Michael Esterlis, MS3 (St. George’s University of London and Thomas Jefferson University) and Qiaohua (John) Zhang, MS3 (Thomas Jefferson University)
If you are planning to go into the field of anesthesiology, you are already an ambassador and are representing the profession even if you are not aware of it yet. Third year rotations are difficult, and it can be commonplace to meet passive disapproval when you are asked the dreaded question “Have you thought about what you want to do yet?” Dreaded not because you are not content with your decision, but often due to preconceived ideas people have about our choice of profession, prejudice and the worry to come across disinterested of your current rotation.
We are here to reinforce that commitment and passion are necessary, and to offer communication strategies and principles to cultivate a strong anesthesia-interest culture on campus.
We want to introduce the concept of “The Enthusiastic Promoter.” Just like a warm smile, enthusiasm can be infectious. People's love of the profession will take care of the marketing. We want to encourage the same attitude to be applied toward anesthesia. The nature of our chosen profession will sell itself, but we should aim to promote it and hold it in the highest esteem at every interaction with our colleagues or casual social conversation.
We hosted a Q&A session and introduction to anesthesia as a career choice at the Jefferson Anesthesia Society event in September, where an audience representing all medical student years had the opportunity to hear residents give an introduction about the profession, what to
expect on an average day, and a chance to ask questions and raise concerns. Some of these concerns were resounded at a Q&A panel with five attending physicians in February. We wish to discuss the fallacies and debunk some common misconceptions.
The anesthesia scope of practice is narrow.
The different hats we wear are best represented by our ability to establish a myriad of effects in our patients as well as our ubiquitous presence in the hospital. We inject extremely potent and potentially lethal drugs with the intention to remove awareness and memory (unconsciousness/amnesia), anxiety (anxiolysis) and pain (analgesia). We also chemically paralyze (muscle relaxation), take over the instrumental work of breathing (intubation and ventilation) and optimize conditions for the surgeon. We then titrate these drugs in real-time, which affect different organ systems, exercising our clinical acumen and using our medical knowledge of multisystem disease. We are required to be experts in physiology and pharmacology to support life under anesthesia, and to ensure the patient regains their ability to breathe independently and safely transitions to recovery. We follow them in the postoperative suite until they are safe to leave our sight. We are the guardians of our patients.
We have the noble privilege to take away people’s pain in settings such as the labor and delivery ward with epidurals as well as spinals in cesarean deliveries, allowing mothers to witness the miracle that is birth while remaining relatively free of pain. With the recent innovation and application of ultrasound, we have the extreme precision to target specific nerves and dermatomes. We can now offer localized long-term analgesia and hasten the recovery of our patients, for example, in joint replacements or incisional laparotomy pain. This allows a hastened process of recovery through earlier engagement with physical therapy. Additionally, vast research opportunities in anesthesia are emphasized by diverse fellowships in fields such as obstetrics, regional anesthesia, pain management, pediatrics, neuroanesthesia, cardiac anesthesia, thoracic anesthesia and critical care amongst others. We are known as the airway experts, often called as a last resort in rapid responses and codes. We practice airway management on daily basis. Our comfort with the MAC/Miller, GlideScope, and fiberoptic bronchoscope is unparalleled. Finally, with the recent opioid epidemic as declared by the CDC, we are stepping to the forefront of the iatrogenic plague that is sweeping the U.S. and the world.
It looks boring behind the curtain.
Find a mentor who is willing to challenge you. After years of practice, an anesthesiologist and a well-functioning team can reduce an extremely complex set of decision-making and procedures to what seems as boring routine, just like a well- rehearsed dance. Ask why something is done—try to get the anesthesiologist to verbalize their thoughts. Learn the complexities of the anesthesia machines, gas laws, how each drug alters the human physiology, and why it is used in a particular circumstance. What happens when we collapse a lung during thoracic surgery? Can the patient even tolerate single lung ventilation? The physiology determines what we must alter on our machines. A thorough understanding of cardiopulmonary physiology allows us to react appropriately to traumatizing disturbances on the other side of the curtain. Find someone who forces you to think through these questions. Learn the surgeries and how each anesthetic plan was tailored and customized for the patient. Ask to become involved in procedures once you understand the decision-making—properly secure a 22 gauge? Let’s seldinger an arterial line. Anesthesia is markedly hands-on, and getting the most of your experience will come from learning-by-doing. If you have the infrequent opportunity to experience a crisis in anesthesia, you will appreciate that avoiding excitement is part of the job. As older anesthetics agents are retired, novel and safer agents are introduced, algorithms are refined, and technology is exponentially improved over the years, safety and quality improvement became an integral part of our core practice principles.
There is not enough patient face-time.
Building the therapeutic relationship is arguably the most challenging and rewarding within the realm of the perioperative period. We need to acquire the skills to build a quick rapport. We need to gain the trust of allowing someone to take his or her life into our hands within minutes of conversation—now that’s a serious task. We often need to calm a child that is scared, or talk with a patient for hours if they have procedural sedation or a regional block with no sedation. We also see patients at the preoperative clinic and use our medical knowledge to ensure the patient is medically optimized to tolerate anesthesia and surgery. In the outpatient setting, we can help manage pain and build long-term relationships with patients.
Concerns about job security with the expanding role of CRNAs and AAs.
One of the authors used to be a respiratory therapist and anesthesia assistant (AA) in Canada prior to medical school, so we offer some insight with the following. Although the CRNA/AA representative bodies will always push for more legislative responsibility as part their agenda to expand their role, it ultimately will not affect you as an individual. Our role is pushed to be more supervisory and with the introduction of the Perioperative Surgical Home, it is important to learn to embrace change. We are challenged academically to be even more diverse, to not only be able to pilot one single patient, but also to be able to manage a surgical suite filled with numerous patients and their comorbidities. Both physicians and allied health care professionals can deliver an anesthetic, however, the CRNA and AA scope of practice is within a defined medical directive (at least in most jurisdictions). The physician’s role is also to know when to step outside the rules and algorithms, after having mastered the art and science of anesthesia. Health care and funding agendas are changing, more focus is being placed on quality-based compensation, and the status quo will consistently be challenged. As future anesthesiologists, we need to be comfortable with calculated risk. We should embrace change and remind ourselves the role we play in safeguarding the patient through their health care journey. The training between physicians and other health care professionals is different, and we should reassure ourselves, welcoming collegial and interprofessional patient care. Finally, we should always strive for lifelong learning.
We encourage you to join or pioneer an anesthesia society on campus. Liaise with your local anesthesia department for mentorship. Most importantly, have fun! Anesthesia is hands- on, so arrange for clinical skills workshops and simulation. We purposely chose not to talk about the perks that come with our field—as nice as they are (lifestyle, indeed). Be armed with information to tackle uninformed concerns, and share your passion. For event ideas, please get in touch with us at [email protected].
posted summer 2017