From the Head of the Bed

Hey folks! This podcast is about recharging. It’s a talk that touches on provider wellness and our need to find time on a weekly basis to pull back and take care of ourselves – to recharge! Below you’ll see the Crisis Text Line phone number: 741-741. This is the number you text if you or someone you know is having a crisis, particularly involving suicidal ideation, depression and/or hopelessness. Below that is an image outlining the National Wellness Institute’s Six Dimensions of Wellness. I talk more about both of these and so much more in the podcast – check it out! In the podcast I reference facts from the following articles: * Tarantur, N., Deshur, M. (2018).  Anesthesia professional burnout – a clear and present danger.  APSF Newsletter. 33(2), 43-44.* Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. AANA journal, 79(2). * Chipas, A, Cordrey, D., Floyd D., Grubbs, L., Miller S., & Tyre B. (2012). Stress: perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists. AANA journal, 80(4), S49. * De Oliveira, G. S., Chang, R., Fitzgerald, P. C., Almeida, M. D., Castro-Alves, L. S., Ahmad, S., & McCarthy, R. J. (2013). The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesthesia & Analgesia, 117(1), 182-193.  * Raj, K. S. (2016). Well-being in residency: a systematic review. Journal of graduate medical education, 8(5), 674-684.  * Crisis Text Line image.  (n.d.)  Copyright 2013-2018 Crisis Text Line.  Retrieved 26 November 2018 from https://www.crisistextline.org.  Screenshot by author* Hettler, B. (1976). Six dimensions of wellness model. National Wellness Institute. Retrieved from https://cdn.ymaws.com/www.nationalwellness.org/resource/resmgr/tools/SixDimensionsFactSheet_Tool.pdf.  Screenshot by author.* Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. * Grant, A.  (2018, December 8).  What straight-A students get wrong.  The New York Times.  Retrieved from https://www.nytimes.com/2018/12/08/opinion/college-gpa-career-success.html

In this episode, I had the privilege of chatting with Michael Mielniczek, BSN, SRNA on an overview of succinylcholine. At the time of this recording, Michael was a second year Student Registered Nurse Anesthetist at the University of Scranton and a student representative for the AANA Foundation.  His background includes experience as a critical care Registered Nurse in Austin and achieving nursing certifications in critical care (CCRN), cardiac medicine (CMC) and cardiac surgery (CSC).   As part of his graduate studies, Michael completed an in-depth project regarding the history, latest research and controversies on succinylcholine titled “Succinylcholine:  From Discovery to Current Evidence for Everyday Practice,” which is also the title of his podium presentation at the 2018 national AANA Nurse Anesthetists Annual Congress in Boston. Michael contacted me with a desire to share what he’s learned on succinylcholine with our podcast listeners and I couldn’t be more pleased to bring you this episode. In the episode, we cover an in-depth overview of succinylcholine pharmacology, dosing, considerations and controversies. While our conversation is strictly based on published anesthesia textbooks and published, peer-reviewed journal articles, we both strongly encourage you to cross-reference any and all information, especially on dosing, with published resources. The resources we pulled from for this conversation are below: Alvarellos, M. L., McDonagh, E. M., Patel, S., McLeod, H. L., Altman, R. B., & Klein, T. E. (2015). PharmGKB summary: succinylcholine pathway, pharmacokinetics/pharmacodynamics. Pharmacogenetics and genomics, 25(12), 622. Barash, P. G. (Ed.). (2009). Clinical anesthesia. Lippincott Williams & Wilkins. Fukano, N., Suzuki, T., Ishikawa, K., Mizutani, H., Saeki, S., & Ogawa, S. (2011). A randomized trial to identify optimal precurarizing dose of rocuronium to avoid precurarization-induced neuromuscular block. Journal of anesthesia, 25(2), 200-204. Lee, C. (2003). Conformation, action, and mechanism of action of neuromuscular blocking muscle relaxants. Pharmacology & therapeutics, 98(2), 143-169. Nagelhout, J. J., & Plaus, K. L. (2014). Nurse anesthesia. Elsevier Health Sciences. Miller, R. D. (2015). Miller’s anesthesia (8th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. Schreiber, J. U., Lysakowski, C., Fuchs-Buder, T., & Tramer, M. R. (2005). Prevention of Succinylcholine-induced Fasciculation and MyalgiaA Meta-analysis of Randomized Trials. Anesthesiology: The Journal of the American Society of Anesthesiologists, 103(4), 877-884. Tran, D. T., Newton, E. K., Mount, V. A., Lee, J. S., Wells, G. A., & Perry, J. J. (2015). Rocuronium versus succinylcholine for rapid sequence induction intubation. The Cochrane Library.

Tim Fitzgerald, MD is a surgical oncologist and Director of Surgical Oncology at Maine Medical Center and MaineHealth. He is an Associate Professor of Surgery at Tufts University School of Medicine and specializes in complex gastrointestinal surgery.  Dr Fitzgerald has published and lectured extensively on enhanced recovery programs for the perioperative environment.  His implementation of an enhanced recovery program for complex gastrointestinal surgical patients at a tertiary medical center in North Carolina resulted in significant reduction in length of stay, decreased mortality and decreased cost. Dr Fitzgerald joined me to record a three-part series on enhanced recovery programs (colloquially referred to as “ERAS” programs).  In part 1, we discuss the realm of quality in healthcare and why enhanced recovery programs matter.  In part 2, we take a deep dive into the details of enhanced recovery programs from the pre-hospital phase through the post-operative phase of care.  In part 3, we discuss the concept of frailty and optimizing patient care in the perioperative surgical home. The American Association of Nurse Anesthetists (AANA) offers a public website with links to numerous consensus guidelines and resources related to implementing enhanced recovery programs. Sources: * Timothy L., F., Catalina, M., Nicholas J., K., Nasreen A., V., Kimberly V., E., & Emmanuel E., Z. (2016). Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter. Surgery Research And Practice, Vol 2016 (2016), doi:10.1155/2016/6830260 * Mosquera, C., Koutlas, N., Fitzgerald, T.  (2016)  A single surgeon’s experienced with enhanced recovery after surgery: an army of one.  The American Surgeon. 82 (7), 594-601. * AANA. (2017).  Enhanced recovery after surgery: considerations for pathway development and implementation. American Association of Nurse Anesthetists. Retrieved from https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/enhanced-recovery-after-surgery.pdf?sfvrsn=6d184ab1_6  

Tim Fitzgerald, MD is a surgical oncologist and Director of Surgical Oncology at Maine Medical Center and MaineHealth. He is an Associate Professor of Surgery at Tufts University School of Medicine and specializes in complex gastrointestinal surgery.  Dr Fitzgerald has published and lectured extensively on enhanced recovery programs for the perioperative environment.  His implementation of an enhanced recovery program for complex gastrointestinal surgical patients at a tertiary medical center in North Carolina resulted in significant reduction in length of stay, decreased mortality and decreased cost. Dr Fitzgerald joined me to record a three-part series on enhanced recovery programs (colloquially referred to as “ERAS” programs).  In part 1, we discuss the realm of quality in healthcare and why enhanced recovery programs matter.  In part 2, we take a deep dive into the details of enhanced recovery programs from the pre-hospital phase through the post-operative phase of care.  In part 3, we discuss the concept of frailty and optimizing patient care in the perioperative surgical home. The American Association of Nurse Anesthetists (AANA) offers a public website with links to numerous consensus guidelines and resources related to implementing enhanced recovery programs. Sources: * Timothy L., F., Catalina, M., Nicholas J., K., Nasreen A., V., Kimberly V., E., & Emmanuel E., Z. (2016). Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter. Surgery Research And Practice, Vol 2016 (2016), doi:10.1155/2016/6830260 * Mosquera, C., Koutlas, N., Fitzgerald, T.  (2016)  A single surgeon’s experienced with enhanced recovery after surgery: an army of one.  The American Surgeon. 82 (7), 594-601. * AANA. (2017).  Enhanced recovery after surgery: considerations for pathway development and implementation. American Association of Nurse Anesthetists. Retrieved from https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/enhanced-recovery-after-surgery.pdf?sfvrsn=6d184ab1_6  

Tim Fitzgerald, MD is a surgical oncologist and Director of Surgical Oncology at Maine Medical Center and MaineHealth. He is an Associate Professor of Surgery at Tufts University School of Medicine and specializes in complex gastrointestinal surgery.  Dr Fitzgerald has published and lectured extensively on enhanced recovery programs for the perioperative environment.  His implementation of an enhanced recovery program for complex gastrointestinal surgical patients at a tertiary medical center in North Carolina resulted in significant reduction in length of stay, decreased mortality and decreased cost. Dr Fitzgerald joined me to record a three-part series on enhanced recovery programs (colloquially referred to as “ERAS” programs).  In part 1, we discuss the realm of quality in healthcare and why enhanced recovery programs matter.  In part 2, we take a deep dive into the details of enhanced recovery programs from the pre-hospital phase through the post-operative phase of care.  In part 3, we discuss the concept of frailty and optimizing patient care in the perioperative surgical home. The American Association of Nurse Anesthetists (AANA) offers a public website with links to numerous consensus guidelines and resources related to implementing enhanced recovery programs. Sources: * Timothy L., F., Catalina, M., Nicholas J., K., Nasreen A., V., Kimberly V., E., & Emmanuel E., Z. (2016). Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter. Surgery Research And Practice, Vol 2016 (2016), doi:10.1155/2016/6830260 * Mosquera, C., Koutlas, N., Fitzgerald, T.  (2016)  A single surgeon’s experienced with enhanced recovery after surgery: an army of one.  The American Surgeon. 82 (7), 594-601. * AANA. (2017).  Enhanced recovery after surgery: considerations for pathway development and implementation. American Association of Nurse Anesthetists. Retrieved from https://www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/enhanced-recovery-after-surgery.pdf?sfvrsn=6d184ab1_6  

The September 2017 AANA News Bulletin contains an article I wrote titled:  SRNAs – Key Tips for Transitioning to Practice. The article builds on podcast #25 – Transitioning to Practice that I put out back in February 2016.  In the article I discuss tips for the last six months of anesthesia school including tips for mastering boards, the transition out of school and the first six months of practice. This podcast pairs with the AANA News Bulletin article providing additional insights and stories to help SRNAs and new grad CRNAs make the transition smooth and begin to set goals for the next season of life. Below are some references made in the podcast: Dweck, C. S. (2006). Mindset: The new psychology of success. Random House Incorporated. Carol Dweck TEDTalk:  The power of believing you can improve Death, Sex & Monday podcast on student loans NOLS Wilderness Medicine for the Professional Practitioner Cornerstone Anesthesia Conferences NOLS Expedition Behavior blog post Heuer, A., Kossick, B. M. A., & Riley, C. J. (2017). Update on Guidelines for Perioperative Antibiotic Selection and Administration From the Surgical Care Improvement Project (SCIP) and American Society of Health-System Pharmacists. AANA Journal, 85(4), 293.

I caught up with Christine Hein, MD recently to talk about healthcare provider wellness. Dr Hein is an emergency medicine physician and Director of the Provider Well-being and Peer Support program at Maine Medical Center in Portland, Maine. I was also very honored to have a special guest on this episode:  Ms Abby Irish, Dr Hein’s daughter. Abby is currently in 8th grade and recently completed a surgery summer camp in Boston. She has a strong interest in becoming a physician and sat in to both listen and contribute to our conversation on provider wellness.  I’m so thankful for her participation and unique views of both her mom’s career and medicine at large! Christine Hein, MD Bio: Dr Hein completed medical school at Dartmouth in 2001 followed by her residency in emergency medicine at Maine Medical Center where she was Chief Resident in her final year.  She currently serves as the Associate Medical Director for the Department of Emergency Medicine and the Director of Provider Well-being and Peer Support at Maine Medical Center as well as the Director of Emergency Medicine for MaineHealth.  She is an Associate Professor of Emergency Medicine at Tufts University School of Medicine and is well-respected as a medical educator, receiving in 2009 the American College of Emergency Physicians National Teacher of the Year award.  Her research interests include burnout, resiliency, critical care and women’s issues in medicine.  Outside of work, Dr Hein is married, has five children and is an avid marathoner, completing over 23 marathons including posting highly competitive times in the Boston Marathon. Quotes: “Three-hundred to 400 physicians each year in the United States commit suicide… essentially two medical school classes of physicians each year.”  Christine Hein, MD “I think that it has professionally been probably the most satisfying experience of my career – to be involved in [Provider Wellness].”  Christine Hein, MD “[Resilience is] the capability of a strained body to recover its size and shape after deformation caused especially by compressive forces.”  Christine Hein, MD   Resources: AANA Health & Wellness and Peer Assistance Website Attending:  medicine, mindfulness and humanity Ronald Epstein, MD TEDTalk:  Everything you think you know about addiction is wrong by Johann Hari Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303. Raj, K. S. (2016). Well-being in residency: a systematic review. Journal of graduate medical education, 8(5), 674-684. Swensen, S. J., & Shanafelt, T. (2017). An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety, 43(6), 308-313.  

This is a quick overview of some continuing education opportunities coming up.  I’ll be co-instructing a NOLS Wilderness Medicine course with my good friend Sara Nelson, MD this October 20-22, 2017 near Flagstaff, Maine.  I’ll also help teach an anesthesia continuing education conference for CRNAs with Cornerstone Anesthesia Conferences from February 26 – March 1, 2018 in Scottsdale, Arizona. NOLS Wilderness Medicine course overview: I’ve taught for NOLS Wilderness Medicine since 2007 and the course Dr Nelson and I are offering this fall is a Wilderness Medicine for the Professional Practitioner course.  This course is open to the general healthcare community and teaches clinicians how apply existing medical knowledge in a new way to manage a patient in a wilderness, remote or disaster setting.  This course is hands-on, fast-paced and super fun!  We’re offering this course at a unique destination location:  the Flagstaff Hut of the Maine Huts and Trails network.  This hut is 1.8 miles from the nearest trail head and is a bit more than a “hut.”  Think lakeside beautiful log cabin with vaulted ceilings, wood stoves, leather couches and fully staffed commercial kitchen.  The huts run completely off the grid yet have heated bunk rooms, hot showers and full electricity.  All meals and lodging are included in course fees.  16 hours of AMA PRA Category 1 CME is included.  Check the links below for more details. NOLS Wilderness Medicine for the Professional Practitioner NOLS Wilderness Medicine continuing education information.   Cornerstone Anesthesia Conferences overview: I’m so excited to contribute to Cornerstone Anesthesia Conferences’ February/March 2018 Scottsdale, AZ conference!  The “Anesthesia Update in Desert Oasis” is going to be a fantastic opportunity for CRNAs to earn 20 CE credits through the American Association for Nurse Anesthetists (AANA).  I’m in the line up to teach 5 topics at this conference: 1.  Ketamine, 2.  Neuromuscular Blockade and Reversal, 3.  Updates in Airway Management, 4.  Leadership in Emergencies and 5.  Enhanced Recovery After Surgery (ERAS): Updates.  It’s going to be EPIC! The conference will be hosted at the Double Tree Resort by Hilton Hotel Paradise Valley.  You’ll receive 20 Class A CE credits, 6 pharmacology credits and a full breakfast buffet each morning as part of the conference.  All of the lectures are based on CPC Core Modules. From Cornerstone Anesthesia Conferences’ website: Cornerstone Anesthesia Conferences is based in Houston, Texas, which is home to the largest medical center in the United States and many world-renowned medical complexes. Founded in 2016 by three lifelong friends, our mission is to serve as the foundation for excellence in continuing education services. Cornerstone Anesthesia Conferences focuses on offering the most up-to- date, evidence-based information with lectures pertaining to the Core Modules of the CPC Requirements. Our topics are hand-picked to correspond with all of the four Core Modules. To that end, we offer world class speakers and cutting edge topics in exciting, fun-filled locations with opportunities for networking, meeting other CRNAs, and relaxing while learning. Check out one of our CRNA seminars today!

In this podcast, I talk with Chuck Biddle, PhD, CRNA about iatrogenic infections related to anesthesia workstation behaviors.  This continues to be a focal point of Dr Biddle’s research on patient safety and is a topic that concerns every anesthesia provider everywhere.  Anesthesia providers have the potential to harm patients via the spread of infectious organisms as part of routine patient care.  Dr Biddle discusses challenges and possible solutions for reducing patient harm related to anesthesia provider practices and the anesthesia workstation.  This topic and related research has the potential to change practice and advance the care that anesthesia practitioners provide worldwide. Dr Biddle is a professor of Nurse Anesthesia at Virginia Commonwealth University (VCU) and provides anesthesia services as a CRNA at VCU Medical Center.  He oversees the research efforts of the Department of Nurse Anesthesia at VCU and has served continuously as the Editor-in-Chief of the AANA Journal for over 25 years.  Dr Biddle’s anesthesia education and Master’s degree were earned at Old Dominion University and his PhD in epidemiology is from the University of Missouri. Highlights: “I think the most important thing that the listener can do, that we can do as practitioners, is to talk about it… because there are people out there far smarter than I with greater perspective – novel perspective – that will come up with solutions for this problem that we’re facing.” Chuck Biddle, PhD, CRNA “There will be a new generation of anesthesia providers and thinkers and engineers and nurses and doctors etcetera that will find solutions to these problems.”  Chuck Biddle, PhD, CRNA Resources: Biddle, C., & Shah, J. (2012). Quantification of anesthesia providers’ hand hygiene in a busy metropolitan operating room: What would Semmelweis think? American Journal of Infection Control, 40, 756-759. doi:10.1016/j.ajic.2011.10.008 Biddle, C. (2009). Semmelweis Revisited: Hand Hygiene and Nosocomial Disease Transmission in the Anesthesia Workstation. AANA Journal, 77(3), 229-237. Munoz-Price, L. S., & Weinstein, R. A. (2015). Fecal patina in the anesthesia work area. Anesthesia And Analgesia, 120(4), 703-705. doi:10.1213/ANE.0000000000000542

In this podcast, I chat with Chuck Biddle, PhD, CRNA about his and other research on at-home cardiorespiratory events following ambulatory surgery.  We discuss risk factors, screening tools and patient education that is designed to enhance patient safety and decrease postoperative negative outcomes following ambulatory surgery. Dr Biddle is a professor of Nurse Anesthesia at Virginia Commonwealth University (VCU) and provides anesthesia services as a CRNA at VCU Medical Center.  He oversees the research efforts of the Department of Nurse Anesthesia at VCU and has served continuously as the Editor-in-Chief of the AANA Journal for over 25 years.  Dr Biddle’s anesthesia education and Master’s degree were earned at Old Dominion University and his PhD in epidemiology is from the University of Missouri. “The first step in fixing a problem is identifying the problem.”  Jonathan Benumof, MD “We are only now… illuminating terrain that previously has been quite darkened… this idea [of] what happens to patients in their homes after anesthesia.  We’re beginning to look systematically at this and I think it’s long overdue.”  Chuck Biddle, PhD, CRNA Resources: Benumof, J. L. (2016). Mismanagement of obstructive sleep apnea may result in finding these patients dead in bed. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 63(1), 3-7. Biddle, C., Elam, C., Lahaye, L., Kerr, G., Chubb, L., & Verhulst, B. (2017). Predictors of At-Home Arterial Oxygen Desaturation Events in Ambulatory Surgical Patients. Journal of Patient Safety. Hill, M. V., Stucke, R. S., McMahon, M. L., Beeman, J. L., & Barth Jr, R. J. (2017). An Educational Intervention Decreases Opioid Prescribing After General Surgical Operations. Annals of Surgery.   STOP-BANG Obstructive Sleep Apnea Questionnaire Washington Post article on Barth’s study AANA Journal homepage Virginia Commonwealth University Nurse Anesthesia Biddle, C. (2013). Evidence trumps belief: Nurse anesthetists and evidence-based decision making.  

In 2014, Mason McDowell, DNAP, CRNA quit his job, sold most of what he owned and moved with his wife and two young daughters to Chad, Africa for a long-term commitment to provide anesthesia and education.  Here is a glimpse of their story. Part 1 overviews Dr McDowell’s experience and challenges providing anesthesia and living in Chad. In Part 2, Dr McDowell offers advice for CRNAs/SRNAs who are looking to travel internationally to provide anesthesia in developing nations. The McDowell family’s time in Chad was interrupted abruptly by a deteriorating political situation making it unsafe for them to stay.  They lived in Bere, Chad for nearly two years before being forced to leave and return to the United States.  Since that time, Dr McDowell has traveled to Nepal and Sierra Leone to provide short term anesthesia services.  In this podcast I talk with him about the challenges of providing anesthesia in underdeveloped settings.  From the bugs at night in the desert heat to draw-over vaporizers and the heart wrenching stories of not having enough resources to provide care, Dr McDowell conveys what it was like for his family to live and work in Chad and what we can do as SRNAs, CRNAs and anesthesia providers to help serve underdeveloped nations. This is really an amazing story that I’m honored to share.  You can read more about Dr McDowell’s time in Chad at his blog: Why We Should Go.  Dig deep, read the stories.  They’re amazing. http://whyweshouldgo.blogspot.com Dr Mason McDowell lives in Western North Carolina and serves as faculty with Western Carolina University’s (WCU) Graduate Nurse Anesthesia Program.  Before moving to Chad, he served as the Assistant Director of the Graduate Nurse Anesthesia Program at WCU.  He is the co-author of the chapter on Hepatobillary and Gastrointestinal Disturbances and Anesthesia in Nagelhout’s Nurse Anesthesia. Resources: Unites States Department of State page on Chad: https://travel.state.gov/content/passports/en/country/chad.html Corbett, S., Fikkert, B.  (2012) When helping hurts: how to alleviate poverty without hurting the poor… and yourself.  Chicago, IL: Moody Publishers.

In 2014, Mason McDowell, DNAP, CRNA quit his job, sold most of what he owned and moved with his wife and two young daughters to Chad, Africa for a long-term commitment to provide anesthesia and education.  Here is a glimpse of their story. Part 1 overviews Dr McDowell’s experience and challenges providing anesthesia and living in Chad. In Part 2, Dr McDowell offers advice for CRNAs/SRNAs who are looking to travel internationally to provide anesthesia in developing nations. The McDowell family’s time in Chad was interrupted abruptly by a deteriorating political situation making it unsafe for them to stay.  They lived in Bere, Chad for nearly two years before being forced to leave and return to the United States.  Since that time, Dr McDowell has traveled to Nepal and Sierra Leone to provide short term anesthesia services.  In this podcast I talk with him about the challenges of providing anesthesia in underdeveloped settings.  From the bugs at night in the desert heat to draw-over vaporizers and the heart wrenching stories of not having enough resources to provide care, Dr McDowell conveys what it was like for his family to live and work in Chad and what we can do as SRNAs, CRNAs and anesthesia providers to help serve underdeveloped nations. This is really an amazing story that I’m honored to share.  You can read more about Dr McDowell’s time in Chad at his blog, Why We Should Go.  Dig deep, read the stories.  They’re amazing. http://whyweshouldgo.blogspot.com Dr Mason McDowell lives in Western North Carolina and serves as faculty with Western Carolina University’s (WCU) Graduate Nurse Anesthesia Program.  Before moving to Chad, he served as the Assistant Director of the Graduate Nurse Anesthesia Program at WCU.  He is the co-author of the chapter on Hepatobillary and Gastrointestinal Disturbances and Anesthesia in Nagelhout’s Nurse Anesthesia.   Resources: Unites States Department of State page on Chad: https://travel.state.gov/content/passports/en/country/chad.html Corbett, S., Fikkert, B.  (2012) When helping hurts: how to alleviate poverty without hurting the poor… and yourself.  Chicago, IL: Moody Publishers.  

I talk with Denham Ward, MD, PhD on the topic of expertise in anesthesia.  Dr Ward is currently the director of the Academy at Maine Medical Center Institute for Teaching Excellence and a Professor of Anesthesiology at Tufts University School of Medicine.  He is Emeritus Professor and Chair of Anesthesiology and Emeritus Professor of Biomedical Engineering at the University of Rochester. This podcast focuses on the idea of developing and maintaining expertise over a career in anesthesia.  Highlights range from defining expertise, specialization in anesthesia, types of problem solving and clinical decision making and how to teach and coach the development of expertise in trainees as well as experienced clinicians. “The difference between medicine and music is… musicians practice, practice, practice and then they go to Carnegie Hall for one evening…  We’re essentially at Carnegie Hall every day.”  Denham Ward, MD, PhD References: Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939 Gawande, A. (2011). Personal best. The New Yorker, (30). 44.  Retrieved from http://www.newyorker.com/magazine/2011/10/03/personal-best. Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux. Moulton, C. E., Regehr, G., Mylopoulos, M., & MacRae, H. M. (2007). Slowing down when you should: a new model of expert judgment. Academic Medicine: Journal Of The Association Of American Medical Colleges, 82(10 Suppl), S109-S116.    

Jon provides a quick update on the publication of the article “Social media in nurse anesthesia – a model for a reproducible podcast” published in the February 2017 edition of the AANA Journal.  This article provides the literature review associated with and production overview of the creation of “From the Head of the Bed… a podcast for the anesthesia community.”  The article was authored by the founders of From the Head of the Bed:  Kristin Andrejco, Jon Lowrance, Brad Morgan, Cassidy Padgett and by Shawn Collins.   References: Andrejco, K. (2017). Social Media in Nurse Anesthesia: A Model of a Reproducible Educational Podcast. AANA Journal, 85(1), 10-16. Biddle, C. (2017). Increasing the Online Presence of the AANA Journal. AANA Journal, 85(1), 6-7.  

In this show I talk about hardship in anesthesia school. Yep. It is for you, actually.  It’s for you if you’re struggling.  Or even if you’re not – cause your classmate or colleague might be. This podcast is about the hardships we face in anesthesia school and how we can find help, cope and pull through to a brighter future.  It’s about knowing you’re not alone.  It’s about learning how to deal with the pain and the challenges and how to find help. To develop this show, I asked for help from my friends, colleagues and from the anesthesia social media world.  Many of you replied with your stories and advice.  I pulled together what I’ve heard and a little of what I went through personally and put it here, for you, for each of us. I want you to know this: If you’re struggling with suicidal ideation or drug abuse there is help available. You are important.  You are not alone.  Your life is important and people care about you. Please seek help and support.  Please tell someone what you’re facing.   Please call one of the numbers below and reach out to a friend, family member or colleague. Help is available.  You are not alone.  People care about you. American Foundation for Suicide Prevention Hotline 1-800-273-8255 National Suicide Prevention Lifeline   1-800-273-8255   AANA Peer Assistance Hotline 1-800-654-5167 National Helpline 1-800-662-4357   Anesthetists in Recovery Overview of Anesthetists in Recovery (AIR) and Partners of Anesthetists in Recovery (PAIR): Bertrand, Anita.  (2013).  Saving Lives: AIR/PAIR.  AANA NewsBulletin.  Retrieved from: http://www.aana.com/resources2/health-wellness/Documents/nb_pan_0513.pdf