Anesthesiology, Perioperative and Pain Medicine

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May 2014

Stanford Anesthesia Education Committee Meeting Minutes May 8, 2014

In Attendance: Drs. Adriano, Jeter, Kelleher, Kim, Macario, McHenry, Press, Ratner, Shafer, Sun, Telischak, Telusca; Cuen, David, Roberts

Introduction: Melissa Cuen was introduced as the new administrative associate to the Education and Training Office. Melissa is a UC Berkeley graduate and comes to us from industry and also worked at the California Society of Anesthesiologists. She will be handling the resident lecture series, resident reimbursements and research fellow appointments, among other things. She will work at an off-site location at Arastradero Road.

The Peer Support and Resiliency in Medicine (PRIME) program: Dr. Ratner and the leadership of the resident wellness program have changed the name of the program to PRIME (Peer Support and Resiliency in MEdicine).

PRIME Scholarship: Donations made to the Amy Wang Memorial Fund are used to promote resident well-being. For example, some of those monies are used to support the CA1 rafting team building trip in the summer. Dr. Ratner and the wellness group proposed a new initiative whereby Stanford residents can apply for a $1,500 PRIME scholarship. Up to two of these scholarships will be awarded each year to promote trainee wellness and resiliency through one of the following ways:
1- Attendance by the resident at a national or international meeting/program focusing on the promotion of physician resiliency/wellness followed by a verbal presentation or written report to the residents, fellows and/or faculty.
2- Implementation of a program by the resident that focuses on the promotion of physician health that is targeted towards trainees and may include trainee’s family members. Program evaluation via surveying participants would be completed.
3- A research project that studies or promotes physician trainee health/resilience.
4- Other activities may be submitted for consideration and all require a faculty advisor
If interested please email Dr. Macario a one page proposal by June 15, 2014. A full scholarship description including selection committee is below in Appendix.

Pediatric Advanced Life Support (PALS) course: Based on interest by the housestaff, Dr. Naiyi Sun updated the group that the first PALS certification course for anesthesia residents was held on Saturday April 26, 2014. 16 residents attended the course including 5 CA-1, 4 CA-2, and 7 CA-3 residents. The format was a condensed 1 day course specifically designed for anesthesia MDs. The 12 evaluations received back showed all residents rated the course 4/4. In response to, "Do you think this course should be offered to anesthesia residents every year?" all residents answered yes. Since the course feedback was positive the department will fund it for next year. The chief residents will survey residents to see how many are interested for a Saturday course next yr and the plan is to offer either 1 or 2 courses per yr.

Weekday afternoon lecture Series: The 2014-15 CA2 lecture resident representatives are Drs. Quentin Baca and Chris Clave and the CA3 representatives are Drs. Stephanie Jones and Jan Sliwa. Dr. Basarab-Tung is the new Director of the CA2-CA3 lecture series and is finalizing the lecture schedules based on meetings with residents to obtain input as to format and content.

Western Anesthesia Residents' Conference (WARC): The 52nd annual WARC resident research conference took place at the Intercontinental Hotel in Century City, CA on May 2-4, 2014. Dr. Tawfik reports that 24 abstracts were presented by 19 residents, two medical students and one fellow. Included were six research abstracts by the residents who received research months in 2013-2014. Drs. Justin Pollock and Jason Johns had verbal presentations. Dr. Barrett Larson won first prize in category Science & Technology for a new ultraportable fluid-cooling device. Next year WARC is in Seattle. All residents receiving research time during the academic yr are required to present at WARC.

Outcomes after residency: Dr. Macario reviewed data on board certification rates, fellowship choices, and practice type for alumni.
Board Certification rates: The 2008-2012 alumni graduates (n=106 over those 5 yrs) of Stanford Anesthesia residency have an overall board certification rate of 97% as compared to the national average of 89%.
Practice type: For the 106 graduates between 2008-2012 where are they now? 31% are in academic practice at one of the 4 affiliated hospitals (Stanford 11%, Santa Clara Valley 8%, Palo Alto VA 7%, Packard 5%), 20% are in community practice in the Bay Area, 20% are in community practice outside California, 20% are in community practice in California outside the Bay Area, and 8% are at an academic medical center not Stanford.
Fellowship choices: For Stanford Anesthesia graduates for this year 2014, 75% will go on to a postgraduate fellowship with cardiac (n=4), pediatrics (n=4), research (n=3), ICU (n=3), regional (n=2), and pain (n=2) as the choices.

Medical Humanities: Drs. Audrey Shafer and Yeuen Kim, Clinical Assistant Professor in the Dept of Medicine, proposed a Medical Humanities experience for the CA3 class titled, “Rodin and Physical Diagnosis: Medical Humanities to Improve Visual Observation and Communication Skills.” This will take place during a normally scheduled CA3 lecture period and involve a guided tour of the Cantor Arts Center and exercises in observing and describing. Dr. Kim indicated the goal is to expose residents to art education and apply what is learned at the gallery to improve clinical skills through tolerance of ambiguity, visual observational skills and building community. This program has been well received at SCVMC. Dr. Kim will work with Janine to schedule the session.

Chief Resident Update:
The new chief residents are working on the block 13 schedule and their plan is to get the future block schedules out at least two months in advance.
The CA1 river rafting trip will be on July 19-20.

We are happy to announce a new scholarship called the Peer Support and Resiliency In MEdicine (PRIME) Scholarship whereby Stanford Anesthesia residents can apply for funding up to $1500 to promote trainee wellness and resiliency in one of the following ways.

1. Attendance at national or international meeting/program focusing on the promotion of physician resiliency/wellness.
The resident would propose a meeting they want to attend and rationale to the Selection Committee. Ideally, the meeting should grant CME credit, but this is not required. The resident may wish to include in the application how after the meeting, they will present salient points relevant to residents, fellows and/or faculty. Alternatively, for example, a written report can be produced. Conference week or absence days could be used to attend.
Examples of meetings:
• AMA-CMA-BMA International Conference on Physician Health
• Canadian Conference on Physician Health
• Mindful Living Programs for Health Professionals
• Mindfulness Based Stress Reduction (does not offer CME)
• University of Mass. Center for Mindfulness in Medicine, Health Care and Society conferences
• International Research Congress on Integrative Medicine and Health

2. Implement a program that focuses on the promotion of physician health that is targeted towards trainees and may include trainee’s family members.
Example: Wellness on Wheels programs are available through Stanford University’s Health Improvement Program (HIP) for groups >10 people. These may include stress reduction, nutrition, exercise, yoga or pilates classes.
The application would specify program and budget needed. Afterwards, the awardee would prepare an abstract/summary of the program, and ideally, include before and after data, representing program evaluation.

3. Perform a research project or participate in an ongoing research project that promotes physician trainee health/resilience. Funds may be requested to assist in data collection, analysis supplies, research assistant time or other approved activities pertinent to the project.

4. Other activities may be approved, if proposed to and accepted by a Selection Committee.

Selection Process:

1. Applicants will submit no more than a one page proposal of how the funds will be used and explain how this activity could promote physician resiliency.
2. Each applicant will identify a faculty member mentor for the proposal.
3. A selection committee will review the applications, and determine which 2 applicants will receive funds.

Selection Committee Members:
Program Director, Associate Program Director, Program Coordinator
Co-Directors of PRIME program or 2 faculty participants in the PRIME program (Emily Ratner, MD and Tara Cornaby, MD)
Chief Resident representative (1), One Resident Education Committee Representative from CA-1,CA-2, CA-3 class

Resident refection essay for the Medical Education and Simulation elective

Dr. Tammy Wang, CA-3, kindly agreed to share her reflections after completing the Medical Education and Simulation Elective in the Stanford Department of Anesthesiology.

My Medical Education and Simulation elective has been an excellent experience. It has reinvigorated me and given me some time to reflect on possible future career paths and choices. This month has reminded me of how much I truly enjoy not just teaching itself, but also thinking about how best to educate medical students and residents. I have thought not just about effective teaching, but also about how students learn, and how to study that. We need to have more educators who do not just impart knowledge, but also assess need and evaluate the efficacy of the curriculum design.

I have also enjoyed having some time to focus on performing a task well. ImPRINT has been a pleasure to coordinate this academic year. However, with my own academic studies and clinical duties taking priority, it has been a challenge to devote the amount of time to the course that it deserved. This month, I was able to put together a robust curriculum for May that I feel proud of. In addition, I have been able to complete a separate scholarly project for submission to MedEd Portal, based on the ImPRINT curriculum.

Our residency exposes us to a great deal of simulation as a learner. It has been interesting and enlightening to further experience simulation as a novice instructor. Through reading articles, observing expert instructors, and self-practice, I have improved my own abilities in debriefing. I have also increased my own medical knowledge and skills in Crisis Resource Management (CRM) by being allowed to attend multiple ACRM sessions. For me, the repetition is really helpful in reinforcing the information.

I have been told repeatedly that we are trained well as Stanford Anesthesia Residents. I have been a little skeptical about that, since I do not feel there is an easy way to gauge that. This is the only anesthesia residency I have ever been through! However, this month, I helped instruct the Internal Medicine resident code team training at the VA, and it does seem clear that our crisis resource management education is robust compared to other specialties. In addition, the instructors at the PALS course this month repeatedly expressed their pleasure at our facile use of CRM principles compared to their typical learners. It has been gratifying to realize that, as I near the end of my training, I do indeed have significant knowledge and skill that I might be able to impart to others in the future.

It has been interesting to learn a little bit about the curriculum available for an advanced degree in medical education as well. The reading for this course has given me a little exposure to the field, and I am definitely interested in learning more.

The primary challenge during the rotation has been time management. It is difficult to simultaneously (1) be an active participant in the plethora of simulation activities Stanford and the VA has to offer, (2) produce meaningful scholarly work, (3) complete the required readings and lectures, and (4) honor the clinical commitment for the elective. There are not enough hours in the month! Certainly any resident choosing this elective must have an on-going project that they can use this month to solidify or complete. It would be a challenge to expect to complete academic work that was started during the same month.

Overall, this has been an excellent elective, and I am grateful for the opportunity to be the inaugural resident. The mentorship during this rotation has been especially wonderful. I am grateful to Dr. Udani for the limitless time and energy he has put into this course. In addition, Drs. Harrison, Howard, and Gaba have been generous mentors and role models. I would highly recommend it to any resident with an interest in medical education and/or simulation.

Education Committee Meeting Minutes April 10, 2014

In Attendance: Drs. Adriano, Djalali, Fanning, Harrison, Hasan, Howard, Johns, Kalra, Kelleher, Kulkarni, Lemmens, Macario, McHenry, Miller, Quick, Press, Tanaka, Telischak, Telusca, Wagaman, T. Wang, Williamson; David, Roberts

Stanford Anesthesia Senior Resident Teaching Scholar: Dr. Chris Miller will be the 2014-15 Senior Resident Teaching Scholar, after Dr. Tammy Wang who has done an outstanding job this academic year. Dr. Miller’s duties will include being the Co-Director of ImPRINT with full job description in Appendix 1.

Medical Student Symposium: The weekend of September 20th, 2014 will be the 3rd annual California Anesthesiology Medical Student Symposium at UC Irvine. Dr. Pedro Tanaka will represent Stanford and he is able to take three CA-2/3 residents, travel expenses for the one day program funded by the Department. The residents will be teaching an airway workshop to medical students as well as answering questions about our residency program. Please contact Dr. Tanaka if interested.

Milestones Update: Dr. Aileen Adriano has been working with the rotation directors on mapping out rotation evaluations according to the 25 milestones and Janine will be programming these evaluations into MedHub. Dr. Adriano will visit each resident class during a lecture period to introduce the milestones and inform residents of the changes to the evaluation process. She will also be attending division meetings to introduce faculty to the new process.
Under the new evaluation system the resident can demonstrate milestones at one of 5 levels:
Level 1: expected of a resident who has completed internship.
Level 2: expected of a resident prior to significant experience in the subspecialties of anesthesiology.
Level 3: expected of a resident after having experience in the subspecialties of anesthesiology.
Level 4: is ready to transition to independent practice. This level is designed as the graduation target.
Level 5: The resident has advanced beyond performance targets defined for residency, and is demonstrating “aspirational” goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional residents will reach this level for selected milestones.

ABA Staged Exams: Dr. Kyle Harrison updated the group on the new ABA Staged Examination system. Beginning with the current CA-1 class, the new examination system will be in three parts. The Basic exam will be given the end of July following the completion of the CA-1 year. It will be offered every six months after that and a trainee must pass this exam to successfully proceed through the training program. Following the Basic exam and residency training, there is the Advanced written exam and then the two-part Applied Exam that includes the Objective Structured Clinical Examinations and an oral exam. The ABA is currently completing the building of a new facility in Raleigh North Carolina where all the Applied exams will take place.

SICU Update: The anesthesia resident on SICU will be acting as chief for some part of the rotation in the next few mths as a pilot and will get feedback from them on that experience.

CA2-CA3 Lecture Series Update: Dr. Alex Quick has helped improve the lecture series and will help identify junior resident representatives to work on a committee with Drs. Basarab and Harrison for next year. They will work together to select lecture topics and presenters for the class lecture series. Changes include that the faculty lecture will be first on the schedule at 4pm followed by the resident presentation such as journal club and PBLDs.

Chief Resident Update: The senior class lottery was held on Monday, April 14th and the chiefs will release the 2014-15 master rotation schedule shortly.

Libero Update: Dr. Tanaka has established a working group of residents (Lena Scotto, Phillip Wang, Sarah Clark, and Lindsay Borg) that will help to evaluate and suggest improvements for the Libero Program. Also this group will organize lectures in themes.

Rwanda Medical Mission: Dr. Natacha Telusca gave a presentation on her recent Global Health experience to Rwanda. Dr. Stephanie Jones also was a member of the team. It was a rewarding experience and encourage other residents to take advantage of this opportunity in the future.

The Annual Program Evaluation Meeting chaired by Dr. Kyle Harrison will be on Tuesday, May 13th in the Anesthesia Conference Room beginning at 5pm.

Next Education Committee Meeting: Thursday, May 8th, 2014 at 3:30pm

Appendix 1
Stanford Anesthesia Senior Resident Teaching Scholar

Summary: A resident leadership position to promote the education mission in the Department of Anesthesiology, Perioperative and Pain Medicine with main goal to enhance the educational experience for Stanford anesthesia residents and medical students
Appointment: 12 months beginning in and around April 1
Eligible: CA1 or CA2 (preferred) at time of appointment
Election: by vote of Education Committee after 1 page proposal (deadline February 15) by interested residents submitted to chair of Education Committee
Vision: The objective is for the department to be a leader in anesthesia medical education and research (e.g., simulation, informatics, blended learning, and classroom innovations).

Job description potential duties available:
• Course co-director for ImPRINT (the monthly curriculum for anesthesia interns)
o Pair CA1 graduates from ImPRINT with next years ImPRINT interns for mentorship
• Ex officio member of Education Committee
• Work with rotation directors to improve resident rotations

• Develop and implement an innovative curriculum for anesthesia residents with goal to publish or present results at national meeting

• Teach in anesthesia simulation courses (EVOLVE, ACRM)
• Help organize the medical student anesthesia rotations at Stanford (resident mentors, scheduling, check list for goals)
• Medical students in the OR and on other clinical rotations

• Promote anesthesia, critical care, and pain rotations to medical students
• Recruit residency applicants in general, & specifically those interested in medical education
• Facilitate participation of other housestaff in activities to promote education
• Further develop the CA1 mentor/bigsib program for first year anesthesia residents

Professional Development
• Department funding available to attend a formal course such as the Society for Education in Anesthesia (SEA), Stanford Faculty Development Center Training for Clinical Teaching, or Stanford Simulation Instructor Course
• Attend Medical Education Seminar Series put on by the Stanford Center for Medical Education Research and Innovation (SCeMERI)
• Participate in Dept. Faculty Teaching Scholar Program and attend those monthly meetings

Budget: Available

Prior Scholars:
Ankeet Udani MD (2012)
Tammy Wang MD (2013)

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