresh medical graduates and residents in the operating room (OR) presents with simultaneous challenges of providing good-quality patient care and ensuring their safety. Everyone emphasizes the need for good medical education but seldom realize the challenges faced in effective clinical teaching, which includes time constraints, lack of dedicated specialists, emergent nature of critical events taking place, lack of educational space, and other teaching resources in the OR .
Students get limited exposure to anesthesiology during their basic medical training. Anesthesiology is considered more of a specialized postgraduate subject; therefore, most of the medical graduates who wish to pursue anesthesiology have very little knowledge about the subject. So the first obstacle is difficulty to begin teaching from the basics. Students face a lot of anxiety initially. They may be nervous about being unable to answer questions, have not had seen something similar previously, inability to perform simple tasks, possibility of causing unintentional harm to patients which can cost lives, and inability to work at a rapid and efficient pace .
The classic approach to teaching clinical medicine where the student evaluates a patient, takes a detailed medical history, and then presents this write up to an instructor followed by discussion and demonstration does not work well in anesthesiology owing to the vast diversity among patients posted for surgery, simultaneous coexisting medical comorbidities in these patients, need for anticipation, early recognition and quick response time to deal with unanticipated events, and difficulty to simulate these life-threatening complications in real life.
Among the various methods of teaching like seminars, lectures, problem-based learning (PBL), one-to-one teaching, and ward round discussion, probably PBL is quite effective in teaching small groups in the OR. The instructor begins with a structured approach starting with discussion of the preoperative history of the patient, reviewing important preoperative laboratory tests, deciding on the plan of anesthesia, and postoperative analgesia for that particular patient. The instructor then demonstrates the correct way of securing an intravenous access, intubation, monitoring, and extubation. The instructor can involve residents by assigning small tasks, which include effective intraoperative monitoring and communication with the surgeon and other OR staff, and also engaging the residents by asking questions like ‘What would you do if this happened while I am not present here? If this complication would occur what would be your first reaction? What would be your next plan in case this plan failed?’ Such questions will instill a sense of participation and promote active learning, good reasoning, and qualitative approach toward perioperative complications and its management.
Another challenge is teaching essential, high-risk and emergency procedures. Demonstrating these skills on mannequins where each one is allowed to spend some time in actual learning by doing is recommended. Most medical students are influenced by the decision-making ability and skills of their instructors; therefore, teaching abilities of the instructors in many ways are pivotal to the quality of education that students gain from PBL . Ability of the instructor to remain calm, teach good practices, and reduce anxiety levels among the residents is very valuable quality.
A curriculum to match international standards should be formulated to involve fundamental and basic training, with rotations in all subspecialties before core training in a specific subspecialty. However, this is not easy and will require standardization by common exit examinations to maintain uniformity in training of young anesthesiologists. Owing to the increasing medicolegal litigations, and stress levels among anesthetists, appropriate steps to ensure effective stress management, formatting medical education in regard to occupational health risks to protect the mental health and well-being of anesthetists should be incorporated in the teaching curriculum .
The dynamic and emergent nature of the specialty has led to use of simulators in teaching and training young anesthetists. It involves a patient management scenario, which can be manipulated using a computer-controlled software. An anesthetist is supposed to be a team leader, contingent planner, and a good communicator, and simulations help in acquiring these vital skills and shall prove to be essential in effective teaching in the near future . Lastly, training curriculum in anesthesia should be developed to generate good anesthetists who are not only well trained in modern technology but can also modulate and work in low-resource setups to meet the rising demand of anesthetists in the remote areas.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
DaRosa DA, Skeff K, Friedland JA, Coburn M, Cox S, Pollart S et al.
Barriers to effective teaching. Acad Med 2011; 86:453–459.
Cook LJ. Inviting teaching behaviors of clinical faculty and nursing students’ anxiety. J Nurs Educ 2005; 44:156–161.
Bhagwat M. Simulation and anaesthesia. Indian J Anaesth 2012; 56:14–20.
] [Full text]
Gupta P, Moore R, Duval Gastao F. Occupational wellbeing in anaesthesiologists: its relationship with educational methodology. Rev Bras Anestesiol 2015; 65:237–239.
Hartland W Jr, Londoner CA. Perceived importance of clinical teaching characteristics for nurse anesthesia clinical faculty.AANA J 1997; 65:547–551.