March 1997
Volume 61 |
Number 3
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PRESIDENT'S PAGE
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| What Are Our Educational
Responsibilities? |
Phillip O. Bridenbaugh, M.D., President
A few weeks ago, I received a letter from one of our members
expressing disapproval about the fact that another anesthesia
organization's continuing medical education (CME) program included
nonphysicians giving lectures related to the science of anesthesiology.
I interpreted the letter to be suggesting that there was something
demeaning about attending a lecture given by someone less well-educated.
My pragmatic response was that ASA has no influence over any
educational courses it does not sponsor and that we all have the
freedom to choose courses we want to attend. I put the matter
out of my mind until being asked later to present some remarks
for the opening ceremony of this year's New York State Society
of Anesthesiologists Postgraduate Assembly honoring its 50th year.
(A splendid opening ceremony, I might add.) It was suggested I
might comment on the role of education in our specialty during
that same period.
I recalled the above-mentioned letter and reflected on the explosion
of CME courses over the past 50 years. What were the motives of
these program providers and why did physicians spend more and
more money to go to more courses in far away places? The most
frequently used explanation would say that: 1) the public demanded
accountability from physicians, as a result of the much publicized
medical malpractice problems; 2) state legislatures and licensing
boards responded with mandatory CME requirements for relicensure
or hospital privileges; and 3) medical education organizations
(e.g., Accreditation Council for Continuing Medical Education
and American Board of Medical Specialties) pushed for recertification
of specialists incorporating some kind of documented continuing
education requirements, with or without testing.
These reasons for continuing medical education to demonstrate
currency of knowledge in the practice of our specialty still exist
and are as important as ever. What has not been addressed, however,
is our responsibility to teach (e.g., nonphysicians), and should
we only teach them what we think they ought to know?
Who Is Responsible for Teaching and What Should They Know?
I raise the question primarily to ask all of us to reflect on
that vast and ever-growing body of knowledge that comprises the
science of anesthesia. In a previous article (ASA
NEWSLETTER, January 1997), I discussed ASA's Task Force
on Restructuring and noted the need to define goals and objectives
for the future before changing our structure. With the advent
of new technology in our specialty and in our hospitals, the need
for new ways to teach besides "slide shows" and "podium
presentations" has become obvious. The traditional method
of inviting select academic anesthesiologists to present a few
lectures in expensive hotels is rapidly becoming inadequate in
meeting the needs of 27,500 active and resident members of ASA.
I believe a majority of our members have developed such a high
degree of knowledge and clinical expertise in a given area of
our specialty that they are eminently qualified to teach - if
they have the desire to develop the
requisite teaching resources and skills. We do not need a limited
number of intellectuals who "know all there is to know"
about anesthesiology; rather, we need a large number of expert
clinicians who have both knowledge and experience in a limited
area of anesthesiology and who are willing to share that knowledge
and experience with others.
Who Do We Teach?
The first priority for our educational programs is to keep our
own members current in their practices. But what about our responsibility
to our nonanesthesia physician colleagues? We get requests from
obstetricians to teach them how to do epidurals; from emergency
medicine physicians to teach them how to intubate, paralyze and
do peripheral nerve blocks; from physical medicine and rehabilitation
physicians to teach epidural steroids, etc. This dilemma provides
me the opportunity to remind ourselves that teaching goes on at
national, state, local and hospital levels.
My question about other physicians is meant to ask, does ASA
have any need to include other physicians in our programs either
as teachers or as registrants? In an effort to neither belabor
the point or prolong this column, I would like us to ask the same
question about any nonphysician patient care group wanting to
learn some aspect of the anesthesia body of knowledge. Are there
circumstances when the teacher or purveyor of a body of knowledge
can determine who should receive that knowledge? I believe that
question has both philosophical and practical answers.
What Is ASA's Responsibility to Anesthesia Education?
I have already indicated that our Society's first priority is
to provide a variety of educational opportunities to more than
27,500 active and resident members. We can rightfully and proudly
say we have always been doing that. However, as noted, our methods
and offerings need to be re-examined in the light of the technology
explosion in the field of communication. An example of a need
of our members is to be able to get "hands-on" teaching
in the performance of technical procedures such as transesophageal
echocardiography, fiberoptic airway management, invasive pain
management procedures, etc.
The ASA House of Delegates, at this past Annual Meeting in October
1996, took the first step in this quest for change by combining
the Committee on Regional and Metropolitan Refresher Courses with
the Committee on Workshops. The new committee is called the Committee
on Outreach Education and is chaired by Joanne M. Conroy, M.D.
With the assistance of Patricia A. Kapur, M.D., Chair of the Section
on Education and Research, the committee will not only continue
to present a limited number of annual workshops and/or refresher
courses, but it is also undertaking discussions on new educational
technology such as interactive computer programs, patient simulators
and increased numbers of hands-on programs.
Since this issue of the NEWSLETTER is dedicated to the
activities of the Committee on Electronic Media and Information
Technology (EMIT), you will understand the value of the fact that
the two committees met recently at the same time and that the
computer expertise from the EMIT committee will be applied to
the study and development of new ASA educational offerings which,
it is hoped, will be equally valuable but available to more ASA
members on a more cost-effective basis.
I would be remiss if I did not acknowledge and remind you all
of the excellent ASA publications and of their impact on the educational
currency they provide. Our journal, Anesthesiology, is
second to none and the premier purveyor in the world of cutting
edge science in our specialty. The ASA Self-Education and Evaluation
(SEE) program continues its excellence in teaching and testing
our members about their knowledge base. The ASA Refresher
Courses in Anesthesiology also provide edited and published
versions of some of the excellent courses given at both annual
and regional meetings.
What all of this demonstrates is that we can and do teach the
cognitive part of our practice, but the technical skills teaching
has been sparse and expensive, by comparison.
A New Educational Responsibility
In closing, I want to suggest that ASA - through its committees
on Physician Resources, Residents and Medical Students, and Communications
- needs to mount a major effort in educating medical students
and the public.
A first-year medical student recently came to ask me about the
future of our specialty. She stated that she had always thought
she wanted to be an anesthesiologist, but she has been told it
was not a wise choice. I inquired who was advising her and was
told it was a retired oncologist.
At our instutition, we are starting anesthesia clubs for our
first-year students where we provide lunch for all interested
and talk about anesthesiology. Nearly 100 students attended a
Saturday session on airway management. Our Committee on Communications
is working through the ASA Web site as well as the media to educate
the public and the medical community about our specialty. We need
to correct a lot of noninformation and misinformation to better
serve our patients and their satisfaction with their anesthesia
care as provided by physicians.
If all of us, in our hospitals and committees, become teachers,
we could make great strides in getting the correct information
about anesthesiology to many people.
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