Lately, my task list at the hospital is anchored around a select few things. Answer stat pages to intubate people with COVID, and with diligence, restock my PPE for intubating people with COVID. But then intercom lullabies for newborn deliveries let me float away, for just a moment, to my baby nieces and older nephew. The mental reprieve fades, so I chart check lab results to do OR cases that –fingers crossed—do not have COVID.
Hopefully, this will not be another lamenting editorial about the pandemic. Nevertheless, I will acknowledge that both inside and outside the GME training bubble, normalcy for me, patients, and families has long since disintegrated.
Practicing in an era of much change in healthcare delivery, we recognize the importance of health professions education, now more than ever. And given the newsletter theme issue of Pain Management, I ask myself, “With any core anesthesiology principles for residents, or learning basic patient care fundamentals for medical students, how will the US medical education system begin teaching things differently, given our current pandemic circumstances?”
Working with medical students in VCU’s Global Anesthesia Program as part of the Acute Care and Systems Strengthening (ACCESS) track for global surgery gives me a case study-like example to answer that question.
This program, led by VCU Health’s Acute Care Surgeon Edgar B. Rodas, MD, FACS, touts a longitudinal track in global health for VCU School of Medicine students. Its scholarly track of students examines health disparities in the global burden of surgical disease across all four years of school. Then, students pick a subspecialty like Anesthesiology during their third and fourth years for a more narrowed focus.
Across multiple anesthesiology subspecialty modules, these third and fourth year medical students participate in journal clubs, ethics discussions, problem based learning challenges, and both high and low fidelity simulations. They are encouraged to think outside the box for global surgery and what anesthesiology practice is like in the United States.
They learn to ask mature, challenging questions like, “How can pain still be adequately managed with limited resources?” How does the rest of the world provide adequate analgesia when opioids and other drugs are in strikingly limited supply? How can we teach international healthcare teams in constrained settings to use point of care ultrasound for regional anesthesia in short amounts of time? How do acute and chronic pain management concepts have utility in healthcare systems where the anesthesia workforce is largely not physician-trained?
And in the era of enhanced recovery after surgery, how do we work with our international colleagues to examine healthcare system infrastructures and identify breakable barriers to meaningful change?
Trainees, whether medical students, residents, fellows, or other health professionals, are all experiencing a critical inflection point, learning literally everything through the COVID lens. And it’s largely unprecedented— at least in most recent practitioners’ memories.
For those of us who are future anesthesiologists, we’re seeing unequivocally that we have important, transferrable skillsets to many unexpected practice environments. Our knowledge of sedation, pain management, drug supply, and resource utilization are just a short list of areas where we’re becoming increasingly valuable.
But we’re also learning to think and practice differently because constrained resources are no longer hypothetical. And looking to my global anesthesia medical students’ experiences, I’m appreciating alongside them that COVID is underscoring the need for all of us to readjust how we think about core anesthesiology concepts like pain management. Because although we in the US can offer many things to other places, we stand to learn just as much.