Anesthesia Guidebook

This podcast is for leaders, clinicians, residents & students who need to get wildly important things done. It’s about how to prioritize when so much of your work seems important. How to find balance when so much seems to be coming at you. How to get started at achieving your biggest goals. This episode will walk you through the 4 Disciplines of Execution by Chris McChesney, Sean Covey & Jim Huling.  I have no financial relationship with these folks, the book or their publishers. It’s just a great concept that will help you get organized, identify your wildly important goal and figure out the work you actually need to do and CAN do to accomplish your goals. The 4 Disciplines of Execution (4DX) model will ask you to identify your wildly important goal. You’ll then create several lag measures (subgoals) and several lead measures (objectives) for each lag measure. These lead and lag measures are where the real work is. The wildly important goal may seem out of reach. Even the lag measures (which lag behind the work you’ll do in the lead measures) may seem a bit ambitious. That’s ok. The lead measures should be the specific actions you will take on a daily or weekly basis that will chip away at the lag measures. As you put the work in on the lead measures, your lag measures will come into sight and slowly be realized. As you stack up achieving the lag measures, your wildly important goal will become within reach. The next components of the 4DX model is the scoreboard where you track your progress on each lead & lag measure. This can be any relevant metric on any kind of progress tracker: a list on a whiteboard, a data point in an Excel file, the pounds on the scale, dollars in the investment account or left on the loan. Whatever. Lastly, is the cadence of accountability. You need to either personally set up a check in on your progress with yourself or you need to set this up with your team, mentor or coach. The authors of the 4DX model recommend this be a short weekly meeting where you review progress from the last week and plan actions for the coming week. Accountability is about follow through, taking steps (as small as they might be) and slowly, setting up the cadence of consistency. I was on the Peloton last night and heard Matt Wilpers say that the order of priorities in exercise is developing consistency, then duration, then load. You can’t go out hard all of a sudden and expect big results. Develop consistency. Show up a little bit each day or each week. Then put the time in. Build the duration of your investment towards your goals. Then you’ll know when to put the extra effort in. Check out the show and if you want to dig deeper, definitely check out the 4 Disciplines of Execution. McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution: Achieving your wildly important goals. Simon and Schuster. What’s your Wildly Important Goal?

What’s up y’all! This is Jon Lowrance and this is episode 112 – How to Transition from Clinician to Chief CRNA. Y’all are going to love this conversation. So… I almost don’t know where to begin cause there’s so much to talk about… This is an episode about chief CRNAs but so much more. It’s like when you watch one of those food documentaries about the best pizza kitchens in the world and you’re like: oh, a documentary about pizza, but then it’s really about the experience of chefs, small business owners, friendship and passion. This episode is like that. It’s about chief CRNAs. And we have a couple of guests that are going to talk with us about an article they published on the research they did into the professional experience of chief CRNAs. But this story is really about the transition that most healthcare providers take when they take the step from expert provider to clinician-leader, practice manager or owner. You’re going to see this through the lens of what these 2 researchers saw when they did a qualitative analysis of chief CRNAs across the state of North Carolina. But you might take something away from this about the physician who leads your team or the CMO or health system president that runs the show where you’re at. If you work in healthcare, cause you probably do – again, unless you’re my mom, who listens to all these podcasts – hey Gail! But for the rest of you, if you’re in healthcare, this episode will likely help you understand your clinical leaders better. I never set out to be a chief CRNA or practice manager. I wanted to be the best clinician I could. I wanted to stand in the gap between the chaos and the outcome. I wanted to master my craft as an anesthesia provider and take the best care of patients possible. Literally, like 6 months before our chief CRNA announced that he was going to step down after 8 years in his role, I had the opportunity to become a daily shift supervisor – like a board runner in the OR. I was like: I’m never going to do that. It seems way too hard. Then our chief stepped down and his role opened up and I was like… wellllllllll… This episode hopefully will be relevant to any clinician who, like me, has stepped into a role or is thinking about taking on a clinical practice leadership role that maybe they’re not totally ready for. You’re not alone. So we’re going to talk with Austin Cole and Robert Whitehurst, co-authors of an article about the competencies & professional development needs of chief CRNAs that was published in April 2024 in the AANA Journal. Austin framed his doctoral project at Duke University around this study. Austin Cole, DNP, CRNA began his career after graduating from the school of nursing at UNC-Chapel Hill. Following graduation, he spent two years as a Registered Nurse in a cardiothoracic critical care unit. He received his DNP and nurse anesthesiology training at Duke University and currently practices as a CRNA at Duke Regional Hospital in Durham, NC. Robert Whitehurst is the President of Advanced Anesthesia Solutions, a CRNA practice providing anesthesia services to a variety of outpatient practices. He graduated in 1997 from East Carolina University School of Nursing with his Bachelor of Science in Nursing and in 2004 from Duke University School of Nursing with his Master of Science in Nursing. Bob Whitehurst is also the Chairperson for the North Carolina Association of Nurse Anesthetist’s Political Action Committee and he’s passionate about patient access to high quality anesthesia care. He’s happily married to Amy Whitehurst; they have 4 children and in his spare time he enjoys hanging out with his family and playing tennis with friends. Austin & Bob’s paper is titled “A mixed-methods exploration of competencies and professional development needs among chief Certified Registered Nurse Anesthetists.” For the study, the authors contacted 85 chief CRNAs across North Carolina and conducted structured interviews and qualitative analysis with 10 of them. They set out to understand the competencies and professional development needs of chief CRNAs. I gotta say, when I read their article, so much of it resonated with me as a chief CRNA. The path for so many practice managers – including physician anesthesiologists and other Advanced Practice Providers, like PAs & NPs, is that a senior clinician with several years of clinical experience often steps into a practice management & leadership role that’s been vacated and their learning curve in leadership happens through on the job training. That’s kinda suboptimal. Yet it’s pretty rare for groups or hospitals to have dedicated mentorship and professional development programs established and to encourage clinicians to develop as practice leaders. It’s even more rare for clinicians to have formal leadership & management training prior to stepping into leadership roles. In the show, we hit on 2 important concepts – the double loss phenomenon and the halo effect. The double loss phenomenon is where the group looses a senior clinician when they step into a leadership role since they’re not doing clinical work as much and they gain an inexperienced leader & manager… someone with little to no experience in that kind of role. No bueno. The halo effect is the cognitive bias where people believe that because they’re really good at doing one thing – like being an expert anesthesia provider – they’ll automatically be really good at another – like being a practice leader. Competency in your clinical practice does NOT translate to competency in leadership & management. They’re two wildly different skill sets and you need to train, study and work hard at leadership & management just like you trained, studied and worked hard to become an expert clinician. So I think you’re going to enjoy this show. Regardless of your clinical background – whether you’re a CRNA, a med student or resident, physician anesthesiologist or some other Advanced Practice Provider. Even though we’re talking about chief CRNAs here, we’re really talking about the phenomenon of clinicians transitioning into leadership & practice management roles. I’m a big believer that if healthcare is going to change for the better… become more effective, efficient, safer and just better for both patients and the people providing the care, we will need expert clinician-leaders. We need these clinician-leaders to learn the art & science of practice management. We need clinicians to develop the key competencies to become expert leaders. That transition and development is not a given. It doesn’t just happen with on the job experience. You can be a very experienced practice leader and be terrible at your job. This episode is a great place to start for new and future clinician-leaders. I hope you enjoy it as much as I did! I’ve got links in the show notes to the article that Austin & Bob published. And with that, let’s get to the show! Cole, A. L., Simmons, V. C., Turner, B. S., Whitehurst, R., & Tola, D. H. (2024). A Mixed-Methods Exploration of Competencies and Professional Development Needs Among Chief Certified Registered Nurse Anesthetists. AANA journal, 92(2), 105–113.

What up yall. This is Jon Lowrance with Anesthesia Guidebook. This is episode #110 – How we do interviews with Alison Kent, MSN, CRNA & April Bourgoin, DNAP, CRNA. In this episode, April, Alison & I talk about how we conduct CRNA interviews as a leadership team with our Department of Anesthesiology at MaineHealth – Maine Medical Center. Maine Med is the only level 1 trauma center in the state of Maine with 700-licensed beds. We run around 60 anesthesia sites of service a day with a staff of just over 130 CRNAs, 50 physician anesthesiologists, a physician residency & fellowship program and have clinical affiliations with 4 different nurse anesthesiology training programs. Alison Kent is the Manager of CRNA Services at Maine Medical Center and completed her Master of Nursing in anesthesia at the University of New England in 2006. She’s been at Maine Medical Center as a CRNA for nearly 20 years and has served in the Manager role since 2017. April Bourgoin is one of two Supervisors of CRNA Services at Maine Medical Center and completed her Master of Science and Doctor of Nurse Anesthesia Practice degrees at Virginia Commonwealth University in 2017. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army as flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major. April joined me on episode 93 of Anesthesia Guidebook where we talked about OR fires and this is Alison’s first, but certainly not last, appearance on the show! These 2 folks are part of the core CRNA leadership team at Maine Medical Center. Together, they truly make the world go round for our team and are like the glue that holds everything together. It’s an absolute privilege to get to work closely with these folks on a daily basis and I couldn’t be more thrilled to have pulled them in on this podcast about how we do interviews. So, let’s tee this up a bit. In today’s anesthesia market, you can go anywhere and make a great money and do interesting cases but the thing that will differentiate your experience with a group is the culture of the team. And your experience of that culture begins with your interview. It actually begins a little earlier than that, even, with how the reputation of the team reaches you – maybe through things like this podcast, or when you reach out to inquire about a group or talk with friends & colleagues who may work or have worked with a particular group. But a really important deep dive into the culture of the team will come on interview day. You should meet some core folks on the team – CRNAs, physicians, trainees, administrative specialists. You should get in the operating rooms and actually see the staff do the work that you’re looking to join them in. You should leave the interview with a very clear idea of what you’re potentially getting yourself into, both in terms of culture and with a thorough run down of the benefits and compensation package. If you’re listening to this and you’re a practice manager or thinking about getting into a role in which you support your team as a leader, hopefully you find this podcast super helpful. Alison, April & I talk through our process & structure for interviews, what kinds of questions we ask, what we look for in candidates and how we work to both recruit folks and protect our culture by making sure we’re bringing in people who are a good fit for the team. A few years ago another chief CRNA asked me if I had any tips on how to conduct interviews. When we talked then, I of course knew that I wanted to get around to doing a podcast on the topic to share the same advice with you. And here it is! Oh, by the way, what we describe is our process as a leadership team. Our opinions expressed here are our views and do not necessarily represent the views or opinions of our employer. Seth Godin has this great definition of culture where he says, “people like us do things like this.” This is how we do interviews as a leadership team. We hope you enjoy our story. If you’d like to apply to work with our team as a CRNA, please reach out to chat or drop your application here: https://www.careersatmainehealth.org/jobs/search Search for the CRNA roles at Maine Medical Center in Portland, Maine. And with that, let’s get to the show.

What up yall! This is a quick shout out to those of you headed to the AANA conference this weekend, August 2nd, 2024 in San Diego. I hope that yall have an incredible time and meet tons of new colleagues, see old friends and have fun gettin’ your learn on. I was talking to one of the SRNAs from the University of New England this morning in clinical and she’s was getting psyched for the conference this weekend. AANA Annual Congress is one of those times where you can kind of lift your head up from the daily grind and look around & see thousands of other CRNAs & SRNAs or RRNAs from around the nation who are all out there doing their thing in anesthesia. It’s such an inspiring time! While I will NOT be there reppin’ Anesthesia Guidebook, my clinical team from Maine Medical Center and MaineHealth will be.   So first, why am I not putting up a booth and talking about Anesthesia Guidebook… first & foremost, I’m not trying to sell you something. Anesthesia Guidebook is still anchored in the concept of free open access medical education. There’s no subscription fee and I’m not trying to make money off of CE credits. There’s a hundred other ways out there for you to make Class A credit and that just hasn’t become a professional focus on mine. Which brings up the reminder that any anesthesia related podcast you listen to will qualify for free Class B credit in the CPC program. If you’re a CRNA and you routinely listen to anesthesia podcasts, all you have to do is self-report your credits to the AANA and you’ll rack up those Class B credits super fast. I actually did a brief podcast on this topic way back in Episode #9 of the podcast if you want to hear more about how to do that. So while there’s no Anesthesia Guidebook table at AANA Annual Congress, you CAN go meet my good friends and colleagues from Maine Medical Center in the exhibition hall. April Bourgoin, Jill Guzzardo and Danielle Beaumont will be there staffing the MaineHealth booth to tell yall about the amazing career opportunities within MaineHealth. We have everything from level 1 trauma center work with my team at Maine Medical Center where I serve as chief CRNA to a full independent practice location in Conway, NH to several other smaller town medical centers throughout Maine, including Pen Bay Medical Center in Rockland, where Jill is the chief CRNA. So April Bourgoin will be out there this weekend. Dr April Bourgoin one of our CRNA Supervisors at MMC, and she’s been on the show before talking about OR fires back in episode 93. I actually just recorded an episode that I’m editing now with April and our CRNA Manager, Alison Kent, on how we do interviews as a leadership team at MMC. That show is targeted towards other practice managers out there but is obviously also probably valuable for SRNAs as it gives you a behinds the scenes look at how we plan team interviews for people applying to be on our team. So April’s out there… you can also meet Danielle Beaumont, our SRNA Clinical Coordinator at Maine Medical Center. Danielle is amazing in that role as she supports SRN As from the University of New England and Middle Tennessee School of Anesthesia. Danielle also just helped us establish clinical affiliations with Boston College and Northeastern University. We’re pumped to start welcoming primary anesthesia trainees from BC and NU in 2025. And then last but not least is Jillian Guzzardo. Jill is one of our per diem CRNAs at MMC but she also serves as the Chief CRNA at one of our MaineHealth sister hospitals, Pen Bay Medical Center in Rockland, Maine. If you’re looking for a small town, coastal Maine community hospital to practice at, Jill is your girl! Pen Bay is literally on a bluff overlooking the Atlantic Ocean. You have close up water views from work. It’s amazing…. I mean, you can also see the ocean from the top floors of Maine Medical Center, but at Pen Bay, you can probably see what the lobstermen are having for breakfast as they motor by in the morning… it’s right there. Jill is one of my favorite CRNAs… after a few years of holding down the fort at Pen Bay as the chief CRNA, she reached out to me and asked if she could come work off shifts and weekends at Maine Medical Center to keep her high acuity patient care skills up. She literally asked if I would give her the shifts that my core team doesn’t want to work… nights, evenings and weekends. I was blown away. All three of this CRNAs – April, Danielle and Jill – are baller clinicians.  I would let any of them take care of me or my family and just love working alongside them in the OR.  They’re also incredible CRNA leaders with a deep passion for helping SRNAs & CRNAs thrive in their practices. And they’re generally just inspiring, friendly humans…  Kind, generous, optimistic people… who are wicked smahat as we say here in New England. So if you’re headed to AANA Annual Congress, even if you’re not looking to move your practice to Maine, do yourself a favor and go meet these incredible people.  April, Danielle and Jill will be pumped to meet you. So that’s it… just wanted to drop a quick shoutout to those of you headed to AANA Annual Congress this weekend and say I hope it’s an amazing conference. Go get your learn on, meet some new friends and stop by the MaineHealth booth and tell my friends I said hello. And with that… I’ll see ya next time!

What’s up yall! I am back after a few months off from the podcast. This is episode 106 – following up: what we know about anesthesia school formatting with Cassie Capps. This is a follow up show to the episode that Cassie brought to us back in December on the effects of anesthesia school didactic formatting on resident wellbeing… whether in-person, online, synchronous or asynchronous styles have any effect on your wellbeing as a trainee. Before we get to this show, I’ve got a couple updates for you… our crew at Maine Medical Center has been on a bit of tour this spring attending conferences, job fairs and universities telling the story about our team and why we may be where you want to invest your career as an anesthesia provider. Cat Godfrey & April Bourgoin were just down at AANA’s Mid Year Assembly in Washington D.C. and then Cat made her way on to University of North Carolina at Greensboro to chat with the residents at Terry Wick’s program. She followed up dropping in on UNC-G with a virtual lunch & learn session with Mary Baldwin University’s anesthesia program over in Virginia. And then, Kristin and I just returned last week from Florida International University’s job fair down in Miami. We were so happy to know that even the locals thought it was super hot cause oooooooo….eeeeeeee… it was swimmy humid and all kinda hot down in the Sunshine State. We were stoked to meet a bunch of FIU anesthesia residents and tell yall about our absolutely gorgeous summers and four season climate up in Maine and how we’re probably where you want to start your career if you’re looking for a top notch level 1 trauma center to be at where you’re treated with respect, well-supported and want to join a thriving team that has a ton of fun working together. Just saying. Part of my intention with Anesthesia Guidebook is to help CRNAs make a successful transition to practice and if you’re looking to do high acuity work in a busy tertiary medical center surrounded by an amazing team and in a phenomenal location, drop me a line and we can chat. I’d love to tell you more about our crew and see if we’re a good fit for where you’re headed. In other news, this fall I’m teaching at Encore Symposium’s Autumn in Bar Harbor and Acadia National Park conference. If you’re looking for a spot to come knock out some continuing education this year, Encore is headed back to Bar Harbor, Maine, which is just outside of Acadia National Park, from October 14-17. If you’ve never been to Acadia, or Bar Harbor or Maine… this is your chance. Come check it out. Acadia in October is simply stunning… a national park, on an island, in Maine. With your anesthesia friends! You’ll be hard pressed to find a cooler spot to come get your learn on. Hope to see you there! All right… with that, let’s get to this show. Cassie Capps is back. We first heard from Cassie in late December 2024 on episode 99 of Anesthesia Guidebook and now she’s back to walk us through the impact of anesthesia school didactic formatting on resident wellbeing. Thank to everyone who took Cassie’s survey and provided your insights… the data was actually a bit surprising so let me re-introduce Cassie to you and then she’s gonna get right to it. This podcast was part of Cassie Capps’ Doctor of Nursing Practice in anesthesiology program at the University of Arizona. Prior to anesthesia training, Cassie was a CVICU Registered Nurse for 8 years and worked in the cath lab for 5 years before that. Prior to nursing school, Cassie completed a Master’s degree in music with a focus on Piano Performance & Pedagogy. Cassie continued to teach piano on the side while completing her doctorate in anesthesiology at the University of Arizona. Her unique experience with anesthesia school included moving through her program as a single mom of an 11 year old daughter. She also continues to play a big role in the lives of her two former stepdaughters, who are now young adults.  This podcast is coming out in May of 2024 and with that, let’s get to the show! References Alajmi, B., & Alasousi, H. (2019). Understanding and motivating academic library employees: theoretical implications. Library management, 40(3/4), 203-214. https://doi.org/10.1108/LM-10-2017-0111 Baqutayan, S. M. S. (2015). Stress and Coping Mechanisms: A Historical Overview. Mediterranean Journal of Social Sciences; Vol 6, No 2 S1 (2015): March 2015. https://www.mcser.org/journal/index.php/mjss/article/view/5927/5699 Berry, G. R., & Hughes, H. (2020). Integrating Work-Life Balance with 24/7 Information and Communication Technologies: The Experience of Adult Students With Online Learning. The American journal of distance education, 34(2), 91-105. https://doi.org/10.1080/08923647.2020.1701301 Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI database of systematic reviews and implementation reports, 13(10), 21-29. https://doi.org/10.11124/jbisrir-2015-2380 Centers for Disease Control and Prevention. (2022). Poor nutrition. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm Columbia University. (2022). How sleep deprivation impacts mental health. https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health Conner, M. (2015). Self-Efficacy, Stress, and Social Support in Retention of Student Registered Nurse Anesthetists [Article]. AANA Journal, 83(2), 133-138. http://ezproxy.library.arizona.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=102321364&site=ehost-live Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2020, 3/22/21). FAQ’s and statement regarding meeting clinical requirements. https://www.coacrna.org/coa-statement-regarding-coronavirus-disease-2019-covid-19/ Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2022). List of accredited educational programs. https://www.coacrna.org/wp-content/uploads/2022/07/List-of-Accredited-Educational-Programs-July-18-2022-1.pdf Day, C. M. F., Lakatos, K. M., Dalley, C. B., Eshkevari, L., & O’Guin, C. (2022). The Experience of Burnout in the SRNA Population and Association With Situational and Demographic Factors. AANA Journal, 90(6), 447-453.  Desmet, P., & Fokkinga, S. (2020). Beyond maslow’s pyramid: Introducing a typology of thirteen fundamental needs for human-centered design. Multimodal technologies and interaction, 4(3), 1-22. https://doi.org/10.3390/mti4030038 Freitas, F. A., & Leonard, L. J. (2011). Maslow’s hierarchy of needs and student academic success. Teaching and learning in nursing, 6(1), 9-13. https://doi.org/10.1016/j.teln.2010.07.004 Griffin, A., Yancey, V., & Dudley, M. (2017). Wellness and thriving in a student registered nurse anesthetist population. AANA Journal, 85(5), 325-330.  Hale, A. J., Ricotta, D. N., Freed, J., Smith, C. C., & Huang, G. C. (2019). Adapting Maslow’s Hierarchy of Needs as a Framework for Resident Wellness. Teaching and Learning in Medicine, 31(1), 109-118. https://doi.org/10.1080/10401334.2018.1456928 Harwood, K. J., McDonald, P. L., Butler, J. T., Drago, D., & Schlumpf, K. S. (2018). Comparing student outcomes in traditional vs intensive, online graduate programs in health professional education. BMC medical education, 18(1), 240-240. https://doi.org/10.1186/s12909-018-1343-7 Hoffman, H. J., & Elmi, A. F. (2020). Comparing Student Performance in a Graduate-Level Introductory Biostatistics Course Using an Online versus a Traditional in-Person Learning Environment. Journal of statistics and data science education, ahead-of-print(ahead-of-print), 1-10. https://doi.org/10.1080/10691898.2020.1841592 Imus, F. S., & Burns, S. (2015). What to Consider Before Beginning Graduate Education: A Pilot Study. AANA J, 83(5), 345-350. https://www.ncbi.nlm.nih.gov/pubmed/26638456 Imus, F. S., Burns, S., & Weglarz, D. M. (2017). Self-efficacy and graduate education in a nurse Anesthesia program: A pilot study. AANA Journal, 85(3), 205-216.  Institute for Healthcare Improvement. (2023). How to improve. https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx Kondo, M. C., Jacoby, S. F., & South, E. C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & place, 51, 136-150. https://doi.org/10.1016/j.healthplace.2018.03.001 Lowrance, J. (2023). Anesthesia Guidebook. https://anesthesiaguidebook.com Malek-Ismail, J. (2021). Thriving in the First Semester of Graduate School: A Process of Rebalancing and Self-Determination. The American journal of occupational therapy, 75(S2), 7512520410-7512520410p7512520411. https://doi.org/10.5014/ajot.2021.75S2-RP410 Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396.  Mesisca, J., & Mainwaring, J. (2021). Stress, Anxiety, and Well-being in Nurse Anesthesia Doctoral Students. AANA J,89(5), 396-402. https://www.ncbi.nlm.nih.gov/pubmed/34586993 Montag, C., Sindermann, C., Lester, D., & Davis, K. L. (2020). Linking individual differences in satisfaction with each of Maslow’s needs to the Big Five personality traits and Panksepp’s primary emotional systems. Heliyon, 6(7), e04325-e04325. https://doi.org/10.1016/j.heliyon.2020.e04325 National Center for Education Statistics. (2021). Table 9. Unduplicated headcount enrollment at Title IV institutions, by control of institution, student level, level of institution, and distance education status of student: United States, 2020–21. In: U.S. Department of Education. Osaili, T. M., Ismail, L. C., ElMehdi, H. M., Al-Nabulsi, A. A., Taybeh, A. O., Saleh, S. T., Kassem, H., Alkhalidy, H., Ali, H. I., Al Dhaheri, A. S., & Stojanovska, L. (2023). Comparison of students’ perceptions of online and hybrid learning modalities during the covid-19 pandemic: The case of the University of Sharjah. PLoS One, 18(3), e0283513. https://doi.org/10.1371/journal.pone.0283513 Palmer, L., amp, J. M., Ren, D., & Henker, R. (2014). Comparison of Nurse Anesthesia Student 12 Lead EKG Knowledge, Interpretation Skill, Satisfaction and Attitude: Traditional Instruction vs. Asynchronous Online Video Lecture. Journal of Online Learning and Teaching, 10(3), 420-n/a. https://ezproxy.library.arizona.edu/login?url=https://www.proquest.com/scholarly-journals/comparison-nurse-anesthesia-student-12-lead-ekg/docview/1650489030/se-2?accountid=8360 Papaleontiou–Louca, E., Esmailnia, S., & Thoma, N. (2022). A Critical Review of Maslow’s Theory of Spirituality. Journal of Spirituality in Mental Health, 24(4), 327-343. https://doi.org/10.1080/19349637.2021.1932694 Pecka, S. L., Kotcherlakota, S., & Berger, A. M. (2014). Community of inquiry model: Advancing distance learning in nurse anesthesia education. AANA Journal, 82(3), 212-218.  Polit, D., & Beck, C. (2020). Nursing Research. Philadelphia, UNITED STATES Wolters Kluwer Health.  Pressman, S. D., Gallagher, M. W., & Lopez, S. J. (2013). Is the Emotion-Health Connection a “First-World Problem”? Psychological science, 24(4), 544-549. https://doi.org/10.1177/0956797612457382 Wilson, J. T., Gibbons, S. W., & Wofford, K. (2015). Process Improvement: Addressing Attrition from the Uniformed Services University of the Health Sciences Nurse Anesthesia Program. AANA J, 83(5), 351-356. https://www.ncbi.nlm.nih.gov/pubmed/26638457 Worthen, M., & Cash, E. (2022). Stress Management. StatPearls [Internet], Jan. 2022. https://www.ncbi.nlm.nih.gov/books/NBK513300/ Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. Excli j, 16, 1057-1072. https://doi.org/10.17179/excli2017-480

Chuck Biddle PhD, CRNA is a Professor Emeritus of anesthesiology at Virginia Commonwealth University and served as the editor in chief of the AANA Journal for 35 years.  His anesthesia education & master’s degree are from Old Dominion University and he completed his PhD in Epidemiology at the University of Missouri.   Chuck is one of my favorite people in the world of anesthesiology.  He’s one of those folks who have put the time in over decades to develop a true, deep mastery of their profession while at the same time bringing with them a level of authenticity, integrity and humility that garners true respect.  He’s a guide.  He’s helped countless physician & nurse anesthesiology trainees develop and gain a love of the work we do.  And one of the central focuses of his career has been fervently working to understand the things that put our patients at risk and develop research and insights for practice to advance patient safety. Which brings us to this show.   In this episode, Dr Biddle turns our attention to what happens to patients after they go home from day surgery. We talk about a study his team did at VCU where they sent patients home with pulse oximeter monitors and tracked their course for 48 hours following day surgery. We talk how novel this idea is in that very few studies have actually looked at what happens to patients following ambulatory surgery and that a certain segment of these patients – those who have obstructive sleep apnea are at particular risk for devastating postoperative complications. Chuck points to Jonathan Benumof’s, MD 2016 article in the Canadian Journal of Anesthesia titled Mismanagement of patients with obstructive sleep apnea may result in finding these patients dead in bed (full article below). Dr Benumof is a world-renowned physician anesthesiology and expert in airway management and pulmonary physiology. He is a professor of anesthesiology at the University of California – San Diego’s School of Medicine. Over the 15 years prior to the publication of Dr Benumof’s article in which he served as an expert witness in litigation cases, he testified on 12 cases where OSA patients died within 48 hours of surgery. In the article, he unpacks each of those cases and provides the following prototypical dead in bed OSA patient: “A 58-yr-old continuous positive airway pressure (CPAP)-compliant male (170 cm, 120 kg, body mass index 40 kgm-2) with polysomnography (PSG)-proven severe OSA undergoes orthopedic, upper airway, or abdominal surgery under general anesthesia. The patient has an uncomplicated stay in the postanesthesia care unit until discharged to an unmonitored bed without CPAP or oxygen. After receiving small (and within standard of care) doses of narcotics for pain for 11 hr, the patient is found DIB [dead in bed]. Advanced cardiac life support is either not attempted or fails to return the patient to their baseline state of life (Benumof, 2016).” This episode is one of those discussions that makes you see the work you do in a whole new light and gives you a renewed sense of ownership over making sure you and your colleagues are doing the right thing for your patients.  This show is coming out on 28 January 2024 and was originally recorded at VCU’s studio with a table top microphone back in the summer of 2017.  I apologize that the audio is a little hazy but the power of Dr Biddle’s research and passion for this topic are still very much relevant to providers today.  So with that, let’s get to the show! Benumof, J. L. (2016). Mismanagement of obstructive sleep apnea may result in finding these patients dead in bed. Canadian Journal of Anesthesia, 63(1), 3.Download Benumof, J. L. (2015). The elephant in the room is bigger than you think: finding obstructive sleep apnea patients dead in bed postoperatively. Anesthesia & Analgesia, 120(2), 491. Hill, M. V., Stucke, R. S., McMahon, M. L., Beeman, J. L., & Barth Jr, R. J. (2018). An educational intervention decreases opioid prescribing after general surgical operations. Annals of surgery, 267(3), 468-472. Biddle, C., Elam, C., Lahaye, L., Kerr, G., Chubb, L., & Verhulst, B. (2021). Predictors of at-home arterial oxygen desaturation events in ambulatory surgical patients. Journal of Patient Safety, 17(3), e186-e191.

Brad & Madisson Marcum join me to talk about the dynamics of being married and going to anesthesia school together. They met in nursing school, had divergent paths professionally for a bit, with Brad starting nurse practitioner school and Madisson considering anesthesia school. They ended up sharing the same goal of becoming CRNAs and we talk through their approach to applying together, getting into the University of Evansville together and working through the program alongside one another. In episode 15, I talked with Jenny & Robert Montague about what it’s like for the significant others of anesthesia residents. Jenny has her Master of Science in Nutrition and works as a Registered Dietitian and supported Robert and their 2 kids while he attended the University of New England’s anesthesia program. In epsisode 50, I caught up with Lein & Nate Woodin to talk specifically on parenting in anesthesia school. Nate is a family therapist and supported Lein and their 2 kids while she went through the University of New England’s anesthesia program. In this episode, Brad & Madisson Marcum talk about what it’s like to both get into and work through anesthesia school together. We’re planning for this to be the first in a series of conversations with them as they progress through their program. They’re just finishing their first year of training and have yet to start clinicals. I plan to touch base with them down to the road to see how that phase of the program goes. Folks are often making difficult decisions around when to do anesthesia school. For a couple in my program, the husband went through school 2 years ahead of his wife, who was in my class, and they overlapped for just one semester. A local couple here in Portland stacked their programs end to end with one of them fully completing the program and a semester after that, the other starting anesthesia school. That stretched their anesthesia training experience to a full six years as a couple. My hope is that this conversation with Brad & Madisson helps you and your partner think through the considerations around what you want to do or how it’s going for you if you’re currently in a program. Brad hails from Salem, Illinois and spent 5 years as a critical care Registered Nurse in the cardio thoracic & transplant ICUs at Mayo Clinic prior to starting anesthesia school in the University of Evansville’s DNAP program. His clinical interests are regional anesthesia and opioid sparring anesthetic techniques with an emphasis on pharmacology and pharmacogenetics. Madisson is from Effingham, Illinois and also spent 5 years as a critical care Registered Nurse in the trauma surgical ICU at Mayo Clinic in Rochester prior to anesthesia training. Her clinical interests are regional anesthesia and difficult airway management. They are focusing their doctoral project on the functionality and effectiveness of virtual reality training in anesthesia programs and plan to utilize Peter Stallo’s SIMVANA VR platform for research. You may remember my conversation with Peter in episode 96 on SIMVANA and virtual reality in anesthesia education. It’s a fascinating discussion on what will likely become a central element to anesthesia education in years to come. Long term, Brad & Madisson intend to become involved in medial mission trips and create a pediatric charity foundation to provide basic necessities to children in need in their local area following anesthesia school. Brad and Madisson Marcum