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You do not
have to be a rocket scientist to enter data into a
computer. Should you wish to launch a rocket, however,
it helps to be a rocket scientist who knows what data
to enter and what to do with it. Rocket scientists
do enter data into their computers even though they
are vastly overtrained for data entry.
Most jobs require multiple skills. We are overtrained
for many of them, yet we do them, usually for one
or more of the following reasons: simple tasks are
embedded in complex tasks, and delegation would introduce
confounding complexities; simple tasks are not delegated
because there is no one available to whom to delegate;
simple tasks might as well be done by the overtrained
individual because there is no need to free up his
or her time.
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A
Wide-Open Future
AAs
have become critical members of the anesthesia
care team. Although trained to work under
the guidance of an anesthesiologist, the
AA’s academic background keeps the
door open to advanced training.
(Photography by Pamela Dabrowa) |
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A nesthesiologists are vastly overtrained for some
tasks. Can we spread the skills of the anesthesiologist
to more patients by delegating some of the tasks for
which the anesthesiologist is overtrained? Is there
an unmet need for additional services by anesthesiologists?
These questions have been raised repeatedly over the
years. In the 1960s, there was an obvious and pressing
need for more anesthesiologists. Therefore, we took
a look at the task distribution in anesthesiology
and concluded that we could indeed free up time by
delegating some tasks.1
Instead of such an analysis, we could have looked
for existing examples of task delegation. It would
have led us to the same conclusion. In many institutions,
anesthesiologists worked with nurse anesthetists in
patient care teams. The arrangement was and continues
to be quite common, and continues to be satisfactory
as judged by the widespread acceptance of the group
concept in the professions.
In the early 1960s, a concern was brought to our attention
by several nurse anesthetists who inquired about what
it would take to become an anesthesiologist. An examination
of many nurses’ academic background showed time
and again that the educational stepping stones for
nurse anesthetists and anesthesiologists were quite
different. Nurse anesthetists who wanted to advance
in their field became discouraged when they discovered
that it would require not only four years in medical
school and time in a residency training program but,
more often than not, also several years in college
to meet medical school admission standards. This observation
led us to examine the concept of career ladders. In
the armed forces, a private can move up through the
ranks and become a general; in industry, a shipping
clerk can ascend and become chair of the board; but
in anesthesia, such upward mobility was never envisaged.
By historical happenstance, nonphysician anesthesia
had its roots in nursing, a noble profession that
does not consider a career ladder in which medical
school and a medical specialty would be a natural
option for advanced standing. Today, we can dream
about the past and what would have happened had anesthesiology
in its early years welcomed nurse anesthetists into
its fold and if the two fields had jointly examined
how best to open all options to nurse anesthetists.
Today, and even in the 1960s, such ideas were not
entertained by either the nurse anesthetist community
or by anesthesiology.
This being the case, we decided to explore a career
path that would prepare a student to become a valuable
assistant in anesthesia while opening the doors to
advanced training in medical school and beyond. The
results of these explorations were the establishment
of two anesthesiologist assistant (AA) programs, one
at Emory University in Atlanta, Georgia, and the other
at Case Western Reserve University (CWRU) in Cleveland,
Ohio. We examined the tasks that then modern anesthesia
required and tried to project future needs. In addition
to the traditional clinical anesthesia tasks, we foresaw
a need to emphasize education in technology and electronics
as related to monitoring of life support systems and
anesthesia maintenance. We considered these trainees
to be “applied physiologists.”
When we approached the universities with this concept,
legitimate questions about the curricular content
were raised. Would the student still be able to receive
a well-rounded general education? How much time and
what specific topics were to be covered in clinical
education? How much laboratory time was to be available
for clinical rotations? Exhaustive scrutiny of what was needed, what was fair
to the student and what would meet a university’s
expectations led us to propose programs that were
eventually accepted. The result of this careful planning
was a master’s degree program at Emory and a
baccalaureate program at CWRU. The Emory program made
premedical requirements a prerequisite for admission,
and the CWRU program incorporated these requirements
in the bachelor degree program. Both programs currently
offer a master’s degree. Of course, both programs
incorporated didactic and practical material specific
to anesthesia. The Emory and CWRU programs graduated
their first students in 1971 and 1973, respectively.
If a student’s performance in academic courses
was competitive at the medical school level and if
the student chose to apply for admission, the programs
strongly supported the student’s application.
Indeed, two of the first three AAs were admitted and
successfully completed medical school. One eventually
became an anesthesiologist.
In the March 2001 issue of the ASA NEWSLETTER,
the interested reader will find a helpful article
by Scott B. Groudine, M.D., “Anesthesiologist
Assistants: Being a (Care) Team Player.”2
In the article, Dr. Groudine provides additional information
on the curricular content and a job description of
the AA.
| References: |
| 1. Gravenstein JS, Steinhaus JE, Volpitto
PP. Analysis of manpower in anesthesiology.
Anesthesiology. 1970; 33:350-357. |
| 2. Groudine SB. Anesthesiologist assistants:
Being a (care) team player. ASA Newsl.
2001; 65(3):16-17,29. |
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J.S. Gravenstein, M.D., is Graduate Research
Professor Emeritus, Department of Anesthesiology,
University of Florida College of Medicine, Gainesville,
Florida. |
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John
E. Steinhaus, M.D., Ph.D., is Professor Emeritus,
Department of Anesthesiology, Emory University
School of Medicine, Atlanta, Georgia. |
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