Put the patients to sleep, not the students

The importance of targeted anesthesia initiatives in medical school

With the advent of the United States Medical Licensing Examination Step 1 scoring change, there is an increased incentive for students to strengthen their resumes with research and extracurriculars. In turn, many medical students feel compelled to commit to a specialty early in their education. However, despite a favorable work-life balance and income, anesthesiology is still viewed as a relatively less competitive specialty. The number of U.S. MD applicants per residency position in 2022 was 1.30 for anesthesiology, 1.36 for diagnostic radiology, 1.48 for general surgery, and 1.53 for dermatology.[¹] These differences may be attributed to the current design of many medical school curricula, which facilitates preclerkship teaching by organ system modules. While certain medical specialties, such as cardiology or gastroenterology, garner interest through this design, anesthesia does not correspond to one particular module. Potential interest is further dismissed in clerkship years, with anesthesia being offered as an elective rotation and not a core experience.[²] If the field is to grow and attract more students, it must do so by providing effective preclinical and clerkship exposures, tailoring these to students’ goals and learning priorities.[³] As medical students in their preclerkship training, as well as aspiring anesthesiology applicants, we propose two approaches to stimulate specialty interest herein this commentary.

Preclerkship students often prefer learning through interactive problem solving over traditional lectures, conveying the importance of problem-based learning (PBL).[³⁴] PBL involves the presentation of a medical case as students are provided with minimal background information. Over the course of the PBL, more information on the case, such as lab tests and diagnostic images, is provided, allowing students to narrow their differentials and ultimately develop clinical reasoning skills.[⁵] Rather than passive memorization of lecture material, students improve their knowledge base on a topic through the opportunity to ask questions, work with peers, and explore multiplex relationships.[⁶] Therefore, we propose the implementation of more pharmacology and anesthesia-driven PBLs in preclerkship years. Students may engage with such material more effectively while improving their knowledge of important principles such as pharmacodynamics and electrolyte imbalances. Not only will this inspire more interest in anesthesia and pursuing elective rotations, but it may also improve clerkship performance. A 2020 survey found that skills acquired in PBL were deemed beneficial during core clerkship rotations for third-year medical students.[⁷] As such, we believe the skill and knowledge obtained from anesthesia-focused PBLs will translate to better performance in anesthesia rotations, thereby affirming one's interest.

Although increasing patient interactions and operating room time are ideal for a successful clerkship experience, such opportunities may be limited across various teaching hospitals. Fortunately, the medical field has been progressing through technological innovations. Mixed reality, in particular, may be beneficial for anesthesiology training among clerkship students. This system generates an immersive, computer-generated environment that combines aspects of the virtual and real world through a headset. In a 2020 randomized control trial, medical students in their urology rotation underwent such simulations involving bladder catheter placement.[⁸] Students that participated in the mixed reality training performed significantly better on objective structured clinical examination compared to controls. As an instructor need not be present, students can also obtain additional practice outside of required learning times. In a 2021 survey of medical students’ preferences and expectations of anesthesia clerkships, students favored “hands-on” learning formats.[³] Mixed reality meets students’ preference for this type of learning while enhancing clinical skills and standardizing teaching among students. Implementation of this unique learning modality in anesthesia clerkships will increase student engagement and performance in the clinical setting.

Recent literature affirms an increasing appeal to anesthesiology among active students. Of note, in the previously referenced survey, Schlecht et al.[³] observed that most medical students believed anesthesia rotations should be mandatory (61%) instead of elective (29%). Given such promising results, we believe an effort must be made to proactively further interest in the field throughout all years of medical school education. Specialty-targeted changes may be particularly beneficial in this regard, whether it be incorporating anesthesia-related PBLs in preclerkship years or mixed-reality during rotations.

Conflicts of interest

No financial and/or material support was received for this research or the creation of this work. No funded writing assistance was utilized in the production of this manuscript. The authors report no other conflicts of interest.