President's Corner

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.

Now let’s think beyond the patient, about how we present ourselves in the perioperative arena while our trainees observe every move. Do we call out microaggression, or even frankly disruptive behavior, when it occurs? Or do we silently observe from our position at the head of the table? Do we perpetuate stereotypes with comments on a particular specialty’s lack of operative abilities? Or roll our eyes and sigh when the medical student is handed the suture for closure?

The message in the editorial and in the ACGME special report is clear – to effect change in perioperative culture, we must model the behavior we wish to see. And those with an extra commitment to education, such as members of this society, should lead the way.

1. Gavin Martin, Clif Flintom, Kate Ulrich, Allan D. Kirk; The Accreditation Council for Graduate Medical Education Special Report on Clinical Learners in Procedural Environments: Several Elephants in a Very Small Room. Anesthesiology Newly Published on December 29, 2021. doi: https://doi.org/10.1097/ALN.0000000000004059

Share this post: