Education: An Essential Leg for Anesthesiology's Four-legged Stool!

ANESTHESIOLOGY encompasses four key activities: patient care, education, research, and practice administration. Similar to a four-legged stool, Anesthesiology is fine if all its “legs” are the same length and sturdy, that is, you can confidently “sit on it, use it as a stepladder, even stack stuff on it.”* When you test the “Anesthesiology stool” what do you discover about its legs? Many anesthesiologists are facile clinicians, always ready to competently care for another complicated patient; others are inquisitive scientists, developing the evidence base to create new knowledge; more demonstrate administrative expertise and effectively and efficiently manage practice environments and groups; hence, three legs of the anesthesiology stool seem assured. What about the “education leg?” Often, it is short and weak; “the stool is lopsided when you sit on it, gives you a scare when you use it as a ladder and the stuff you stack on it slides off onto the floor.”* If anesthesiology hobbles along without a strong education leg, this is a recipe for disaster and unsafe patient care.* A strong education leg will allow anesthesiologists to devote more time and energy in studying, measuring, and applying more scientifically based approaches to our teaching. Educators need a forum to share processes and tools to measure the outcomes of their teaching efforts. Students of anesthesiology will benefit greatly when the education leg is solid, that is, life-long learning will become an integral part of the fabric of the clinician. This and the three companion Editorials, in the subsequent issues of ANESTHESIOLOGY, are designed to focus on several of the key aspects of education to raise our level of awareness so that we will focus on teaching to assure that the “education leg of Anesthesiology” is as long and strong as its three sister support legs. Anesthesiology education is a vibrant activity. The enterprise is vast. In the United States in 2008, (1) accredited Graduate Medical Education programs included 131 core anesthesiology residencies and 136 subspecialty fellowship programs educating 5,208 residents and 396 subspecialty anesthesiology fellows; (2) 71,578 medical students received some modicum of anesthesiology education; and (3) 102,572 graduate medical education trainees in nonanesthesiology specialties (a 5% increase from 2005) clamored for anaesthesiology-related education (e.g., airway management, vascular access, and safe local anesthetic use). The number of full-time clinical anesthesiology faculty responsible for providing anesthesiology education is more than 6,000. These numbers increase even more when nurse anesthesia ( 1,200/yr) and nonphysician healthcare professional ( 230,000/yr) students are included in the anesthesiology teaching activity. Addition of the large number of medical, graduate medical education, and nonphysician healthcare students worldwide solidifies the huge responsibility of anesthesiology education. Also remember that all anesthesiologists, as role models, further the understanding of our profession by becoming better teachers of other physicians, such as surgeons, neurologists, hematologists, pediatricians, and intensivists, and of nurses, anesthesia technicians, and the institutional officials with whom we work. How will all these students best learn anesthesiology from us, their teachers? Answers to this critically important question about students and learners come from thoughtful consideration of a definition of education: