The Daily Dose • Saturday, May 15, 2021

Becoming a Leader in Anesthesiology: Examining the Role of Leadership in Preparing the Next Generation of Anesthesiologists

Mark Arcario, MD, PhD

Many of the leaders in the field of anesthesiology convened for the AUA 2021 Annual Meeting on May 14 for the session, “Education Advisory Board II: Teaching about Leading,” which examined the critical role of leadership in both the development of trainees and in creating continued excellence in the field of anesthesiology. Three speakers, Deborah Culley, MD, Berend Mets, MBChB, PhD, FRCA, FFASA, and Alex Macario, MD, MBA, presented the latest data, and an optimistic outlook, on how the next generation of leaders in anesthesiology can be supported.

Keith H. Baker, MD, PhD, Vice Chair for Education in the Department of Anesthesia, Critical Care and Pain Medical at the Massachusetts General Hospital and Associate Professor of Anesthesia at Harvard Medical School, moderated this introspective and thought-provoking session.

Dr. Deborah Culley, Chair of the Department of Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania, presented a review of literature asking the question, “Can Mentorship Change the Outcomes of Trainees?” Her initial slide representing a 2006 review article, “Mentoring in Academic Medicine: A Systemic Review,” published in JAMA, provided an overall pessimistic view; mentorship in academic medicine has no significant effect on trainee outcomes. The article, however, presented a way forward, suggesting investigation to better support trainees to reach their desired outcomes. What followed was slightly more positive. Looking at multiple studies, it was shown that participation in a program to develop mentorship skills led to improved mentorship in the form of better effective communication, better fostering of independence in trainees, and other key variables. These studies recognized and suggested that trainees performed better with an array of mentors with different techniques and approaches as well as varied racial and gender backgrounds.  More recent research suggests that effective mentorship can lead to increased academic rank, increased academic productivity, better job satisfaction, and even higher salary. She then showed data that examined what the barriers are to effective mentorship, and what might be done to remove those barriers. Generally, most studies pointed only to relationship dynamics, which are generally nonmodifiable, and organizational factors, such as whether mentorship is promoted or what venues mentors/mentees are available to gather and work together. Overall, there is still some work to be done to examine these relationships and optimize them, but the outlook is optimistic that mentorship helps craft trainees into productive academicians.

Next, Dr. Berend Mets, Chair of Anesthesiology and Perioperative Medicine at Pennsylvania State University, delved deeper into developing leadership. Using William Morton and Virginia Apgar, two quite famous anesthesiologists, as his models, he asked the question “Can leadership be learnt?” Starting in 1970, “Parkinson’s Law or the Pursuit of Progress,” a book by C. Northcote Parkinson, suggested that leadership cannot only be learned, but improved. Parkinson suggested that leadership had six key elements that could be improved with study and practice: imagination, ability, personal magnetism, knowledge, determination, and ruthlessness. Breaking these down one-by-one, Dr. Mets provided anecdotes of situations showing whether each of these characteristics could be learned or improved. He then referred back to William Morton and Virginia Apgar and demonstrated how they satisfied or did not satisfy each of these criteria, making the point that, although they were ultimately successful leaders, they were able to lead through different approaches.

Rounding out the session was Dr. Alex Macario, Professor of Anesthesiology, Perioperative and Pain Medicine from Stanford University, who focused on how leaders can reduce burnout, a significant concern given the ongoing global pandemic of SARS-CoV-2. He began the talk by defining exactly what burnout is, requiring emotional exhaustion, detachment, and feeling ineffective. He quickly pointed out that distinction needs to be made between depression and burnout as the treatment is quite different for these two conditions. He showed that frontline care delivery, the healthcare organization, and the external environment have significant impact on burnout, suggesting that this is a systems issue, not necessarily an individual issue. The cure for burnout is organizational change. He described well over 100 scales to measure burnout with varied efficacy, making the task of identifying those who are burned out, and why, a complex and difficult task. Studies looking at burnout, however, have shown that physician-directed efforts to reduce burnout were ineffective, while those changes coming from the organization were more likely to improve burnout rates. Summarizing the steps that can be taken to reduce burnout, Dr. Macario ended with a call to action. As leaders in the field of anesthesiology, it is our responsibility to reduce burnout and promote healthy professional lifestyles for our trainees.