Academic and Professional Challenges in Cardiac Anaesthesia

It is through understanding, mitigating, or, in fact, embracing the prevailing challenges as viable opportunities for growth that real progress occurs in the right direction… As the leading national journal in the field, alongside its unwavering commitment to research, The Annals of Cardiac Anaesthesia acknowledges the peculiarities of this dynamic specialty. These challenges, in turn, may give rise to a unique set of academic and professional obstacles [Figure 1].[1-3] That being said, a nuanced discussion on these challenges is essential, especially considering the thought-provoking findings revealed by recent literature on the subject.[2,3]Figure 1: Academic and professional word cloud of cardiac anaesthesiaA recently published web survey by Borde, et al.,[2] involving members of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA), highlights significant concerns. The survey was conducted in two distinct sections. The first part focused on demographics, working patterns, and burnout perception, while the second part assessed aspects of emotional exhaustion, depersonalization, and low personal accomplishment, using the Maslach Burnout Inventory Human Services Survey tool. Although responses were received from 325 out of the 2,262 IACTA members surveyed, it was remarkable to discover that one in every other cardiac anesthesiologists was at high risk of burnout, with one in every four respondents meeting the criteria for burnout syndrome. The authors ascribed their findings to a wide range of stressors working in tandem: a demanding specialty with a considerable workload, a high-pressure surgical environment, inadequate workplace support, professional dissatisfaction, and the administrative burden. They simultaneously highlighted that respondents with less than 5 years of experience exhibited an accentuated risk of burnout compared to those with more than 20 years of experience. Attributing the same to a “survival effect,” however, might not provide the most holistic explanation, especially when the survey linked thoughts of quitting the specialty to a heightened risk of burnout. This points the need for mentorship and the requisite support for academic advancement in the field.[2] Ahead of a popular systematic review by West, et al., published in The Lancet, which discusses the general impact of individualized and organizational strategies in ameliorating physician burnout, the early initiation of interventions during residency warrants specific attention.[4-6] This becomes even more relevant when considering the potential implications of burnout among physician faculty on medical education, as exemplified by the 2017–2018 Accreditation Council for Graduate Medical Education (ACGME) “well-being” survey, which included eight Pennsylvania anesthesiology residency programs.[5,6] Meanwhile, the little control anesthesiologists have over operating room (OR) schedules is often cited as a key factor in burnout. Addressing the concept of “trainee well-being” could, therefore, yield significant long-term benefits.[5] Strengthening the teacher-trainee alliance hinges on understanding the values that both learners and educators associate with their learning experiences. Acknowledging the significance of transformative learning experiences in cardiothoracic ORs, Bose, et al. contemplated two parallel surveys for learners and teachers in cardiothoracic anesthesia.[3,7] Adapted from the Pratt and Collins Teaching Perspectives Inventory (TPI), the surveys enrolled trainees (residents and cardiothoracic anesthesiology fellows) and educators (board-certified cardiothoracic anesthesiologists) across 165 ACGME-accredited anesthesiology residency programs in the United States. By charting the average responses to each of the 22 questions for both groups across four domains—learning environment, learner engagement, session management, and teaching methods—the complete set of surveys from 57 learners and 19 educators revealed no statistically significant differences, except for the question concerning “Let trainee perform critical technical steps” (P = 0.02).[3] While the surveying group proposed that the discordance arose from the learners’ interest in attaining proficiency in skills such as transesophageal echocardiography (TEE), the integral role of performance in time-sensitive critical scenarios cannot be undermined in cardiac anaesthesia.[3] This, when viewed through the five teaching perspectives of the abovementioned Pratt and Collins TPI—transmission, apprenticeship, developmental, nurturing, and social reform—further supports the learners’ perspective on self-determined learning, or heutagogy.[3,7] Heutagogy is indeed at the heart of transformative educational epistemologies, where novel teaching strategies are employed to better align with the aims and objectives of competency-based medical education.[7] The 2023 SIMULATOR randomized clinical trial on the effectiveness of simulation-based training for TEE serves as a good example here. The trial demonstrated higher theoretical and practical test scores among the fellows in the simulation group, with a reduced time frame for performing a complete TEE exam. This group also showed improved self-assessment of proficiency compared to the traditional group, 3 months post-training.[8] Even the National Medical Commission (NMC) guidelines emphasize the use of simulators in high-risk clinical scenarios, encouraging their use for assessments as well.[9] In addition to high-fidelity simulators, the prospects are promising with the inclusion of teaching innovations such as virtual reality, serious gaming, and hybrid-, and on-site simulations.[10,11] Fostering well-directed faculty development programs also plays a crucial role in this regard.[12] While staying abreast of research developments in our specialty is undeniably essential, we must not “miss the forest for the trees.” The perspectives of practitioners, educators, and learners in this field are all equally important. It is time for us, both individually and collectively as a fraternity, to embrace these evolving academic and professional challenges. By addressing them head-on, we have the opportunity to grow and emerge stronger than ever before.