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Can Strategic Choices Keep Physician Anesthesiologists “In the Room Where It Happens?”

Wasnick, John D. MD, SM, MPH

doi: 10.1213/XAA.0000000000000425
Case Reports: Letters to the Editor

Department of Anesthesiology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas,

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To the Editor

Alem et al1 note “it is incumbent on anesthesia training programs to consider reassessing and ensuring that educational curricula and clinical experiences parallel the evolving needs anticipated for anesthesiologists entering future models of clinical practice.” This is indeed sound advice; as a program director, the last thing I want to do is prepare graduates who are likely to be the victims of disruptive innovation as opposed to being disruptively innovative. Unfortunately, there are competing visions of what the future model of anesthesiology clinical practice might become. What strategic guides are available to anesthesiology educators to ensure the relevance of our graduates in an ever changing health care marketplace? To borrow from Broadway’s Hamilton, how do we keep our graduates very much “in the room where it happens?”

Fortunately, Porter and Lee2 have previously provided 6 guiding questions that health care organizations can use to help them discern strategy. At least 3 of these strategic questions can be adapted to assist anesthesiology educators in deciding to enact or to discard educational requirements. Strategic questions to consider when adjusting curriculum should include the following:

  • What is anesthesiology’s fundamental goal?
  • What is anesthesiology’s business?
  • How will anesthesiology differentiate itself in each business?

Value (Outcomes/Price) according to Porter and Lee is the “true north” of health care strategy. Any educational activity that enhances our trainee’s value to health care purchasers (eg, design of management pathways, perioperative risk reduction) should be enacted. Alem et al1 are to be commended for including so many value-creating activities in their curriculum. McEvoy and Lien3 in their accompanying editorial suggest that anesthesiologist’s training focus on caring for the sickest of patients and in so doing they address the second discernment question. What will be the future business of physician anesthesiologists? Caring for an increasingly aged and sick perioperative population seems inevitable. Consequently, training that enhances critical care skills should be expanded. Finally, educational reforms that permit anesthesiologists to effectively differentiate themselves such that they can enmesh and embed themselves in care teams to oversee episodes of surgical illness should be readily embraced. Residents need to be integrated into practice units directly alongside physicians from other medical disciplines that participate in specific care episodes. In this sense, the suggestion of McEvoy and Lien on 2-phase resident training provides a mechanism to address the third strategic question by ensuring both core and specialized training for each graduate.

When considering the many suggested curricular reforms that have appeared or are likely to appear in the future, strategic questioning can assist program directors in determining whether a proposed educational reform enhances the ability of our resident to create value. We have an opportunity to take a strategic shot at revising our curriculum. Like Hamilton, we cannot afford to miss the mark, lest we suffer his fate.

John D. Wasnick, MD, SM, MPH
Department of Anesthesiology
Texas Tech University Health Sciences
Center School of Medicine
Lubbock, Texas

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1. Alem N, Cohen N, Cannesson M, Kain Z. Transforming perioperative care: the case for a novel curriculum for anesthesiology resident training. A A Case Rep. 2016;6:373379.
2. Porter ME, Lee TH. Why strategy matters now. N Engl J Med. 2015;372:16811684.
3. McEvoy MD, Lien CA. Education in anesthesiology: is it time to expand the focus? A A Case Rep. 2016;6:380382.
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