Central Line

Episode Number: 120

Episode Title: Subspecialty: Critical Care

Recorded: January 2024

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VOICE OVER:

Welcome to ASA’s Central Line, the official podcast series of the American Society of Anesthesiologists, edited by Dr. Adam Striker.

DR. BROOKE TRAINER:

Welcome to ASA’s Central Line. I'm your host for today's episode, Dr. Brooke Trainer. And today we get to talk about a topic that I'm personally passionate about: critical care. This is the first installment of our plan to dig into clinical topics and issues that are particularly interesting to subspecialists throughout 2024. That also means that we'll feature some pretty interesting anesthesiologists who are experts in their subspecialty. And to get us started, I'm here today with Drs. Somnath Bose and Talia Ben-Jacob. They're both intensivist and both involved with the Society of Critical Care Anesthesia, or SOCCA, to talk about the role of Intensivist and the value that we bring to departments and hospitals. Thanks so much for joining me today. And before we jump in, Dr. Bose, maybe you can start us off to tell our listeners a little bit about yourself, your role as a critical care anesthesiologist in your hospital.

DR. SOMNATH BOSE:

Thank you, Dr. Trainer. It's a pleasure to be here and also in the company of DR. BOSE. I am an anesthesiologist and an intensivist based out of Boston. I practice at Beth Israel Deaconess Medical Center, which is a teaching hospital of the Harvard Medical School. In addition to being a busy clinician, both in the operating room and intensive care units, I'm also involved in teaching and training the next generation of trainees. Administratively, I direct one of the satellite ICUs of the bilge system, and I'm also engaged in research, uh, which is specifically focused on recovery after critical illness.

DR. TRAINER:

Wonderful. And Dr. Ben-Jacob, could you also tell our listeners a bit about yourself and your role in your hospitals?

DR. TALIA BEN-JACOB:

Thank you so much for having me, Dr. Trainer. My name is Talia Ben-Jacob, and I'm the chair of critical care medicine in the Department of Anesthesiology at Cooper University Hospital. I'm also an associate professor of anesthesiology at Cooper Medical School of Rowan University. In addition to all my active roles with SOCCA, I'm also the chair on the committee on young physicians for the American Society of Anesthesiologists. And I sit on the committee on critical care medicine as well.

DR. TRAINER:

Great. You guys are both at some pretty busy institutions. I just want to touch upon a little bit about, you know, anesthesia and critical care specifically. I am biased. I'm a critical care intensivist as well at a busy center. And I really strongly believe that anesthesiologists make excellent critical care docs. I actually think it's the wave of our future, but I think the anesthesiologist intensivist right now in the United States is pretty rare, but is there something unique that you think we bring to the table specifically for the hospitals and our environments? I'll open it up, actually to Dr. Ben-Jacob first.

DR. BEN-JACOB:

So I think by, you know, anesthesiologists have a very unique role, and we have a very unique skill set. And by virtue of the way that we understand physiology, pharmacology and resuscitation, we're probably really the best suited doctors out there to manage critical care units. You know, we spend a lot of time resuscitating traumas and the trauma bay or in the operating rooms, and we're able to really extrapolate all that knowledge and bring it with us to when we manage patients in the critical care units, just by simple virtue of the fact that we, like, think quickly on our feet, have a broad knowledge base that varies across many disciplines, many subspecialties, and then also compounded by like our airway skills, we really do provide a unique skill set for patient care.

DR. TRAINER:

Anything to add, Dr. Bose?

DR. BOSE:

Yeah, I think, you know, Dr. Ben-Jacob has kind of, you know, summarized the highlights. I would just add that the things that the skill sets that she's explained comes naturally to us as anesthesiologists. But the training, the additional training of, um, critical care training that that we get also expands our reach in a rather, uh, you know, unique manner. So it gives us the perspective of taking care of more than one patient at a time, which also gives us longitudinal patient care experience. And, uh, quite honestly, ours is probably the only department or specialty which interfaces with pretty much all other specialties in the hospital. So we are uniquely positioned to kind of not only lead lead the perioperative setting, but also, uh, we as we interface with other specialties, we have a unique perspective on care delivery. So not only can we provide care in the operating room and ICUs, but we can add value to the health care systems in general.

DR. TRAINER:

Oh, absolutely. I mean, this is something that as anesthesiologists, the future, you know, expands. we really need to start thinking more and more about how we can add value to our hospitals, our C-suite executives, to even our colleagues, the anesthesia care team, our surgeons. Um, so you make a great point.

Another area that we really should talk about is the unique value that we bring, uh, in the space of patient safety. And so, Dr. Ben-Jacob, um, if there's anything you think we can add to make the case for how anesthesia critical care intensivists specifically add to improving patient safety in hospitals?

DR. BEN-JACOB:

You know, that's something that anesthesia does really well. You know, we have so many standard operating procedures, so many algorithms, so many protocols that we've created. We've created not just like the difficult airway algorithm, but we also have like PEARLS, you know, which is the anesthesia perioperative version of ACLs and BLS, um, that we have provided not just for our own anesthesiologists, but for like organizations across the board to, you know, better patient care by following a decision trees and algorithms to provide safe care to our patients. We have the Anesthesia Patient Safety Foundation, which guides our knowledge on making patient care not just better in the operating room, but also in the ICU. And so we've really like as anesthesiologists and intensivist, we've really been at the forefront and the lead for making patient care better. Going back to what Dr. Bose said about our interactions with all the different disciplines, we're focusing on transitions of care, on handoff processes, right? We care about correct site surgery. And these are all things that we've spearheaded and led. And, you know, it's not just safer for patients in the OR, but it's safer for patients across the board, not even just in the ICUs, but in the hospital in general.

DR. TRAINER:

That's exactly right. And, Dr. Bose, I'll let you add anything if you'd like.

DR. BOSE:

Yeah, I think like being an integral part of the perioperative setup, where basically it's been the crucible of patient safety, quite honestly, makes us natural leaders. And every day we are part of these safety checklists and other patient safety initiatives in the operating rooms. So we are naturally very much ingrained into that culture, which we kind of bring to other places.

So one case in point we are Dr. Ben-Jacob talked about handoffs. I would also add that our expertise kind of goes into improving safety in the other periprocedural areas. And I would say like the other procedural areas which are not operating room areas. And also this kind of extends to management of codes on the floor, leading codes on the floor, airways on the floor. So all these initiatives, which are so ingrained in us, kind of makes us natural leaders and leading a patient safety initiative.

So I would just also add to that, for example, we've had a group of us intensivists here at BI who are leading simulation experiences across the board for all specialties, which is a prime example of how we can be at the forefront of improving patient safety, not only in the operating rooms, but even beyond.

DR. TRAINER:

Yeah, absolutely. And a lot of what both of you have mentioned are, they're not even realized gains. Right? These are gains which, you know, the hospital, our patients, our colleagues are benefiting from, just from that extra knowledge and expertise that we have in the operating room and outside the operating room. I mean, just that alone, we're, you know, able to apply that knowledge to all kinds of different spaces, like you said, transitions of care, um, different, you know, handoff areas. And so absolutely positioned to provide unique expertise in value at all stages of the care. And that's not always like calculatable. Right? As in a teal savings or a real expense. That's why I say an unrealized advantage for or a gain for our position. And so just because we're you touched upon this a little bit, Dr. Bose, um, already I'm going to continue on with another question that is, you know, the role that Intensivists play outside of the ICU. Obviously, critical care medicine is expensive. You know, we talked about some of these unrealized gains that don't count. But, you know, anesthesiologists have established ourselves as patient safety leaders. And so how does that translate outside of the ICU? You know, I'd love to hear you kind of expand upon that just a little bit, and I'll toss it back to you, Dr. Bose on, you know, our leadership outside of the ICU and and things like that.

DR. BOSE:

Yeah. So I think we can take the example of, of the Covid pandemic. And I think the leadership and our roles outside the ICU is probably the best example of what we could do outside the operating room. So you had a situation where operating room volume was entirely down, but we stepped up not only to provide care in the ICUs, but we stepped up in many other ways. For example, disaster management was actually under the leadership of the anesthesia department, at least here in Boston at our institution. And we kind of stepped up to kind of manage triaging calls, uh, setting up disaster management teams within the hospital. And also, I would just go as far as to say that we even set up a field hospital in the convention center. So this kind of goes well beyond just what we can do, uh, just within the confines of an operating room and an ICU. So these are things which get us at the forefront of, of care delivery. In addition to this, we think about other examples like, you know, our expertise in things which come naturally to us, for example, management of emergencies and other things. We have leaders who've kind of gone on to become the chair of the code committee within the hospital, which is, again, something which is absolutely valuable. We've had, uh, members of our team who've gone on to chair ethics committees, which is, again, uh, not typically thought of as in the domain of anesthesiologists. But again, we are not just anesthesiologists. We have another, rather a whole host of other, uh, things up our sleeves, which make us uniquely positioned to take other roles. I'll let Dr. Ben Jacob add, if she wants to add anything.

DR. BEN-JACOB:

Well, I was just going to say, by sheer nature of the fact that we always consider anesthesia a team sport, we're always very used to managing a team, managing people, getting people from different backgrounds to work together, whether, you know, just in a standard case in the operating room, running a code on rounds in the ICU. And you'll see that, like across the board, that has led to people developing their leadership skills and not just becoming chairs of like, ethics committees and code committees, but becoming chairs of Department of anesthesia, moving up with administration within the hospital. I think the fact that, like, you know, we pay so much attention to patient safety, there's anesthesiologists and critical care specialists that are out there being patient safety officers. And in addition, I think that we also contribute to the training of, you know, the future of anesthesiology and hopefully, you know, encouraging others to go into our subspecialty. You know, given the fact that we're often doing didactics on rounds and giving lectures and teaching about different concepts, that makes us effective educators and teachers and role models and mentors to the trainees around us.

DR. TRAINER:

Absolutely. These questions come to mind when we're talking about our roles around the hospital. And so it's going to sound redundant, but I just want to hear clearly how useful you all believe our anesthesiology training, like the privileges that we receive, the specific procedures, credentials that we receive in anesthesiology, how that translates into receiving credentials in the ICU and the importance of that, and maybe distinguishing ourselves, anesthesiologists, from, for example, our surgeon colleagues or our trauma ICU colleagues or even our medicine colleagues, the difference in those credentials and training. But I'm curious to hear why specifically a resident--we talked about training the future--would choose to go the anesthesia route to go into critical care versus like the surgery route or another route medicine route.

DR. BEN-JACOB:

Um, so I think, like obviously we talk about our unique expertise in the airway, right? We're the airway specialists. The code gets called and then sometimes, you know, it gets followed by an anesthesia stat or, you know, anesthesia will get called to the ICU to be backup because they're concerned they're not going to get the airway, and they need us to back them up. You know, oftentimes when I'm in the ICU and my colleague on the other side of the unit is not anesthesia trained, he'll have me be the one to supervise his patients when the fellows are intubating or when I'm rounding in the ICU with a non-anesthesia trained ICU fellow, he'll be like, oh, you're on. Can we use the fiberoptic to intubate everybody? Um, and yes, over time with multiple airways like or you know, our interventional pulm colleagues can do things like that.

But I think really what sticks with me, is the fact of like, you know, I'll tell this one story about this patient that I had and like, where you could really see the difference between, you know, an anesthesia intensivist versus a non anesthesia intensivist. There was this poor woman and she, you know, she was in her 90s and she had fallen in the nursing home and she had a hip fracture. But also when she had fallen, she had broken a bunch of her ribs. Andthey had taken her to the operating room to fix her hip, and they couldn't get her off the ventilator. They had tried. And, you know, she had failed extubation and was re intubated. And then when I took over on service and I actually did have an anesthesia care fellow with me at the time, we looked at the patient and we realized probably that it wasn't intrinsic lung disease. Like, yes, she had a history of COPD, asthma, but that was not the reason why she was failing extubation. We figured she must have been failing extubation because even though her hip was fixed, her rib fractures were not um, and so we were actually able to do serratus anterior blocks for her. And within 24 hours she was extubated and off the ventilator.

DR. TRAINER:

That's amazing.

DR. BEN-JACOB:

That was like our expertise at work, you know, like, we could do that. We could take our regional anesthesia skills and apply them here in the ICU. And, you know, it was just the best feeling. And then the family was just so thankful, you know, and everybody was so happy. And she did make it out of the hospital and went back to her nursing home.

DR. TRAINER:

So my follow up to that is, let's take, for example, an anesthesiologist who's decided to go work in this hospital as just a critical care intensivist. You know, they’re obviously anesthesiology trained, but they're hired in this particular hospital to just do critical care, and maybe they're hired under the department of surgery. And so when they're going through credentialing and privileging, do you think that in that circumstance, the anesthesiologist intensivist should keep those anesthesia skills? I mean, as long as obviously they have the, um, ongoing, you know, professional evaluations that meet those minimum standards. But do you think it's important for them to keep their skills in regional, keep their skills in, um, you know, fiber optic, difficult intubations, for example, like that are unique to anesthesiologists? Or do you think it's okay to let those anesthesia privileges go, um, to just work in an ICU or do you? It's sort of a rhetorical question, but I'd love to hear your guys's opinion on it.

DR. BEN-JACOB:

I'm just gonna echo your statement and say, I think it's a rhetorical question. I think you should never lose any of the skills that you have, just in general as like a broad statement, like across the board. Um, but definitely because I think that, like, when you least expect it, you may be using those skills, you know, um, if the patient had bilateral rib fractures, maybe we would have done a thoracic epidural, you know, or even for like a hospice case, at least you can give some lidocaine in an area, you know, to help someone for palliative purposes. So I think all you can use, any of the skills that you develop as an anesthesiologist in the ICU and vice versa. I remember when I applied for my privileges, I think the previous ICU doctors were as they could do a fiberoptic intubation, didn't really bronch. So when I was filling out the paperwork to get credentialed at my hospital for ICU, bronchoscopy wasn't listed as a potential skill as an anesthesiologist.

DR. TRAINER:

Um, anything to add?

DR. BOSE:

If you've been proficient in the unique skill set, it's not a good idea to lose it, number one. Number two is, uh, it also is somewhat contextual, I would say. Right. For example, um, the example that you gave is somewhat, uh, different. But if you're in a large academic setup which has teams which are available most of the time, like able to provide those services, then, you know, absolutely like the experts can come and do a block, which is maybe something atypical and it's outside your comfort zone, then that's fine. But, uh, in general, I agree with the Dr. Ben-Jacob that, uh, in the skills are something that are acquired through years and it's, it's not a good idea to probably lose them. So I also find it quite personally satisfying if I end up doing a thoracic epidural on one of my call nights where I do not have any coverage overnight for, say, a fracture. So yes, it's somewhat contextual, but I think as a general rule of thumb, it's not a good idea to lose the skills that you've acquired over a period of time. Right?

DR. TRAINER:

The skills or the, uh, credentials or privileges to be able to do or apply those skills. Yeah, I agree, I do have a few more questions, um, but I do want you to just stay put with me for this short patient safety break.

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DR. SCOTT WATKINS:

Hi, this is Dr. Scott Watkins with the ASA patient safety editorial board. Medication and medical supply shortages threaten the safety and quality of patient care. Clinicians and clinical practices should be proactive and develop a plan for dealing with shortages before they occur. Establishing a direct line of communication with supply chain personnel, considering an emergency stockpile, and staying informed of impending shortages using FDA resources are all good places to start. During times of medication or supply shortages, clinics need processes and protocols for managing scarce resources and reducing waste, and tracking and reporting any complications that result from substitute medications or supplies. It is important that clinicians receive education whenever substitute or unfamiliar medications or supplies are introduced into clinical practice to reduce the possibility of errors. Clinicians can ensure that they continue to provide the right care to the right patient at the right time, regardless of the limitations imposed by the supply chain, by taking a proactive approach to medication and supply shortages.

VOICE OVER:

For more patient safety content, visit asahq.org/patient safety.

DR. TRAINER:

All right. Welcome back. Thank you all for joining us today. We have Dr. Ben-Jacob and Dr. Bose here with us talking about this subspecialty of critical care in anesthesiology. And I do have a few more questions for you. Thank you all. Um, so anesthesia, critical care medicine, the fellowship numbers, we talked about residency training and everything like that and how it's actually rare to see in our specialty the combination of anesthesiologists and critical care intensivist. Luckily, we are seeing an increase in the number of fellowship positions, but unfortunately, there's still this shortage of those applicants applying to those positions. Um, there's clearly a shortage of anesthesiology intensivists around the country. It seems less than 5%. Um, and so I'm curious if you all have any input, um, and you can shed light for our audience members on what's being done to increase the workforce, uh, in critical care in anesthesia, and appeal more to residents through their training. Uh, Dr. Bose, do you want to start us off?

DR. BOSE:

Sure. I think for us who are in academic setups, we have to be good role models for the next generation. I think that's the biggest thing that we can do and not only advertise, but showcase the value that that intensivists bring. And again, this is not a comparison between anesthesiologists or anesthesiologists and intensivists, but we have to emphasize what this additional year of training does for your career. Now it's a one-year fellowship, which is kind of shorter than what most people would go through. For example, if you were in the pulmonary or medicine route or surgical critical care, but it does give you an unparalleled flexibility and versatility. Basically, you're it increases your scope of practice. It may not directly, uh, translate into additional remuneration, but then that kind of equals out over a period of time when you prove your worth through the hospitals, and which is pretty easy to do, quite honestly. So remuneration aside, I think we have to be good role models and essentially champion our own cause. And I think some of the societies are doing these things. But we as specialists intensivist should, uh, try to kind of showcase our worth to med students, residents as they come along through our units.

DR. TRAINER:

And Dr. Ben-Jacob, anything to add there in that space?

DR. BEN-JACOB:

Right now is a very interesting time for anesthesia. I would say. Like, I think I would probably say it's not just intensivist that are short across the board that we are globally short across the board. So in times where the compensation for being a general anesthesiologist, where the compensation is so high, it's really hard to actively recruit people in general to go to fellowship. But I will say that I agree with Dr. Bose because what's very interesting about the fellowship statistics, when you look at them for a while, anesthesia critical care had been on the decline. The two years after the pandemic, we saw a surge in the number of applicants applying for critical care, but it has now since decreased, which is a sign to me that, like what Dr. Bose said, when people really saw the role of an anesthesiologist as a critical care doctor, and we were brought to the forefront and the spotlight and, you know, received accolades for all our contributions to the pandemic, it really triggered something in trainees about how critical care is a feasible career and is a rewarding career. And I think that's why we had such great recruitment that year. But as it's dwindled away and as we're short anesthesiologists in general, I think it will be a little harder to recruit people. But I'm hopeful that it will get better over the next couple of years as things start to level off.

DR. TRAINER:

So, I mean, that sounds good. That's good news on the horizon. I have food for thought. Um, throwing a little curveball out here. Um, I was interested in, you know, doing something, you know, whether it be cardiac anesthesia or critical care, um, some fellowship. But then, you know, I was prior military. They told me, no, you have to come straight to work. But then in the military, they let me do critical care. Of course, you know, patient populations a little less sick and complex than, you know, in an academic center, for example, where I am now. But, um, but I was doing critical care in the military and then graduate, fast forward to the VA and going to do critical care in the ICU there, but without a fellowship. Again, they let me, you know, work in the ICU doing critical care without a fellowship initially. And it was it was me who decided like, oh Lord, like, these patients are sicker than my comfort zone. And I now know what I don't know. And it frightens me enough that I want to go gain more knowledge. And I went back mid-career to get a critical care fellowship. But my question is, what do you think about anesthesiologists doing critical care in the ICU? Maybe not in, you know, cardiac ICUs, or maybe not in certain ICUs, but without a fellowship. Do you think our training as a resident prepares us to be critical care intensivist without fellowship training?

DR. BOSE:

In my biased opinion, is no. And because, that's because, um, the practice of critical care is similar in many ways to what we do in the operating rooms. The similarities I think we've kind of discussed about managing medications, pharmacology, pathophysiology and so on and so forth, but it's also quite different in a couple of ways.

So the first one that I would say is, um, the ability to give longitudinal care through days to weeks, number one. Ability to take care of multiple patients at the same time. And I'm not talking about 2 or 3 rooms for like say 2 hours or 3 hours, but multiple patients over a period of time. And then I would say one of the bigger things is dealing with families, having tough conversations, uh, dealing with end-of-life situations, palliative care, um, thinking about providing goal congruent care. These are like nuances which can only be learned if you spend at least a dedicated year for a fellowship.

So, um, it's similar in many ways. Um, I'm sure there are some who've kind of just done residency and they could be fantastic intensivist. But that's a rarity. And I would say, like, as a rule of thumb, you would have to go through the rigors of a pretty well-structured training to not only be comfortable in delivering the care in a very high acuity, high situation through days and days, and also be able to manage, you know, the other interdisciplinary interpersonal things that come along with ICU practice. And I'm not talking about the procedural aspects as well. I would imagine that anybody who's gone through the rigors of a structured residency program would be comfortable with basic procedures, but then there are some procedures which are exclusively done in the ICU, which I think are standard residency program will not let you be comfortable with. Now, elsewhere in the world, the residencies are longer, and maybe what you come out of residencies for, let's say, which is like a seven year training program or so on and so forth, might be somewhat distinct, but we are talking in the US context. So my answer would be mostly a no.

DR. TRAINER:

Okay. So what about other countries and how they've incorporated critical care into their fellowship training? You know, if we did that in the US, you know, what would that look like? Would that be an additional year? And so we'd make our anesthesia residency five years, or could you really see us restructuring our residency focus to get them critical care trained in the four year mark? Maybe I'll ask Dr. Ben-Jacob to take that on.

DR. BEN-JACOB:

Well, I think that that's kind of what I was leaning towards. As of now, like just based like our residents only do four months of critical care, um, throughout their residency, two months as an intern, uh, as their, like, intern prelim year, and then two months later through residency, because that's the minimum requirement. But there are a lot of other programs that do a lot more ICU. So I think if you standardize the process across the board and there's been talk about this for many years, whether you have to add on an extra year to anesthesia residency, there's articles that are published on this, or if you can just incorporate enough months, um, within the training, because a lot of times during your CA3, there's a lot of elective time. So, you know, it's really just dependent across the board because I think really, uh, Dr. Trainer, you said it best when you said you don't know what you don't know. And that's one of the great things. And why I love critical care is that I, like, learn something new every time I'm in the ICU.

DR. TRAINER:

Yeah. That's right. Um, so going back a little bit to what we were talking about earlier with maintaining privileges and credentials and not letting them lapse, I know we had you know, you both had emphasized that that's super important that, um, critical care anesthesiologists maintain and keep their privileges in the ICU. But what about those who sort of let them go in the operating room? How do you balance maintaining them in both places, like how do you balance your time as an anesthesiologist in the ICU versus the OR? I mean, do you even have a choice? Um, really ultimately? But you know, that that's necessary, obviously, in order to maintain those privileges.

DR. BEN-JACOB:

Well, I practice in both areas. So I mean, so that's one really easy way. Like I go back and forth, which is really great. And that's part of the reason why I did critical care is because I get bored and I just didn't want to get bored. And so it's really great. Like I'll do OR OR OR and then all of a sudden my ICU week will come and I'll be in a completely different environment. And it's a great break from the OR. And then when I'm done with my week of critical care, I get to go back to the OR. And so I that's how I just practice in both disciplines. And when I was looking for jobs, coming out of fellowship, like that's what I wanted to do, I wasn't going to take a job that was only one.

But I had one colleague who did give up rounding in the ICU shortly after fellowship. Uh, one of my co-fellows gave up running in the ICU, but he then joined, like, the liver transplant team. Um, so when he's in the operating room, even though he doesn't necessarily practice in the ICU anymore, he still using his ICU skills, taking care of the sickest patients, you know, in the operating room. Um, so that's another way to do it.

And I then I had another co fellow who gave up all of his operating room time to solely be in the ICU, but I still think he's out there managing his drips, doing his airways, doing procedures. He's actually certified. He actually did cardiac and critical care. So he's still out there like doing TEEs and echoes, like still using all the skills that he gained through his anesthesia residency and his cardiac anesthesia fellowship, but just applying them in the unit.

So even if you don't do both, there's still ways of doing both. But, you know, my other ICU colleagues have to get credentialed for sedation. And so like I'll credential them for sedation, you know, and then you just go back and forth to get your numbers to make sure that you stay up to date on any of the privileges that you think you're lacking in.

DR. TRAINER:

Yeah, and that's so true. You know, you're applying your anesthesia skills all the time in the ICU. I know I'm preaching to the choir here, but for our audience, you know, giving anesthesia for, you know, bedside procedures for bedside tracks, pegs, bronchoscopies. Um, there's a lot of opportunity to continue to do anesthesia, even in the ICU in addition to the procedures. Um, so, I mean, it is a great way of, you know, being able to do both.

And before I let you all go, I do want to ask you if you could tell our listeners, who maybe aren't so familiar with SOCCA, a bit about the organization and your work within it, and why you believe membership in SOCCA is so important to you. And I'll give this first to Dr. Bose.

DR. BOSE:

Thank you. So, um, SOCCA is truly, you know, the niche organization in the US for anesthesia intensivists. And I think this is, uh, again, like, ICU is a multidisciplinary space. But if you look into societies, SOCCA is the one which truly caters to, uh, you know, the anesthesia intensivists. So it's a smaller community. It's a tight knit community. And it kind of is tailored towards pretty much anybody, like in starting from trainees to, like, new attendings to even, like senior folks. And it has multiple arms and, uh, it has a research arm and there's, there's an education arm, there's a clinical practice arm, and each has a number of subdivisions, kind of, you know, going into the entire spectrum of critical care. So you will find, uh, your colleagues or you're going to find people who share similar interests, uh, in the society. That's one. Um, the second most important thing is it's not only, this is a society that's just doesn't cater to folks who are in the academic setup, and there is a very strong presence of folks who are practicing in private setups or in communities, and we can all learn from each other. So it is truly something which is, uh, small, tight knit and extremely valuable for networking, for anesthesia intensivists.

DR. TRAINER:

Anything to add, Dr. Ben-Jacob?

DR. BEN-JACOB:

So I agree with everything that Dr. Bose said. I actually sit on the Committee of Education for SOCCA, and through there, like I run, I've run the anesthesia board review course for graduating fellows for like the past 3 or 4 years now. And I just think that, like, it's really a society that's geared towards anesthesia critical care, like for instance, our board exam, or at least when I graduated from fellowship, our board exam was at a different time than all the other critical care board exams. And so if it weren't for SOCCA coming up with their board review specifically geared towards a time where, like, we were taking the boards versus all the other board review courses that came out after our boards, it would have been a lot harder to study. And so it's small things like that. But I really think like just echoing what Dr. Bose said with the mentorship, like, these are my people, like within less than a year of me starting being an attending, I became the only anesthesia crit care attending in my hospital. And as a new grad, as someone just freshly starting out, I was I really needed mentorship or guidance. And it's like, now I'm now I'm essentially in charge of the anesthesia care because I'm the only person, but I'm brand new. And so, you know, I just wanted to make sure that my residents were getting the training that they deserve, that they were accomplishing the things that they needed to accomplish to be successful anesthesiologists, let alone try to convince people to go into critical care or even just make sure that my practice was up to date. And SOCCA really provided me like a network of people who were able to answer my questions, mentor me, sponsor me, and really promote me and, you know, get me to where I needed to be in order to provide excellent patient care and then take care of my trainees, too. Yeah.

DR. TRAINER:

And, you know, I'll I'll echo what you said about the board review, because I actually was not involved with SOCCA as just an anesthesiologist, even though I was still taking care of ICU patients and working in the ICU. But once I needed to pass that exam, I know SOCCA offered this preparation and reviews. It was like live webinars and you could ask real live questions. And the Q and A and all that, that was so helpful. And they really covered like key topics, key words and everything like that. Um, I can actually remember some of the questions being exactly what we talked about in those webinars. Um, so that was super helpful. And that's when I got involved with SOCCA was to help with that. And then you realize how wonderful of a network of colleagues and opportunities there are for other leadership, um, through that organization.

So thank you both for all that you do in that society. And, and thank you especially for all you do for our specialty. And thanks for joining us today and sharing your expertise and experience. So thank you to all our listeners, and we do hope you'll join us again next time for the next episode of Central Line.

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