Residents in a Room

Episode Number: 60

Episode Title: Anesthesia Research Careers

Recorded: January 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.

I think I just really like, um, solving problems.

Even just being curious about questions, I think is a form of research in and of itself.

If you show interest, people are willing to help you out.

A lot of times the best research questions come out of clinical work.

DR. MEG ROLFZEN:

Welcome to residents in a room, the podcast for residents by residents. I'm Meg Rolfzen, a CA3 at the University of Nebraska medical center, and I'm the host for today's episode. I'm here with Dr. Eric Gross and some fellow residents to learn more about research within an anesthesiology career, about the Foundation for Anesthesia Education and Research, or FEAR, and more. We have multiple questions for Dr. Gross. We expect to learn a lot today and invite you to learn along with us. But first, let's meet our other residents for today's discussion.

DR. VANJA TOLJ:

Hi everyone! My name is Vanja Tolj. I'm an intern at Tufts Medical Center.

DR. ZHAOSHENG JIN::

Hi everyone! My name is Zhaosheng Jin. I'm a CA3 at Stony Brook medicine. I'm also the senior editor of the ASA monitor, Residents Review.

DR. ROLFZEN:

And Dr. Gross, can you also introduce yourself to our listeners?

DR. ERIC GROSS:

Great, thanks. I'm Eric Gross. I'm an associate professor of anesthesiology at Stanford University.

DR. ROLFZEN:

Great with that. Let's dig in. I'll start. What drove your interest in research initially, especially in this field, especially in anesthesiology. And how did you initially get involved?

DR. GROSS:

Yeah, thanks. I had some initial research experiences in undergrad. And then after undergrad I was a biomedical engineer at a startup company. But I'd really say my aha starting point for research was when I started working as a research technician at the Medical College of Wisconsin. It was for three anesthesiologists. So during this time, it was a few years after Sevoflurane and Desflurane were approved in the US for clinical use, and the group I was working with wanted to find out whether these new volatile anesthetics and yes, I say new, but now it's almost 25 years later, had a cardioprotective properties. So I performed day to day experiments to answer this question. And this experience really opened my eyes to biomedical research. And I could have a career as a physician scientist doctor.

DR. TOLJ:

Dr. Gross, how is your research going, and can you talk about your experiences in your work?

DR. GROSS:

So with research, it's you're just constantly learning. And so presently my research focus is on alcohol metabolism. And so this area became really interesting to me because when you think about alcohol in high enough quantities, it actually functions as an anesthetic. And it is considered one of the world's oldest pain relievers. But what we know now is, is that the amount of alcohol you need for something like anesthesia or pain relief is really a level that leads to intoxication. And so, you know, one of the questions I had and suggested to me was that if we could actually understand how alcohol is metabolized, maybe we can find something in that pathway that can lead to, you know, understanding the mechanisms of anesthesia or lead to better pain relievers than what we presently have. And so, you know, we started working on this and we we have some ideas about the alcohol metabolism pathway and ways we can maybe make new drugs for pain control. Um, one of the angles, which has been interesting, we've been taking over the past several years, is also studying a genetic variant in the alcohol pathway that causes people to flush after they drink alcohol. And it turns out that this genetic variant is carried by about 560 million people worldwide, or 8% of the world population. It's probably one of the most common genetic variants in the world. And so, you know, studying this alcohol metabolism pathway on this genetic variant in the alcohol pathway could really help us to understand how we actually manage pain, maybe develop new pain therapeutics, and at the same time really potentially unlock the mechanism and understanding of how or what causes general anesthesia.

DR. JIN:

Can you give us a picture of what our career looks like if we want to engage in research, either a little or a lot through our careers in anesthesia, and do you think the research provides a reliable career foundation?

DR. GROSS:

Yeah, that's a good question. Um, you know, just the short answer is, is that research can provide a reliable career foundation. When you look at research, it's part of the academic mission of many anesthesiology departments within the United States and throughout the world. Research is really pivotal to advancing your field and ultimately providing the safest anesthesia to our patients.

When you think about the last several decades, there's been breakthroughs in monitoring. There are things that we really take for granted, such as the pulse oximeter, the EKG monitor, measuring end tidal CO2 in a intubated patient. And, you know, with these, this made anesthesia much, much safer. And these were all very big research breakthroughs. And there still continues to be innovation in the field. Things like the improved resolution of ultrasound for regional techniques and even methods to intubate with video laryngoscope. So those are all things that have really evolved and gotten so much better in the last decade.

And really, not only anesthesiologists make advances in the medical device field, but also in ways of introducing new drugs in the field of anesthesia, such as sugammadex and dexmedetomidine. You know, ultimately, when you think about it, we have the opportunity with research to advance our field in the device industry, developing novel drugs, and ultimately really leading to a better and safer overall care for our patients.

DR. ROLFZEN:

That's great. One benefit of the field of anesthesiology is having, you know, days that don't look similar to each other, back to back to back. And I was wondering how research also plays a role in making your days unique. I was hoping you could explain what a day in the life looks like when you're non-clinical and when you're clinical, and how you balance both of those entities.

DR. GROSS:

One thing about anesthesiology that's really, um, a nice, um, aspect of it is that we we really have a day to day job. In terms of what we do, and if you're working in the general operating room, such as I do, there isn't as much pace of patient follow up after that surgical procedure and post-operative experience. And so when you talk about day to day experiences, uh, the day to day life of myself usually involves at least one day a week practicing in the operating room, taking care of patients, and providing general anesthesia. And, um, other days involve sometimes having meetings with, uh, the people that work with me, developing scientific ideas, um, talking about what our research is in the next steps. Other days, um, involve actually doing a lot of writing. I always felt like my, my writing skills were were not the, not the greatest. That's why I went into engineering years ago. But I feel like how things go full circle, um, the things that sometimes you may not be the greatest, uh, your greatest strength may be the thing you do quite a bit of. And at this point I seem to, um, on a, on a daily basis, um, use my writing skills either, um, through writing scientific papers or grants or, um, even just writing correspondences and emails about how to get a research project going in terms of other things that happen day to day. At times I have, um, scientific meetings that may I may attend, and also additional opportunities with, uh, working with others to help develop research questions. And so there isn't really a day to day per se, that that is a routine. Um, and that's what's really nice about research. But then it's also something you have to be cognizant of because you always want to keep trying to advance what you're doing and keeping things in motion. And so sometimes when people don't have the, the, the factored in or formulated day to day, it actually takes a little bit of time to figure out what you should be doing that's most important for that day to move, uh, to move your research forward.

DR. TOLJ:

Thanks, Dr. Gross. And what do you think are some of the barriers and limitations that we should know about before launching careers in anesthesia research?

DR. GROSS:

I think the one thing to remember is, is that there really are no barriers. A lot of the barriers that are that people think are present within research are things that can be taken down. And so one example is, is that it's sometimes it's hard to find the right research question. And so if you're looking for a research question, a lot of times you can ask other individuals, um, that you work with about some of the, uh, opportunities that they may have for you to start with research. Other things that potentially, you know, that may be limitations is a lot of times people say that they have a hard time finding the time to do the research with a challenging clinical schedule. Um, I would challenge that as something that has always been something that's been difficult to try and work with, especially with getting research started, but finding a the right group of people and having a continued conversations about your research interests. And. Leading your research question. Um, it really will help towards getting that time that you may need to to help get a career and a project launched.

DR. JIN:

Thank you, Dr. Gross. My next question is with regards to senior residents or young faculties, who does not have a lot of prior experience in research. What's your advice on how they can start getting involved?

DR. GROSS:

Yeah, I think, um, there's two ways to go about it is.

One is, is that I always felt like, um, a lot of times the best research questions come out of clinical work. And so a lot of times you'll start making interesting observations in the clinic. And if you have the opportunity to think about those a little bit more, those can lead to really interesting questions that you can get involved in research with. You know, one example is, is that at least when I, when I started doing clinical work out on the West Coast, um, compared to when I was in the Midwest, was I noticed that there were several people that seemed to flush after they were actually having anesthesia. And this really led us to to trying to understand this alcohol metabolism pathway a little bit more, and how it actually could be related to the mechanism of anesthesia. And this really was generated out of a clinical observation that then led to adding and asking more research questions upon more research questions, which has led to, um, you know, uh, some of the things that we're looking at today.

Also, it's all really important to find a good mentor. A lot of times people start on their research path and they don't know how to do certain things. I myself, I didn't know how to write well. I didn't know how to formulate a scientific question. I didn't know what a hypothesis was. All these things, when you find the right mentor that was able to spend the time with you, will help you get to understand the scientific realm and the scientific community, and really what the important things are in order to ask a very sound research question. We talk a lot about rigor and, um, and repeatability and research nowadays. And finding the right mentor can actually help you. Um, not only, um, delve deeper into the research question, but also develop it in a certain way that you can have something that that can be long lasting, that that can be rigorous and, um, and have reproducibility.

DR. ROLFZEN:

Wonderful. So my next question revolves around FAER. I know it's been around for over 35 years and has been dedicated to developing the next generation of physician scientists, but I was wondering if you could speak to your role in FAER, Dr. Gross and how it supports anesthesiologists, both staff, fellows, residents and medical students.

DR. GROSS:

Right. Uh, FAER has just been, uh, the Foundation for Anesthesia Education and Research, has just been an excellent foundation to help many people launch their research careers. I've had the opportunity to be part of fair for the last number of years, really helping in an advisory role with reviewing and, um, reading the research grants that are submitted to FAER. Um, I've also had the opportunity to mentor a recent FAER, uh, awardee, and I've really seen how FAER has actually worked to help bridge that distance between when you're actually, um, working through residency and finishing up residency to becoming a faculty member, uh, with a with a really excellent research question.

Things that FAER have that provides for opportunity is not only just the idea of protected time for research, but also the idea of mentorship. FAER has just been an excellent foundation to help move our field forward and help bring together our next generation of anesthesiologists to focus on research and education.

One of the things I'll point out is that FAER does offer what they call a research fellowship grant, and that's offered to residents and fellows and provides one year of support for research. That is something that's open to all residents, and you can apply through your institution for this, uh, year of research that helps, that is funded through FAER and that can help get your research career started. They also have additional grants, such as a mentor research training grant, which is for two years, which is more near the completion of your residency to help get your research career started. I've known many of different faculty that have had a tremendous amount of support through FAER that have mainly helped them launch their research careers.

I also want to point out that FAER is also involved at the medical student level. Um, I've been involved in the MSR program, which is for medical students, which is an 8 to 10 week, um, internship in the summer where people can get exposure to the field of anesthesiology and anesthesia research through being paired at one of the universities that is accepting students as a host. This has also been an excellent experience where people at the medical student level can actually learn a little bit more about anesthesiology and really gain that exposure that sometimes is not there during those formal years where you decide what you want to do for residency. Those are just a couple things that I'd like to highlight with FAER, and the opportunities that are available through FAER for people at all different levels medical students, residents and, uh, early career faculty.

DR. TOLJ:

Speaking of launching your career and kickstarting it, what role do you think grants play in fostering careers and research? And as a physician scientist, how do you prioritize or balance between grant applications and actual research activities?

DR. GROSS:

Yeah. I think it's, um, it's really interesting how the last number of years there's been a focus on grants to provide opportunities for research. And people may think of grants in different ways. There's different types of grants that you can receive. Sometimes there's, um, at the national level, there's there's grants that can actually help support your research. Um, and one, for example, is FAER through the foundation, but there's other opportunities through the NIH and other sources where you can get receive funding for your research. A lot of people don't recognize that grants and funding at times for smaller projects don't need to have that national or even regional recognition. And sometimes there's opportunities within your own department to get a small amount of money to fund a research project. And this may be adequate to have a research project to get started.

When we talk about grants, I think it's just a mechanism to provide funding to answer research question. At times, though, it may not be completely necessary to get a research question completed. If you have resources within the department that you can use. If you also have a research question that does not require a lot of additional personnel besides yourself. And if you have a really interesting question you want to put the time into, um, either, you know, after you're done with your clinical duties or while you have downtime during clinical duties. At times, um, grants may not be important, really to get a research project started. It's just the opportunity to find the right question and to be have the, um, skill sets and the and the opportunities to answer that question.

DR. JIN:

Thank you, Dr. Gross. My next question is, um, how is the specialty doing when it comes to advancing patient safety? And also, what kind of problems do you think research can help solve in anesthesia and perioperative care?

DR. GROSS:

Yeah, I think that's an excellent question. There is also an Anesthesia Patient Safety Foundation that helps support safety related research. They also provide funding and support for bigger safety related questions. I think that when we look back at anesthesia a number of years ago, we didn't have things like the end tidal CO2 monitoring, uh, pulse ox, or any of these different devices that we use to monitor people to make sure they're safe during surgery. And I think that, you know, over the years with that technology, our profession has gotten quite a bit safer than what it used to be. And so I think some of the major accomplishments that have occurred over the last several decades have led us to providing even better and safer care than what we've had in the past. Even look at the idea of introducing sugammadex to our armaments. We used to use different agents to reverse rocuronium, and now we have an agent that just reverses it quite quickly.

I think in terms of safety, I think it's, uh, moving our focus more into precision medicine. It's trying to understand what individualized treatments may be more effective for some people compared to others, and learning what drugs may actually be more effective for certain populations compared to other populations when we when we provide anesthesia. I think the other thing with that, we're continuing to evolve in our monitoring. I think that there's quite a unique position for artificial intelligence and machine learning to be integrated into the operating room to really tell us something that may be happening with our patient maybe minutes before we may even realize it. And so I think that there's a lot to still do in the forefront of patient safety. And I think that we we are in an era that we're going to have tremendous opportunities to move the dial forward even further, so that our rates of issues with our patients or rates of complications with our patients will be much less even even than they are now in the future.

DR. JIN:

So what's your advice to non MD/PhD residents who have not had a lot of academic opportunity as a student who is interested to pursue a career as a physician scientist?

DR. GROSS:

The short answer is it's never really too early or never too late to start a career as a physician scientist. Most of the time it really comes with being observant and asking questions. Really, some of the best questions come from observations made in the clinical setting, and it leads you to ask more questions about the why. And so for residents that are interested in research, find others within the research field to help support your career. And, you know, keep asking those questions you may observe in the clinic about why. And I think it's really important for people to think outside the box, too. And so sometimes if you have a research question and you want to look for additional advice, think about people outside of the field of anesthesiology. Also, sometimes there are bigger breakthroughs that are made when there's interdisciplinary science and opportunities to look at an important question through different angles. And so really, it's just never too late to start a career involved with research. I think that you just really need to focus about the research question and really having the passion to answer that research question. And that will lead you to a fruitful career as a researcher.

All right. So it was really great to get to know everyone and meet everyone through this podcast. I'd be really curious to know a bit more about your research, about your interests in research and what you've been working on lately.

DR. ROLFZEN:

Sure. Thanks for that question, Dr. Gross. I was fortunate enough to be accepted into a residency research track at the University of Nebraska medical center, and under the mentorship and guidance of Karsten Bartels, I've been engaged in some health services research evaluating perioperative outcomes. As the field expands to embrace perioperative medicine, my interest resides in kind of further understanding how behavioral health equity affects perioperative outcomes.

DR. JIN:

So my interesting research is to use mobile technology in the peroperative period. And I'm also very lucky to be on research tracks as Donnybrook, uh, with Doctor Sergio Bagozzi, uh, as my mentor, who was one of the co-investigator in the neuroethics trial, which looked at cognitive rehabilitation. Uh, my current project is on the use of mobile pedometers for promoting perioperative ambulation. And I had the honor of presenting that at the fair residence and scholarship program.

DR. TOLJ:

Thank you for that question, Dr. Gross. I'm just starting my career here as an intern at Tufts. But my most recent presentation was at the Midwest Anesthesia Conference on a case I saw my M4 for a year about anticoagulation monitoring during cardiac surgery in patients with Antiphospholipid antibody syndrome. Since the use of ACT, which is our standard monitoring system, it’s phospholipid dependent, it leads to falsely elevated levels. Currently, I'm in the process of figuring out my career interests and goals. I recently rotated through our chronic pain clinic, um, and it was quite interesting to me. So I'm looking to get more involved in this field of anesthesia.

DR. GROSS:

I'd also be interested in how each of you got involved in research initially. Um, what was your motivation and how were you introduced into research? Uh, within the field of anesthesia.

DR. ROLFZEN:

I got this thought from Dr. Meredith Adams. But, you know, research isn't necessarily binary. I've always been kind of interested and curious in learning different things, and I don't think that's just a function of like, data collection. But even just being curious about questions, I think is a form of research in and of itself. And my undergraduate career, I did some basic research with ovarian cancer cells. Um, and that kind of just translated into more curiosity in residency. And I jumped at an opportunity. And, um, I think saying yes is one of those functions of being a resident and getting those opportunities.

DR. JIN:

I think I just really like solving problems. And I've also been really lucky in having had a string of very good, very supportive and experienced mentors along the way. Uh, Doctor Sergio Spaghetti being my current mentor, and then Doctor Tajima as my previous mentor when I was an SDC trainee England.

DR. TOLJ:

I also think I've been very fortunate of having seniors or upperclassmen that have brought me into their own projects and kind of mentored me through the whole process, I think from a recent med student and now intern, when you do a project that's like focused on idea or one aspect of anesthesia, you really get to know that. And it's a great learning experience as well as getting to know, like, the most up to date research in that field.

DR. GROSS:

So if there was a resident or medical student that wanted to get started out in research, what types of tips and tricks might you provide to them in order for them to get their research project or research career started.

DR. JIN:

So, um, that's a very interesting question. So I actually have a side interest in promoting resident and student scholarship. And at my residency program, I help organizing a academic mentorship kind of pathway, um, to support residents and students to participate in things like publications and presentations and also kind of helping them to develop the relevant skills. Um, and I think the really the first step is, I think, like Vania pointed out, just kind of saying yes and kind of putting the effort and being receptive to learning new skills.

DR. ROLFZEN:

That's a great point. As a jumping off point to that as well, we we engage in Journal Club frequently in our residency, and I think that's a great entry point for residents who don't have prior experience or have some experience and want to engage further in research to be able to take those skills learned in Journal Club and apply that in other settings, and ask questions to the people who have resources to be able to help.

DR. TOLJ:

I think from, um, a medical student standpoint, a lot of med schools now will have an anesthesia interest group through the ASA, so reaching out to the interest group at their, um, medical school could be helpful because a lot of those interest groups have either a faculty or a resident mentor. And that would be a way to get to know people in the department and ask for research. And then from a resident standpoint, I think the journal clubs such as Dr. Rolfzen pointed out, but also just going to Chiefs and asking, um, I feel like if you show interest, people are willing to help you out too. And getting started with anything is important because you get your feet wet, and then you can try to figure out what your interests are and what you would actually like to work on.

DR. ROLFZEN:

I think this is a great time to bring up, um, research that was recently published in ANA that showed that anesthesiology as a field ranked eighth to 10th place out of 11 medical specialties in the percent of research oriented entering residents, defined as those with advanced degrees or, uh, having published at least three research publications before residency. And so I think there's room to grow. And I think FAER does a great job of promoting research within this field.

Thanks for joining us. For residents in a room, the podcast for residents by residents. This has been a great conversation. Thank you, Dr. Gross and both of you residents also. It's been a great time meeting you. We hope you enjoyed this and we hope you will join again next month for some more.

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DR. JIN:

Thank you Dr. Gross and thank you, Dr. Rofzen.

DR. GROSS:

Great. Thank you all.

DR. TOLJ:

Thank you Dr. Gross.

VOICE OVER:

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