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April 2000
Volume 64 |
Number 4
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| Increasing Anesthesiology's
Profile Among Medical Students |
Tripti C. Kataria,
M.D., Chair-Elect
Resident Component Governing Council
It has been said before: Anesthesiology is one of the best-kept
secrets in medicine. It deals with physiology and pharmacology
in a growing and expanding field. Historically, anesthesiologists
were primarily based in the operating room. Now our field includes
preoperative assessment, postanesthesia care, the intensive care
unit, pain management and intraoperative management. With such
an expansive field and so much to offer, how do we inform medical
students about anesthesiology's benefits?
At many medical schools, students are given two weeks or less
of anesthesiology during their third or fourth year. These two
weeks may be elective since some schools do not require any anesthesiology
as a core rotation. One way to improve our teaching of anesthesiology
to medical students would be through a three-tiered approach.
This approach would expose medical students to anesthesiologists
throughout their medical school career.
The first step would occur during basic science training. Physiology
and pharmacology are the backbone of anesthesiology. What other
field in medicine has a more intimate knowledge of the interactions
among cardiovascular, pulmonary and renal physiology? Our profession
requires us to understand not only the healthy physiologic state,
but also the pathological state and changes in light of coexisting
disease. With this core knowledge of physiology and pharmacology,
we can apply these principles in a clinical setting to obtain
a desired effect. This melding of education in physiology and
pharmacology in healthy and pathologic states is one of our specialty's
greatest strengths. Moreover, a large part of our professional
expertise deals with airway anatomy. We can give an exceptional
perspective of its anatomy and the changes that occur within different
pathological states. This knowledge and expertise could be taught
to medical students by anesthesiologists in the classroom at the
basic science level.
The second step would be in a more traditional clinical setting,
similar to that of a CA-1 resident: initial airway management
would be emphasized over intubation. As one of my attendings always
says, "Not being able to intubate does not kill someone. Not being
able to ventilate does. Ventilation saves lives." Students often
lose sight of the forest for the trees. They become so focused
on intubation that they forget the basic tenet that ventilation
is the key. Again, we need to emphasize the importance of ventilation
first, then intubation. During this time, a review of basic cardiovascular
and pulmonary physiology and a review of anesthesia's effect on
the human body would reinforce the connection between basic sciences
and clinical medicine. Lastly, exposure to other areas of anesthesiology
including regional anesthesia, obstetrics, critical care and pain
management would complete the experience.
The third step is something anesthesiologists can contribute
to medical students to connect the basic sciences with the clinical
setting. Basic airway management, or the ABCs (airway, breathing
and circulation), is something that can be taught to medical students
in various stages of their medical school career. Basic life support
is an essential part of medicine applicable to all fields. At
some stage of almost every physician's career, he or she encounters
an airway issue. Because of our expertise in airway management,
we are capable of teaching this information early.
In fact, the ASA Resident Component conducted a basic airway
management workshop for medical students at the American Medical
Student Association National Convention on March 1718, 2000,
in Washington, D.C. The emphasis was placed on the ABCs and intubation.
Our curriculum was based on the advanced cardiac life support
(ACLS) airway management protocol. We taught airway anatomy, mask
ventilation and tracheal intubation as well as provided initial
exposure to laryngeal mask airways (LMAs). We included LMAs in
the curriculum because they are becoming more common on code carts
across the nation. The airway management workshop gave students
the opportunity to handle airway equipment, including the LMA,
and to learn to become more familiar with it in preparation for
an emergency situation. Such workshops are an excellent way to
expose medical students at an early stage of their career to proper
airway management and to the field of anesthesiology in general.
We anesthesiologists have a vast background that allows us to
participate in all phases of medical education from the basic
sciences through pharmacology and physiology, to the interim before
clinical rotations via airway management workshops, to clinical
electives. Having anesthesiologists participate in all three phases
assures a constant exposure to our specialty by improving the
understanding of our large contribution to medical education.
Tripti C. Kataria, M.D., is a CA-2 resident
in anesthesiology at Brigham and Women's Hospital, Harvard Medical
School, Boston, Massachusetts.
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