The Daily Dose • Friday, May 24, 2024

Triumph in the Tripartite

Connor Brenna, MD

Academic centers are engaged in a tripartite mission to deliver education, research, and clinical care. Against this backdrop, clinician investigators are expected to perform all three. An expert panel of early-career investigators shared their wisdom on these pillars in the Early-Stage Anesthesiology Scholars (eSAS) panel, “Succeeding Across the Tripartite Mission,” moderated by Bradley Fritz, MD, MSCI, assistant professor of anesthesiology of Washington University School of Medicine in St. Louis, during the Scholars’ Program on Saturday, May 18 at the 2024 Annual Meeting, presented by IARS and SOCCA.

The first mission, education, is familiar to many early-career scholars as current or former trainees. However, although entrants to the medical profession typically share an interest in lifelong learning, not all interactions during clinical training are educational. In “Becoming an Effective Educator,” Seyed A. Safavynia, MD, PhD, an assistant professor of anesthesiology in the division of neuroanesthesiology and assistant program director of the anesthesiology residency program of Weill Cornell Medical College, shared insights into anesthesiologists’ role as teachers. Most academic physicians will deliver only a handful of lectures per year — instead, teaching often occurs at the bedside. Dr. Safavynia highlighted the traditional focus on “micro-moments:” the lessons we teach or are taught sporadically and reactively, for example, when we make a mistake and are quickly corrected. However, these micro-moments are short-lived, immemorable, and dependent on making mistakes to reflect on. Instead, one way that educators can become more effective is by embracing a broader view of education. Dr. Safavynia advises that we must get to know our audience, and their individual learning goals, and to provide tailored lessons that they are motivated to receive.

Secondly, by extrapolating these goals into longitudinal learning opportunities beyond a single bedside moment, we can help learners to reflect on their actions (rather than ephemerally reflecting in action). Thirdly, effective educators give meaningful feedback. As Weller and Gotian write, in “Evolution of the feedback conversation in anaesthesia education: a narrative review,” experiential learning hinges on receiving external feedback and reflecting upon it, and they present many models to support educators in intertwining constructive criticism and discussion. Finally, educating is a practiced skill. As teachers, we can lead by example by seeking out feedback for ourselves, reflecting on it, and coming to know our own strengths and areas for improvement.

In “Partnering with Clinical Focused Faculty on Scholarship”, Douglas Colquhoun, MB ChB, MPH, MSC, assistant professor of anesthesiology at the University of Michigan, presented on how academically focused department members can effectively partner with their clinically-focused colleagues. Both work together in a virtuous circle, in which clinical experience informs research questions and research findings inform clinical practice. Furthermore, many of their professional goals are aligned: academically focused faculty may seek out promotion through the development of collaborations and trusted clinical partners, the expansion of their research programs, and growth towards senior authorship and international reputation. Clinically oriented faculty may seek out evidence of scholarship through collaborative involvement in research, and authorship among teams.

Dr. Colquhoun reminded the academic clinician that they have a lot to offer in these partnerships — a superpower, as he called it — including expertise in question development, acquisition of funding, navigating regulatory bodies like REBs, analyzing and interpreting data, and developing manuscripts. While often spontaneous, these partnerships can also be formalized. Dr. Colquhoun detailed his own experience at the University of Michigan, as director of the Anesthesia Clinical Research Committee (ACRC). The ACRC has embraced this vision of partnership by reorienting itself from a process sometimes seen as adversarial to one of mentorship, connecting research teams with research-oriented faculty to facilitate the maturation of academic projects in the department. The model reflects the value proposition of working together: when academically and clinically focused faculty partner up, they are greater than the sum of their parts.

Finally, Kimberly Rengel, MD, MSCI, an assistant professor of anesthesiology in the department of anesthesiology, division of anesthesia clinical care medicine at the Vanderbilt University Medical Center, detailed the role of clinical care, and how it can inform the questions that academic clinicians spend their careers asking and answering. In “Clinical Practice to Inform Latest Research,” she described recognizing early on in training that surgical patients are an aging population, and wondering how their lives continued after leaving the hospital — especially after very invasive procedures. Previous work by Lawrence and colleagues (“Functional independence after major abdominal surgery in the elderly” and Stabenau and colleagues (“Functional Trajectories Before and After Major Surgery in Older Adults”) has shown that it takes many patients weeks to return to baseline activities like bathing and feeding themselves after a major surgery, and months to return to instrumental activities of daily living. Consequently, many patients must seek out higher levels of care after hospital discharge.

Dr. Rengel’s clinical experiences inspired an interest in perioperative medicine beyond the operating room, particularly in the concept of prehabilitation to safeguard patients against postoperative loss of function. She joined the BH Robbins Scholar Program to study this, and with mentorship from Christopher Hughes, MD, professor, anesthesiology critical care medicine, multispecialty anesthesiology, chief, anesthesiology critical care medicine, and medical director, neuro ICU at Vanderbilt University Medical Center, led the completion of a pilot trial combining physical and cognitive training before surgery. This unfolded into the COgnitive and Physical Exercise to Improve Outcomes After Surgery (COPE-iOS) trial, which is currently recruiting and expected to complete in 2026. Dr. Rengel described how her interactions with preoperative patients led her to the High-Risk Surgical Encounter (Hi-RiSE) Optimization Clinic at Vanderbilt, which utilizes an innovative hub-and-spoke model to address potentially modifiable risk factors for poor postoperative recovery before an operation even takes place. She has recently assumed the role of director in the Hi-RiSE Clinic, and continues to explore questions of how to best prehabilitate patients through the interlocking clinical and academic aspects of her work.

Each pillar of academic medicine’s tripartite mission — education, research, and patient care —demands a specialized set of skills. However, while the demand for proficiency across all three domains can be daunting, these skill sets are interconnected. The session’s three speakers demonstrate that education can make us better learners, scholarship can help us to partner with clinically oriented colleagues, and clinical care can inform our research questions, so that we too can succeed across the tripartite mission.