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Core Clinical Competencies in Anesthesiology

A Case Based Approach

Parker, Nathaniel W., MD

doi: 10.1213/ANE.0b013e318207b37f
Book, Multimedia, and Meeting Reviews: Media Reviews

Cedars Sinai Medical Center Los Angeles, California (Parker)

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) endorsed 6 core competencies as a guideline to ensure that United States–trained anesthesia residents are receiving complete education in their specialty areas. The 6 recognized core clinical competencies are

  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism and
  • Systems-Based Practice.

Drs. Gallagher, Lewis, and Schwengel have endeavored to write a book that addresses each of these competencies individually in the context of clinical anesthesia case scenarios. Core Clinical Competencies in Anesthesiology is formatted using case scenarios to address the core competencies. The cases are first introduced, and then divided into the various competencies in which repetitive language reiterates the objectives of the core competencies. Unfortunately, this formatting architecture ultimately proves to be distracting because it results in an excessive amount of redundant information.

The “Medical Knowledge,” “Patient Care,” and “Practice- Based Learning and Improvement” sections provide the meat of the book, and are well-suited to medical student, intern, and CA-1 readership level. These informative sections occasionally provide references for further reading. The “Professionalism” and “Interpersonal and Communication Skills” sections appear to be rather superfluous and primarily suited for young trainees looking for guidance on how to act professionally with colleagues.

According to the “Systems-Based Practice” summary on page 5, “the main idea of systems based practice is related to money.” As physicians, we should encourage one another to be more deliberate in our thinking about the professional impact of anesthesiologists on patient care and the medical system, including perioperative care, research, health care policy issues, and being responsible citizens for the stability of the planet we all share. Rather than focusing on advancing the specialty by improving clinical research and educational programs, the authors reductionistically suggest that money is the central issue of “Systems-Based Practice.”

Clearly, the strength of this paperback book lies in the 77 case scenarios presented. The mistakes of others are second only to our own mistakes in serving as learning tools. To the authors' credit, they admit to struggling to find the appropriate connections to all of the competencies for every case. Pages 3 to 6 provide a succinct summary of each of the core competencies and would be an effective stand-alone guide for reading the case scenarios and avoiding the need to continually reiterate the same points (e.g., “Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities”) throughout the entire book. In the opinion of this reader, the attempts to enhance the readability of the text by injecting humor actually detracted from the educational value of the text, and would be more effective if it appeared less frequently and was dispersed more subtly throughout the text.

With regard to their purpose in writing this book, it is clear that these well-meaning physician authors worked hard to fulfill their primary writing objectives. On the other hand, even the most casual observer may wonder what the editors were thinking during the editing process given the level of intelligence and knowledge of the current graduate level anesthesiologist audience. A new anesthesia textbook outlining the management of morbidity and mortality cases is a potentially valuable addition to the current body of educational material available to trainees in anesthesia.

Does this textbook fill a necessary educational niche or is it a superfluous addition to the residents' library? In the opinion of this CA-3 resident, the best aspect of this manual is its undeniable potential. The case scenarios provide a highly engaging format for learning about clinical anesthesia. Given the high degree of redundancy in the text (perhaps as high as 50%), it could obviously be significantly edited to make it more concise without losing any vital information. Despite the shortcomings of this first edition, this reviewer is looking forward to reading the next edition of this book.

Nathaniel W. Parker, MD

Cedars Sinai Medical Center

Los Angeles, California

© 2011 International Anesthesia Research Society