Achieving Excellence in Medical Education (2006, 2007)

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His main objective was to make education reachable to the masses. In pursuance of this objective, the University has established various educational institutions in the fields of medicine, dentistry, nursing, allied health sciences, engineering, management, computer science applications and basic sciences, thereby contributing to the global needs for knowledge and education.

Vinayaka Missions Research Foundation has translated its Vision "to achieve excellence in education for the enrichment of the society" through its Missions of "spreading education globally" and successfully established many international co-operations across the globe. Vinayaka Missions Research Foundation excels in diverse disciplines through dedicated teaching by distinguished academicians. The University offers excellent infrastructure and right ambience to its students and constantly aims at achieving 'Excellence in Education'.

The students acquire knowledge, self-confidence, moral values, leadership and skills in their chosen fields to meet the challenges of the competitive world.

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In fact, studying in the University is a rich and rewarding experience for the students. Approved by Medical Council of India. Imagine the impact that Peter Safar, M. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania; — , had when reviving people who were near death by cardiopulmonary resuscitation! With the contributions of several individuals, John W. Severinghaus, M. Bendixen, M. John J. Bonica, M. Department of Anesthesiology, University of Washington, Seattle, Washington; — , tirelessly promoted the concept of multidisciplinary care in the treatment of patients with chronic pain.

Amazingly, current concepts of pain management include all of the aspects and more that were originally recommended by Dr.

Excellence in medical education

Bonica in the s and s. And John Lundy, M. These are examples of anesthesiologists who went beyond the usual boundaries of anesthesiology to pursue excellence. To be sure, these individuals not only are responsible for the enhancement of anesthesia, but also were recognized as anesthesiologists for their contributions to medicine overall. How will anesthesiologists be viewed 50 yr from now?

To answer that question, I would like to reflect on how we should define the path forward. Considerable conceptual evidence suggests that medical professions, including anesthesiology, are in danger of becoming trade unions. If so, what is the difference between a profession and a trade union? There have been several learned individuals who postulated that the practice of medicine as a profession has dramatically decreased in the past 10 yr.

Historically, the practice of medicine was based on professional autonomy, with regard to its scientific and clinical knowledge. Have we lost our professional autonomy? If so, is that bad? The answer to both questions is absolutely yes. As anesthesiologists, we must control the intellectual content and resources of our specialty. However, in the past 20—30 yr, this autonomous position in society has been perceived by governments of many countries, and economists therein, as an impediment to an economically sound and responsive healthcare delivery system.

How can we ensure that we control our autonomy, to some extent, to pursue excellence? The good news is that these agencies have insisted that basic standards and protocols be met, which anyone who has undergone inspections by the Joint Commission and the Centers for Medicare and Medicaid would know. However, where is the encouragement and even demand for the pursuit of excellence and creativity? The challenges and problems posed by all of these groups usually demand attention to short-term responses and solutions, leaving little time or energy for long-term vision.

Yet our future is dependent on long-term vision, so what should we do? Please understand that I do appreciate the current demands for safety for which our specialty was praised by the Institute of Medicine in its book To Err Is Human. As anesthesiologists, we need to be dedicated to creativity and the pursuit of excellence, which are crucial to both our professional autonomy and the development of long-term vision by the specialty.

Medical care and its organizations gradually evolved from to During those years, many advances were made in our specialty, including the evolution of our specialty into many subspecialties. In addition, the duration of our residencies lengthened from 2 to 3 yr so that we could not only improve training in the operating room, but also expand into the entire perioperative period. This lengthening of duration also allowed our residencies to have dedicated time toward research, if so desired.

There is no doubt that the American Society of Anesthesiologists ASA played an enormous leadership role in this evolution. After medical school, how did my personal concepts about our specialty evolve? I was heavily influenced by what went on at UCSF in Highlights of those influences are illustrated in table 2.

Table 2. Professor Emeritus, Department of Anesthesia and Perioperative Care, UCSF was busy determining the minimum alveolar anesthetic concentration MAC in various clinical situations and was also determining the pharmacokinetics i. As mentioned previously, John W.

Sol Shnider, M.

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Professor, Department of Anesthesiology, UCSF , had a sheep model that allowed a precise definition of vasopressors used to sustain blood pressure in pregnant women and their effects on uterine blood flow. My second year, I had the privilege of performing pulmonary function tests in the Cardiovascular Research Institute, where I learned that John A. Clements, M. One of my resident colleagues, George A. Gregory, M. Professor Emeritus, Department of Anesthesia and Perioperative Care, UCSF , was beginning to get quite interested in research that would ultimately decrease the mortality rate in premature infants.

That those types of investigations were clearly known by a first- or second-year resident who had no research experience was stimulating and invigorating.

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First, we could not avoid seeing the research clinically, because it was being performed in patients. It was the foundation of our teaching, and, furthermore, we were proud to be associated with individuals who were advancing anesthesia knowledge in such a dramatic fashion. Last, we were very proud, as residents, to be associated with these advances in anesthesia knowledge.

It was clearly an atmosphere about which I wanted to learn more and be an active participant. The potential opportunity to pursue excellence beyond any preconceived boundaries was mind-boggling to me. For example, although we were concerned about financial well-being as junior faculty, I watched William K. Hamilton, M. Professor Emeritus, Department of Anesthesia and Perioperative Care, UCSF , my predecessor as chair, worry about supervising our intensive care unit when we could not collect professional fee income.

Covering the intensive care unit shifted funds from faculty salaries, which was not popular with our faculty, including me. Hamilton insisted that we continue a major leadership role in critical care despite the financial implications, and I am grateful that his instincts were so visionary. Our anesthesiology department now plays a dominant role in the provision of critical care at UCSF.

I am also grateful that he allowed a very opinionated young faculty member, me, the opportunity to debate with him regarding the issues of those times as they related to anesthesiology. However, during the most recent 10 yr, the rate of change has far exceeded that of the previous 25 yr. We have had extremely rapid change in several aspects of our daily professional lives, including hospital admission policies e.

During that time, our specialty did achieve excellence in operating room anesthesia. We, and the ASA as an organization, should be congratulated. However, anesthesiologists, including myself, were concerned that as a profession we were not ready for the future. We interviewed many leaders in American medicine and even outside medicine, which led to the current conclusion regarding the increasing dominance of perioperative medicine and the need to increasingly review the entire perioperative process as one integrated unit, including emphasis on critical care medicine.

One prediction by those we interviewed was that anesthesia would not step up to the plate; the prediction was that, for financial reasons, anesthesiologists would not be leaders in perioperative medicine. Another prediction was that an increasing number of beds would be dedicated to perioperative medicine and critical care. That process has evolved more rapidly than even our task force anticipated, as indicated by the increased number of perioperative directors. Has anesthesia stepped up to the plate? Has there been debate?

One indicator that addresses the first question is the number of advertisements in the journals I read. By rough count, there has been a severalfold increase in the number of perioperative director advertisements in the United States since that task force report. Furthermore, most of the appointed perioperative directors are anesthesiologists. We, as a specialty, did indeed step up to the plate. Our future is widely discussed and debated, especially by our leaders.

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I have heard Mark J. That those types of investigations were clearly known by a first- or second-year resident who had no research experience was stimulating and invigorating. First, we could not avoid seeing the research clinically, because it was being performed in patients. It was the foundation of our teaching, and, furthermore, we were proud to be associated with individuals who were advancing anesthesia knowledge in such a dramatic fashion. Last, we were very proud, as residents, to be associated with these advances in anesthesia knowledge. It was clearly an atmosphere about which I wanted to learn more and be an active participant.

The potential opportunity to pursue excellence beyond any preconceived boundaries was mind-boggling to me. For example, although we were concerned about financial well-being as junior faculty, I watched William K. Hamilton, M. Professor Emeritus, Department of Anesthesia and Perioperative Care, UCSF , my predecessor as chair, worry about supervising our intensive care unit when we could not collect professional fee income.

Covering the intensive care unit shifted funds from faculty salaries, which was not popular with our faculty, including me. Hamilton insisted that we continue a major leadership role in critical care despite the financial implications, and I am grateful that his instincts were so visionary. Our anesthesiology department now plays a dominant role in the provision of critical care at UCSF.

I am also grateful that he allowed a very opinionated young faculty member, me, the opportunity to debate with him regarding the issues of those times as they related to anesthesiology. However, during the most recent 10 yr, the rate of change has far exceeded that of the previous 25 yr. We have had extremely rapid change in several aspects of our daily professional lives, including hospital admission policies e.

During that time, our specialty did achieve excellence in operating room anesthesia. We, and the ASA as an organization, should be congratulated. However, anesthesiologists, including myself, were concerned that as a profession we were not ready for the future.

We interviewed many leaders in American medicine and even outside medicine, which led to the current conclusion regarding the increasing dominance of perioperative medicine and the need to increasingly review the entire perioperative process as one integrated unit, including emphasis on critical care medicine. One prediction by those we interviewed was that anesthesia would not step up to the plate; the prediction was that, for financial reasons, anesthesiologists would not be leaders in perioperative medicine.


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Another prediction was that an increasing number of beds would be dedicated to perioperative medicine and critical care. That process has evolved more rapidly than even our task force anticipated, as indicated by the increased number of perioperative directors. Has anesthesia stepped up to the plate? Has there been debate? One indicator that addresses the first question is the number of advertisements in the journals I read. By rough count, there has been a severalfold increase in the number of perioperative director advertisements in the United States since that task force report.

Furthermore, most of the appointed perioperative directors are anesthesiologists. We, as a specialty, did indeed step up to the plate. Our future is widely discussed and debated, especially by our leaders. I have heard Mark J. Lema, M.

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Does the pursuit of excellence have any boundaries as far as our specialty is concerned? The pursuit of excellence demands our attention both inside and outside the boundaries of our specialty, as exemplified previously by Snow, Bonica, Bendixen, and others. Furthermore, our specialty has a continued parade of challenges or opportunities to address.

For example, what if robots become increasingly important for surgery and possibly anesthesia? What if the delivery of anesthesia becomes completely automated, especially with regard to drug administration and its monitors? Its effectiveness remains to be determined. If so, how will that influence our future? Table 3. Automated Delivery of Anesthesia. What if acute pain management is dominated by self-administered devices by nonintravenous routes fig.

How will that influence our future? From AcelRx Pharmaceuticals, Inc. These centers have been described and will insert central and arterial lines. I repeat the previous statement: To achieve excellence, we must examine both inside and outside our boundaries. There are many more examples and possible future developments that could be listed. However, the fundamental question is, how do we respond to these questions and still pursue excellence?

Do we need a specific process to address these developments? Do we respond prospectively or react retrospectively? In my opinion, retrospective reactions usually are made in an atmosphere not conducive to the pursuit of excellence. Even with my passion for predicting the future, I could not have possibly imagined the impact of surgical resident work hours and reimbursement schemes on the practice of surgery, especially preoperative evaluation and postoperative care or the lack thereof.

These added responsibilities are generally desired by our specialty, but has that helped us plan for the future—or has it bound us down and made us less creative? I am encouraged that our specialty has stepped up to the plate in such a thoughtful and meaningful manner with regard to perioperative medicine, but I remain concerned about preoperative evaluation. In my opinion, preoperative evaluation needs to be performed by anesthesiologists or closely supervised by us. In the pursuit of excellence of every aspect of our specialty, I am concerned about the increasing trend to relinquish our responsibility of preoperative evaluation to other providers.

As indicated previously, the need for our specialty to be creative and in control of its intellectual content demands emphasis on research. The ASA has been acutely aware that our share of academic research funding has been inappropriately small when considering the importance of our specialty in American medicine. The ASA has placed added emphasis in research by celebrating it in a variety of ways, including increased funding to the Foundation for Anesthesia Education and Research and the establishment of the Severinghaus Lecture in Translational Science.

Despite the currently poor economy, I, perhaps, hopefully not alone, believe that some interesting opportunities may be on the horizon. Decrease maximum allowed length of applications from 25 pages to 12 Focus more on anticipated impact of the research Focus less on methods and other details.

Despite recent changes in NIH leadership, I believe this direction will continue. Also, the NIH is anxious to facilitate better connections between basic and clinical research, i. Historically, moving new medical discoveries into clinical practice has been haphazard, occurring largely through continuing medical education programs, pharmaceutical detailing, and guideline development. Proposed expansion of the National Institutes of Health NIH Roadmap includes an additional research laboratory Practice-based Research and translational step to improve incorporation of research discoveries into day-to-day clinical care.

While economic downturns are not good for the NIH, I would argue that these are great opportunities for departments to use clinical monies for NIH applicants. This approach could be successful in the long run by positioning anesthesiologists at the front of the line when NIH funding improves. These proposals and actions are wonderful. After their inspiring recommendations, some questions naturally followed. Subsequently, Alex Evers and I wrote an editorial in April We came to the conclusion that these are steps in the right direction, but more is needed.

What is needed is top research talent. Why do physicians start research careers? The answer is that they dream that they will solve a major medical problem important to society overall. Physician—scientists are attracted to fields such as medicine and pediatrics because they dream of curing major healthcare problems such as cancer and Alzheimer disease.

So the question is, if I were to ask all of you anesthesiologists what pressing clinical problems for the specialty of anesthesiology need research for a solution, what would I hear? I believe that an inconsistent and quite diverse answer, which would not be sufficiently concise for the pursuit of excellence, would follow. We need to know what these problems are. I apologize for being a bit harsh with this statement: Although our specialty should be and is proud of our significant contributions to patient safety, it is inappropriate to content ourselves with the fact that few patients experience intraoperative death due solely to anesthetic mishap.

For example, we need to take ownership of the substantial perioperative morbidity and mortality.

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