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Dr. Erik Hofmeister: Building Skills and Confidence Through Anesthesia Education
486 Plays1 year ago
Are you someone who doesn’t feel confident in your anesthesia skills or knowledge?
Are you seeking resources beyond this podcast to improve your anesthesia expertise?
Veterinary professionals often find themselves crunched for time, so finding resources that will guarantee rapid results in training is crucial to advancing anesthesia knowledge. How can we integrate effective training modalities into veterinary practice that will provide meaningful educational opportunities, improve skill levels, and heighten overall job satisfaction?
With so many options out there for continuing education, how can you effectively evaluate training programs to know what educational resources to use that will produce the most meaningful results for you?
In this episode, we talk with Dr. Erik Hofmeister, a professor of veterinary anesthesia at Auburn School of Veterinary Medicine with over 20 years of experience teaching veterinary students. With his guidance, we will discuss what causes individuals to lack confidence in their anesthesia skills, evidence-based recommendations for effectively learning skill sets related to anesthesia, and how to appraise existing anesthesia training programs to ensure that you get a fulfilling education experience.
Resources mentioned in today’s episode:
Read 2023 AAHA Technician Utilization Guidelines or watch a quick summary of these guidelines.
Understanding How We Learn: A Visual Guide
If you are creating an anesthesia training program, consider reviewing the book Understanding by Design recommended by Dr. Hofmeister
Not mentioned in today’s episode, but we encourage listeners to review Dr. Hofmeister’s and Dr. Love’s JAVMA article on patient safety culture in veterinary medicine (Open Access).
If you are looking for more information on veterinary education, please check out Dr. Hofmeister’s podcast, Reflections in Veterinary Education (RIVE), and his blog The Vetducator - Help for every stage of your veterinary career.
As a reminder, the NAVAS Virtual Spring Symposium is taking place next month on April 27th and 28th. Registration is free!
If you like what you hear, we have a couple of favors to ask of you:
Become a member of NAVAS for access to more anesthesia and analgesia educational and RACE-approved CE content.
Spread the word. Share our podcast on your socials or a discussion forum. That would really help us achieve our mission: Reduce mortality and morbidity in veterinary patients undergoing sedation, anesthesia, and analgesia through high-quality, peer-reviewed education.
Thank you to our sponsor, Dechra - learn more about the pharmaceutical products Dechra has to offer veterinary professionals, such as Zenalpha.
If you have questions about this episode or want to suggest topics for future episodes, reach out to the producers at education@mynavas.org.
All opinions stated by the host and their guests are theirs alone and do not represent the thoughts or opinions of any corporation, university, or other business or governmental entity.
The NAVAS Podcast is published monthly on or near the 15th of the month.
Special thanks to Chris Webster for editing, producer Maria Bridges, and Saul Jimenez for IT support in making this podcast a reality.
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Transcript
Introduction and Purpose of Podcast
00:00:06
Speaker
Hello, gas pastors, and welcome back to another episode of the North American Veterinary Anesthesia Society podcast, sponsored by DECRA. I am your host and self-declared proud gas passer, Dr. Bonnie Gatson. Our mission with this podcast is to explore the latest advancements and hot topics in veterinary anesthesia to help anesthesia professionals
00:00:29
Speaker
and caregivers advance and improve the safe administration of anesthesia and analgesia to all animals. And because the mission of NAVAS is focused on continuing education, we decided to bring you an entire episode just about that, education and training.
00:00:47
Speaker
But first, I want to thank our sponsor, Decra, who makes this podcast possible. The folks at Decra allow us here on the NavVis podcast to bring you anesthesia-related content that we feel benefits the veterinary community and they fully support us in that educational mission.
00:01:05
Speaker
We encourage you to please check out their line of veterinary anesthesia related products at www.decra-us.com.
Mastering Anesthesia Skills: Challenges and Insights
00:01:15
Speaker
So a few years back, even before I did my anesthesia residency training, there was a wonderful book I read by Malcolm Gladwell called Outliers. If you've not read it or really read any of Mr. Gladwell's books, I strongly encourage you to do so.
00:01:33
Speaker
All of his books are excellent. But in this book, Outliers, he argues that in order to obtain mastery in any skill, you would need to practice, albeit correctly, for 10,000 hours. As far as anesthesia is concerned, that would mean that even if you did nothing in your 40-hour work week but anesthetize animals, it would take you almost five years to completely master the subject.
00:02:01
Speaker
And albeit I have an anesthesia consulting business. So generally people are seeking me out when they want anesthesia help. But one of the most frequent questions I get asked is,
00:02:14
Speaker
What can I do to learn anesthesia so we can help our patients better, even when you're not here? We get some anesthesia training in veterinary school or in technician training programs, but anesthesia is a skill that requires a mastery in a very specific set of technical skills, as well as critical thinking skills that need to be accessed swiftly so that anesthetists can effectively troubleshoot problems as they arise before resulting in significant patient harm.
00:02:44
Speaker
Now, on top of possibly feeling somewhat insecure about your own personal anesthesia skills, last year the American Animal Hospital Association released their recommendations for utilizing veterinary technicians.
00:03:00
Speaker
These recommendations include many skills with a range of difficulties related to anesthesia from low-level skills like endotracheal intubation and anesthetic monitoring of healthy patients to more advanced skills like direct blood pressure monitoring. These recommendations now have set up an expectation for veterinary technicians to competently perform a wide range of anesthesia related skills. So
00:03:30
Speaker
Whether you are feeling not so confident about your level of anesthesia knowledge, or if you are looking to achieve those 10,000 hours needed for skill mastery, this episode is for you.
Dr. Hofmeister's Journey and Passion for Anesthesia
00:03:43
Speaker
How do we set up ourselves for success to learn the skills and knowledge necessary to become capable and competent in anesthesia?
00:03:53
Speaker
And what are the most effective training modalities to achieve this goal? To help us navigate these questions is a guest that I'm very excited to have on the podcast, Dr. Eric Hofmeister. Dr. Hofmeister is a veterinary anesthesiologist that has trained arguably thousands of veterinary students in academia.
00:04:15
Speaker
He has published a countless number of journal articles and contributed to many book chapters where his research focus has been on patient safety and veterinary anesthesia, which I'm sure all of my listeners are now very well aware of that. I love this topic, but he also has a research focus in the scholarship of teaching and learning and in evidence-based decision-making.
00:04:39
Speaker
He is currently a professor of anesthesiology at Auburn School of Veterinary Medicine. So he is a fantastic guest to help answer some of these questions about anesthesia education and training. So please sit back and enjoy this episode of the NavVis podcast all about anesthesia education and training. Do you mind introducing yourself and briefly describe your past training and your current role?
00:05:09
Speaker
Hello, welcome everyone. I'm Eric Hofmeister. I'm an anesthesiologist at Auburn University in Auburn, Alabama. I grew up in Los Angeles, California and went to school undergrad and vet school at Washington State University up in Pullman. And then after graduation, I did an internship in private practice back in Southern California.
00:05:28
Speaker
And then I actually wanted to be an orthopedic surgeon, but did not match for a residency. And there were some unmatched anesthesia residencies. And I thought, oh, I'll do that for a couple of years and then go to surgery. One of them was at Georgia. So I went to the University of Georgia for my residency and I stayed on there as an anesthesia faculty and decided anesthesia is pretty cool. And then I've also been a department chair at Midwestern University in Phoenix. And I've been here at Auburn for about five years.
00:05:58
Speaker
So I ask all my guests this question. I mean, you said you kind of fell into it, but then you stayed. So what drew you to staying in anesthesia?
00:06:09
Speaker
I think similar to surgery, you can solve things relatively rapidly. You know, you don't have any asthmatic cats that you're just managing for five years of their life, like internal medicine. So yeah, things happen relatively quickly. You either fix it or you don't. And it's a lot more satisfying in that regard. So I think on a fundamental level, that's really the thing that I like about anesthesia.
00:06:34
Speaker
Yeah, I can totally relate to that. I think when I was early in my career, I thought I wanted to specialize in something like oncology or internal medicine, but for the exact same reasons you just pointed out, I like having like rapid feedback and fixing problems quickly. It seems to be less of something you can do in those other specialties. Yeah, for sure. So what drew you to veterinary academia? Because it seems like you started your career there and you're still there. So why do you like it there?
00:07:03
Speaker
So back in the day,
Skills and Competency in Veterinary Anesthesia
00:07:05
Speaker
so I'm a 2000 graduate from vet school. And in the 90s, early 2000s, there were very few private practice anesthesiologists. I can count on one hand the number that were in practice when I was finishing my residency. So it was pretty much assumed that if you do anesthesia, you go into academia. And now obviously that's totally flipped. There's ton of people in private practice. It's a great way to get into a private practice career.
00:07:32
Speaker
But yeah, back in the day, it was pretty much you're going to be an academic. So that was one thing. And then the other thing is I really like teaching. I've been teaching, you know, pretty much my whole life. Like I think I was 12 years old and helping one of my karate instructors, you know, at one of his branch schools. So I've always enjoyed teaching and it's a great opportunity to do that. And I also really enjoy research and I've actually gotten to enjoy research more and more over a year. So teaching, clinics, research, that's kind of your classic academic role.
00:07:59
Speaker
So the reason I have you on the podcast today is really because of your interests in education. And I really wanted to speak with you today specifically about anesthesia training. So you have a long history of teaching students, residents, technicians, and I feel like you at this point have a hunch as far as what works and what doesn't work when it comes to educating people in anesthesia.
00:08:26
Speaker
And as I'm sure you know, in most veterinary practices, sedating and anesthetizing animals is most often performed by veterinary technicians under the supervision of a veterinarian, of course. And last year, the American Animal Hospital Association released their recommendations for skills
00:08:45
Speaker
that can be performed by veterinary technicians, which included many skills with a range of difficulties relating to anesthesia. We're talking low-level skills like tracheal intubation, monitoring healthy patients under anesthesia,
00:09:00
Speaker
more advanced skills like placing our geo catheters or even performing ultrasound guided nerve blocks. So with these technician utilization guidelines, there's an expectation for veterinary technicians to possess really a wide range of anesthesia related skills.
00:09:18
Speaker
So with that, our goal really today is to talk about how veterinary technicians can get these skills and how they can improve themselves related to feeling more confident in performing anesthesia.
00:09:33
Speaker
And so I kind of want to start first with veterinarians. And as my listeners know by now, I have an anesthesia consulting business. So I very regularly speak with veterinarians who feel really insecure about their anesthesia knowledge. And mind you, you know, I'm probably only speaking to vets who don't feel comfortable with anesthesia. So I probably have like a biased view on this topic.
00:09:56
Speaker
But you've touched hundreds, if not thousands of veterinary students in anesthesia. And yet when I speak to many young graduates in my business, there are many veterinary professionals that express concerns about their gaps in their skill level or their knowledge base. And this, of course, also applies to veterinary technicians. But really, why do you think it is
00:10:17
Speaker
that a general practitioner or a veterinary technician might feel less confidence in their anesthesia skills. Where is that knowledge gap really coming from or at least their feelings of a lack of confidence in anesthesia?
00:10:31
Speaker
My diagnosis of this problem is that we as educators are making it too complicated. And this is probably an unpopular opinion in a lot of ways. But yeah, I think that we're making it too complicated and we're expecting them to have a knowledge level and competence and expertise that you just don't need for general practice. The example that comes to mind for me is like, you know, students are always like, OK, can you talk to us about anesthetizing patients with cardiac disease?
00:11:01
Speaker
And I'm like, all right, I'm going to make this real simple. You guys got a little white fluffy dog with a heart murmur? It's fine. Carry on. Right. Do that in practice. No worries. If you've got a cat with HCM or a Doberman with really bad DCM, you might want to send that somewhere else.
00:11:17
Speaker
Because that's what they need to know. It's like, what do I need to worry about? What is normal? What's abnormal? We don't need to get into all the esoterra. I'm not going to tell you how to synthesize a DCM dog. It's not useful for you in practice, for the most part. Send that somewhere else or call up your local anesthesiologist and be like, hey, I have this case. But they're not going to retain that information over the next 10 years between when they graduate and when they're going to use it. So I think that we make it too complicated. We got to just simple it down.
00:11:46
Speaker
So based off of that philosophy whereby you feel like we're just making anesthesia way too complicated and an academic setting, what do you think would be the minimum competency level for an individual to start performing anesthesia without like direct supervision? Like maybe there's a veterinarian around or like an experienced technician nearby if there's like assistance needed.
00:12:14
Speaker
But what types of skills do you feel are essential to master for the purpose of performing anesthesia?
00:12:20
Speaker
So first of all, the question of mastery, I think, is an important one to take a moment to think about and define. So when we think about expertise, so I did a master's degree in sport pedagogy, and the lab that I worked in spent a lot of time thinking about expertise, certainly with golf instructors. But it can be applied to any discipline, especially if it's psychomotor skills like intubation or placing an IV catheter. Expertise is complicated.
00:12:47
Speaker
And so I think that rather than mastery, I would say competence is kind of my target slash goal. So in terms of competence, what I want for the vet students, and I'll modify this a little bit for the technicians, but what I want for the vet students is I want them to be able to safely anesthetize a routine case for like a spay or neuter or dental, like the things they're going to do in practice. So that includes, you know, sedation,
00:13:13
Speaker
IV catheter, induction, intubation, placing monitoring, and then monitoring the patient and recovering the patient. And I would say dealing with common, not uncommon problems. And so I think that it's pretty much a similar list for the technicians. I think that I would say instead of dealing with problems, my expectation would be able to identify when a problem is happening and let the veterinarian know.
00:13:40
Speaker
to be able to distinguish normal from abnormal and be like, okay, no, everything's fine or something's odd here. Let me let me let the vet know. So that's kind of what comes to mind for me.
00:13:51
Speaker
One thing I find that maybe this is true of specialty hospitals because I work a lot more commonly in specialty hospitals, a lot of specialists would argue with me, like I would say surgeons or other specialists who are relying on technicians to perform their anesthesia. One of the arguments that gets me a lot of times is that although you're arguing that minimum competency levels recognizing abnormalities, they would probably argue that a minimum competency might be basic troubleshooting.
00:14:21
Speaker
So, what would you say about that or is it just that technicians are performing like maybe more high level anesthesia because they're in a specialty hospital? Does the competency level have a gradient? This is essentially what I'm asking depending on kind of the situation of where you're working.
00:14:38
Speaker
Yeah, 100%. I'm thinking more about the tech in practice, in general practice, that's doing a bunch of things. They're not just doing anesthesia Monday through Friday. They're also doing room appointments, and maybe they're setting up a surgery. Maybe they're cleaning instruments. This person has so many things that they need to do that they're not going to have the opportunity to have that specialized knowledge to handle common anesthetic problems.
00:15:06
Speaker
unless that's their interest. If they're members of NavAss, maybe they are interested in it, or focusing on that skill set. Certainly for the technicians at the university that I work with, I encourage them to handle what I call first-order problems. It's like, okay, you've encountered a problem, do your best to solve that.
00:15:25
Speaker
And if your first step is not sufficient, then let me know. So I do want to empower them to do that. You're facing a patient who's tachycardic and there's depth seems a little light. Try giving a dose of hydro and see what it does. Or give a little fluid bolus if they're hypotensive. All these things I empower our technicians to do. And in practice, you might get your technicians up to being comfortable with that point. But I would say step number one is recognizing it.
00:15:53
Speaker
Then the other consideration that I would have, I have a friend who's a small animal surgeon in private practice in the Northeast. She has her surgery team. There are technicians that do surgery and anesthesia and support her and everything. She was having a semi-complicated case. I don't know, it was diaphragmatic hernia or something.
00:16:13
Speaker
You know, the technicians were like, oh, we're not quite sure what to do. And she's like, yeah, that's fine. We haven't done one of these before. Like, I don't expect you to know this stuff if you haven't been exposed to it. So that's kind of what comes to mind for me is in practice, you're doing space, you're doing neuters, you're doing mastermables, you're doing biopsies, whatever, dentals. And then like a hind limb amputation comes in and you as the vet, like it was three years since you did your last hind limb amputation, you know?
00:16:43
Speaker
Yeah, I expect that this is going to be more challenging for you. So it's the same thing with anesthetists. Like you get in your routine, you know how to handle the things that you know how to handle. And then when something weird comes along, you're going to need help. And that's normal.
00:16:56
Speaker
Yeah, I think that you make a really good point maybe indirectly in that there needs to be like a general understanding amongst the team about what we're comfortable, what we're not comfortable in it and being okay with situations where we're not comfortable. Recognizing that I think is
00:17:14
Speaker
huge and then providing some time for your staff or yourself to get a little bit of a better understanding. Of course,
Learning Approaches and Teaching Methods
00:17:21
Speaker
sometimes it doesn't always happen, but allowing that space for people to say, I don't know this is huge, in my opinion.
00:17:30
Speaker
Yeah, absolutely. 100%. And across the board, you know, like sometimes students will ask me something I'm like, I don't know, you know, and I've been doing this 20 plus years. So I think that that having that humility is really important. And especially, you know, as I think about technician anesthetists,
00:17:48
Speaker
When I talk to them doing CE and whatnot, one of my goals is for them to feel empowered to say to the veterinarian, like, hey, so I haven't run one of these before. Can we talk about it? You know, can we have that conversation? And hopefully you're in a practice that has a positive culture towards that, because when people make assumptions is when medical errors start happening.
00:18:10
Speaker
Right. So what do you think is more dangerous as far as a person's ability to perform anesthesia safely? Being overly competent in one's skills and being unwilling to change? Or being extremely timid and not being confident enough in one's skill?
00:18:28
Speaker
I think this is probably going to depend on your personal perception, so I don't think this is across the board. For me, I would rather have the extremely timid person than the overconfident person, even though they're both problematic. The overconfident person
00:18:44
Speaker
is going to make errors and they're not going to learn from them is my main concern. Like medical errors happen, medicine is complicated, there's a lot of moving parts, you know, this is how it is. But the overcomitant person is not going to learn from them and they're not going to get better.
00:19:00
Speaker
the excessively timid, anxious person is going to like have an outsized emotional reaction if something goes wrong and that may impede their learning. But on a certain level, I think that it will also help motivate them to get better and hopefully over time they will. So the timid person has an opportunity for growth whereas the overconfident person doesn't. Yeah, I kind of agree with your assessment on that.
00:19:25
Speaker
So let's jump into how people learn. So there's a ton of theories out there that have been floated around that describe how people learn new information. I know that you've done, you know, your master's degree in some of these types of theories. So this is like a huge question, but can you condense down like what we know about theories about how people best retain information and learn new skills?
00:19:54
Speaker
Yeah, absolutely. So it's not an opinion-based thing anymore. We have pretty compelling evidence from neuropsychological studies about how people learn. What I suggest people do is go to learningscientists.com and they have the evidence-based ways that humans learn.
00:20:20
Speaker
And they also have a visual guide. This is understanding how we learn a visual guide that basically details the ways that humans learn effectively. And it's pretty much known we know how to do this effectively. And so that's that's my go to nowadays is we got the evidence. If we're evidence based clinicians, we should be evidence based educators as well. And so going with these approaches is the best way to do it.
00:20:50
Speaker
We can put a link in the show notes to that website. And also, I know for our listeners, they can't see this, I can. I guess I can see Dr. Hofmeister, but he's holding up a manual that is called understanding how we learn, visual guide, essentially. So if you're interested in that, please be on the lookout for that manual.
00:21:12
Speaker
So the ones that they talk about are spaced practice, which is basically you don't cram all the information, you space it out, and that requires your brain to get the information back. Interleaving, which is interacting with different topics. Elaboration, which is explaining the topic.
00:21:30
Speaker
concrete examples, which is coming up with specific things that represent that dual coding. So looking at information both with words and visuals and retrieval practice, practice thinking about the thing to recollect it. So that's how basically I go about teaching these days is just using those evidence-based strategies
00:21:50
Speaker
And when you learn about it, you'll realize that our education system does not do a good job of teaching people these strategies, especially the vet students. I find it's often a little bit like, OK, so you've learned how to do well in the system so far. But unfortunately, this is not a great way to actually lead to long term learning.
00:22:12
Speaker
So do you find you need to use a combination of all of these things or do you find there are students that lean more heavily into one of these modalities versus another? What do you do? What's your style of teaching?
00:22:22
Speaker
Yeah, that's a really good question. So you can use all of these and ultimately you're right that some of them may work better for some students than others. Like some students really like the visual things where they get to interact with visual material as well as the text. So ideally you want to try to have all of these involved so the students can pick and choose.
00:22:46
Speaker
I personally tend to focus a lot on retrieval practice, where they'll have lots of opportunities to think of the information and retrieve it and practice it, because that makes the most sense for me. And it's also relatively easy to do. But of course, this means that you can't just have two exams.
00:23:06
Speaker
You know, like you've got to have quizzes throughout and you've got to have other like small, small opportunities for the students to retrieve that information and use it. So there's like the classic saying, see one, do one, teach one. Do you think that repetition like that is helpful or really works?
00:23:27
Speaker
Yeah, I mean, to be honest, I will do that as well. You know, I'll do that with our residents, especially like, OK, I'm going to show you how to do it and then I want you to do it and then I want you to teach someone else how to do it. So there is a role for that in terms of we have to balance out the amount of time that we have and the amount of resources that we have and the number of cases that we have with what we need to do for learning.
00:23:52
Speaker
So I'll use that as a shorthand, realizing that this person is not going to get competent with that process, right? That they're just not going to reach the point of competency with one visual and two iterations. They've done
00:24:07
Speaker
A few studies now with skill acquisition and like with surgery time, for example, I know that they've done with hemulaminectomies. I think they've done with spays. How many you have to do before you reach asymptote where basically more cases doesn't give you any faster surgery time. And for hemulaminectomies, I think it's something like 40 or 50. You know, if we're asking someone to do a skill once and they were like, okay, now teach it and now you're good, you need to realize that that's not happening.
00:24:36
Speaker
Do we have any evidence in anesthesia? How many cases, healthy or otherwise, that we need to anesthetize before there becomes that delta where doing more cases doesn't mean you're gaining any more practical skills?
00:24:54
Speaker
No, that's a fascinating question, though. That would be an absolutely really interesting study. I will say that I think that you do reach an asymptote, right, where it's not totally flat. There's always room to learn. Like, I saw a case last year that I'd never seen before. I'm like, I don't know what the heck is going on here. You know, called it a couple of the other anesthesiologists. We all stood around looking at this coach. We were like, yeah, that's weird.
00:25:19
Speaker
So, you're always going to be learning stuff and encountering weird things. But no, I don't think we know that for even simple things like catheter placement or tracheal intubation, no idea what the learning curve is on those things. Interesting. So, again, a call for people who are interested in research. Come find Dr. Hofmeister. Yeah, I love doing those kinds of things.
00:25:39
Speaker
How effective do you find self-study is? I'm only asking because sometimes I find technicians just feel like their practice that they're working in doesn't give space to learning anesthesia skills. So they've just decided they're going to go ahead and just take it upon themselves, power themselves to like self-study, which I think is fantastic.
00:25:58
Speaker
But do you think that just learning things by yourself is helpful or do you think it's better to kind of curate specific learning objectives to guide students through? Which one do you think, I mean, do you think you need a combination of both approaches? You know, what kind of works there?
00:26:14
Speaker
So when I think about how to get someone to be incompetent at a thing, my favorite resource is this textbook called Understanding by Design, where you start with the end in mind. So what do you want to be able to do? What do you want the student to be able to do? And then you need to design the learning objectives to meet those goals. And then you need to design the instructional activity to meet those learning objectives.
00:26:44
Speaker
which is the exact opposite of how most people go about teaching, right? Most people are like, I'm going to write a lecture and this is what I'm going to tell them. And it's like, well, okay, well, why are you going to tell them that? Like, what's the goal that you're aiming for? So we got to start with the end in mind.
00:26:59
Speaker
So if your goal as a technician, you're in a practice, you're interested in anesthesia, do you want to get better? I would say, you know, find a program that starts with the goal in mind.
Support in Clinical Learning Environments
00:27:12
Speaker
And maybe this is an in-house program. So my friend who's a surgeon, she put together a program for her technicians to get them more comfortable with anesthesia and, you know, did rounds and whatnot to help them reach that point.
00:27:24
Speaker
If it's an external source, does the goal that that program have, does that align with your goal? And if so, then hopefully they have the learning activities that lead to the learning objectives that lead to that ultimate goal. In answer to your question about the self-study, yeah, I think self-study can absolutely be done well, assuming the curriculum and the program is designed well. You know, if it's kind of haphazard, or there's no accountability, or you don't get feedback, or you don't get opportunities for practice,
00:27:53
Speaker
these are all failure points in self-study. But if you have a program and you have an opportunity to practice it, you have the opportunity to get feedback, maybe talk to the other people in your practice, like, hey, this is what I learned. I think there's a lot of potential there. One of our techs is going through a advanced pain course. And so she'll sometimes bring questions. She's like, hey, I didn't quite understand this concept. Can we talk about it? And it's like, yeah, let's do that.
00:28:17
Speaker
Yeah, I'm thinking more of veterinary technicians that are in, you know, general practice that want to get better at anesthesia. And they ask me like, what book is it that you always read? And I go, Oh, you mean like Lomond Jones? And they're like, yeah, I want that one. And sometimes I have to be like, I don't know if that's going to be really helpful for you. You know, so I think that it's amazing that technicians want to get better.
00:28:42
Speaker
Just sometimes I find there's a combination of you need to guide them a little bit about what you're talking about, like feedback, like providing feedback. I've seen you do anesthesia. I see you're weak in these areas. Here's a resource that you can use to help you with that particular area.
00:28:58
Speaker
Yeah, for sure. I think just picking up a textbook and reading it, one, it's not fun, right? You know, do you think about like what's sustainable? So like reading Lemon Jones cover to cover is not, it's not a joyful activity. And so if it's not fun, it's going to have a hard time.
00:29:14
Speaker
maintaining that motivation. And then also saying, again, matching the learning activities with the learning objectives, is your objective to be a board certified anesthesiologist? Then you need to read Lemon Jones' cover to cover. If your objective is to feel more comfortable managing the cases that are in your practice day to day, that's not going to align well. So finding other resources would be essential. So I want to ask another kind of situational question about learning anesthesia.
00:29:41
Speaker
Anesthesia can be very stressful in general and it can be a stressful event for many learners. So for clinical anesthesia, do you think that educators should remove the learners from this environment initially when they're starting to learn new skills?
00:29:57
Speaker
kind of to improve cognitive ability and take out like stress from impairing the ability to learn? Or do you think we should kind of be encouraging the opposite, like putting these learners in these stressful clinical situations and then with the thought of like, well, you have to think clearly under duress, so you might as well like be in this environment so that you can start learning that kind of skill. So what do you think is a better approach or is it more nuanced than that?
00:30:27
Speaker
Yeah. So I'll say, first of all, that there is evidence that simulation training helps with skill acquisition. So you're practicing on a mannequin or in a simulated setting. Doing that does improve your skills.
00:30:43
Speaker
There's that evidence. I will say anecdotally, I was at Midwestern University, where we had a pretty substantial simulation effort. As part of the surgery lab, the students would do a spay approach on a low-fidelity simulation. It didn't look like an animal, but it had layers, tissue layers, they had to use a scalpel, they had to suture, and yada, yada, yada.
00:31:06
Speaker
Did it help their skills? Possibly. But until they have an animal on the table, I find the students just don't take it very seriously and that that impedes their motivation for engaging a lot with simulation. So I recognize that there is evidence for simulations. I am personally not a huge fan of simulation-based learning.
00:31:30
Speaker
What I would rather do would put students in a situation where they are really strongly supported so they can have these feelings of stress or anxiety, but that they don't impede learning and that we're supporting them, that, you know, maybe small group settings. We're having a positive approach to their learning.
00:31:54
Speaker
We're holding them to high expectations without being excessively critical. So I find that that works pretty well. In clinics, our rotations are three weeks, and I meet with the students at the end of each week. And at the end of the first week, they're always like, yeah, the first couple of days are really stressful, but the technicians were really great, felt really supportive. I started to figure things out, and I'm really learning a lot. So when I'm faced with that evidence, I'm like, ugh.
00:32:22
Speaker
Yeah, I think it was working pretty well. Hard to argue against it.
00:32:26
Speaker
Okay. I'm asking because I think a lot of veterinary technicians probably feel like they're learning as in like a trial by fire. So they're right away just doing a seizure on this case and you know, maybe they're not feeling super confident or they're very nervous. But what you're saying is that's okay as long as there is somebody supporting that person in some capacity and providing positive feedback as opposed to being critical in that situation.
00:32:55
Speaker
Yeah, exactly. And I would say not anesthesia, but anytime you just take someone and toss them in, that's not going to be a great situation for them. You know, so if I was onboarding a new technician, you know, let's say I was a more experienced technician in the practice, I'd see about talking to the doctor and be like, Hey, I want to get this new tech comfortable and trained with how we do anesthesia here. So could we have a day where, you know, maybe we have a couple fewer
00:33:21
Speaker
to do so that we can really take the time and make sure that they're comfortable and that we don't have time pressure on top of everything else. And that gives them the space to ask questions and also acknowledge like, oh yeah, this is different than how I've done before, how I learned in school, how do you do it? I think that the culture is probably the most important piece of that and allowing people the space to say, I don't know.
00:33:47
Speaker
Yeah, that's probably a huge part of what we're talking about today. You know, you've taught anesthesia both clinically and like didactically in a classroom, you know, for a while now. So could you summarize in your opinion, kind of what steps you think are best when it comes to kind of how you approach teaching anesthesia, which I know is like a huge question, but like, what's your general approach to that? So my approach with
00:34:13
Speaker
didactic teaching as much as possible is use active learning. So I want the students to be talking about situations. I want them to be engaging with practical problems. So I don't do very much lecturing in my lecture classes. I'll give them enough background material so they know the assignment they know we're talking about. And then I'll give them like, hey, OK, so here's a case. This is what's going on with this case.
00:34:40
Speaker
turn and talk to your neighbors, chat about it for a few minutes. I'll wander around the room. If you have any questions, please ask. And then I'm going to draw you all back together and I'm going to ask you to share what your thoughts are. And then I take the information that they give me. I provide context and feedback for like, okay, I hear what you're saying. That's not exactly what I would be thinking.
00:35:00
Speaker
but I understand your rationale or if they get really close, I'm like, yeah, that's what I would be thinking for this case. Here's another possibility. So I am providing my expertise in that way. That's my preferred way to run lectures.
00:35:16
Speaker
It's interesting. So do you give students like rating assignments ahead of time or, you know, cause students still have to know basic things like a full new agonist versus a partial agonist, you know, to answer those types of questions. So how are you providing that type of information to students?
00:35:32
Speaker
Yeah, that's a good question. So I try to offload as much of that out of class time as possible. So I have reading assignments with just like simple, short, multiple choice questions that really are just testing like, do you have this basic information?
00:35:50
Speaker
because class time is valuable. You know, I don't have a lot of class time, so I don't want to use that class time looking at the lowest levels of Bloom's Taxonomy, like the understanding knowledge stuff. They can read a book for that. The university is paying me a tremendous amount of money. I'm not here to teach you what a full mu agonist is, right? You can go read that. Go hit up Wikipedia. I'm here to teach you how to use that information and make clinical decisions with it.
00:36:19
Speaker
So let's jump into training programs then because there's like a lot of training programs out there in the zeitgeist that technicians, they can either like purchase on their own, or maybe there's like a training program established through their workplace.
00:36:34
Speaker
that claim to enhance their anesthesia knowledge and their skill sets. It's possible maybe they'll even, a technician could earn an anesthesia certificate. There's a lot of those programs that exist. So if you're a technician and you're trying to find a training program, that would be the highest efficacy. In your opinion, what does one of those training programs really need to have to work effectively?
00:36:58
Speaker
First of all, I would say I applaud you for your ingenuity and curiosity and enthusiasm. Second of all, I would say do not pay for this out of your own pocket. This should be a practice expense because it is going to make you a better employee. I just need to open with that. Don't pay for these things yourself. In terms of what to look for, I would say,
00:37:20
Speaker
I'm not very familiar with those programs, so I would probably get one of the other more experienced technicians
Mentorship and Training Program Assessment
00:37:27
Speaker
to look at it with me. Obviously, the veterinarian or the practice manager look at it as well and say, does this seem like something that is doable? Does it seem like this would help the practice and help with the cases that we're seeing?
00:37:43
Speaker
I think I would just evaluate it on a case-by-case basis. In terms of the learning activities, obviously, the more engaged the student is with the content, the better. So, good learning activities have, again, all the things that we talked about with evidence-based learning. So, the repetition, the interleaving, space practice, etc.
00:38:07
Speaker
you know, something that had those sorts of strategies built into it, I think would be better than here's a stack of notes. We're going to give you a quiz at the end of the week. But that also might have a role depending on, you know, what kind of time you have.
00:38:19
Speaker
Yeah, I also think like working off of what you mentioned earlier, talking about kind of getting together and deciding, you know, either as a practice manager, a technician and the veterinarian kind of coming together and deciding, you know, what do you want for your practice as far as a competent veterinary technician performing anesthesia? Like what does that look like? And then deciding what objective outcomes you would
00:38:46
Speaker
require from a trading program? Is this like a catch-all trading program? You might as well just buy an anesthesia textbook at that point and have them read it because it's just sprouting information. In this lecture, we're going to talk about managing hypotension. You're like, oh, that's exactly what I feel like our technicians really struggle with. We like this program. Do you think that is a good approach or is there something like
00:39:16
Speaker
I don't know. Is there a different approach that you would kind of take when you were assessing a training program? Something that comes to mind for me is going back to, I think we make anesthesia too complicated. So, you know, if I'm looking at that, like, hypotension talk aimed at technicians, you know, you probably need a little bit of basic physiology and what's going on. But at the end of the day, the vast majority of what we do in medicine is a bunch of if-then statements.
00:39:43
Speaker
So you really just need a flowchart, you know, like, okay, you're faced with hypotension and follow this flowchart and understanding why to follow that flowchart. That's something that I've been doing with the students for the past few years and they love it. They're like, Oh my God, this is so simple. Why didn't we learn it this way? I'm like, I don't know. Because all medicine is just a bunch of if then statements and we could just have a computer do it all and be a lot better than us.
00:40:05
Speaker
Yeah, it's funny that you say that. I feel like when I teach technicians how to manage hypotension, I usually tell them there's only a few levers. There's like four or three levers you can pull. And there are some clinical scenarios you're going to pull different levels in different ways. But I'm not going to treat hypotension in a dog with a heart murmur, maybe the same way I'm going to treat it in a healthy dog. But there's like three things you can do. That's it.
00:40:34
Speaker
Yeah, exactly, exactly. Keep it simple. Yeah. Yeah. Okay, that's fair. So what about mentorship programs? I used to work at the University of Florida and we developed, I was not necessarily a part of this, but when we were onboarding new technicians onto the service, we created, I say we, but again, it was not me necessarily, but the zeitgeist basically created an anesthesia training program that really heavily focused on mentorship.
00:41:02
Speaker
And every week that technician was rotating with different experienced technicians on the service with the goal of, you know, there'd be like a list of goals, like of skills that they would learn that week with a mentor. So do you think mentorship programs are effective for anesthesia training?
00:41:19
Speaker
I would say that any education that is individualized is going to be better than education that is not individualized. So again, my friend who's a surgeon in practice, she's like, yeah, they don't really know how to use the ventilator. And so let's spend time on that.
00:41:37
Speaker
You know, they're fine with like, intubation and catheter placement. So we don't need to spend much time on that. So I would say, yeah, any program that's, that's more individualized is generally going to be better. So mentoring programs where you have a one-on-one or even one-on-three sort of setting, I would expect to, to be a good way to do that because then you're focusing on what the learner needs. What do you think makes a good mentor?
00:42:03
Speaker
I think that someone who's patient is really important. That's one of the things that I'm really impressed with our technicians here is that they're just so patient with the students. They're like, it's okay. And then they'll just explain things to them to help them feel better. Obviously, interest and enthusiasm, drafting someone to be a mentor who doesn't want to do it is not a good approach. So interest, patience.
00:42:28
Speaker
a certain level of competency, but I would push back a little bit on saying that that person necessarily needs to be an expert. I also teach martial arts, and when I had my own school, I would routinely have my middle-ranked students who have been practicing for a year or so, taking some of the new students, and it's like, okay,
00:42:47
Speaker
go teach them how to do a front kick, go teach them how to do a center punch. And it's like you do not need, I've been doing martial arts for 25 years, you do not need a four-three black belt to show you how to do a fist, you know? In the same way with our vet students, like you do not need a board certified surgeon to teach you how to do a single throw on suture.
00:43:09
Speaker
you know, a senior student could probably teach you that junior student. So I think that a mentor needs to be more competent, but does not necessarily need to be expert level. Do you think then that mentor needs to have some humility as far as what they can and cannot teach if we're not relying on competency?
00:43:27
Speaker
Oh yeah, yeah, yeah, 100%. I guess that's a, that's a default assumption for me is that like, we've all got to have like a basal level of humility, interested working and emotional intelligence. That's just like you walk in the door. I assume that's what we're doing.
00:43:41
Speaker
So if you're like going into a mentorship program, like I'm a technician and I want to get better at my skills and this particular practice I work at has like a mentorship program, what kind of questions do you think that technician can ask to decide if a mentor is going to be like a good fit or not a good fit?
00:44:01
Speaker
Wow. Gosh, that's, that's so complicated for me because it really plugs into like what the culture is like in that practice and what the individual personalities are like. Honestly, I, and this is probably just because the lens that I view the world through is like medical error and safety culture and that sort of thing. I would probably like be like, okay, so
00:44:27
Speaker
Let's say, tell me the last time a technician made an error and what the response was.
00:44:33
Speaker
And that'll actually pretty much tell me everything I need to know about that practice, right? Because if their practice is like, oh yeah, like the vet yelled at them and there is an inquiry and, you know, is a big mess, that is a very different practice from, oh yeah, you know, like we figured out what happened and we figured out the causes of it and we figured out how to prevent it from happening again, or at least minimize the risk of it happening again.
00:45:00
Speaker
Those are two different cultures and one of them I want to work on and one of them I don't.
Balancing Accountability and Learning from Errors
00:45:04
Speaker
That's probably like my shorthand for would this be a good place to work and would they be good at mentoring and all that other sort of stuff.
00:45:12
Speaker
Yeah, that's a great response. And the follow up question I have, which is a question I did ask Dr. Lydia Love was on podcasts a few episodes ago, and we talked about safety culture in that episode. And one of the complicated questions that I asked her, I'm just curious what your opinion is, even though it's a little bit off topic.
00:45:31
Speaker
has to do with practices where medical error occurs. The goal obviously is to try to balance between doing like a root cause analysis and deciding what the problem was and how to address it, but also holding people accountable when they make mistakes because ultimately there is a level of accountability.
00:45:52
Speaker
that does need to happen. And so how can you kind of balance the two, you know, between like making sure that you're covering your practice and you're safe from liability, but also creating like this culture where it's safe to make mistakes, at least in the sense that we try to figure out what the problem is and correct it.
00:46:14
Speaker
So I appreciate this question. I am going to push back on it and say, I don't believe that that accountability is necessary or even most of the time appropriate. Because my argument is that humans are biased. We are not rational actors. And we're in a very complex system of medicine.
00:46:38
Speaker
The reason the errors happen is because we're human and we're in a complex system. The reason is not because you, Bob, did a thing. You, Bob, did a thing as a consequence of the system.
00:46:51
Speaker
Now, the exception is, you know, the nurse in the UK who is walking around giving people KCL to kill them, right? There are bad actors and those you need to find. But the people who are at what we call a sharp end of the error, I think that the question should be raised, are they a bad actor? Especially if there's repeated problems. But more commonly, the problem is we don't have a culture where they can ask questions.
00:47:18
Speaker
where they feel like they can be heard. And so if they don't know how to do something, they're just going to try to do it. Maybe we don't have good training standards in our practice. Like we're not doing a good job of informing these people how to manage these cases. Maybe we're all rushed and stressed and tired and overworked. You know, these are the things that I think about rather than the human being who like did the thing.
00:47:42
Speaker
So if you could wave a magic wand, money and time are just like not a concern. And you're tasked with designing a training program within a veterinary hospital to enhance anesthesia knowledge and teach new skills. What would that training program look like?
00:48:00
Speaker
Well, I think that some places have done pretty well with it. Let's focus on veterinary technician, since that's kind of what the episode is primarily aimed at. I think that I would have someone who is a content expert, so like an anesthesiologist or an experienced veterinary technician,
00:48:20
Speaker
who would be able to give the information that that person needs on a one-on-one basis, like I talked about. Individualized learning is good. And then I would also have an education specialist who was along for the ride, who could contextualize the information for the learner, who could provide some tips and tricks about how to apply it and how to learn it more effectively.
00:48:47
Speaker
sometimes interpret the information that's being given by the expert in a more meaningful way. So that's what comes to mind for me. I think it's Nottingham in the UK has these clinical educator people who are veterinarians just walking around the hospital who are doing that very thing. They're not seeing cases. They are contextualizing the cases and the information for the veterinary students, which I think is a really neat idea. So yeah, pretty resource intense, pretty time intense, but that's
00:49:17
Speaker
If I could magic it away, that's how I'd go about it. And I guess because money and time are concerns, realistically, how much time do you think that a hospital can realistically spend on educating and training, either veterinarians or technicians, on a monthly, yearly, daily basis? What do you think is realistic?
00:49:45
Speaker
I think for a general practice, what I would start with is someone who's interested in teaching and getting that person some degree of education and how to do effective teaching. They don't need to get a master's degree or anything like that, but they need to know some of the basic concepts for effective teaching and then have that person basically in charge of training.
00:50:09
Speaker
and be like, okay, this is how we're going to do training. And I think just that step, honestly, just having a person who is a leader in that regard for training in the practice who knows a little bit about effective teaching could probably design a program or a plan that would be effective for that practice. And I say for that practice, because it's a little bit like with patient safety culture, like
00:50:34
Speaker
Every practice has their own problems and you can't just design a safety program for every clinic that's going to work for everyone. So having it bespoke by someone that's in the practice that knows what they're doing, I think would probably be the way to go. Yeah. I love that idea about just starting with supporting education about education. You know, this is like a personal story, but I started my career in academia.
00:51:03
Speaker
And I think very quickly realized that I was being asked to do a lot of teaching and I didn't really know how to teach. Had no idea. Yeah, we're trained as clinicians, right? Yeah. Yeah. And so, you know, I feel like, you know, looking back on my career now, like if I had a training program that was like, okay, so you're onboarding here at like this university or whatever.
00:51:28
Speaker
you're going to take these few classes. I mean, it didn't have to be like a big thing, but it could have been like, here's a few hours of basic training on education. I mean, that would have been huge. And I probably hilariously would at the time would not have understood why it was such a big deal. I probably would have rolled my eyes and been like, oh, more training. But I now recognize how valuable that would have been for me personally, anyway.
00:51:57
Speaker
I mean, for everyone that comes in academia, right? There's this persistent problem in our culture that we believe that anyone can teach and that, yeah, whatever, you just see it and you can teach it.
Improving Anesthesia Knowledge and Resources
00:52:09
Speaker
And anybody who's been in academia from a clinical training program realizes that's not even remotely true.
00:52:15
Speaker
We have now the Academy of Veterinary Educators, which is a group that we're dedicated towards getting educators to be better educators, basically, and acknowledging that it is a separate skill to teach people.
00:52:32
Speaker
Right. So do you have any like journal advice for veterinary professionals? This can be technicians, general practitioners, special, even specialists, you know, anybody who wants to improve their anesthesia knowledge, you know, what's the best way that they can go about achieving this goal, assuming that they're already like are motivated to get better. Listen to this podcast.
00:52:55
Speaker
You know, yeah, seriously, like Navas has a lot of great resources, like make use of those resources. There's a lot of tremendously valuable information. You know, I've done some of the Navas CE events, the fireside chat. There's all kinds of good stuff out there. Some of the blog posts, you know, I'd start there, like engage with that content that is with that organization, because that's
00:53:17
Speaker
one of the major goals of NAVATH. So use those resources, I would say, to start. And then, you know, just start having the conversation, like just sit down at a staff meeting and be like, hey, you know, can we talk about our anesthesia training? And are we comfortable with where we are? Or do we want to get better? And if we want to get better, what would that look like? Just starting those conversations, I think would be tremendous.
00:53:41
Speaker
Yeah, and following up on those conversations, I have to say because I find like sometimes there's a huge motivation at the beginning, you know, someone goes to a conference and they like learned a skill and they want to do it.
00:53:55
Speaker
And then they get to the priority, they're like, we're all going to, and everyone's like excited, but you need somebody at that point in time, like a point person to be like, you are going to be responsible for moving this forward because you need to like not just have the conversation in my opinion, but also have space for somebody or allow a person to really push the program forward.
00:54:18
Speaker
Yeah, absolutely. A hundred percent. That's a really good insight. I have seen so many things just like you described, like people get worked up and excited and start this initiative or whatever, and then it fizzles out. So having the dedication and the interest and the resources, the accountability. Yeah. So I know you have a podcast about veterinary education. Where can people go to, to find more information about that?
00:54:42
Speaker
I do. I have a couple of resources that may be interesting. We have Reflections in Veterinary Education, RIVE, which is our podcast. We have monthly episodes there where we have guests, we have topics, we talk about journal articles. If you're interested in veterinary education, definitely recommend that you look that up on YouTube or on podcasts. I also blog.
00:55:03
Speaker
at the vegicator.com, V-E-T-D-U-C-A-T-O-R. So I talk about applications, interviewing, negotiation, primarily aimed at vet students and interns and residents and faculty. But there's, I think, information there that's helpful for anybody in the veterinary profession. Awesome. Well, thank you so much for your time today. I found this conversation to be very insightful, and I just really appreciate your time. Thank you so much for inviting me. I had fun.
00:55:38
Speaker
If you like what you heard today, I encourage you to check out NavAss and consider becoming a member. As a member of the North American Veterinary Anesthesia Society, you get tons of benefits, including access to CE events, focusing on anesthesia and pain management, blog posts, fireside chats with boarded anesthesiologists, as well as specialty technicians and just so much more.
00:56:00
Speaker
visit www.mynavs.org to advance your anesthesia journey today. If you have been enjoying the content of this podcast, I would sincerely appreciate it if you could give us a like or subscribe to our podcast, write a review, or simply spread the word about this podcast to your friends and coworkers. We appreciate any and all listener support.
00:56:23
Speaker
If you have any questions about this month's episode, the Navas podcast in general, or if you want to suggest topics you would like for us to discuss in future episodes, please reach out to us at education at mynavas.org. We would love to hear from all of you.
00:56:40
Speaker
Also, again, a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. Visit their website, www.decra-us.com to learn more about their line of veterinary anesthesia products.
00:56:56
Speaker
This podcast was produced by Maria Bridges, edited by Chris Webster of Chris Webster Productions, and technical support was provided by Saul Jimenez. I want to thank our guest, Dr. Eric Hofmeister, for giving his time to speak with us about anesthesia education and training. And lastly, a huge thank you to all the gas pastors out there who choose to spend their time with me today on the North American Veterinary Anesthesia Society podcast.
00:57:22
Speaker
Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future. I'm your host, Dr. Bonnie Gatson, and thank you for listening. See you next month with another episode of the Nav-Ass Podcast.