Hi,

This is our first Book Reviews podcast for the SEA Good Bedtime reads. My name is Viji Kurup and I am an 

Viji Kurup MD Professor Vice Chair for Medical Education Yale University

anesthesiologist at Yale University. The book I am reviewing for this edition of our newsletter is Tribal Leadership by Dave Logan, John King and Halee Fishcher-Wright.

When COVID hit our hospital, things changed drastically. We were working in unfamiliar territories. There was a lot of uncertainty and things were evolving quickly. The morale of my colleagues as well as my residents was dropping, and during one of my late night calls, I got talking with my call team and one of my residents mentioned a book named Tribal Leadership and how it described groups and cultures. This conversation sparked my interest and I read the book over the next few weeks. I also recommend the TED Talk by Dave Logan to get a sneak peak at his philosophy.

The author Dave Logan specializes in strategy and cultural performance and is a faculty member at USC’s Marshall school of business. He describes tribes within organizations that have distinctive identifiers. The book is meant to help leaders identify tribes of people within their organization and gives tools to upgrade their tribes’ culture stage by stage. The authors comment that this book is a result of research over 10 years across 24,000 people. 

The premise of the book is that it is possible to create high performing organizations if we pay attention to the culture of the people. In most organizations, cultures can be divided into 5 stages:

Stage 1 where the motto is ‘Life sucks’, where members feel that everything is futile and worthless. People are hostile and think that they need to band together to get ahead in a violent and unfair world. We may not see a lot of this except in individuals and even then, hopefully very rarely.

Stage 2 motto is ‘My life sucks’ where members feel that although things around them are good, they may not be having a share of it. We can see examples of these when we listen to people complain in our workrooms of how bad their lives are. People are passively antagonistic. They have seen it all before and watched it fail. They are sarcastic and resigned. 

Stage 3 motto is ‘I am great’ and by implication ‘You are not’ and is most commonly seen in academics where people individually achieve heights that the rest of the group may not reach. Here people are driven by their own ego to publish, get more titles and power within the organization. Here, winning is personal and they seem to be constantly disappointed that others don’t have their ambition or skill.

Stage 4 motto is ‘We are great’ where leaders inspire their groups to achieve unique outcomes and results. In this stage people naturally use ‘We’ when describing results rather than ‘I’. Team accomplishments are celebrated.  Everyone seems happy, inspired and genuine. Here the team comes together despite differences to work towards a common goal. 

Stage 5 is called ‘Life is great’ where the members work together towards aspirational goals and collaborate and communicate seamlessly. The group talks about infinite potential and how the group is going to make history because doing so will make a global impact. The group is constantly pushing the limits and is not in competition with anyone. 

The authors stress the importance of tribal culture and triadic relationships as opposed to dyadic ones, which seem to be important to form effective and stable relationships. The authors illustrate these stages and their relation to each other with very effective use of stories and examples from real life. For anyone who is looking to create effective teams and is currently in leadership or aspiring to be a leader, this book is a very good and easy read. 

After reading the book I could look around me and classify behaviors of people and see which stage they are currently in and what might be driving them, and what might inspire them to go to the next level. This book can add to your understanding of teams and provide some ideas on how to motivate your team and how collectively we can all achieve great things. I hope you enjoy this book.

I cannot remember where my first Society for Education in Anesthesia meeting was held or how I got there. It must have been in 1998 or 1999. I do vividly remember coming down to breakfast at about 7:30 that first 

Michael Sandison, MD Professor Emeritus  Albany Medical College

 morning and walking into animated committee meetings already in progress. I noticed one particularly large group brainstorming about upcoming meetings. I sat at an adjacent empty table and listened to the conversation. They were talking about themes for future meetings, possible speakers, interesting workshops and potential venues. I was struck by their enthusiasm, creativity and belief in the organization’s relevance and future. I had found “my people”.

Those people turned out to include Kathy King and Cathy Kuhn from Duke. At that time the Residency Review Committee had mandated that the departmental chair serve also as Program Director. Many chairs designated a faculty member as “Director of Education” or some such title. I had just been appointed to this “Quasi-PD” position by my outgoing chair at Albany Medical College. My predecessor, Kevin Roberts, had been appointed Acting Chair of the department. As he handed me a SEA newsletter, he offered me two words of advice for the new role: “Join SEA.”

I was woefully unprepared for this new position. Although I was regarded as a decent teacher by the residents and faculty, my approach to teaching was based simply on emulating my best teachers at the University of the Witwatersrand in Johannesburg. That first SEA meeting opened my eyes to the discipline of pedagogy and the possibility of a career in anesthesiology education. I returned home after that meeting recharged with a sense of direction, possibility and purpose.

Several meetings followed. I started making notes entitled: “Ideas from SEA”. The oldest list that I found was from the Spring Meeting of 2000, and it included a talk by Phil Lui entitled “Characteristics of Extraordinary Anesthesiologists: Implications for Anesthesia Education”. I later adapted that talk for inclusion in our introductory didactic program. Other entries in my notes include, “Look up the full Bloom’s Taxonomy”, (testimony to my lack of preparation as an educator) and “Writing is Thinking”.

That meeting led to my attending the SEA Workshop on Teaching, where I encountered people like Gary Loyd, Melissa Davidson, and Mike Olympio. This workshop laid the foundation for my ongoing education and professional development.

Over the next twenty years, SEA spring and fall meetings followed in places like Cleveland; Montreal; Harrisburg; Washington, DC; Nashville, and Santa Fe; with some of the best meetings being held in smaller cities, which I would never have thought to visit. “Dine Arounds” hosted by local SEA members gave me an insider’s perspective and a better appreciation of this vast and varied country. Friendships and collaborations followed. These relationships blossomed into mentorships and provided opportunities both to support and to be supported by others in the Society.

SEA has been central to the development of my professional career as an anesthesiology educator. I am grateful that I took Kevin’s advice to attend that first meeting.

L. Jane Easdown, MD

A few years ago, the SEA Board of Director’s launched an outreach program to contact other anesthesiology societies to offer workshops and share resources and educational material. This outreach program is led by Dr. Deb Schwengel. One of the advantages of the outreach has been learning about the other societies and what they create and offer to members. The Society of Neurosurgical Anesthesia and Critical Care (SNACC) is one of the societies with a strong education focus. SEA members may benefit from familiarity with SNACC’s offerings, which can help both training programs individual trainees. 
  
SNACC membership comprises neuroscientists, neurointensivists and neuroanesthesiologists. The society was founded in 2007 and has traditionally had a one-day meeting ahead of the ASA, which made it very difficult to SEA members to attend. SNACC had its first freestanding meeting in September 2019, which allowed for additional days of programming. For the first time, a group of SEA members could attend the full meeting! SNACC leadership was keen to work with SEA to provide new experiences for their membership. Through this relationship we have learned that SNACC has many educational resources for use for the general public.

SEA/SNACC Workshop- SNACC invited SEA members to conduct a workshop for the September 2019 meeting, and from several topics offered they chose curriculum development. Deb Schwengel organized a workshop with Karen Souter, Shobana Rajan and me as presenters and. The workshop was fully subscribed including many of the SNACC officers. Several attendees were developing a new rotation, so this workshop was very timely. We presented the Kern system for curriculum development. This was highly successful, and we have been asked to provide other topics in the future.   
 
The SNACC website-  For those of us that teach in neuroanesthesia rotations there is a wide variety of educational material to be found on the SNACC website, and it is open to the public. Three sections are worth highlighting:

• Education Corner: You can find PBLDs, quizzes, interesting cases, blogs, discussion boards and best articles of the week etc. The SNACC Education Committee and the Committee on Trainee Engagement create and edit this material.   
• Neuroanesthesia Classroom: The Committee for Trainee Engagement has developed a 4-week rotation curriculum for neuro rotations. This curriculum is linked to SNACC resources such as review articles or PBLDs. This can be a terrific way to compare with a national standard and also as a guide for new programs. It will direct rotation directors to high quality educational material. Residents and fellows can use this curriculum and links for exam preparation.  
• Fellows and Residents: This is a section for trainees to find educational material. There is also information about neuroanesthesia fellowships. SNACC was instrumental in establishing an accreditation for neuroanesthesia fellowships. Under the leadership of Dr. Andrew Kofke, an international group, the International Council for Perioperative Neuroscience Training (ICPNT) was created to explore curriculum, evaluation selection and all other aspects of a training program. In 2019 the first neuroanesthesia training programs were accredited, and many more are in the process of accreditation. There is information on neuro fellowships on the site. Almost all academic anesthesia programs are recruiting for neuroanesthesia staff, and there is a huge need for highly qualified faculty.  

The SNACC newsletter- Anyone can subscribe. The latest newsletter describes the activities of the last meeting, ongoing projects, noteworthy research and updates on SNACC meetings. The newsletter has an education corner to keep you up to date with the output from active education committees at SNACC.   

In summary, through the SEA outreach program we have made a strong connection to SNACC. This group is highly focused on education and has open resources that all programs can use. I hope this shows how SNACC’s resources can benefit medical students, residents and fellows. Continued outreach to anesthesia societies will help us find common ground that will enrich us all. 

Barbara Orlando, MD

When I moved to the United States and decided to go back to work after an eight-year break to take care of my kids, I did not imagine how tough it would be to enter the workforce the second time around. As an attending I took interest in wellness after going through a pretty rough residency and reading more and more stories about burnout and suicide among our lines. Having a daughter interested in going into medicine was another reason to try to improve this growing problem. 

2020 SEA Fall Meeting Preview: "Advancing Your Educational Scholarship"

Susan M Martinelli, MD FASA SEA Fall Meeting Chair

Robert S Isaak, DO FASA    SEA Fall Meeting Co-Chair

Fei Chen, PhD, MEd    SEA Fall Meeting Co-Chair

 

Lisa Caplan, MD

Kathleen Chen, MD, MS

David Young, MD, MEd, MBA

 

 

Ed Kosik, DO, FASA
Associate Professor, University of Oklahoma HSC 
John H. Saxon III, M.D. Professorship of Anesthesiology
Medical Director of Anesthesiology Simulation

The uncertain times of the COVID-19 pandemic brought out our best as we stayed focused on the safety of our learners and our educational mission. Even though our Simulation Center was officially closed, extensive education efforts took place.

Zoom lectures were offered on a multitude of anesthesia related topics. Simulation, both screen-based and high fidelity, was used extensively to educate our medical students. A simulation session that seemed straightforward before the pandemic took substantially more effort because we had to sanitize all the equipment and operate the simulators without the aid of technicians. Finding masks, gloves and sanitizing equipment was challenging. The debriefing skills that I obtained over the years helped to address and humanize medical students’ and residents’ concerns about COVID-19 and the effects on their education.
 
The fortitude of my colleagues both clinically and educationally was paramount.  We figured out how to make education work despite a potentially dangerous clinical situation.  An instructional video for donning and doffing personal protective equipment was literally made overnight; lectures were provided; mock oral board exams were successfully held; anesthesiology mock OSCEs were modified and successful; and ACLS classes were held in smaller groups. All of these efforts were made as we practiced social distancing and adhered to institutional safety guidelines.

I am more thankful than ever for my anesthesia colleagues and the people I am surrounded by. It is through their bravery and collaboration that we keep striving to move forward to make the best out of a challenging situation and never losing focus of the things that matter. 

Albertz, M1

Hoagland, M1

Masaracchia M1

LeRiger M2

Dachsangvorn, O3

Chatterjee, D1

 

Monica Bhutiani MD

Brian Gelfand MD

Meredith Kingeter MD

The transition from intern year to clinical anesthesiology represents an exciting but challenging time. Historically, our program utilized June of PGY1 year to prepare interns to work in the operating room. During this month, a hands-on and didactic educational format facilitated residents’ progression from paired oversight to semi-solo to eventually solo status by July 1st of CA-1 year.

Responding to local and national concerns of resident burnout, especially during the current pandemic, we restructured the program with emphasis on wellness and burnout prevention, while still ensuring intraoperative competence based upon established metrics. We incorporated strategies including paired intraoperative mentorship with predictable and assured OR relief, evening online lectures in interactive PBLD format, and resilience workshops.

During this transition period both intraoperative as well as social and emotional supports are imperative to decrease burnout and bolster mental wellbeing. Traditionally, interclass friendship and camaraderie vital for the forthcoming clinical years stems organically from frequent social interactions both within and outside the hospital. However, due to infectious concerns, many of those opportunities are not possible this year. With some creativity, we supplemented their curricula with online weekly social hours to facilitate debriefing, decompression, and growth as a class as well as a structured 1:1 peer mentorship program that paired rising CA-1 residents with senior mentors to provide psychosocial support, encourage self-reflection, and bolster professional connectedness.

Overall, these changes were implemented for the well-being of our residents, especially in the current climate shaped by COVID-19. Although the impetus for these changes was the pandemic, we believe resident wellness represents a needed priority even in times of normalcy, and we will continue to build upon these changes towards a programmatic paradigm shift of greater resident support and wellbeing. 

Anticipating that there will be continued restrictions on travel and CME moving into the new year, we regretfully announce that the SEA Workshop on Teaching has been canceled for 2021. Look for an announcement at the SEA Fall Meeting about plans for a “Virtual Teaching Workshop Masterclass” for 2021 that will provide an opportunity for a refresher course for past graduates of the workshop as we explore ways to make modules of the workshop virtual. Our contract with the Alfond Inn is still in force for 2022, and we look forward to welcoming everyone back January 29, 2022 through February 1, 2022 in Winter Park Florida.

Call for Nominations

Due Monday, June 22, 2020

The SEA Duke Award for Excellence and Innovation in Anesthesia Education was created back in 1996, thanks to a generous gift from the Department of Anesthesia at Duke University. The purpose of the award is to recognize people who have had a long commitment to teaching and have contributed positively to the advancement of teaching anesthesia to medical students, residents, and faculty. Because we at the SEA are at the forefront of spearheading educational efforts in our specialty, past recipients have tended to come from within our midst.

Membership in SEA is not necessary for consideration, though the nominating individual does have to be a SEA member.

The Society for Education in Anesthesia (SEA) is creating a task force on Diversity and Inclusion. The goal of this task force is to inform and educate the society on how to integrate diversity and inclusion as core operating principles of the SEA and its work.

The SEA welcomes applications from any active member of the society who has an interest in diversity and inclusion to serve on the Task Force as either the chairperson or as a member.

Chairperson
The SEA Task Force on Diversity and Inclusion chairperson will have a record of sustained service to the SEA and experience in diversity and inclusion work.

The SEA Nominating Committee (Chaired by Immediate Past-President Michael R. Sandison, MD) has identified the following candidates to run in this year’s election for the Society for Education in Anesthesia Board of Directors:

Vice President / President-Elect (One Position – Two Year Term)

The Society for Education in Anesthesia (SEA) is deeply saddened by the recent events that have impacted our nation, culminating with the inhumane deaths of Ahmaud Arbery, George Floyd, and Breonna Taylor. Our society supports equitable justice, education resulting in awareness and tolerance, and most importantly respect for humanity.

SEA values an inclusive community, and as such we celebrate diversity and the richness it brings to our organization and our practice. SEA firmly rejects racism in any form.

Thirty years ago HIV/AIDS still held thrall of the world.¹ I wrote the following as I switched careers from law to medicine:

It was the call I received regarding the HIV positive man whose will I had executed one week earlier which made me reflect on the difference between the power of words and the fight for life.  The news of his death recalled the irritation I had felt at trying to get him to meet with me to devise ways to settle an estate of which the greatest asset was the eleven-year-old son he would leave behind alone.  The moment that I heard of his death, all of the work, all of the time, all of the trouble was absolutely meaningless...trite.

Emuejevoke Chuba, MD PGY-2 Anesthesiology Resident Temple University Hospital, Philadelphia

Major Stephanie Parks, DNP, CRNA Task Force 13 Strike Team Alpha OIC Temple University Hospital

The American Society of Anesthesiologists (ASA) and Society for Education in Anesthesia (SEA) today announced a call for nominations for the new ASA-SEA Distinguished Educator in Anesthesiology award. The award recognizes mid-career physicians who have demonstrated a substantial commitment and achievement as educators in the field of anesthesiology.

“We’re excited to collaborate with SEA on this effort, an organization that shares our values regarding the importance of education to improve patient care,” said ASA President Linda J. Mason, M.D., FASA.  “It’s important for mid-level career physicians, those who have been in practice 5-15 years, to be recognized for their contributions and achievements in anesthesiology education.  Recognizing these individuals helps to move the profession forward and serves as an opportunity for networking and continued mentorship of young educators and residents.”

Herodotos Ellinas, MD Associate Professor Medical College of Wisconsin Milwaukee, WI

Book Review: The Five Dysfunctions of a Team
Book Author: Patrick Lencioni
Publisher: Jossey-Bass, an Imprint of Wiley
Review Author: Herodotos Ellinas

High-performance teams are not the result of sheer luck. During a crisis such as the COVID-19 pandemic, leaders must assemble effective multidisciplinary teams or adapt existing ones. Leaders who assemble such teams should base membership on a careful evaluation of talents, which includes assessing members’ interactions and evaluating their critical thinking when they navigate rapidly changing terrains. Although Lencioni does not discuss an extreme crisis in The Five Dysfunctions of a Team, the reader can extrapolate from the author’s key concepts. Lencioni narrates a fable of an organization that hires a new CEO, Kathryn, to revive a struggling company. The author, in this easy-to-read book, cleverly walks the reader step by step through Kathryn’s challenges in putting together a “high-functioning” team.  

An old-school executive hired at a high-tech Silicon Valley company, Kathryn arrives at her first day of work and discovers that her staff of seven talented executives have total inability to work well together. Their constant disagreements and incapacity to take responsibility for their actions impart negativity to the workplace, further contributing to the existing chaos. As an experienced leader, Kathryn quickly realizes the dysfunction of these executives and subjects them to a pair of off-site retreats to identify the underlying issues that led to the company’s current situation. In the process, some of her decisions make her unpopular, but her persistence prevails in creating a high-performance team. 

This was another successful year for the SEA/HVO Fellowships. We received 22 applications and awarded 8 Fellowships. See the HVO announcement below. The new Fellows will be traveling to Vietnam, Rwanda or Ghana for their month of teaching anesthesia residents, anesthesia nurses or anesthesia clinical officers. Congratulations to them all.

Health Volunteers Overseas (HVO), in collaboration with the Society for Education in Anesthesia (SEA), is pleased to share that eight anesthesia residents will receive a 2019 SEA-HVO Traveling Fellowship.