Re-Thinking the Anesthesia Rotation
by Alessandro De Camilli, MD
To augment recruitment to our specialty, we need to start at the grassroots. The COVID-19 pandemic shed light on a lack of critical care training among practicing anesthesiologists, as well as lack of appreciation for the specialty in the global medical community. A large contributing factor is the myopic perspective of our specialty offered on the standard boilerplate anesthesiology rotation. Medical student exposure to anesthesiology is almost exclusively dedicated to intubation and the role of the intraoperative provider: a rote sequence of injections and dials, staying quiet so as not to wake the beast across the drapes. We love to show off our cheap thrills: the magic of propofol, the placement of arterial lines, and we stick to cheeky truisms: “physiology and pharmacology in action,” “our patients are 100% compliant!”, “we protect patients from the surgeon!” But in doing so, we are selling ourselves short. It’s time to draw back the curtain and show them how much the role of a modern-day anesthesiologist and intensivist can transcend this role.
First, we need to show them our world beyond the operating room. Sitting with the resident for hours on end gives the wrong impression, unless we are trying to sell students on the role of a private practice solo provider. It may be more useful for the student to shadow the attending, who is juggling multiple emergent responsibilities, and triaging perioperative medical issues. If perioperative medicine is our future, we should use it as a selling point.
Second, we need to strengthen their exposure to surgical critical care. I may be biased in saying that anesthesia intensivists represent the apex of our field—we work as real doctors, our procedural and intellectual prowess on full display. This is also the arena in which we have the most leverage in garnering respect from the broader hospital. The future generation of physicians need to see that we are not just a technician behind the drapes being yelled at about paralysis. When the drapes come off, we engage in high level medical decision making with these very same surgical colleagues. In most European countries, Anesthesiology and Critical Care are integrated into the same specialty. Medical Students would likely welcome this perspective.
Third, we should expose them to our ever-increasing footprint in the hospital at-large. Medical students might be thrilled to be included on the airway stat team: we can show them how critical our expertise on respiratory failure is in the peri-arrest setting (and additionally, that we know more about hemodynamic management than most others called to assist in the same setting). We should include them on the ICU triage team, showing them how anesthesia intensivists are necessary for critical care resource allocation. We should expose them to regional anesthesia, of course, but additionally the regional anesthesia requests outside of the OR - ICU, pain clinic, etc. which also involve complex medical decisions.
The broad reach of anesthesiology on the functioning of the hospital is significant. As I moved through student, resident, fellow, attending—I began to notice this “anesthesia creep” into almost every arena. We are the hospital’s insurance policy against failure, the sole arbiters of patient safety. The hospital has grown to rely on us for any situation which requires urgent, high-level, acute care, or one in which a patient is having a life-threatening experience (or an experience that would benefit from amnesia). We protect from iatrogenic harm—drug overdoses, procedural error, or apnea due to an overzealous PCA prescription. We allow for time-sensitive interventions to occur without a hitch—neuro-embolization for acute stroke, STEMI activation for patients who need higher level of monitoring. And we are a necessary utility by which the hospital’s greatest revenue generators—surgeons—can thrive.
I think we would immensely benefit from a recruitment standpoint if we brought students into this broader world of anesthesia as a bridge between the hospital and its ability to function safely.
These changes will require some hefty changes from anesthesia program coordinators/directors, but they are necessary if we want to keep up recruitment to our fast-evolving field.
Alessandro De Camilli, MD
Memorial Sloan Kettering
New York, New York
SOCCA Reception at 2023 SCCM Critical Care Congress in San Francisco
Time: 5:00 PM – 7:00 PM PT
Location: Hilton Union Square (333 O’Farrell Street)
Room: Franciscan A
When: February 2, 2023 | 6:00 PM ET
Where: Register online
Description: Join us for our first Early Career Intensivist Group Meet and Greet of the year on February 2 at 6pm ET. We will have SOCCA board member Dr. Ashish Khanna joining us for a lively discussion about navigating through life as an Early Career Intensivist. We look forward to seeing you soon!
Mechanical Circulatory Support (MCS) / Extra Corporeal Membrane Oxygenation (ECMO) / Cardio Thoracic ICU (CTICU) Workgroup
Members who have a special interest in MCS are invited to join this workgroup. Our first meeting will be January 19, 2023, at 5PM CST. Please register in advance: SOCCA CTICU/ECMO Meetup Link.
This year, SOCCA is seeking committee volunteers for our communication, education, membership, and research committees—as well as the new clinical practice committee. To view committee descriptions and submit an application, visit https://socca.org/get-involved/.
You may submit an application for a SOCCA Committee between November 1, 2022 and December 31, 2022.
Learn more & review SOCCA’s Volunteer Selection Criteria.
This election cycle, SOCCA will be electing three members for the Board of Directors (3-year term). Further details about the governance structure of SOCCA are described in SOCCA’s Society Bylaws.
SOCCA members interested in serving in an elected positions on the SOCCA Board of Directors should submit a letter of interest, photograph, and curriculum vitae to Vivian Abalama, IOM, CAE ([email protected]) with subject line “2023 SOCCA Board of Directors Election.”
Review criteria by which Board of Directors and volunteer leaders are evaluated: Volunteer Selection Criteria.
You can apply via email only for a Board of Directors position between November 1, 2022 and December 5, 2022.
SOCCA Innovators Award: applications open 9/30/2022 – 12/31/2022.
Gender Equality in Critical Care
Major professional societies & organizations have the obligation to initiate & sustain strategies that support & enhance gender equality in critical care. WICC invites members of SOCCA to participate & discuss ways to advance these goals & values. Understanding & recognizing gender diversity challenges & carrying on the momentum gathered in recent years within SOCCA and outside it, will enable a positive environment for more women to enter & remain within ACCM.
SOCCA has a calendar/list of events. Visit it regularly & save essential dates.
The SOCCA Speakers Bureau has officially launched! As a SOCCA member, you may now:
Have you made any changes in 2022? It’s time to update your SOCCA demographic profile and / or renew your membership. Keep your SOCCA experience seamless & don’t miss out on any updates & member benefits. Visit: buff.ly/3sPMG6j
SOCCA would like to acknowledge the invaluable contributions of our female intensivists during this month and year-round. Throughout September, four of our members will be sharing their experiences as a woman in critical care.
Read: Burnout: No Easy Answers in a Post-Pandemic World, by Sarah Alber, MD
Read: Belonging to an Organization: Professional Advancement & Personal Gains, by Nazish Hashmi, MD
Read: Mentors and Mentees: A Powerful Connection, by May Hua, MD, MS
Read: Women in Critical Care: Where We Are & Where We Want to Be, by Shahla Siddiqui, MD, MSc, FCCM
Shahla Siddiqui, MD, MSc, FCCM, and Co-Chair of SOCCA’s Women in Critical Care recently edited a special issue of Journal of Critical Care featuring women as first and senior authors. Read Dr. Siddiqui’s introduction in Volume 71 | October 2022 issue.
The SOCCA Early Career Intensivists working group provides new members and members who are early in their careers with the resources needed to ease the transition from trainee to practicing intensivist. Learn more.
Have you read “SOCCA, the Pandemic, and the Future” by SOCCA’s Miguel Cobas, MD, FCCM, in this month’s ASA Monitor? Visit: https://socca.org/wp-content/uploads/2022/04/Cobas_SOCCA.pdf
As a SOCCA member, you are eligible to receive a discount on an IARS membership. IARS membership benefits include a subscription to Anesthesia & Analgesia, SOCCA’s official journal, A&A Practice e-journal, free journal CME, access to a member community and discounted registration to the IARS Annual Meeting. Click here to view a list of membership options.
Anesthesiology Critical Care Fellowship Programs
Have you visited SOCCA’s Anesthesiology Critical Care Fellowship Programs page? If you would like your organization’s program added to our site, let us know here: https://socca.org/new-socca-fellowship-listing/.