Residents in a Room

Episode Number: 63

Episode Title: Non-clinical resident education tracks

Recorded: April 2024

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VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

The goal is that they'll have something that could either be published in the health services literature or show some impactful change.

… help residents develop their passion, expertise and leadership within medical education…

Prototype development, working on their devices, presenting at conferences, presenting a competitions…

DR. DANE SAKSA:

Welcome to Residents in a Room, the podcast for residents by residents. But today, without residents. That's right. A few of my fellow attendings and I will be taking over, but we'll make sure that it stays very interesting and relevant to all our resident listeners out there. So my name is Dr. Dane Saksa, and I'm here with Drs. Marianne Chen and Phillip Adams, and the three of us are going to discuss one of our shared passions, and that's for advancing innovative non-clinical residency tracks. And that will be the topic of today's show. So I'm really happy that both of you could join me for this. I think it will be a really interesting conversation to learn about what we're all doing at our different institutions.

So I'll start with the first question for all of us. Now we all represent different non-clinical residency tracks. So let's start by just introducing ourselves to our listeners. Talk about who we are, where we work, what we're interested in, and the kind of non-traditional track that we're here to represent.

I can go ahead and get us started. As you heard, my name is Dane Saksa, and I'm on the faculty of the Department of Anesthesiology at UCLA. Clinically, I'm a general anesthesiologist, and that means my job ranges from OB anesthesia to all types of cases across three different hospitals and several surgery centers. I'm also the director of our non operating room anesthesia, so I spend a lot of time in places like the interventional radiology suite and GI procedural areas. But really today I'm here to talk about one of my more exciting non-clinical interests, something that's more relevant to resident education. And that's really thinking about how we can train our future anesthesiologists to be excellent leaders within their departments or future health systems. And that's why at UCLA, over the past year, we've worked to create a structured track within our residency program to really explore what it means to be a leader within the field of anesthesiology. So I'll dive more into that later. But Dr. Adams, how about I pass it off to you?

DR. PHILLIP ADAMS:

Yeah. Thanks. Dr. Saksa. My name is Phillip Adams. And I am at the University of Pittsburgh and UPMC in Pittsburgh, Pennsylvania. I'm a pediatric anesthesiologist there. I primarily focus on pediatric cardiac anesthesia and transplant anesthesia. I also serve as the residency program director for Pitt, UPMC, and due to my own personal failures in medical device innovation and a bit of a flop, and then I NIH funded research, I kind of drove me to want to help to develop the particular tracks that we currently have with us at Pitt, which is our Panther research track, but more so today. What I'm here to talk about is our Pittsburgh Innovation and Technology track, what we lovingly refer to as the Pitt track. It's the Pitt Panther, so that's why everything has to have that theme. But I'm excited to share it with you and to hear more about all of your tracks as well.

DR. SAKSA:

Thanks, Dr. Adams and, uh, Dr. Chen, why don't you introduce yourself and tell us what you're here to share with us today?

DR. MARIANNE CHEN:

Great. First, thank you so much for inviting me to the podcast today. My name is Marianne Chen and I am the Residency Program Director at Stanford University Department of Anesthesiology, Perioperative and Pain Medicine. I practice as an adult general anesthesiologist with a subspecialty focus on liver transplant anesthesiology. I'm here today to discuss a few of our non-clinical tracks, something that I feel very passionate about, which is our medical education track. We have also a global health equity track, but today I'll be mostly focusing on our medical education track.

DR. SAKSA:

All right. Excellent. So before we talk in depth about our respective tracks, I had a quick question for both of you. Why do you think these more innovative, less traditional training tracks are so important? And what do you think residents and our entire departments really gained from having these types of tracks that focus on some of the more non-clinical aspects of being an anesthesiologist? Dr. Adams, do you want to start?

DR. ADAMS:

Yeah, I'd be happy to. Thanks. So our idea is that in general, our anesthesiology training really isn't and really shouldn't be a one size fits all mentality. We want to be able to create different avenues for residents who come in with different interests, both clinically, professionally, scholarly. And so we felt that it was important to be able to help those residents move beyond the operating room or other typical ways that residents tend to get involved. And it's also a way for us as anesthesiologists to really expand our expertise beyond the operating room as well. So I think we're always looking for ways to be involved and to be innovative in our specialty. So I think that that's why these kind of tracks are important. I think it's important for our programs because these residents really come in with great ideas. And to think that any of these tracks are stagnant is silly, because our residents, they keep coming up with new ideas. They're always evolving, and it really helps to push our programs forward.

DR. SAKSA:

Yeah, I couldn't agree more. Especially what you said about them being so resident driven. I mean, I think we'll all hear from one another that a lot of these ideas came straight from the residents, and we're just here to facilitate their great ideas. So I couldn't agree more. What about you, Dr. Chen?

DR. CHEN:

Yeah thanks, yeah. What I love about anesthesiology is the field has so much depth and breadth and really allows for physician anesthesiologists to be involved in so many aspects of medicine in addition to our clinical practices, such as the tracks, we're going to talk about medical education, innovation and technology, and leadership throughout the hospital and academic systems. Our mission for our residency program is to inspire, develop, and educate future leaders in the field of anesthesiology, and that really goes beyond just the clinical training. I think if we can support our trainees in gaining skills and vision to help enable and develop their careers, we can, you know, really make a difference in the future of medicine. These tracks also as a program, allow our faculty to mentor residents and allow them to collaborate on impactful initiatives both locally within our department as well as both regionally and nationally. So I really do think that these tracks really add to the education that our trainees are getting.

DR. SAKSA:

Yeah, that's an excellent way to phrase it. I couldn't agree more. And I think the one thing that I would add is just selfishly, as a department, these tracks help us recruit excellent residents. And anesthesiology residency is an exciting field and it draws incredible applicants. And I'm just continuing to be more and more impressed with each and every class, of all the diverse interests and how important these tracks can be in recruitment, and that really becomes an asset and a reflection on our department as a whole. Thanks for sharing. So, Dr. Chen, let's dig a little bit deeper into what's going on at Stanford. So let's start with you. Can you tell me a little bit more about the medical education track? What makes it unique? What are the kind of components that you guys really emphasize, and what kind of immersion does your track provide?

DR. CHEN:

Sure. So the goal of our med-ed track is really to help residents develop their passion, expertise and leadership within medical education. Being a medical educator is not really taught or focused on during medical school or most residency programs. Yet, we do expect our faculty to be great educators when they join our academic medical centers. The focus of this track sets a foundation for the residents who are interested in pursuing careers within academic medicine, and also becoming leaders within medical education going forward in their careers. So the main focus of the track is on innovation and generation of novel teaching methods and use of the latest medical education strategies for adult learners, as well as learning and understanding research within medical education, which can be quite different and kind of a different approach than traditional scientific research. The three main components of our track: one is first, longitudinal faculty mentorship. We also provide a monthly curriculum lecture series, and then also a resident driven project.

So at Stanford, we're very fortunate to have a very robust teaching and mentoring academy that's run through the Stanford School of Medicine. The Academy provides different types of workshops, courses on medical education, and just lots of different opportunities to network within the different medical educators throughout the School of Medicine. The Academy also organizes the Stanford Health Professions Education and Scholarship Program, which is a monthly seminar series, and the seminar covers topics such as curriculum development using the current approach, survey methods and analysis for meta studies, best practices and assessment, feedback, and medical education, to name a few. So the residents in our med-ed track attend these monthly seminars, as well as quarterly seminars run through our department, which are more specific to medical education within anesthesiology. Um, the residents that attend these seminars also get mentorship from educators outside of our department. So educators in other departments within School of Medicine. And that also really helps them to kind of fill out a broader view of medical education within the entire academic system, and not just within our department. The residents also helped lead and direct the curriculum for our Categorical Intern monthly anesthesia program, and also serve as our curriculum officers for our residency didactic program. And then the kind of final component is of the track is the resident driven project. It's a project that they design, they work with their mentor on and hopefully can change the curriculum at our institution or our kind of a bigger change within medical education.

DR. SAKSA:

Yeah. I don't mean to put you on the spot, but I'm just curious, what are some of the current projects or innovations that your residents are focusing on right now? I'm just curious of what's getting them excited right now within the medical education field.

DR. CHEN:

I think a big topic right now that a lot of our residents are interested in is feedback. And so we have a resident project that is focused on creating kind of like a daily reminder app to encourage more regular, specific feedback between faculty and residents. We're changing how we do didactics at Sanford, and we're moving from an afternoon session to full education days. So we have a resident who's working on a project that's kind of shaping those education days, kind of thinking about what the curriculum will look like, what are the topics that want to be covered, how to introduce novel teaching into those education days and really build a didactic over three year period that will kind of meet all the needs of our resident.

DR. SAKSA:

Well that's great. That's a big change, and it's excellent that it's being resident driven. Very cool. You know, you already talked a lot about the mentorship, which sounds incredibly robust. Anything else you'd like to share about your program?

DR. CHEN:

Yeah. Speaking of mentorship, I do want to mention that when we kind of asked the residents what they wanted to get out of these tracks and these programs, the number one response was longitudinal mentorship. So each resident in the track gets assigned a mentor who is equally passionate about medical education. They're expected to meet regularly with those mentors, and the mentors also oversee the projects that the residents are working on. And you know, when you think about residents starting their careers, kind of having that mentor and developing that relationship really early on is such a huge part of their success later on as well. And so we've really focused our track to to kind of help support that component of it.

DR. SAKSA:

That makes a lot of sense. I think for all of our tracks, mentorship is key for these early career positions.

DR. CHEN:

I love sharing about the med ed track at Stanford, but I am really interested in learning more about your track. So, Dr. Adams, can you share some details about UPMC's technology track and what that looks like and how it's run?

DR. ADAMS:

Yeah, thanks. But first I just wanted to comment on your education track. That sounds awesome. And like Dr. Saksa had said, I think it's really great that it's, you know, resident driven. You know, myself as a young program director, we have senior anesthesiologists who come up and always say, well, back when I was a resident, and as hard as I try, I still find myself even falling into, well, back when I was a resident. We know that's not how things are and we have to evolve and adapt. I think Covid totally upended the way that we approach education, and so we really need the fresh perspectives of, you know, the students in this current era. I learned a ton from what you just said, and I think it's completely awesome.

For our Pittsburgh innovation and technology track, really, it was born out of failures. I think maybe like a lot of really great things. Throughout the years, we've had residents with really great innovation ideas, ideas for medical devices, but they didn't really have the engineering background or the ability to prototype, didn't really know where to go with those great ideas. Likewise, we have this amazing bioengineering school, our Swanson School of Engineering at the University of Pittsburgh. And there you have amazing engineers and you have access to all sorts of resources. They can build anything, prototype anything, but they're not in the operating room, so they don't really know what needs to be built. And again, through fumbling around, we kind of created this, this great marriage where we had the ideas and they had the abilities and resources. So it was really this great symbiotic relationship. And we also tied ourselves in with our University of Pittsburgh Katz School of Business as well, so that our residents can not only have access to the resources to build and to prototype, but also learn ways to pitch and to get their ideas out there and startups what to do from the business component as well.

So like I said, if you in the beginning, you know, we kind of stumbled along and, you know, did what we could on our own, started to develop these relationships. And it was really, again, the residents that helped us find the pathway to be what the Pitt track is to what it has evolved to today. And so now what it currently involves is each year we take a scholar who will matriculate into the Pitt track, and they are enrolled in the Swanson School of Engineering Certificate and Biomedical Engineering program. So not quite a master's program, but it's something that we were able to, through some strategic scheduling, fit into the residency training. So it doesn't extend training at all. And the other great thing is because they are UPMC employees, we're able to get the tuition covered for them. So in two semesters time, they're able to earn that certificate. And if they choose to stay on as faculty, we have a faculty program aimed at advanced degrees, so they're able to stay on and finish the full masters of biomedical engineering. So it's a great jump start for that pathway. Also, we provide up to six months of protected time that they can utilize for prototype development, working on their devices, presenting at conferences, presenting a competitions. Because this is some of the other great resources we have. At the University of Pittsburgh, the Clinical and Translational Science Institute holds a competitive innovation. It's called Pinch or the Pitt Innovation Challenge. And so again, it's one of the great ways to get your ideas out there to earn some extra cash to to fund these things. And so those are the approaches that we're taking to help our residents get their ideas from concept to prototype and hopefully even to market.

DR. CHEN:

That sounds great. I love that you guys are so closely tied through the School of Engineering and School of Business. And I think that's, you know, a big part of kind of utilizing the resources around you. I'd love to hear of any kind of success stories or kind of new technologies, projects that came out of this program, if you could share that.

DR. ADAMS:

Yeah, definitely. We have had two successful patents, which I think is really incredible. Those devices currently trying to be brought to market. We had four devices that at least made it to the prototyping stage, and this was done in about probably six years time that we've achieved those kind of milestones. But I would say really formally, for what we're calling our Pitt track, that that's been in place for about three years, and the first certificate will be able to award after this next spring semester. So again, in the progression and evolution of the program, we've kind of gone the informal route of starting with a rotation and, you know, getting some things done. And now with the whole formal track, we're very excited that, again, we had some prototypes made and even some patents awarded, so.

I think the other thing too is some of the intangible successes. And while this might sound a little paradoxical, again, even the failures, the failures can be viewed as success in the sense because it's kind of silly just to think that because you have an idea, all of a sudden you're going to get a patent and create a startup and then sell it for millions of dollars, right? Learning that there's so much red tape, there's so many hoops to jump through, you know, what are the intricacies of getting your idea patented, copyrighted, what already exists, bringing the the lawyers into the mix, the FDA and getting approval from that standpoint. So really learning what all goes into it is, again, something that's extremely valuable, even if it isn't quite the outcome you're looking for, but you're learning so much all throughout that time. So you know, in a nutshell, that's our Pitt track.

Now, we've heard about a really exciting education track at Stanford. I just discussed our Pitt track at UPMC. Now, I'd like to turn this back to Dr. Saksa, actually. I'm really interested to hear about what UCLA is doing with their leadership track.

DR. SAKSA:

Thanks, Dr. Adams, I appreciate it and really appreciate what you've done in just three years to have such a formal, interdisciplinary program going. I can't imagine where it'll be in ten years.

So yeah, a little bit about our leadership track, which is also very new at UCLA. It's really grown organically over the past 1 to 2 years. And it all kind of started with conversations between some faculty and some residents, some of whom had completed an MBA or similar degree. And we all felt like medical training at both the med school and even the residency level were really lacking in any formal leadership training. And it's it's easy for all of us to find articles throughout the Harvard Business Review or other business school journals that discuss why doctors really need more leadership training. And I think we all feel that in our career. But it kind of felt like nothing was changing at the curriculum level, at least for our residency. And so, yes, of course, these residents are getting really valuable leadership skills when they help manage a trauma in the middle of the night, communicating with the nursing teams and the surgical teams. But we felt that we were missing something more structured, and we did want to make sure that all of our residents got exposed to some curriculum and some discussions about this, but we also wanted to create something a little bit more rigorous for those handful of highly motivated residents from each class.

And so we really started this about a year and a half ago with kind of shot in the dark, and we tried out an informal journal club, and we opened it up to residents, faculty, CRNAs, and we discussed a business school case, a case study that wasn't even related to anesthesia, actually, and it was about an expedition to Everest that was fated by poor teamwork and big egos and suboptimal communications. And the conversation was amazing, and it spread across all levels of our department. And the applications to crisis management in the OR and in the hospital were everywhere. So we knew we really had some momentum to work with there. So at that point, alongside two of our very driven CA2 residents, just like all the tracks we've discussed today, this was really resident driven, but we started to create a blueprint for a leadership and anesthesiology track, and we got approval and a budget from our department's executive leadership. They've been very supportive, which I'm very appreciative of.

The residents get up to a few weeks of protected time each year for projects, for committee meetings. And then we solicited applications from our interns and our CA1 classes to just see who was interested in starting the longitudinal leadership experience for the rest of their residency. And we got a really inspiring turnout. We had seven interns and eight CA1s take the time to put together really excellent applications, and we were only able to offer 2 to 3 spots per class. But I think this just goes to show, and along with both of the programs you discussed, obviously the interest is there. The trainees recognize this need to diversify their training. And I'm so excited that we've got the buy in from our department to make this leadership track a reality at this point.

DR. ADAMS:

That's really awesome. You know, just hearing all this, it seems as though the ingredients for any of these sorts of tracks is it takes a group of inquisitive individuals that have some drive who are driven to push things forward and really being adaptive, because it sounds like yours grew out of a simple discussion and a bigger discussion, and to putting the actual track together and then continuing to adapt it. So that's really awesome.

I'm curious, so you mentioned that there's a few weeks protected time that they could get really involved and invested in their leadership work. Can you expand on that? Like what is the what's more, the day to day like, is this all throughout the year or is it really specific? And then I've also hoping that maybe you could expand a little more on what kind of supports available. What kind of deliverables have you witnessed come out of this track?

DR. SAKSA:

Yeah, thanks for asking. So the first branch of this I think, is educational. We wanted to, um, make sure that we were continuing to engage in these exciting conversations that were happening. So we now have regular, sort of like Dr. Chen's education track, we have regular monthly meetups within our leadership track cohort, and we discuss readings or case studies related to leadership topics. And I'm there and one of our associate deans for faculty development is really invested in this project. And he provides some of that senior leadership, which I think is really powerful. And sometimes our discussions tie directly into health care or anesthesiology. Other times we're just discussing new literature or hot topics in the management world. Like, for example, we all just got a copy of a new book called Super Communicators, and we're all just starting to read it, but I'm really looking forward to discussing it together over the next couple of months. And even though the book's not about health care, I'm excited to pick everyone's brains to see you know how it applies to our day to day.

And then the next element is really the element of individual growth. And this kind of like project-based element that we've all discussed for the leadership track participants. So me and that associate dean for Faculty development, we meet with each of them one on one quarterly, and we mentor them through a longitudinal project. So these these are younger residents. So they've got a couple of years. But the goal is that they'll have something that could either be published in the health services literature or show some impactful change operationally or within the residency program of our department, kind of their first foray into change management and operational leadership within their organization.

And so, for example, one participant she's currently mapping out and trying to create a more structured mentoring program for female members of our department. And she wants that to start as early as undergrads who are interested in anesthesia and she felt like this was a way where she could really contribute to the pipeline of engaged and passionate female perioperative leaders. Another one of our trainees, he's passionate about medical education as well as leadership, and he's dreaming up ways to incorporate some of this training on communication and emotional intelligence and change management, and figure out how that could be incorporated into maybe a short module for medical students before they start their clinical rotations. Think about how beneficial that would be. And so it's very cool to see how diverse their interests are. And we're letting them run with that. And we're just trying to provide them with the support and scaffolding to really make sure that they're successful there.

And then lastly, I just want to mention I think a big important part of leadership is advocacy. We're here on a podcast that's supported by the ASA and all of our leadership track participants, they're definitely expected to join one of our department's committees, whether it be quality improvement or clinical operations or even finance. But also we want them to explore involvement in California Society of Anesthesiologists committee or even ASA involvement. And then we all plan to attend the ASA Advance Conference together. Our department has committed funds and protected time for that, and that's just going to be a cool experience for them to be inspired by leaders in the field and just network with those who have similar interests.

So there's a lot of pieces to it. And this is like we all said, it's going to grow and it's going to evolve. And I'm excited to let the residents take it where they want it to go.

So I think we got a pretty great picture of what everyone's doing at their institution. And man, it's inspiring. What do you think? Do you wish you'd had an option for a track like this when you were a resident?

DR. ADAMS:

As I mentioned in the beginning, I kind of failed at both of the concurrent tracks that we had. I was on a research route and I grew frustrated, you know, trying to submit K grants and whatnot. And I came to realize that really research wasn't for me, and I was much happier in education, but really looked at a way to streamline how our residents could better use their time throughout residency to be successful, which is how we came up with our research track. And really the same with innovation. I had an idea it never even made it to prototype. But, you know, residents behind me then also coming in with ideas, you know, it was important to kind of share with them my failures and how what they could do differently and who they could engage with. And like I said, it all just continued to grow. So, you know, through my own defeats, I really wish these things existed, but it's been it made it that much more exciting to help create them and see other people be successful in them.

DR. SAKSA:

And it's inspiring, I'm sure, for them to hear all the things that you went through without having this structured experience and thinking about how, how much they can grow from it. What what about you, Dr. Chen? You're a program director now, so what do you think this medical education track will do for the careers of your residents?

DR. CHEN:

Yeah, thanks for asking. I remember my first few years as an early career faculty member where I was, you know, trying to solidify my independent clinical practice as well as learn to be a good attending, learn more about medical education and teaching, which is what I was most interested in and just really feeling at many times lost and not knowing, you know, what direction my career was going to go. Uh, but I was very fortunate to find a good mentor, um, early on who helped to support and sponsor me. But I think about how much more prepared I would have been if I had something like the medical education track during residency. I think I would have felt much more purpose as I started my career. I have much more skill and just more confidence as I started my career within academic medicine. And I really see residents on this track joining academic anesthesiology departments, being future GMI leaders within residencies and fellowships, hopefully leading courses within medical schools and then developing into, you know, national leaders getting involved with both larger organizations like ACGME to help shape the education of all medical learners.

DR. SAKSA:

Absolutely. I think it's clear that all three of our tracks are gonna make a difference in the careers for these residents, so I'm excited to see where they all go. So before we wrap up, what advice would you have for any medical students or early residents who really want to get into a program like the ones we're talking about today? Any advice, any tips, anything you can leave our listeners with?

DR. ADAMS:

Yeah, I would say do not do it just to do it. I wouldn't pursue these kinds of tracks as just, you know, a way to buffer the CV. I would really suggest that you only pursue these, one, if you have an absolute genuine interest in the topic or the field, and two, that you have an idea of how you'll use this to, to jump start, you know, a long term career in that particular tracks area because they are they're extra work really. We we can't let you do less residency. So you really need to be intrinsically motivated and committed and know how how you're going to use these tracks to benefit your career.

DR. SAKSA:

Yeah, I agree with you wholeheartedly there. And I also would emphasize to our listeners, if you have your heart set on one of these tracks, that it doesn't end up being in your future plan, there's still so much to learn and so much to gain from still thinking about these things. I want to emphasize that most of us aren't going to just go sit in an operating room in our career. The field of healthcare is changing, and so every one of our listeners today is going to be a medical educator, and it's going to be an innovator, and it's going to be a leader in some sense in the perioperative setting. So the the biggest disfavor you can do is to think that none of this applies to you regardless. And so I would encourage you to all be thinking about how you can, you know, build yourself as a complete perioperative physician, not just one thing.

DR. CHEN:

Yeah, I completely agree with both Dr. Adams and Dr. Saksa. And just want to add that I do think that many more programs are going to be creating kind of similar non-clinical tracks, and it's really exciting to kind of see where the specialty is going. So really excited for the future of our field and the outcomes from all these different tracks.

DR. SAKSA:

Yeah, absolutely. So this has been a great, interesting conversation. I think all three of these tracks, they're just examples of all the many important and innovative tracks that are out there. So it's important for med students and residents to know that they exist. So I really appreciate both of you joining me today. And to our listeners, thanks for following and liking Residents in a Room, the podcast for residents by residents. Thanks for letting us take it over today and we hope you'll join us again soon.

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