Anesthesia Guidebook

In this episode, the founders of From the Head of the Bed… Jon Lowrance, Kristin (Andrejco) Lowrance, Brad Morgan & Cassidy Padgett, talk about how to communicate with preceptors as anesthesia trainees. This conversation was recorded as one of the original podcasts released at the launch of From the Head of the Bed, the podcast the proceeded Anesthesia Guidebook, back on March 10, 2015. Over 7 years later, it’s getting a re-release here as part of the Thrive in Training series and the tips shared are just as relevant as ever. All four of these folks were third-year SRNAs at the time of this recording and offer tips for anesthesia trainees hitting the clinical environment for how to communicate with preceptors. How well you get along with the folks you work with in the OR will either make or break your day – as an anesthesia trainee and as a licensed anesthesia provider. It takes a hefty dose of emotional intelligence to navigate the relationships found in the OR. This is one of the things that many anesthesia trainees find surprising: just how hard they have to work to understand the people they work with, what relationships are already at play in the OR between OR RNs, surgeons, CSTs & anesthesia providers and how to create positive working relationships with preceptors. It’s rare that anesthesia training programs – for CRNA or physician anesthesiologists – provide education on how to become a clinical anesthesia educator or preceptor. Those skills are usually left up to anesthesia providers to figure out on the job. Given that, many anesthesia providers don’t approach their roles as preceptors and clinical educators with deliberate and highly functional skills and techniques. They just do their job as anesthesia providers and expect anesthesia trainees to figure the job out as they work together through the day. Given this context, it’s critical for anesthesia trainees to understand how to communicate with preceptors in order to create positive working relationships. That’s not to say that the onus is just on anesthesia trainees for creating their own positive educational experiences. Certainly, clinical faculty and anesthesia training programs should bear the primary responsibility for creating effective educational environments for their trainees. But given that the quality of educational settings for anesthesia trainees can vary greatly, along with the clinical teaching skills of faculty, it can only help if you as an anesthesia trainee show up with some knowledge of how to communicate with your preceptors. So that’s what we talk about in this podcast. We hit on the following topics: Importance of communication skills in the perioperative environmentHow to prepare for clinicalsTips for making pre-clinical phone calls to preceptorsThe use of cell phones/electronic devices in the ORCommon questions preceptors ask studentsHow your communication skills should evolve during trainingImportance of being teachable, flexible, humble and thankful In the podcast, we talk about the “smooth & in” video. Unfortunately, I can’t find it and the prior link has been removed. It was a classic. If someone can find it, let me know.

This episode offers a run down on how to prepare for the clinical phase of anesthesia training. We touch on practical tips like which apps are helpful, what gear to utilize & how to acclimate to the clinical environment as well as meta issues like developing emotional intelligence and the right kind of attitude to create success in your journey. I also highlight a bunch of other shows on Anesthesia Guidebook that are not part of this series that you may find helpful. Outside of the Thrive in Training series, we’ve got lots of content on pharmacology and much more to come.  But to prepare for clinical, don’t miss the shows on the top drawer run down (episodes 17, 18 & 19), which for years were the number 1 requested content and remain some of the most listened to episodes.  Other shows on pharmacology include run downs on dexmedetomidine, succinylcholine, buprenorphine, the pharmacokinetics & pharmacodynamics of volatile anesthetics, local anesthetics and ondansetron for preventing spinal induced hypotension.  We’ve got an episode on a multi-modal, opioid sparing approach to total knee replacement surgery, one that overviews regional anesthesia, one on opioid free anesthesia and one on the anesthesia implications for patients who use cannabis.   Other content that you’ll find helpful are 2 shows for anesthesia trainees who are going through the process with your families:  episode 15 is specifically about your significant others and anesthesia school with Jenny & Robert Montague.  Rob is now one of my CRNA colleagues here in Portland, Maine and his wife, Jenny, is a Registered Dietician.  They have 2 young kids and talk about the experience of doing anesthesia school as a family.  The other episode is number 50 – parenting during anesthesia training with Lein & Nate Woodin.  Lein was actually in Robert’s class at the University of New England and her husband, Nate, is a licensed child therapist.  They’re an amazing couple, also with 2 young kids, and we focus in specifically on the changing dynamics of parenting during anesthesia training.  Nate brings a wealth of experience to the conversation as a child therapist and husband of an SRNA.   A couple other episodes you’ll want to go back to check out that would fit perfectly in the Thrive in Training series:   Episode 10 is 10-quick tips on mastering airway management, episode 24 is with Jason Bolt and we talk about avoiding landmines as an anesthesia trainee in how you represent yourself on social media.  Episodes 31-37 all deal with learning anesthesia & the path to expertise; so we hit on deliberate practice, understanding cognitive state of flow in balancing challenge with skill and the power of the invisible can-of-calm.  We also hit on asynchronous learning, emotional intelligence of SRNAs and the transition, this year, of entry-to-practice training for CRNAs becoming a doctorate degree, when, for the last 30 years or so, it’s been a master’s degree.   Then there’s a 10-episode run on provider wellness from episodes 51 through 60 that touch on everything from how to pay your debt off, to dealing with the pandemic to how to weather the storms and setbacks you’ll have in anesthesia training.  The top show in that run for anesthesia trainees, if you want to go back and just pick out one, is episode 54: hardship in anesthesia school.  This continues to be one of the most-listened to episodes from all of Anesthesia Guidebook and zeroes in on the best advice and stories I have for you if you find yourself up against a wall or being beat down by god-knows what on your path to becoming an anesthesia provider.   Here’s the NRS Video Dream where Ben Marr imagines what life would be like if he was good at paddling. It’s amazing! (This is what it’s like to be a novice in the OR, watching the expert providers all around you… you just WANNA BE GOOD!)

This show is so much fun and launching this now coincides with the launch date of my friends’ journey, which you’ll hear all about in this episode.   Kyle & Jen Steen have been friends of mine for the last 7 years. Kyle’s been a CRNA for 13 years, Jen is a fashion designer and farm-to-table chef. The short story is they built out a custom Sprinter van into a tiny home on wheels, sold pretty much everything they own, including their house, and hit the road this week on a mid-career van life adventure with no end date on the calendar. Kyle is 41, Jen is 39. They’re in the middle of their careers. Kyle Steen, MSN, CRNA, van builder, adventurer, husband to chef & creator Jen Steen. In this episode we talk about the why behind their decision and the how – both financially and specifically: like what kind of van they built, how they paired down 25 years of accumulated stuff to the absolute bare necessities and what they hope to do while they’re on the road. This is a long-form interview.  We take our time over the next hour to talk through their decision & dream.  I can remember talking with Kyle & Jen when they first hatched this plan and I’ve watched them pull this dream together over the last couple of years.  We did this interview from their van on the day before their epic road trip kicks off this week.  You can see photos of the van in the show notes to this episode, on Anesthesia Guidebook’s Instagram page or in the biggest and best way by following Kyle & Jen on Instagram @FrankvannSteen.  It’s not every day you see a highly intelligent, socially well-connected couple quit their high income day jobs and hit the road full time in a tiny home van.  We talk in this episode about the American Dream and the accumulation of wealth, status & possessions.  What I love about Kyle & Jen’s story is that they kept seeing people embrace the mantra of delayed gratification all the way up to retirement and then hit walls:  walls like ailing health, limited physical ability, cancer, strokes or just the fear of change that security & stability can subtly bring to one’s life… and they didn’t want that.  They didn’t want to just keep contributing to retirement accounts and doing the same thing every day while the best years of their life passed them by.  So they’re doing something different.  They’re taking a break from their careers to travel & create an adventure and a life worth living. I think it’s so interesting because many people who go into anesthesia get very used to the income and routine of their careers.  Kyle & Jen’s decision drops the gauntlet for the rest of us to re-evaluate our lives and the why behind our lifestyles.  Where do you really derive your sense of enjoyment from?  If money wasn’t an issue, what would you do with your time?  Are you able to get to the point, even for a short period of time like a month, 3 months or a year, where your financial situation would allow you to chase that dream? To do that thing that may right now already be fading from the front of your mind under the scrutiny of Common Sense, your Practicality or sense of “but what would people think?”   And maybe it’s not about finding a bunch of days all strung together but the ability to drop down a day or two per week.  We work on average four 10-hour shifts at our hospital.  My wife just dropped a day and now only works three 10-hour shifts a week.  That extra day off each week has made a huge impact on her well being and satisfaction, especially because it gives her more time to spend with our little 9-month old munchkin.  We also both take around 10 weeks off a year.  We could certainly work more and make more money, but we value the time more than the money we would make. I came across this idea years ago that “what’s not important will continue on without you.” Kyle’s decision to step away from full time anesthesia work to adventure with Jen came at the same time that a couple of our other CRNAs, physician anesthesiologists and even our lead administrative specialist, retired after long, long careers at one institution.  Those people will be missed and there was a lot of legitimate nostalgia shared when looking back over their careers.  But the patients keep coming, the department has hired replacement staff and the healthcare machine churns on.   I’ve always been wary of the sense that CRNAs and physician anesthesiologists are just cogs in a giant healthcare wheel.  It can be de-personalizing, anonymizing and demoralizing.  When you think about the statement “what’s not important will continue on without you,” it’s a reminder that we have to actively build for purpose in our careers…  Research shows* that if you can arrange for 20% of your time at work to be geared towards something you truly are intrinsically motivated for, it’s prot

In this episode, I’m joined by Temima Luchansky & Maya Kelkar, the 2 current SRNA reps to the AANA Health & Wellness Committee, to talk about how to find balance in anesthesia training. Now if that immediately sounds impossible to you, then you’re listening to the right podcast. We’re going to talk about a very concrete way of looking at your life and specific tips for how to manage the incredible challenges we face as anesthesia trainees. Balance can be an elusive concept to understand and an even more elusive state of being to achieve. Thankfully, the National Wellness Institute provides a simple framework to help us better understand what finding balance looks like in real life. It’s called the Six Dimensions of Wellness. You can think of it like this: there are six domains in each of our lives: social, emotional, occupational, physical, spiritual and intellectual. Temima & Maya share insights for what each of these domains means to them as anesthesia trainees, the specific challenges they face in each domain and specific tips for how to thrive in each of these domains. Finding balance happens when we work towards putting equal energy & focus into each domain. In the US, especially for Finding balance happens when we work towards putting equal energy & focus into each dimension of our lives. For anesthesia and other healthcare trainees, a disproportionate amount of energy is usually placed on developing the occupational domain as we work through school and towards passing boards. Now, there’s times in our lives when we are intentionally out of balance: when we charge in one domain harder than in the others. And that can be ok for a period of time. It can resulted in a concentrated period of extreme growth and development. But for the long term, understanding what each of these domains can look like in your life and working to put equal energy into each of them can help build real wellness, resiliency and a very tangible & practical sense of balance in our lives. I’m so grateful that Temima & Maya took time out of their busy lives to join me to discuss the Six Dimensions of Wellness in this podcast. Both of these women are SRNA representatives to the national AANA Health & Wellness Committee. Temima became interested in volunteering on this committee after listening to a prior podcast on Anesthesia Guidebook with other SRNA reps to the Health & Wellness Committee. And Maya came up with the idea for doing a deep dive on this specific topic after listening to a talk I gave at last year’s Idaho State Association of Nurse Anesthetists virtual conference on provider wellness. Both of these individuals have powerful voices and are on a mission to help other SRNAs thrive in their training. I think you’re really going to enjoy hearing from them, which is why I couldn’t find any way to trim this show down from around an hour & twenty minutes… it’s a long podcast but we talk through so much and they give wonderful, practical examples of how to work towards a healthy state of balance & wellness during your anesthesia training. So break up the show over a few commutes or work outs and let us know what you think on Instagram, Facebook, Twitter or as comments on the website. Speaking of the internet webs… the show notes of this episode has links to journal articles and a quick PDF run down on the Six Dimensions of Wellness from the National Wellness Institute. We also link to the American Association of Nurse Anesthesiology’s website for Student Wellness which hosts a ton of resources for SRNAs who are actively trying to make it all work during training. The AANA has put in a huge amount of effort on fostering proactive wellness initiatives for SRNAs & CRNAs in the last few years and I know these are having far reaching impacts in the anesthesia community. Which reminds me, Temima & Maya will be hosting a live Zoom session for SRNAs they’re calling SRNA Shared Experiences through the AANA. These are free, live Zoom sessions with a focus on peer-to-peer support in a judgment free zone. Participants talk about the SRNA experience and how to be successful and well in anesthesia training. The next session is in 2 days… Monday, March 21. They run every other month, so if you miss Monday’s SRNA Shared Experience, you can circle back in May to hear from and talk with SRNAs around the nation in these free peer-to-peer support sessions. So a bit on Temima & Maya and then we’re on to the show… Temim Luchansky was born & bred in Baltimore, Maryland. She worked in Baltimore at a medical ICU for 2 years and then did 2.5 years of travel nursing in several hospitals throughout New York City in a mix of ICUs including CICU, SICU, CTICU, getting a variety of experience before CRNA school. She’s currently in the inaugural DNP Nurse Anesthesia class at Johns Hopkins University with an anticipated graduate date of 2023. Maya Kelkar is a 2nd year nurs

Jenny Finnell, MSN, CRNA joins me to talk about how anesthesia trainees can master the didactic phase of their training. We cover lots of tips in this show: everything from how to make challenging content stick to how to get organized, which apps & resources are helpful and how to maintain mental wellbeing during anesthesia training. This episode will help you dial in your plan for success in didactics. Our goal is for you to thrive and not just survive in school. The volume of information you have to master is immense and the learning curve is incredibly steep, especially when you begin to integrate clinical training into your journey. Creating early success in didactics is key to progressing in anesthesia school. There’s 3 domains of knowledge in any kind of training: the know-whatthe know-why and the know-how. The know-what is the core information, principles & facts.   The know-why is understanding the situationally-specific rationales for actions & processes. And the know-how is where we learn to put the know-what & the know-why into practice: it’s the experiential, practical application of knowledge.  The didactic portion of training is where we pick up most of the know-what.  What you need to know is learned by studying, being taught, reading, watching video & listening to lectures & podcasts.  It’s here where we also learn a lot of the know-why: the rationales behind why we do things the way we do them in anesthesia.  You’re only able to develop the art of anesthesia if you have a solid foundation in the science of anesthesia.  Learning the know-how: the actual mechanics and flow of putting everything together, the timing & art of anesthesia is learned best by doing… especially when that experiential education is under the guidance of a skilled preceptor, clinical coach or mentor.   Jenny Finnell, MSN, CRNA runs the CRNA School Prep Academy, which is a mentoring and professional coaching community designed for those who want to pursue a career as a CRNA.  Her team offers a blog, podcast and public & private forums as well as individualized coaching for every phase of preparing for anesthesia training.  She’s active on Facebook & Instagram if you want to see what the CRNA School Prep Academy is all about or you can certainly cruise over to her website at CRNAschoolprepacademy.com.  Resources: The CRNA School Prep Academy Ultimate Resource Guide: …this is Jenny Finnell’s Six-Page Free Resource Guide. In it, she lists the best podcasts, YouTube channels, apps, websites, books related to anesthesia, studying/learning, grad school interviews and professional resources. What Straight-A Students Get Wrong by Adam Grant, NYTimes Editorial Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. AANA journal, 79(2). Vargo Anesthesia Mega App. This is an incredibly thorough app covering run downs on surgeries, pathological conditions, pharmacology and detailed weight-based guides to pediatric anesthesia. While you have to pay for this app, the cost is definitely worth what you get. Master Anesthesia app in App Store: check out the story from app creator Matthew Willis in Episode 38 of Anesthesia Guidebook. This app is FREE and growing in its scope of surgeries & medications but rolled out with a phenomenal calculator for quickly seeing max doses of multiple local anesthetics. Writing in the Sciences: FREE course on professional/scientific writing from Stanford University. Take this course to improve your professional writing.

Jenny Finnell, MSN, CRNA, the creator behind the CRNA School Prep Academy joins us today to talk about growth mindset. Learning to develop a growth mindset is key to pushing beyond where you’re at currently to where you want to go. Carol Dweck is a psychologist and the Lewis and Virginia Eaton Professor of Psychology at Stanford University. Her research found that people generally work from two mindsets: a fixed mindset or a growth mindset. Dweck argues that intelligence is not fixed trait but something that can be developed and expanded with the right kind of training, effort and encouragement. Your IQ and certainly your SAT/ACT/GRE scores and even GPA are not the final word on your capacity, intelligence or potential. They’re merely snapshots of your performance at particular points in time on particular assessments. The way you see intelligence, challenges, obstacles, the success of others, the value of effort and your potential all relate to which mindset you work from. Her book, Mindset: the new psychology of success, is a worthy read for any one looking to master their craft and/or help others along the way. Whether you’re on the path to becoming an expert clinician, want to train the next generation of providers or even parent more effectively, Dweck’s work will show you the path. Two Mindsets Chart. (2016). GLT Carol Dweck: Two Mindsets Chart and Compelling Questions. Guidline Leaders and Teams. Retrieved from https://guidingleadersandteams.com/resources-glt/carol-dweck-two-mindsets-chart-and-compelling-questions-glt/. Screen shot by author.Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc.. Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Jenny Finnell, MSN, CRNA runs the CRNA School Prep Academy, which is a mentoring and professional coaching community designed for those who want to pursue a career as a CRNA. Her team offers a blog, podcast and public & private forums as well as individualized coaching for every phase of preparing for anesthesia training. She’s active on Facebook & Instagram if you want to see what the CRNA School Prep Academy is all about or you can certainly cruise over to her website at CRNAschoolprepacademy.com. We’ll talk a little bit more about what she’s been up to with her company at the end of this show but first… I’m so glad Jenny joined me to talk about growth mindset. Learning to develop a growth mindset is key to pushing beyond where you’re at currently to where you want to go. Whether you’re an experienced anesthesia provider, a current anesthesia resident or someone who’s on the path towards anesthesia training, understanding how to embrace a growth mindset and move beyond the limitations and shackles of a fixed mindset will help you actually thrive on the journey. If you don’t just want to survive anesthesia training – or worse, not even make it, but you actually want to thrive, you need to understand how to develop a growth mindset. Resources: Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc.. Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/ Jenny Finnell’s podcast: Growth Mindset & Why This Single Thing Can Allow Your Journey To Be Easier Grant, A. (2018, December 8). What straight-A students get wrong. The New York Times. Retrieved from https://www.nytimes.com/2018/12/08/opinion/college-gpa-career-success.html

The key to thriving in training is setting a trajectory in life based on your deep interest, learning to embrace deliberate practice in your craft, remembering your why and locking on to the hope that comes with knowing your goal is worth the work you will put in. This series is designed to help physician and nurse anesthesia residents succeed in anesthesia training. Topics covered include: developing a growth mindsetdialing in didacticscrushing clinicalsdeveloping time managementavoiding landmines and overcoming set backsdealing with hardship in anesthesia trainingfinancial managementpreparing for and acing exams and boardstips for the job hunttransitioning to practice and through the first six months after training I originally released this on February 21, 2015 on From the Head of the Bed (the predecessor podcast to Anesthesia Guidebook). I talk with Mason McDowell, DNAP, CRNA and Kara Michalov, MSN, CRNA on their top tips for success in anesthesia school. This is a bit of a 10,000-foot overview of how to thrive in anesthesia school. In later episodes in this series, we’ll dive into many of these topics in more detail. In this episode, we discuss: how to start strongshould you work or moonlight during training?advice for starting clinical how to socializing (or not) in the OR as a residenthow to recover from novice mistakes and keep goinggoal setting with preceptors project/thesis identification & tips advice on studying for boards At the time of this interview, Mason McDowell, DNAP, CRNA was the Associate Professor and former Assistant Director of the Nurse Anesthesia Program at Western Carolina University.   His Doctorate of Nurse Anesthesia Practice (DNAP) from Texas Wesleyan University included research focused on perioperative patient management and cardiac risk assessment.  He is the co-author of the Hepatobiliary and Gastrointestinal Disturbances and Anesthesia chapter in Nagelhout’s Nurse Anesthesia.  A few weeks after this interview in 2015, Mason moved with his wife and two daughters to Bere, Chad to provide anesthesia. You can hear more about his story in episode 61 & 62 of Anesthesia Guidebook. You can also read about his experiences in Chad at http://www.whyweshouldgo.blogspot.com.  At the time of this interview, Kara Michalov, MSN, CRNA was a CRNA in Asheville, North Carolina. Kara and Mason are co-authors of Intravenous Acetaminophen and Intravenous Ketorolac for Management of Pediatric Surgical Pain: A Literature Review, which was published in the February 2014 edition of the AANA Journal (Vol. 82, No.1). A remarkable note on her paper:  her and her primary co-author, Kit Baley, submitted their paper for publication and received no request for corrections from their peer reviewers.  This is an incredible accomplishment as they essentially wrote a perfect paper on this topic prior to submitting it for publication.  Nice job, Kara & Kit! 

The Thrive in Training series is designed to help physician and nurse anesthesia residents succeed in anesthesia training. The key to thriving in training is setting your trajectory in life based on your deep interest, learning to embrace deliberate practice in your craft, remembering your why and locking on to the hope that comes with knowing your goal is worth the work you will put in. Topics covered include: developing a growth mindsetdialing in didacticscrushing clinicalsdeveloping time managementavoiding landmines and overcoming set backsdealing with hardship in anesthesia trainingfinancial managementpreparing for and acing exams and boardstips for the job hunttransitioning to practice and through the first six months after training In this episode, the second in the series, I talk with Mason McDowell, DNAP, CRNA and Kara Michalov, MSN, CRNA about the following: – advice for how to prepare for nurse anesthesia school– advice for students with families, significant others & pets– what to study (or not) ahead of time– how to prepare for the Big Interview to get into school I released this episode originally on February 21, 2015 on the podcast From the Head of the Bed. Today, exactly 7 years later, it’s coming back to Anesthesia Guidebook as part of the Thrive in Training series with a fresh introduction. I also summarize tips for preparing for anesthesia school at the end of the show. What Mason & Kara share remains relevant and they offer keen insights from their personal experience. You’ll definitely enjoy this conversation! At the time of this interview, Mason McDowell, DNAP, CRNA was the Associate Professor and former Assistant Director of the Nurse Anesthesia Program at Western Carolina University.   His Doctorate of Nurse Anesthesia Practice (DNAP) from Texas Wesleyan University included research focused on perioperative patient management and cardiac risk assessment.  He is the co-author of the Hepatobiliary and Gastrointestinal Disturbances and Anesthesia chapter in Nagelhout’s Nurse Anesthesia 5th Edition.  A few weeks after this interview in 2015, Mason moved with his wife and two daughters to Bere, Chad to provide anesthesia. You can hear more about his story in episode 61 & 62 of Anesthesia Guidebook. You can also read about his experiences in Chad at http://www.whyweshouldgo.blogspot.com. At the time of this interview, Kara Michalov, MSN, CRNA was a CRNA in Asheville, North Carolina. Kara and Mason are co-authors of Intravenous Acetaminophen and Intravenous Ketorolac for Management of Pediatric Surgical Pain: A Literature Review, which was published in the February 2014 edition of the AANA Journal (Vol. 82, No.1).

This is the first episode in a series that will focus on helping anesthesia residents thrive in training. This is designed for physician and nurse anesthesia trainees and will unpack crucial beta for helping you dial your game in during anesthesia training. In this first episode I discuss finding your why behind going to anesthesia school. Your why is what will propel you through the tough times in training and help you find the motivation to excel. Angela Duckworth is a psychologist and researcher who, in her bestselling book titled Grit – the power of passion and perseverance, says that grit is what separates those who succeed from those who fail when facing extreme challenge. Your why will help you develop the level of grit that you need to get through the challenges of anesthesia training.   Grit is what you have when your passion fuels a perseverance that propels you through obstacles to achieve your goals. Duckworth says there’s four components of developing grit: interested, practice, purpose and hope. Do you have an authentic interest in the work anesthesia providers do? Are you stoked about the field of anesthesia and have an accurate mental representation of what it’s actually about? You will need to develop deliberate practice in order to master the craft of anesthesia and become competent in the core skills/knowledge base. If you’re unwilling to do this, anesthesia training will quickly seem overwhelming and you probably won’t make it. But deliberate practice is the key to unlocking true skill development and expertise and will make the road ahead achievable. You must know your purpose – or your why – behind going to anesthesia school. This episode is all about finding that. It will be the reason you come back to when the road gets tough and you have to find the motivation to push through the challenges, set backs and hurdles that will inevitably come your way. And lastly, hope is what you will have in your back pocket when you believe that the journey is worth all the hard work you put in. Hope comes when you believe that the juice is worth the squeeze, that the payoff is worth the effort. Interest. Practice. Purpose. Hope. When you understand and foster each of these in your journey, you will develop a grittiness that will see you through the steepest of climbs and most difficult days. Stay tuned for the upcoming series where you’ll hear from CRNAs, professors and SRNAs alike on the following topics: developing a growth mindsetdialing in didacticscrushing clinicals developing time management avoiding landmines and overcoming set backsdealing with hardship in anesthesia trainingfinancial management preparing for and acing exams and boardstips for the job hunttransitioning to practice and through the first six months after training This series is an active work in progress so if there’s something you want to hear about, be sure to reach out and let me know!

This is run down specifically on NBCRNA’s Continued Professional Certification (CPC) Program Assessment (or Exam) for CRNAs. Episode 64 was a 10-minute run down on the whole CPC Program – a quick overview. In episode 65, I did a whole hour-long deep dive on the program, including the CPC Assessment. This episode cuts out all the other content on the CPC Program and just focuses on the exam. This is the element of the CPC Program that causes the most anxiety for CRNAs so it’s worth doing a whole show on. I talk about the background of the exam, the layout & nature of the exam, the decision about taking in person at a Pearson Testing Center or at home on your own computer and tips for preparing (or not) for the exam. In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Several elements of the CPC Program have changed since 2019 so the last 3 episodes on Anesthesia Guidebook are all new. Drop me an email or comment on Instagram/Facebook if you’ve got questions on the exam after listening to these 3 episodes. Links below for content from NBCRNA to help you naviaged the CPC Program along with the powerpoint outline I’ve used to present on the CPC Program at state & national conferences for CRNAs. The CPC Program at a glance. Check your progress in the CPC Program here: NCBRNA Website More on the CPC Program: NBCRNA CPC Program CPC Program Overview: Lowrance 1-hour presentation PDFDownload

This is an all-new 1-hour overview of the NBCRNA’s Continued Professional Certification (CPC) Program for CRNAs. In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Instead of brining that episode forward to Anesthesia Guidebook, I’ve decided to complete re-write this update because the CPC Program has evolved even since 2019. Episode 64 of Anesthesia Guidebook includes a brief 10-minute run down on the CPC Program that you can share with friends who just want a quick overview. I recorded the 1-hour run down first and then realized that there’s probably some CRNAs out there who just want a quick overview, so I hammered episode 64 int0 just over 10-minutes. The CPC Program at a glance. Check your progress in the CPC Program here: NCBRNA Website More on the CPC Program: NBCRNA CPC Program CPC Program Overview: Lowrance 1-hour presentation PDFDownload

This is a short overview of the NBCRNA’s Continued Professional Certification (CPC) Program for CRNAs. In April of 2019, I interviewed John Preston, DNSc, CRNA, FNAP, APRN and Lisa Kamen, CAE of the NBCRNA on the CPC Program for the podcast From the Head of the Bed. At the time, Dr Preston was the Chief Credentialing Officer at NBCRNA; he is now the CEO of NBCRNA. Lisa Kamen is an association manager who supports the work of NBCRNA as a full time staff member. Instead of brining that episode forward to Anesthesia Guidebook, I’ve decided to complete re-write this update because the CPC Program has evolved even since 2019. Episode 65 of Anesthesia Guidebook includes an all-new 1-hour run down on the CPC Program. I actually recorded that show first and then realized that there’s probably some CRNAs out there who just want a quick overview, so I’ve hammered this episode out in just over 10-minutes. I covered the basics of the CPC Program but if you want to know more details, some back story on the program and more tips on crushing the CPC Assessment (exam), be sure to check out the next podcast! The CPC Program at a glance. Check your progress in the CPC Program here: NCBRNA Website More on the CPC Program: NBCRNA CPC Program CPC Program Overview: Lowrance 1-hour presentation PDFDownload

Dr Ian Hewer is the program director of Western Carolina University’s Doctor of Nursing Practice in nurse anesthesia program.  At the time of this interview, Ian had been a CRNA for 20 years, was an assistant professor in WCU’s nurse anesthesia program, held two master’s degrees – one in sociology, the other in anesthesia – and was enrolled in his PhD program at the University of North Carolina-Charlotte.  His PhD is in Health Services Research and the focus of his dissertation was economics & billing practices in anesthesiology. I originally recorded this interview with Ian back in February of 2015 when I was still a SRNA at WCU and Ian was one of my professors and clinical preceptors. We discuss the differences in billing models such as medical direction, medical supervision and independent practice in the United States.  We talk about the Tax Equity and Fiscal Responsibility Act of 1982 and how TEFRA – again that’s the Tax Equity and Fiscal Responsibility Act – requirements influence reimbursement and anesthesia practices.  We go over opt out and what that means – how in nearly half of all states, CRNAs are not required to have supervision by any physician, podiatrist or dentist in order to bill directly for their services.  We discuss how market forces such as an evolving payor mix can influence decisions on billing models and practice structure for anesthesia groups, hospitals and individual providers.  We talk about the challenge of studying big data in establishing differences in quality outcomes between CRNAs and physician anesthesiologists. We also discuss the future of anesthesia economics and concrete steps healthcare organizations and providers can take to lower costs and maximize efficiency while maintaining high quality outcomes. If you want the inside scoop on economics in anesthesiology, start with this podcast.  I’ll also mention here that Western Carolina University is likely opening their bridge program for Master’s prepared CRNAs to obtain their DNP in the summer of 2022.  So if any of you master’s prepared CRNAs out there are looking for DNP programs, keep WCU on your radar.   Resources: Lewis SR, Nicholson A, Smith AF, Alderson P. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2 Hewer, I. (2018). ANESTHESIA CARE TEAM TYPE AND HOSPITAL CHARACTERISTICS: ARE INCREASED LEVELS OF SUPERVISION ASSOCIATED WITH DIFFERENT ACUITIES AND OUTCOMES?. (Thesis). University of North Carolina at Charlotte. Retrieved from https://repository.charlotte.edu/islandora/object/etd%3A1088

This is part 2 of my conversation with Mason McDowell, DNAP, CRNA. In 2014, he, along with his wife and 2 young daughters, sold everything they owned and moved full time to the heart of Africa… to the town of Beré in the nation of Chad, to provide anesthesia services at hospital with severe resource limitations. Dr McDowell was a professor of mine and the assistant program director at Western Carolina University when he made the decision to move to Chad. I remember him preparing and talking about the why behind his decision and watching that process unfold was incredibly powerful. In part one of our conversation (episode 61), Mason talks about the decision to go to Chad, what he and his family did there and why they had to evacuate the country emergently and return to the United States. In this episode, Mason shares advice for those who wish to travel and provide anesthesia for underdeveloped, impoverished and/or remote communities. The stories Mason shares in this 2-part series are remarkable but they only scratch the surface of his time in Chad. I’ll link to his blog at whyweshouldgo.blogspot.com in the show notes where you can read about the day-to-day, night-to-night tales from providing anesthesia and general medical services in Chad. THOSE stories are heart wrenching. There we innumerable times when Mason and his team had to make decisions based on the severe resource limitation that we simply would never have to make here in the United States. I’d like to share one of Mason’s stories with you here: 4-3-2-1 8 Dec 2014, Bere, Chad by Mason McDowell, DNAP, CRNA I was called out of our morning meeting at the hospital around 730am with the wave of a hand. I knew what it was even before I asked for confirmation: Bébé? Oui.  A mother had just delivered twins but baby #2 wasn’t breathing. I gave oxygen, breathed for him with an ambu bag and tried to keep him warm. Danae (the OB/GYN) lifted her scrub shirt to press baby against her skin to warm him as I continued to hand ventilate. Eventually he was breathing on his own and was sent to our “NICU”– that’s the neonatal intensive care unit; except in Chad it means he is getting oxygen while he rests in a tiny cardboard box in our OR with 2 hot water bottles tucked beside him. Guess what? He’s still alive tonight! Flash forward to around 8pm when our volunteers arrived from the US. They were only here 10 minutes before an urgent phone call: maternity…a mom turned quickly…send Mason now! I threw on scrubs and my friend Shawn (also an anesthetist) hurried along behind me.  We arrived to find a seemingly dead looking pregnant woman laying on the floor and frothing at the mouth. We moved her quickly down the sidewalk to the OR and began CPR. Chest compressions, oxygen/ventilation, IV epinephrine…Nothing. Now thats a terrible situation–lifeless and pregnant. I told Danae “she’s dead-dead …get the baby out”.  I barely finished the sentence before Danae cut down and retrieved a baby girl. Good pulse but not breathing. After an extended period of manual ventilation and stimulation the baby perked up and breathed on her own! The unmistakeable scent of Arabic perfume lingered in the air as it radiated from the cloth I used to wrap the baby in. The fabric had been part of her mothers clothing. Blood covered the OR table, floor, and the surgeon. We cleaned up the baby’s mother and brought in the family for a final viewing. Tears and prayer filled the OR. The family left to find a truck to carry the body away and I walked home alone under a brilliant night sky, still replaying the events of the day and looking for lessons to learn.  I returned home to find suitcases filled with treasures from the US. Our friends brought items purchased or donated for us and our hospital– it was like an early Christmas. After 30minutes of sorting goodies and eating junk food another call came: stat C-section. Seriously?! A very young mother with complicated labor was already in preop when I arrived. Unfortunately the dead body from an hour ago was still in the OR (still waiting for family) and we had to find a way to move it out and bring in the new patient without making a big scene. If it wasn’t so sad it would have been comical. We pushed the dead woman into our tiny preop room after angling the new patient’s stretcher in a way that she had to twist around to see the body. And that’s exactly what she tried to do. We built a human wall with the 4 of us as we shuffled along pulling the new patient past the body (just 2 feet away).  Now in the OR: IV fluid, monitors, spinal anesthetic administered easily–cut down and baby retrieved in textbook fashion. Except…Silent baby. Floppy baby. Apneic baby. After stimulating, warming, and ventilating with oxygen…nothing. Pulse rate 160:perfect. But he’s not breathing.  Ventila

This podcast and the one to follow are pure gems.  You’re gonna hear from Dr. Mason McDowell who in 2014, sold everything he, his wife and 2 young daughters owned and moved full time to the heart of Africa… to the town of Beré in the nation of Chad to provide anesthesia services at hospital with severe resource limitations.   Dr McDowell was a professor of mine and the assistant program director at Western Carolina University when he made the decision to move to Chad.  I remember him preparing and talking about the why behind his decision and watching that process unfold was incredibly powerful.  He’ll talk a little about that in this show.   I just want to frame how massive of a change this was for Dr McDowell and his family. They lived in a planned community of beautiful residential homes and businesses nestled in the mountains of Asheville, North Carolina. The community housed a satellite campus for WCU and our anesthesia program. Mason could walk to work from his home, step across the street to a number of stellar restaurants or high end shops or even stroll to the end of the block to the grand movie theater to watch a show with some fresh popcorn. He was well-respected in the local community and maintained an anesthesia practice at the local 800-bed trauma center with all the technology and resources you could imagine. And they decided to leave all of that and move full time to Bere, Chad. The hospital where Mason went to work didn’t have a functional anesthesia machine. Mason flew to Europe to buy a draw-over vaporizer so that he could bring inhalational anesthesia to the Bere. Before Mason and that machine showed up, the options were either ketamine or spinals. That’s it. The stories Mason shares here are remarkable but they only scratch the surface of his time in Chad.  I’ll link to his blog at whyweshouldgo.blogspot.com in the show notes where you can read about the day-to-day, night-to-night tales from providing anesthesia and general medical services in Chad.  THOSE stories are heart wrenching.  There we innumerable times when Mason and his team had to make decisions based on the severe resource limitation that we simply would never have to make here in the United States.  I’d like to share one of Mason’s stories with you here: 4-3-2-1 8 Dec 2014, Bere, Chad by Mason McDowell, DNAP, CRNA I was called out of our morning meeting at the hospital around 730am with the wave of a hand. I knew what it was even before I asked for confirmation: Bébé? Oui.  A mother had just delivered twins but baby #2 wasn’t breathing. I gave oxygen, breathed for him with an ambu bag and tried to keep him warm. Danae (the OB/GYN) lifted her scrub shirt to press baby against her skin to warm him as I continued to hand ventilate. Eventually he was breathing on his own and was sent to our “NICU”– that’s the neonatal intensive care unit; except in Chad it means he is getting oxygen while he rests in a tiny cardboard box in our OR with 2 hot water bottles tucked beside him. Guess what? He’s still alive tonight! Flash forward to around 8pm when our volunteers arrived from the US. They were only here 10 minutes before an urgent phone call: maternity…a mom turned quickly…send Mason now! I threw on scrubs and my friend Shawn (also an anesthetist) hurried along behind me.  We arrived to find a seemingly dead looking pregnant woman laying on the floor and frothing at the mouth. We moved her quickly down the sidewalk to the OR and began CPR. Chest compressions, oxygen/ventilation, IV epinephrine…Nothing. Now thats a terrible situation–lifeless and pregnant. I told Danae “she’s dead-dead …get the baby out”.  I barely finished the sentence before Danae cut down and retrieved a baby girl. Good pulse but not breathing. After an extended period of manual ventilation and stimulation the baby perked up and breathed on her own! The unmistakeable scent of Arabic perfume lingered in the air as it radiated from the cloth I used to wrap the baby in. The fabric had been part of her mothers clothing. Blood covered the OR table, floor, and the surgeon. We cleaned up the baby’s mother and brought in the family for a final viewing. Tears and prayer filled the OR. The family left to find a truck to carry the body away and I walked home alone under a brilliant night sky, still replaying the events of the day and looking for lessons to learn.  I returned home to find suitcases filled with treasures from the US. Our friends brought items purchased or donated for us and our hospital– it was like an early Christmas. After 30minutes of sorting goodies and eating junk food another call came: stat C-section. Seriously?! A very young mother with complicated labor was already in preop when I arrived. Unfortunately the dead body from an hour ago was still in the OR (still waiting for family)

All right y’all, you’re about to hear from Kate Balzano and how she paid off over $100,000 in student loan debt in a year. There’s three reasons I wanted to bring Kate’s story to you: The first is that Kate is all around an amazing human.  I have the privilege of working with her on a regular basis and get to see her passion for anesthesia, the balance she brings to her life and her interest in training SRNAs as a top notch clinical preceptor.  The second is that Kate and her husband paid off close to $140,000 of student loan debt in just about a year after she passed boards as a CRNA.  She’s gonna unpack the why and how behind that decision in this podcast. And the last is that she is a rare human in that she wholeheartedly believes that anesthesia training was actually easier having 2 young children than what she imagines it would have been prior to having kids.  You heard that right.  Kate thought it was easier to do anesthesia school as a mother WITH kids than without them.  She’ll explain why during this show. Kate Balzano-Cowan, MSN, CRNA currently practices anesthesia as a CRNA in the Department of Anesthesiology and Perioperative Medicine at Maine Medical Center in Portland, Maine. Prior to nursing, Kate was an organic chemist with research and management experience in both industrial as well as pharmaceutical research labs. Kate has earned a Master’s of Science in Nurse Anesthesia from the University of New England, a Bachelor’s of Science in Nursing from the University of Massachusetts, and an American Chemical Society certified Bachelor’s of Science in Chemistry with a minor in Biology from Northeastern University. If you’ve been following Anesthesia Guidebook, you know that I started a podcast called From the Head of the Bed back in 2015 and having been pulling some of those episodes over to Anesthesia Guidebook before phasing out the old show. This is one of my favorite conversations and Kate and I released this back in October of 2019. Bringing this forward to Anesthesia Guidebook here at the end of December in 2021 is super special because just last week I made my final payment on my own student loans. While I was nowhere close to Kate’s 1-year pay off timeline, I can’t tell you how good it feels to pay back all $197,000 of my student loans in 6 years and 6 months. That’s an average of $2700 a month for 6 & half years. And I’m am stoked to be done with those loans. When I got out of anesthesia school, I had 17 different student loans and opted to consolidate all those bad boys down to one behemoth monster. Doing that brought my overall interest rate way down and just made my repayment plan more manageable… I only had to make one payment. I also signed on with a group who happened to have a rolling student loan repayment program that didn’t phase out after a 3-year sign on bonus or specific amount like many groups. It hasn’t really sunk in yet that I’m done paying off almost $200,000 in student loans.  I’m 38 years old and I’ve been in debt with student loans for 20 years, over half my lifetime.  While my payoff time of 6 & 1/2 years after graduation can certainly be classified as aggressive, Kate’s is otherworldly.  Another colleague we work with had over $200k in student loans and got hers paid off in right around 4 years.  That’s super aggressive and I saw her put in the hard work of delayed gratification and working epic amounts of overtime for those four years. While I’m going to talk more about finances and why you shouldn’t do anesthesia for the money in the future on the podcast, I want to just say right here that Kate’s story and my story and that of so many other CRNAs who pay their loans off quickly and move forward towards their financial goals are testament that you can do it, too. As Kate says in this show, where there’s a will there’s a way… anesthesia school can seem daunting, especially now with it shifting to a doctoral degree for entry to practice for CRNAs. But it’s worth it. It’s totally worth the financial hardship you’ll endure up front. The pay off is totally worth it. You’ll be able to handle your student loans in stride and have more than enough to be well and happy! Check out the links below to think more about student loan debt. Death, Sex & Money podcast series on student loan debt. Take the Quiz… see where you line up on WNYC’s Death, Sex & Money student loan project quiz. Beyond the Mask with Jermey Stanley:  Episode 23 – The Wealthy CRNA. Get tips on financial management specific to CRNAs in the above podcast and through Jeremy’s company: CRNA Financial Planning. Cycle back to Episode 18 of this show to hear Jeremy talk through freelancing options for CRNAs.

This is episode 59 – How To Achieve Your Goals.  This is one of my favorite episodes and the content here is something that I come back to again and again.  I’ve listened to it probably 5 or 6 times since I first released it and every time I come back to this, I leave with refreshed clarity around what’s important and a renewed sense of how to move forward. This episode was first released in January 2020 on From the Head of the Bed – the podcast that was the podcast before Anesthesia Guidebook. You know, the thing we did before we did this thing. Cause there’s always a thing before the thing. Or the thing behind the thing. There’s evolutions to what we do. Chapters. Seasons. Change and growth and movement. I talked about that a bit on the last episode about the rhythms in your life… This episode is a follow up to that.  The last episode was really about how to rest and carve out time to restore your energy and clear you mind.  This one is about how to set a trajectory in your life and do the work to achieve your goals.   Transcript: #59 How to Achieve Your GoalsDownload References Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt. Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Dalio, R. (2018). Principles. Simon and Schuster. 

When’s the last time you put your cell phone down and did something relaxing or to recharge your energy? When’s the last time you felt relaxed and refreshed? Can you imagine feeling refreshed & relaxed, clear-minded and rested on a regular basis? Tanked up? Ready to charge? Finding rhythm and downtime to recharge seems wildly counterproductive at first and like a luxury serious people can’t afford (or successful people… or people who are on the path to become successful). That’s what this podcast is about. This is about how to recharge yourself and be well. You can find space for this even during anesthesia training. It’s actually crucial that you do so. It will help you perform at your top level and crush school & clinical. You can find space for this even if you lead a busy life with kids & jobs and a never-done to-do list. It’s actually crucial that you do so. Brené Brown talks about in her research on vulnerability and shame, she “discovered” that people who rated their lives high on markers of life satisfaction and well-being all consistently engaged in unstructured time designed to rejuvenate themselves. It turns out she wasn’t the first person to realize this. Other researchers and sociologists have studied this and call it “play.” That’s right. Like playtime. Time set aside to do things for fun. Things that fill your cup, restore your energy and help you whether the demands of the rest of your life. That’s what this podcast is about. I originally put out what you’re about to hear in February of 2019 on the podcast From the Head of the Bed. In the show I mention taking van trips and that references the Sprinter van that my wife and I built out a few years ago as a camper van. You can hear more about that and how one SRNA converted an old ambulance into his home on wheels for grad school in episode #6 of Anesthesia Guidebook, titled Van Life in Anesthesia School with Marcus House. AANA Ask For Help website AANA Student Wellness website References: Tarantur, N., Deshur, M. (2018).  Anesthesia professional burnout – a clear and present danger.  APSF Newsletter. 33(2), 43-44.Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. AANA journal, 79(2). Chipas, A, Cordrey, D., Floyd D., Grubbs, L., Miller S., & Tyre B. (2012). Stress: perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists. AANA journal, 80(4), S49. De Oliveira, G. S., Chang, R., Fitzgerald, P. C., Almeida, M. D., Castro-Alves, L. S., Ahmad, S., & McCarthy, R. J. (2013). The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesthesia & Analgesia, 117(1), 182-193.  Raj, K. S. (2016). Well-being in residency: a systematic review. Journal of graduate medical education, 8(5), 674-684.  Hettler, B. (1976). Six dimensions of wellness model. National Wellness Institute. Retrieved from https://cdn.ymaws.com/www.nationalwellness.org/resource/resmgr/tools/SixDimensionsFactSheet_Tool.pdf.  Screenshot by author.Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Grant, A.  (2018, December 8).  What straight-A students get wrong.  The New York Times.  Retrieved from https://www.nytimes.com/2018/12/08/opinion/college-gpa-career-success.html

Josh Lea, DNP, MBA, CRNA and Kelly Gallant, PhD, MSN, CRNA join me to discuss workplace incivility in anesthesia training. We discuss the role of precepting SRNAs and anesthesia residents, root causes and implications of incivility and processes for improving healthy work environments.  Josh Lea, DNP, MBA, CRNA is a professor of anesthesia at Northeastern University’s Nurse Anesthesia Program and staff CRNA at Massachusetts General Hospital in Boston.  He serves on the board of the Anesthesia Patient Safety Foundation and focuses on burnout & creating healthy work environments as his area of research and publication. He has spoken extensively on the topics both nationally and internationally through his work with the Anesthesia Patient Safety Foundation and as a member of the American Association of Nurse Anesthetists (AANA) Health and Wellness Committee.  Kelly Gallant, PhD, SRNA completed her anesthesia training at Northeastern University in Boston. She received her Bachelor’s degree from Northeastern in 2010 and spent 8 years working in the surgical intensive care unit as a Registered Nurse while researching pediatric pulmonary hypertension and caregiver reactions as part of her PhD, which she completed at Northeastern in 2017. Kelly then returned to school to study anesthesia completing her Master of Science at Northeastern in May 2020. Kelly was the fiscal year 2019 SRNA Representative to the AANA Health & Wellness Committee. and also contributed to episode #52 – SRNA Wellness in COVID-19 of Anesthesia Guidebook. References: Elmblad, R., Kodjebacheva, G., & Lebeck, L. (2014). Workplace Incivility Affecting CRNAs: A Study of Prevalence, Severity, and Consequences With Proposed Interventions. AANA Journal, 82(6), 437–445. Katz, D., Blasius, K., Isaak, R., Lipps, J., Kushelev, M., Goldberg, A., Fastman, J., Marsh, B., & DeMaria, S. (2019). Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Quality & Safety, 28(9), 750–757. Neft, M., Hartgkidek, A., & Lea, J. (2017). Wellness milestone: The road to wellness: Paving the way toward a healthy work environment. AANA NewsBulletin. Mahoney, C. B., Lea, J., Schumann, P., & Jillson, I. (2020). Turnover, burnout, and job satisfaction of certified registered nurse anesthetists in the United States: Role of job characteristics and personality. AANA Journal, 88(1), 39-48. Mahoney, C. B., Lea, J., Jillson, I., & Meeusen, V. (2014). Turnover of nurse anesthetists: The similarities and differences between countries. BioMed Central Ltd. 14(2). Other Resources: Do you want to learn from APSF about patient safety? Easy. Just subscribe to the APSF Newsletter for FREE and connect with APSF on Twitter, Facebook, and LinkedIn. AANA Promoting a Culture of Safety and Healthy Work Environment: Practice Considerations PDF AANA Webpage on Bullying, Disruptive Behavior and Workplace Incivility AANA SRNA Wellness Need Help? Not sure? Check out AANA Ask For Help website. AANA Nurse Anesthesia Leadership Survival Guide PDF Do you have more questions about workplace incivility? Feel free and contact Joshua Lea, DNP, MBA, CRNA at [email protected], Kelly Gallant, PhD, MSN, CRNA at [email protected] or [email protected].  For concerns related to alcohol or other drugs, call the AANA Helpline at 1-800-654-5167 for 24/7 live confidential help.

In this podcast, Matt Zinder, MS, CRNA, CH walks us through a fifteen-minute guided relaxation session that is sure to leave you feeling refreshed and renewed. You should try this at home, on your lunch break or to help you go to sleep at night. Get to a place where you can close your eyes and tune out distractions. Hopefully, you’ll find yourself relaxed and refreshed, ready to move forward with renewed energy or simply fast asleep. Matthew Zinder, MS, CRNA, CH has worked in some level of healthcare for close to 25 years, starting as an EMT in a volunteer fire station. Matthew owns and operates the Maryland-based mobile anesthesia practice Zinder Anesthesia, LLC, that has been in business since 1984. It consists of 20 practitioners and covers 50 locations throughout the state of Maryland. Matthew speaks at many professional conferences, both nationally and internationally, involving topics such as stress management, business of anesthesia, hypnosis, and the practice of anesthesia. Matthew also has an active hypnotherapy practice that caters mainly to healthcare providers. He is the founder and director of Maryland Emergency Response, a disaster relief 501(c)(3) non-profit organization that works to aid victims following natural and/or man-made disasters. Matthew is currently the District IV director for the Maryland Association of Nurse Anesthetists. Check out episode #55 – How to Be Well During the Pandemic where Matt and I talk about the stress management and mindfulness for healthcare providers in more detail. Be well! Meditation apps: 10% Happier – healthcare providers get a free 6 month membership in light of the pandemic. 10% Happier has guided meditation and stress management content. Email [email protected], let them know you’re a healthcare provider and they will give you instructions for accessing the content. Insight Timer – 35,000 free guided meditations. Books (for your self-quarantined downtime): Why We Sleep by Matthew Walker, PhD 10% Happier by Dan Harris Meditation for Fidgety Skeptics by Dan Harris The Biology of Belief by Bruce Lipton Why Zebras Don’t Get Ulcers by Robert Sapolsky

Why Zebras Don’t Get Ulcers, by Robert Sapolsky is a book explaining the physiology of chronic stress and techniques for managing it. Sapolsky is a professor of biology and neurology at Stanford University. Matt Zinder recommends this book, saying, “It’s the seminal text on stress. This author describes to minute detail what stress is, what stress does to the body and ends with some techniques for managing stress.” Image retrieved from https://animals.desktopnexus.com/wallpaper/2068315/. This podcast was originally published on From the Head of the Bed on March 17, 2020. That was during the early stages of the COVID-19 pandemic. Now, in December 2021, as the pandemic has stretched out nearly 2 years, we’re revisiting Matt Zinder’s advice on how to be well and cope with the stress and change that the pandemic has brought. Matt walks us through several techniques for stress management and mindfulness in this podcast. This episode, and the one to follow, where Matt actually guides us through a 10-minute spoken meditation, are just as helpful if not more so now as they were nearly 2 years ago. Just this week, my local health system in Maine has been hit harder with COVID-19 patients than at any time in the pandemic. Our local level-1 trauma center is completely full with patients. We’ve suspended all surgical cases with the exception of true emergencies. Just today, we stood up an emergency ICU/IMC unit in one of our PACUs to help alleviate the strain on our regular ICU staff and build capacity. After each wave that comes & goes in the pandemic, another one seems to follow. This has resulted in fatigue, stress, burnout and frustration in many healthcare workers. Tens of thousands of healthcare works have either left their jobs or hit the travel circuit. The reasons they are motivated to quit or take travel assignments are complex and multifactorial. However, this phenomenon in the middle of the pandemic has exacerbated the staffing crisis and strained health systems to levels not seen in modern times. Responding to COVID-19 and its variants with vaccines, boosters and other therapies is crucial but only one part of addressing the broader healthcare crisis in the US. Systemic change is needed. Research shows that about 80% of individual burnout can be attributed to factors that need to be addressed at the organizational or system level. While it’s important to recognize that and put energy and attention into creating more functional organizations and healthcare systems, this podcast is about what we can do as individuals to bolster our resiliency during the pandemic. Matthew Zinder, MS, CRNA, CH has worked in some level of healthcare for close to 25 years, starting as an EMT in a volunteer fire station. Matthew owns and operates the Maryland-based mobile anesthesia practice Zinder Anesthesia, LLC, that has been in business since 1984. It consists of 20 practitioners and covers 50 locations throughout the state of Maryland. Matthew speaks at many professional conferences, both nationally and internationally, involving topics such as stress management, business of anesthesia, hypnosis, and the practice of anesthesia. Matthew also has an active hypnotherapy practice that caters mainly to healthcare providers. He is the founder and director of Maryland Emergency Response, a disaster relief 501(c)(3) non-profit organization that works to aid victims following natural and/or man-made disasters. Matthew has also served as the director for the Maryland Association of Nurse Anesthetists. Matt Zinder has made his email address public for questions, comments or speaking engagements: [email protected]   Meditation apps: 10% Happier – healthcare providers get a free 6 month membership in light of the pandemic. 10% Happier has guided meditation and stress management content. Email [email protected], let them know you’re a healthcare provider and they will give you instructions for accessing the content. Insight Timer – 35,000 free guided meditations. Books (for your self-quarantined downtime): Why We Sleep by Matthew Walker, PhD 10% Happier by Dan Harris Meditation for Fidgety Skeptics by Dan Harris The Biology of Belief by Bruce Lipton Why Zebras Don’t Get Ulcers by Robert Sapolsky

This episode speaks to why anesthesia school/residency is hard and what we as SRNAs, residents, program faculty, preceptors, CRNAs and physician anesthesiologists can do about it. Anesthesia training is hard because life is hard and doesn’t stop just because you enroll in an incredibly difficult program. Anesthesia school is also hard because anesthesia school is just really hard. Whether you’re a physician resident or SRNA, you have to learn to take an incredible degree of ownership for your actions and couple a voluminous depth of information with rapid, correct and highly skilled actions under time pressure in the clinical setting.  That’s anesthesia training! Do you need help working through the challenges of anesthesia school? Not sure if you need help? Check out the AANA’s website Ask For Help to find links to resources and context that clearly shows that SRNAs and providers alike are not alone when they face stress, burnout, frustration and challenges where professional help can be, well, helpful. You can also check out the AANA SRNA Wellness website for more content on finding a path towards peace of mind and wellness. Below are crucial numbers to know in order to get help or support those who are in crisis. Also, the full transcript to this podcast is in PDF format so you read on the go. And the link to Jocko Willink’s video “Jocko Motivation ‘GOOD’.” Be sure to watch that every morning you wake up during anesthesia training!! The Crisis Text Line is 741741… you can text anything to that number and a trained crisis volunteer will be on the other line: 24/7/365 for free! You can text if you’re a friend, preceptor or program faculty. You can text if you’re the one in crisis and need to talk (text) with someone to find the motivation to stay stay safe and get help. Hardship in Anesthesia School transcript PDFDownload BOOKS FOR YOU: Trevor Noah’s Born a Crime David Goggins’ Can’t Hurt Me Laura Hillenbrand’s Unbroken Jocko Willink’s Extreme Ownership

I originally released this podcast on April 4, 2020 to offer advice & encouragement to SRNAs who had been furloughed from clinical due to the COVID-19 pandemic. While elements of this show speak specifically to that context, the themes ring true for overcoming any set back during anesthesia school. At the time, our level 1 trauma center, along with hospitals across the nation, clamped down on all non-essential staff, removing medical students, nursing students, SRNAs and others from the clinical environment in order to reduce their risk of exposure to COVID-19 and reduce transmission rates in general. This was an unprecedented moment for SRNAs across the nation. Adrienne Chavez and Kelly Gallant and I talked about that on the last episode of Anesthesia Guidebook. They were SRNA representatives to the AANA Health & Wellness Committee at the time and shared their stories of what they were facing and how they were keeping their focus on moving forward as the pandemic spread worldwide. With anesthesia school, you gotta believe that the juice is worth the squeeze and keep your eyes on the finish line while finding ways to cope and be successful along the way. So again, while this show was originally focused on how SRNAs can deal with the set back of being furloughed from clinical because of the pandemic, the themes and advice I share is applicable to almost any set back you may be facing. So with that in mind, let’s get right to the show! References: Edmond Eger NYTimes Tribute: Grady, D.  (20 September 2017).  Dr. Edmond Eger II, 86, Dies: Found Way to Make Anesthesia Safer.  The New York Times.  Retrieved from https://www.nytimes.com/2017/09/20/obituaries/dr-edmond-eger-ii-86-dies-found-way-to-make-anesthesia-safer.html.Audio Player

This podcast was originally posted on April 13, 2020, in the early stages of the COVID-19 pandemic. At the time of this podcast both Kelly Gallant and Adrienne Chavez were SRNAs completing their anesthesia training. They have both completed their training and passed boards as CRNAs. This show continues to have value for SRNAs & anesthesia residents as the themes we discuss around wellness & resiliency remain as relevant as ever. At the time of this recording, Kelly and Adrienne were the immediate past and current SRNA Representatives to the American Association of Nurse Anesthestists’s Health and Wellness Committee, with Kelly serving in 2019 and Adrienne in 2020. I caught up with them to discuss how SRNAs were facing the challenges and concerns of the COVID-19 pandemic as well as resources that Kelly and Adrienne created, along with the rest of the Health & Wellness Committee, that are available on aana.com. Kelly Gallant, PhD, SRNA is wrapping up her training this spring at Northeastern University in Boston. She received her Bachelor’s degree from Northeastern in 2010 and spent 8 years working in the surgical intensive care unit as a Registered Nurse while researching pediatric pulmonary hypertension and caregiver reactions as part of her PhD, which she completed at Northeastern in 2017. Kelly then returned to school to study anesthesia and will graduate from Northeastern’s Nurse Anesthesia program with her Master of Science in May 2020. Kelly was the fiscal year 2019 SRNA Representative to the AANA Health & Wellness Committee. Adrienne Chavez, BSN, SRNA is currently training at the University of Maryland. Adrienne received two Bachelor’s of Science degrees from the University of Maryland, one in psychology and the other in nursing. She is currently enrolled in the University of Maryland’s Doctor of Nursing Practice program with an anticipated graduation date of May 2021. Most recently she worked at the National Institutes of Health as a critical care Registered Nurse. She is the fiscal year 2020 SRNA Representative to the AANA Health & Wellness Committee. Resources from the AANA Health & Wellness Committee: aana.com/covid19 – AANA developed this great resource which has answers to questions SRNAs and CRNAs are asking. The website is constantly updated to include the latest news & information relevant to the current pandemic with topics including clinical practice, critical care management, COVID-19 employment issues, the SRNA experience and more. AANA COVID19 Well-being. This site includes CRNA-produced content on wellness related to the current pandemic, including other  podcasts and Aly McLean, CRNA’s “Mindfulness while wearing an N95 mask” video, which is also linked here. aana.com/thriveThe THRIVE initiative provides resources for the general public and AANA members in regards to career transitions related to the CRNA role. RNs looking to become nurse anesthesia students, new graduate CRNAs looking for their first job, transitioning in mid- to late-career, and retirement are all covered with a multitude of resources.  AANA COVID19 Infographic:  https://www.aana.com/docs/default-source/marketing-aana-com-web-documents-(all)/2020_ppr02_flyer_corona_wellbeing_v6.pdf?sfvrsn=e6e394ca_4

This is one of my favorite podcasts that I’v recorded. If you’ve had the privilege of working with or getting to know Dr Christine Hein, MD, – or once you listen to this podcast – you’ll know why! Christine Hein, MD is an emergency medicine physician and the Chief Wellness Officer at Maine Medical Center, Maine’s only level 1 trauma center and academic teaching hospital. We recorded this episode in August of 2017 when Dr Hein was developing the Provider Well-being and Peer Support program at MMC. Since that time, the well-being program has grown substantially with continued support from the medical center and numerous volunteers. Maine Medical Center made a substantial statement of supporting provider wellness by establishing the Chief Wellness Officer position and Dr Hein was selected to serve as the first Chief Wellness Officer. She’s in the trenches as an emergency medicine physician and actively engaged in resident education. She’s an absolute master at all things related to provider wellness, a wife and mother of 5 kids and an elite distance runner. She has somehow found a way in her professional life to maintain a since of joy & optimism that is truly authentic and infectious. It’s like she walks around just spilling joy everywhere; she’s like an overflowing glass of water just sloshing a refreshing positive vibe wherever she goes, leaving the rest of us better off for having interacted with her. Yet that vibe is not some shallow surface level corporate smile campaign. With Christine, it’s actually rooted deep in a career as an emergency medicine provider and as a proficient healthcare leader & administrator. She’s someone who’s been in the arena, with her face mared by dust & sweat & blood*, to borrow from Theodore Roosevelt’s speech. And it’s from her personal story as an emergency medicine physician and from some dark places in her personal life – which she talks about in this episode – that she’s developed this deep desire to improve the lives of other healthcare providers around her through her work on provider wellness. So all that comes through in this episode. That’s who were talking to today. You’re going to love it. And not only that, but we also had the immense pleasure of being joined for this discussion by Dr Hein’s daughter, Ms Abby Irish. This is the first time that a guest has brought one of their children along to a podcast recording and that, again, speaks to how important this topic is to Dr Hein and one of the reasons why I love this episode. At the time of this recording Abby was an 8th grader who was interested in becoming a physician. She had just finished surgery summer camp in Boston and talks about her experience at the start of the show. We run the gamut of provider wellness in this conversation. We discuss burnout, wellness, resiliency, organizational drivers of burnout and ways hospitals, med schools & anesthesia programs can build structural components to eliminate burnout and foster well-being. We talk about peer support & how that’s different than professional counseling. We touch on substance abuse, suicide and the stigma of mental health concerns and getting help & support. We share personal stories from our careers and those of others that bring these concepts to life and give them real traction. As healthcare providers, we spend an incredible amount of time, energy and money becoming highly qualified in our fields yet rarely create space for deliberately developing a sense of well-being in our professional and personal lives. We should remember that as health is more than the absence of disease, joy in work is more than the absence of burnout. We owe it to ourselves, our colleagues and our patients to be whole people, grounded in a deep sense of well-being. This show explains why doing that matters and gives actionable steps we can take to minimize burnout and foster joy in our work. One more thing before I introduce you to Dr Hein and Abby: we discuss a shocking statistic that 300-400 physicians commit suicide each year in the United States. That’s 1 to 2 medical school classes of physicians each year. It’s remarkable. I had a classmate in anesthesia school who took her own life and last year a SRNA reached out to talk after her roommate and classmate took her life just months before the end of their program. Research shows that upwards of 21% of SRNAs experience suicidal ideation during their training. If that’s you, or someone you know, I want you to know that you’re not alone and there’s a wealth of resources created by people who understand what you’re going through and who care deeply about your wellbeing and safety. I’ve got links in the show notes to people you can call or even text. The Crisis Text Line is 741741. You can text any message to the number 741741

I’m joined today by Nate & Lien Woodin who are married and the parents of two boys – aged 6 & 9 as this show comes out on the first of October 2021. If you’re a critical care nurse, medical student, resident or SRNA – or a spouse or partner to one of these folks – and you’re wondering how to hold it together as a parent & partner during anesthesia training or even if it’s possible for you to go back to anesthesia school – this podcast is for you!  We don’t hit a list of bullet points on this one.  There’s no simple how-to here.  Instead, we walk through Lien & Nate’s story and in it you’ll find some incredible insights of how they prepared for anesthesia school, parented during anesthesia school and stuck together as a couple all the way through.   Lien just wrapped up her Master’s of Nursing in Anesthesia at the University of New England a couple of weeks ago and decided to go back to school after working as a nurse for 20 years – 17 of which were as a critical care nurse in a cardiothoracic intensive care unit.  Nate is a Licensed Marriage and Family Therapist who focuses his practice on child & adolescent therapy.  He completed his Bachelor of Arts in Psychology at the University of New Hampshire in 2000 and his Master’s of Arts in Marital & Family Therapy from the University of San Diego in 2007.  He completed a post-master’s Certificate of Studies in Play Therapy in 2009 from the University of California, San Diego.   Lien worked as a critical care Registered Nurse at Maine Medical Center and came back to train for a couple of months with the anesthesia team at Maine Med, where I work as the SRNA Clinical Coordinator.  We got to spend a few days in the OR together and that’s where I first heard snippets of her story.  When she talked about how hard it was to make the decision to go back to school after working as an ICU nurse for 20 years, how her & Nate have a son with PANDAS which encompasses a set of neuropsychiatric disorders and how Nate is a child & family therapist who Lien always bragged about as being such a huge support to her as a SRNA and their boys, I knew I wanted to get them on the podcast and hear more about their story.  And it’s a remarkable story.  I think you’ll really enjoy hearing it.   A couple other things before we get to the show…  Lien was in the same class as Robert Montague. You may remember Robert and his wife Jenny from episode 15 titled “Significant Others and Anesthesia School.” That episode came out in December of 2020. Robert also just successfully passed boards and became a CRNA along with Lien. He and Jenny are doing well and are also enjoying life after anesthesia school. I think both this and that podcast would be key shows to listen to if you’re considering going back to anesthesia school as parents – or if you’re in an anesthesia program or residency now and need a little encouragement to keep going and find ways to make it work. They’re great shows for you and your partners. There’s never really a good time to go to anesthesia school and having a significant other and kids can make the process very challenging. And while both of these families have found ways to thrive during their programs, others are frankly not. For, I think the first time ever on the podcast, in this episode, I talk a little about my own path in anesthesia school which involved going through a divorce in the fist six months as well as meeting my wife in the program who I now share a life with along with our 3-month old son and how helpful marriage therapy has been for both of us. I know other SRNAs who are either in or have gone through extremely challenging family situations including the loss of a child, or a partner, severe illnesses, trauma & surgery, ugly divorces, restraining orders, physical & emotional abuse and more. For those of you out there who are struggling I want you to know that you’re not alone and that help is available. The AANA has a wealth of resources available that I’ll link to in the show notes. There’s also a free 24-hour Crisis Text Line if you need support right now… you can text anything to the number 741741 and a trained counselor will reach out with support over text. You can also find support at your university or hospital through wellness committees and student or employee health services… there are usually always free, confidential counseling & therapy resources available. Don’t struggle alone. Reach out to one of these resources. Get help. It’s a very human thing to do. And hopefully you’ll find a little hope & encouragement through Lien & Nate’s story… Resources: AANA SRNA Wellness Crisis Text Line text “hello” or “help” or whatever to 741741 and a trained counselor will respond. It’s free and it’s over text.

This episode was originally published in April 2019 on From the Head of the Bed… a podcast for the anesthesia community. In this podcast, Skyler provides a thorough overview of local anesthetics including relevant anatomy and physiology (i.e. nerve fibers, sodium channels, pKa, etc), types of local anesthetics and factors that effect onset, potency, duration of action and absorption. We touch on methemoglobinemia, Local Anesthetic Systemic Toxicity (LAST) and common dosing and max dosing for local anesthetics. This is a great run down for anyone wanting to brush up on local anesthetics! At the time of this recording, Skyler Rouhselang was a second-year SRNA at Marian University in Indianapolis, IN. She attended Ball State University for her undergraduate education where she earned her BSN in 2013. Skyler went on to work in the medical ICU at a level 1 trauma center in downtown Indianapolis for 5 years before returning to school to complete her Doctor of Nursing Practice degree. Skyler has married and changed her name to Skyler Williams, DNP, CRNA. As of September 2021, Dr Williams practices anesthesia as a CRNA at IU Health Arnett Hospital in Lafayette, IN. Resources Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.  Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.

This episode was originally published in April 2019 on From the Head of the Bed… a podcast for the anesthesia community. In this podcast, Ashley walks us through an overview of the most common IV anesthesia induction agents. We cover propofol, ketamine, etomidate, barbiturates (e.g. methohexital), dexmedetomidine and benzodiazepines (e.g. midazolam). A run down of the mechanism of action, dosing, onset, metabolism and physiologic effects are provided. This is an excellent introduction to these common medications and how to utilize them as part of a routine IV induction of anesthesia. Ashley Scheil earned her BSN from Purdue University in 2012. She worked as a critical care Registered Nurse in the surgical ICU at the Roudebush VA Medical Center in Indianapolis for 6 years before going back to anesthesia school to earn her DNP at Marian University in May of 2020. Dr Scheil, DNP, CRNA practices anesthesia at IU Health Arnett Hospital as of September 2021. Resources Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Cohen, L., Athaide, V., Wickham, M. E., Doyle-Waters, M. M., Rose, N. G., & Hohl, C. M. (2015). The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Annals of emergency medicine, 65(1), 43-51. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier. Morris, C., Perris, A., Klein, J., & Mahoney, P. (2009). Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?. Anaesthesia, 64(5), 532-539. Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.Audio Player

This episode was originally released in April 2019 on From the Head of the Bed… a podcast for the anesthesia community. In this podcast, Skyler walks us through the pharmacodynamics of volatile anesthetics. We talk extensively about the concepts related to minimum alveolar concentration (MAC), the mechanism of action of volatile anesthetics and the physiologic response to volatiles. You don’t want to miss this excellent overview of core anesthesia concepts! At the time of this recording, Skyler Rouhselang was a second-year SRNA at Marian University in Indianapolis, IN. She attended Ball State University for her undergraduate education where she earned her BSN in 2013. Skyler went on to work in the medical ICU at a level 1 trauma center in downtown Indianapolis for 5 years before returning to school to complete her Doctor of Nursing Practice degree. Skyler has married and changed her name to Skyler Williams, DNP, CRNA. As of September 2021, Dr Williams practices anesthesia as a CRNA at IU Health Arnett Hospital in Lafayette, IN. References Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.  Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.

This episode was originally released in April 2019 on From the Head of the Bed… a podcast for the anesthesia community. In this podcast, Skyler gives a succinct run down on the pharmacokinetics of volatile anesthetics. We talk about uptake, distribution, elimination and metabolism and unpack concepts such as blood gas solubility, oil gas solubility, Fa/Fi curves and more. You don’t want to miss this excellent overview of core anesthesia concepts! At the time of this recording, Skyler Rouhselang was a second-year SRNA at Marian University in Indianapolis, IN. She attended Ball State University for her undergraduate education where she earned her BSN in 2013. Skyler went on to work in the medical ICU at a level 1 trauma center in downtown Indianapolis for 5 years before returning to school to complete her Doctor of Nursing Practice degree. Skyler has married and changed her name to Skyler Williams, DNP, CRNA. As of September 2021, Dr Williams practices anesthesia as a CRNA at IU Health Arnett Hospital in Lafayette, IN. References Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.  Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences

In this episode, which was originally released in April of 2019 on From the Head of the Bed… a podcast for the anesthesia community, Ashley provides an incredibly detailed run down of the anesthesia machine: the flow of gas through the machine, high, intermediate and low pressure system components in the machine, variable bypass vaporizer structure & function, relevant gas laws, safety systems & features and more! If you’re an anesthesia learner just hitting the ORs, this show will give you a detailed run down on what you need to know to use the anesthesia machine. If you’re a seasoned provider and clinical educator/preceptor, this show provides a wonderful reminder of core information on the machine so you can best support your learners. Ashley Scheil earned her BSN from Purdue University in 2012. She worked as a critical care Registered Nurse in the surgical ICU at the Roudebush VA Medical Center in Indianapolis for 6 years before going back to anesthesia school to earn her DNP at Marian University in May of 2020. Dr Scheil, DNP, CRNA practices at IU Health Arnett Hospital as of September 2021. Resources E – Cylinder Calculation Amount of oxygen in cylinder in liters divided by liters of flow: At full pressure (1900 PSI): 660 liters / 3 lpm = 220 minutes of O2. At half pressure (950 PSI): 330 liters / 10 lpm = 33 minutes of O2. Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.  Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.

In this episode, Ashley and I talk through how to set up an operating room anesthesia workstation, perform a preoperative patient assessment and progress through an IV induction and intubation. You’ll hear Ashley walk you through everything from how to do a quick machine set up, where to put your tape, how to introduce yourself to patients & work through a preop assessment and how to proceed from getting in the door of the OR through getting the tube where you want it to go after induction. This is a great podcast to help SRNAs and other anesthesia learners to get their clinical flow down! Ashley Scheil earned her BSN from Purdue University in 2012. She worked as a critical care Registered Nurse in the surgical ICU at the Roudebush VA Medical Center in Indianapolis for 6 years before going back to anesthesia school to earn her DNP at Marian University in May of 2020. Dr Scheil, DNP, CRNA practices at IU Health Arnett Hospital as of September 2021. Resources Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education. Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.  Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.

Ben Levin, MD This podcast was the last episode I published on From the Head of the Bed and originally came out on July 4, 2020. In August of that year, I launched Anesthesia Guidebook and this episode is being re-released on September 16, 2021. In this episode, I have the privilege of speaking with Ben Levin, MD on the perioperative management of patients with left ventricular assist devices (LVADs) for non-cardiac surgery. This is your podcast if you’re looking for a refresher or quick overview of managing patients with LVADs as an anesthesia provider! We discuss how LVADs work, why people have them, the differences between LVADs as bridge to transplant or destination therapy and crucially, how to manage these patients perioperatively during non-cardiac surgery with special emphasis on monitoring and hemodynamic management. Dr Levin received his Master’s of Science in biomedicine and his medical degree from Tufts University Medical School. He completed his anesthesia residency at Maine Medical Center in Portland, Maine in 2020 and recently returned to MMC after completing a fellowship in critical care at Massachusetts General Hospital. His clinical areas of interest include cardiovascular surgery and critical care, echocardiography and mechanical circulatory support devices. Dr Levin provided a PDF of a presentation on LVADs he gave as his senior project during his residency and you can find that below. It’s got all the references, studies, graphs, management algorithms, chest xrays and device pictures you could want to make this info sink in. LVADs-with-Ben-Levin-PDFDownload References Rogers, J. G., Butler, J., Lansman, S. L., Gass, A., Portner, P. M., Pasque, M. K., … & INTrEPID Investigators. (2007). Chronic mechanical circulatory support for inotrope-dependent heart failure patients who are not transplant candidates: results of the INTrEPID Trial. Journal of the American College of Cardiology, 50(8), 741-747. Rose, E. A., Gelijns, A. C., Moskowitz, A. J., Heitjan, D. F., Stevenson, L. W., Dembitsky, W., … & Watson, J. T. (2001). Long-term use of a left ventricular assist device for end-stage heart failure. New England Journal of Medicine, 345(20), 1435-1443.

This episode was originally released on From the Head of the Bed on March 3, 2019 and recorded in Scottsdale, Arizona. Tom Baribeault, DNP, CRNA and Jayme Reuter, MS, CRNA talk with me about opioid free anesthesia. We discuss the progression to opioid free anesthesia (OFA), where OFA fits into enhanced recovery programs and the specific techniques of how to provide a comfortable, opioid-free perioperative experience for our patients. Find out more about the Society for Opioid Free Anesthesia, including a resource-filled members-only section of their website which includes overviews of pharmacological alternatives to opioids and specific opioid-free anesthetic plans. At the time of this recording, Tom Baribeault was the Chief CRNA at Lexington Surgery Center in Lexington, Kentucky. He completed his anesthesia training at Case Western Reserve University. Tom has a passion for teaching anesthesia providers and others on opioid-free anesthesia, enhanced recovery after surgery, ultrasound guided regional anesthesia and point of care ultrasound. He is the president and founder of the Society for Opioid Free Anesthesia and is a member of the American Association of Nurse Anesthetists and the Kentucky Association of Nurse Anesthetists. Since this recording, Tom completed his Doctor of Nursing Practice Jayme Reuter, MS, CRNA is the Program Director and founder of Cornerstone Anesthesia Conferences. She completed her anesthesia training at Baylor College of Medicine and practices at Houston Methodist Hospital, which is part of Texas Medical Center. She created Cornerstone Anesthesia Conferences in 2017 with a mission to be the foundation for excellence in continuing anesthesia education.

This episode was originally released in April of 2020 on From the Head of the Bed… a podcast for the anesthesia community and is being re-released on 5 September 2021 on Anesthesia Guidebook. In this episode, I speak with Shane Garner, MS, CRNA, NSPM-C about an introduction & overview of regional anesthesia. We discuss: opioid-free anesthesiahow to gain experience in regional anesthesia as a SRNA or CRNAfellowships in pain management available to CRNAs the Non-Surgical Pain Management (NSPM) board examinationhow to start a block program and gain surgeon buy-inExparel (bupivacaine liposome injectable suspension)when to use regional anesthesia catheters and more! Shane Garner, MS, CRNA, NSPM-C Shane Garner is a CRNA who works in Ripon, Wisconsin and is passionate about teaching anesthesia providers on personal finance as well as regional anesthesia.  He has a Bachelor of Science in Nursing from the University of Minnesota and graduated from Rosalind Franklin University with his Master of Science in Nurse Anesthesia in 2012.  He went on to complete a fellowship in Advanced Pain Management at the University of South Florida before becoming board certified in Nonsurgical Pain Management through the NBCRNA. Shane is an adjunct faculty member at the University of Alabama at Birmingham’s nurse anesthesia program and regularly instructs with Twin Oaks Anesthesia & Cornerstone Anesthesia Conferences. Resources: University of South Florida Advanced Pain Management Fellowship NBCRNA Non-Surgical Pain Management Board Exam

Study Link: http://depaul.qualtrics.com/jfe/form/SV_9Y32tyhtj6i8GZU Nicole Kellogg, BSN, SRNA and Elizabeth Fullford, BSN, SRNA join me to discuss the anesthetic considerations for cannabis users. This podcast is part of a study they’re conducting on the efficacy of an educational podcast for SRNAs and CRNAs. PLEASE COMPLETE THE PRE-SURVEY AND POST-SURVEY HERE. The study will be live through the end of October 2021. At the time of this episode’s publication (1 September 2021) Elizabeth Fulford & Nicole Kellogg were third-year anesthesia trainees at the NorthShore University HealthSystem School of Nurse Anesthesia.  Elizabeth Fulford, BSN, SRNA received her undergraduate degree from Michigan State University in 2011. Prior to anesthesia school, Liz primarily practiced in pediatric ICUs and also adult post-anesthesia care units in several states throughout the country.  She is an avid skier and enjoys camping with her husband Sean and fur child, Mandy. Nicole Kellogg’s, BSN, SRNA nursing background was in rapid response and in a medical-cardiac intensive care unit.  She lives in Geneva, Illinois with her husband and two young kids and says fulfilling her dream of becoming a CRNA would not be possible without her family.   Nicole Kellogg, BSN, SRNA Elizabeth Fullford, BSN, SRNA Below are the outline with citations of the podcast discussion plus the full bibliography. FULFORD-KELLOGG-Podcast-Show-NotesDownload References Alexander, J. C., & Joshi, G. P. (2019). A review of the anesthetic implications of marijuana use. Proceedings – Baylor University Medical Center, 32(3), 364-371. doi:10.1080/08998280.2019.1603034. Drug Enforcement Agency. (n.d.). Controlled Substance Schedules.https://www.deadiversion.usdoj.gov/schedules/#:~:text=Some%20examples%20of%20substances%20listed,methylenedioxymethamphetamine%20(%22Ecstasy%22). Echeverria-Villalobos, M., Todeschini, A. B., Stoicea, N., Fiorda-Diaz, J., Weaver, T., & Bergese, S. D. (2019). Perioperative care of cannabis users: A comprehensive review of pharmacological and anesthetic considerations. Journal of clinical anesthesia, 57, 41-49. doi:10.1016/j.jclinane.2019.03.011 Flanagan, B. (2021). Harnessing the Endocannabinoid System: What It Means for the Anesthesia Provider. AANA Journal 89(3), 261-268.  Holmen, I. C., Beach, J. P., Kaizer, A. M., & Gumidyala, R. (2020). The association between preoperative cannabis use and intraoperative inhaled anesthetic consumption: A retrospective study. Journal of clinical anesthesia, 67, 109980-109980. doi:10.1016/j.jclinane.2020.109980 Horvath, C., Dalley, C. B., Grass, N., & Tola, D. H. (2019). Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations. AANA Journal, 87(6), 451-458. Huson, H. B., Granados, T. M., & Rasko, Y. (2018). Surgical considerations of marijuana use in elective procedures. Heliyon, 4(9), e00779-e00779. doi:10.1016/j.heliyon.2018.e00779. Salottolo, K., Peck, L., Tanner Ii, A., Carrick, M. M., Madayag, R., McGuire, E., & Bar-Or, D. (2018). The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient safety in surgery, 12(1), 16-16. doi:10.1186/s13037-018-0163-3. Twardowski, M. A., Link, M. M., & Twardowski, N. M. (2019). Effects of Cannabis Use on Sedation Requirements for Endoscopic Procedures. The Journal of the American Osteopathic Association, 119(5), 307. doi:10.7556/jaoa.2019.052

In this episode you’re going to hear from Shane Garner, MS, CRNA, NSPM-C on the 5 Keys for Achieving Financial Independence. This show was originally released in April of 2020 on From the Head of the Bed and I’m pulling it forward to Anesthesia Guidebook on August 30, 2021. I’m pumped Shane brought this intel to the podcast… anesthesia providers are high income earners but it’s rare to see any formal training on financial literacy as part of core medical & nursing education or during anesthesia training programs.  CRNAs & physician anesthesiologists get out and make great money but often fail to apply basic financial principals like living below your means, becoming debt free and saving & investing for the future.  It sounds like boring stuff but these are some of the keys that will create freedom and peace of mind for your future.  If you apply a fraction of what you’ll hear in the next 30 minutes, you’ll set yourself on a trajectory you can truly be stoked about and you’ll thank yourself down the road.  You owe it to your future self to check this episode out and apply what you hear. The 5 Keys to Financial Independence are 1. Set goals to live below your means. 2. Pay yourself first. 3. Avoid debt. 4. Invest in low cost index funds. 5. Educate yourself. Shane Garner is a CRNA who works in Ripon, Wisconsin and is passionate about teaching anesthesia providers on personal finance as well as regional anesthesia.  He has a Bachelor of Science in Nursing from the University of Minnesota and graduated from Rosalind Franklin University with his Master of Science in Nurse Anesthesia in 2012.  He went on to complete a fellowship in Advanced Pain Management at the University of South Florida before becoming board certified in Nonsurgical Pain Management through the NBCRNA. Shane is an adjunct faculty member at the University of Alabama at Birmingham’s nurse anesthesia program and regularly instructs with Twin Oaks Anesthesia & Cornerstone Anesthesia Conferences.   Shane Garner, MS, CRNA, NSPM-C Resources The White Coat Investor The Bogleheads‘ Guide to Investing (book) The Simple Path to Wealth (book) The Millionaire Next Door (book)

Dr Matthew Willis is the CRNA who created and produces the educational app Master Anesthesia, which is available from the App Store and Google Play Store. I’ve been using this app for the last several months and I’m super impressed at a few things: it’s packed with real-world information that’s evidence based from case tips to pharmacologythe calculator is amazing… it’s so easy to use and gives you all the information you really need super fast.. more on that in just a secMatthew has made crowd-sourcing the continued build of the app super easy… he’s looking for people to contribute so the quality and scope of the app will continue to improve as more people make contributions.  It’s like a curated wikipedia app focused specifically on anesthesia content.  And you get recognition in the app for your contributions.  And lastly, the app is 100% free!  My other go-to anesthesia app cost me $100 and it only gives me half the information Master Anesthesia does.  I’d have to pay another $100 for access to the coexisting disease information.    I can’t say enough about how significant it is that Matthew has kept this app completely free for the anesthesia community and he continues to dump an incredible amount of personal time building it despite having a full time job and a family.  The Master Anesthesia app is quintessential free open access medical education or FOAM… a concept I recently talked about on the podcast in episode #34.  FOAM removes pay walls and financial barriers so healthcare providers – and importantly students and residents – can access leading content for free.  For the first 30 minutes of the discussion, we unpack the app and its features and in the back half of the interview, Matthew discusses how he started the app as his DNP project and what fuels his motivation now. So the app features a run down on common surgeries, pathologic conditions, anesthesia-related drugs and a super high-powered calculator.  This calculator is unlike anything I’ve seen; it really is unique.  It tells you everything from common vital signs, airway device sizing, tidal volumes, drug & fluid calculations and local anesthetic dosing all based on the weight and/or height of your patient.  The local anesthetics dosing also does combined medication dosing so you can rapidly see the remaining maximum dose amounts and volumes based on what’s already been given for any concentration of local you plan to give.  It’s amazing… if you only get the app to use the calculator, it would be worth your time & effort. Matthew Willis, DNP, CRNA has a background in finance, web and mobile design. He received his undergraduate degree in nursing from Boise State University in 2014 and completed his doctor of nursing practice and anesthesia training at the Louisiana State University Health Sciences Center in 2019. He currently works as an independent anesthesia provider in Iowa and has a wife and 4 children. I reached out to Matthew after I made suggestion on content within the app and he graciously agreed to come on Anesthesia Guidebook to share his story. Again, Matthew currently is not making any revenue off Master Anesthesia and I have no financial connection with Matthew or this app… this episode is just good ole’ storytelling with no conflicts of interest. App Store Link:  https://apps.apple.com/app/id1550793078#?platform=iphone Google Play Link: https://play.google.com/store/apps/details?id=com.masteranesthesia Website Link: Landing Page Facebook Group Link:  https://www.facebook.com/groups/masteranesthesia

This episode is coming out on August 21, 2021 but it FIRST came out way back on September 19, 2015.   The show is on emotional intelligence of SRNAs with Dr Shawn Collins, DNP, PhD, CRNA. At the time of the interview, Dr Shawn Collins was the nurse anesthesia program director and the interim dean of the College of Health & Human Sciences at Western Carolina University (WCU).  I was super early in developing the podcast From the Head of the Bed and was actually still a SRNA at WCU even though the show was published after I graduated.  In the show, Dr Collins will walk us through what emotional intelligence is and how, if harnessed, can impact your work as an anesthesia trainee and provider.   I think emotional intelligence is central to human behavior, relationships and success in whatever you’re doing… it’s about how we relate to one another.  I love how Dr Collins talks about getting a bird’s eye view of any situation you’re in and reading the emotional state of the other people around you.  Exercising emotional intelligence is often about learning how to walk through your life with this third-person view point of the situations you’re in.  It’s about understanding where other people are at, where they’re coming from, what their biases & goals might be and adapting your interaction with them to get you both – or a whole team of people – moving in the direction you want.  It’s thinking about: who is this person, where are they coming from, what might their hopes, dreams, fears or concerns be right now, how do they perceive me, who do they think I am – who am I FOR REAL – where am I headed, what are my goals and how can I tailor my interaction with this individual, in the context of all this, to get us both moving where we need to go.  This is every day stuff for anesthesia providers.  Emotional intelligence, when harnessed, will make your interactions with patients so much better and more meaningful.  It’ll help you deal with surgeons, OR nurses, CSTs, hospital administrators, preceptors, your boss, your trainees & students with greater skill & efficacy.  Emotional intelligence is like a key that unlocks an incredibly powerful, supercharged tool in relationships and it will help create success for you in whatever stage of your career or, for that matter you marriage or dating relationships or business partnerships, that you’re in.   Dr Collins completed his master’s in anesthesia at Erlanger Medical Center at the University of Tennessee Chattanooga, his doctor of nursing practice degree at Rush and his PhD in leadership at Andrew’s University.   Dr Collins is currently the associate dean for academic affairs and graduate studies for Loma Linda University’s School of Nursing, where he supports 2 master’s programs, a PhD program and 8 clinical doctorates.  He was the program director when I attended WCU and was instrumental in helping my classmates and I launch the podcast From the Head of the Bed, serving as our project chair and one of the co-authors of the paper we published on social media in nurse anesthesia education in the AANA Journal.  Without him giving us a huge GREEN LIGHT and a lot of support & guidance along the way, From the Head of the Bed, and therefore this podcast would not exist…  And with that, let’s get to the show….  Resources Collins S. Emotional Intelligence as a Noncognitive Factor in Student Registered Nurse Anesthetists. AANA Journal [serial online]. December 2013;81(6):465-472. Available from: Academic Search Complete, Ipswich, MA. Accessed September 19, 2015. Collins S, Andrejco K. A longitudinal study of emotional intelligence in graduate nurse anesthesia students. Asia Pac J Oncol Nurs [serial online] 2015 [cited 2015 Sep 19];2:56-62. Available from: http://www.apjon.org/text.asp?2015/2/2/56/157566 Kristin Andrejco was a co-author, along with Dr Collins, of the above study published in the Asia Pacific Journal of Oncology Nursing. She helped create From the Head of the Bed and still exerts a bit of influence on Anesthesia Guidebook under her new name.

This episode originally appeared on the podcast From the Head of the Bed on August 6, 2015. It’s re-released here on August 17, 2021. Dr Shawn Collins, DNP, PhD, CRNA and I discuss the transition from Master’s level training for CRNAs to practice doctorates, most commonly the Doctor of Nursing Practice degree or DNP. Every CRNA program must transition to the doctorate level for new classes by January 1, 2022, with every SRNA graduating from doctorate level training by 2025. Most of the 124 CRNA programs in the US have already transitioned to doctorate degrees, with some having done so more than a decade ago. Dr Collins and I discuss why CRNA training transitioned from the master’s level to the doctoral level and what this means for education, clinical practice and business. Beginning the fall of 2019, the Council on Accreditation of Nurse Anesthesia Educational Programs, which sets the standards for university programs, began revising those standards based upon recommendations from a “Full Scope of Practice Competency Task Force.” The COA updated several standards and requirements of CRNA doctorate programs including increasing the number of required anesthesia cases, mandating specific training in the use of point of care ultrasound for diagnosis and therapeutic interventions, 12-lead ECG interpretation, radiology & flouroscopy use, chest X-ray interpretation and more. You can read about these changes and the specific requirements for CRNA doctoral programs at the COA’s website. At the time of the interview, Dr Shawn Collins was the nurse anesthesia program director at Western Carolina University and the interim dean of the College of Health & Human Sciences.   He was the program director when I attended WCU and was a huge source of encouragement and support to me personally as I ran the gauntlet of anesthesia training. He was also instrumental in helping my classmates and I launch the podcast From the Head of the Bed, serving as our project chair and one of the co-authors of the paper we published on social media in nurse anesthesia education in the AANA Journal. Dr Collins has obtained both his doctor of nursing practice degree and his PhD and compares these degrees, along with other types of doctoral programs, in this podcast. He was instrumental in developing the DNP program at WCU, transitioning the master’s-level nurse anesthesia program to a practice doctorate.  Dr Collins is currently the associate dean for academic affairs and graduate studies for Loma Linda University’s School of Nursing, where he supports 2 master’s programs, a PhD program and 8 clinical doctorates. 

This podcast follows up on the previous show which discussed free open access medical education (FOAM) and the use of social media in anesthesia education. Here, I discuss the power of asynchronous learning to shape the future of anesthesia education. The power of asynchronous learning comes from the ability of content experts to produce something truly informative and engaging once and then make that widely available to learners over a prolonged span of time. The opportunity, the chance, the potential of asynchronous learning is to harness the best educators and minds to create engaging content to help raise the level of expertise of providers while reducing the upfront workload and cost of producing that content. Asynchronous learning challenges traditional paradigms of education. It brings up numerous questions for us to consider… Why does every university need to have an expert in pharmacology on campus to deliver semester-long courses on anesthesia pharmacology year after year? Why do universities struggle to find and retain content experts when they could harness the power of asynchronous education to share a library of the best resources for cheaper tuition? Why do universities, who charge astronomical tuition fees, then require their students to purchase third-party board preparation programs?  Shouldn’t the tens of thousands or even hundreds of thousands of dollars in tuition be enough to get students successfully over the hurdle of boards? Why are continuing education conferences so boring and expensive? Why do continuing education conferences rarely improve clinical skills or change practice?  Why are thousands of grand rounds presentations given every year across the US and only a very select few individuals who happen to show up hear what leading experts are saying? Why does it take on average 17 years for new evidence to find its way into widespread practice? Why do we too often put profits ahead of advancing our field and improving access to patient care? We have the opportunity to redesign the way we do education in the future.  Harnessing technology to maximize the benefit of asynchronous learning can reduce costs and likely make education more efficient and effective. Some of you are today’s thought leaders and content creators.  Some of you will be the content creators, professors, educators and clinical experts of the future.  How will you step into those roles?  How will you harness the technology available to us to create more compelling, more interesting and effective learning tools? These are the questions that will help us redefine what is possible in the way we train anesthesia providers and build better continuing education.

Free open access medical education – or FOAM – is any medical educational content that’s shared freely on open access platforms, meaning the public can consume it without having to be a member of an organization or pay a subscription fee.  The reason it’s significant is that it brings evolving science & literature – and discussions around the art & science of medicine – into the hands of providers without the traditional paywalls that trade associations or peer-reviewed journals put up between you & their content in order to fund their work.  FOAM is all about the accessibility of information and given the rapid pace at which medical information evolves and podcasts, blogs & online journals can be updated, FOAM helps shape conversations around what’s happening right now in healthcare.   It’s been said if you want to know the state of the literature 5-7 years ago, read the latest edition of any textbook. If you want to know what was going on 2-3 years ago, read the print journal that just came to your mailbox. And if you want to know what’s happening and changing right now, get on social media. In this episode, I discuss the history of FOAM and talk through the influence of social media in anesthesia education. We take a look at the incentives that shape the behavior of content producers in the social media world and look at ways of harnessing FOAM and social media platforms to leverage these tools for the greatest impact. Resources: Andrejco, K. (2017). Social Media in Nurse Anesthesia: A Model of a Reproducible Educational Podcast. AANA journal, 85(1). Retrieved from https://www.aana.com/docs/default-source/aana-journal-web-documents-1/social-media-0217-pp10-16.pdf?sfvrsn=89cd48b1_6 Chan, T. M., Stehman, C., Gottlieb, M., & Thoma, B. (2020). A short history of free open access medical education. the past, present, and future. ATS scholar, 1(2), 87-100. https://www.atsjournals.org/doi/pdf/10.34197/ats-scholar.2020-0014PS

In this episode, I tell you a story about whitewater paddling and unpack the concept of flow described by psychologist and author Mihaly Csikszentmihalyi, PhD. I also present the Can-O-Calm for the first time on the podcast. This secret, magical, weightless and even sterile (when you need it to be) tool will help get you through the most dire of circumstances with your head right, your vision clear and yes, your voice calm. The concepts of flow help us understand how to prepare for emergencies, train for challenging cases and design specialty teams, fellowship programs, board examinations, continuing education as well as primary residency programs. Below are images of Dr Csikszentmihalyi’s flow concept as well as the quote by Elaine Scarry presented in the podcast. Mihaly Csikszentmihalyi’s Flow Concept. Mihaly Csikszentmihalyi’s expanded Flow Concept “What occurs in an emergency is either immobilization, incoherent action or coherent action…  If we act, we act out of the habitual…  If no serviceable habit is available, we will use an unserviceable one and become either immobilized or incoherent.” – Elaine Scarry, Thinking in an Emergency Sources Csikszentmihalyi, M. (1997). Flow and the psychology of discovery and invention. HarperPerennial, New York, 39. Scarry, E. (2012). Thinking in an Emergency (Norton Global Ethics Series). WW Norton & Company.

This podcast discusses deliberate practice, a concept developed by renowned cognitive psychologist Anders Ericsson, PhD. Deliberate practice is the kind of practice that top performers employ in order to reach the very highest levels of excellence across domains. Ericsson studied countless musicians, athletes, dancers, chess players, medical professionals and others to uncover the secrets and power of deliberate practice. Malcolm Gladwell popularized some of Ericsson’s work in his 2008 book, Outliers, as the 10,000-hour rule to expertise, stating that on average, it takes about 10,000 hours to develop as an expert. But it’s not as easy as that. It’s not that simple. It’s not just about being on the job for 10,000 hours. And you know what I’m talking about. You’ve worked with people who are very experienced yet not the best – not even great – perhaps even mediocre, at their jobs. What Ericsson saw is that it takes top performers around 10,000 hours of deliberate practice – a concentrated, effortful, focused kind of practice, with feedback from a coach, to achieve the top level in any field. Check out the podcast and links in the show notes for a quick break down and some examples of how to harness deliberate practice to improve your anesthesia career. Resources: Ericsson, K. A. (2008). Deliberate practice and acquisition of expert performance: a general overview. Academic emergency medicine, 15(11), 988-994. Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81. Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939 Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt. Weinger, M. B., Banerjee, A., Burden, A. R., McIvor, W. R., Boulet, J., Cooper, J. B., … & Torsher, L. (2017). Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(3), 475-489.   Young, J. 5 May 2020. Researcher Behind ‘10,000-Hour Rule’ Says Good Teaching Matters, Not Just Practice. (podcast). EdSurg Podcast.  Retrieved from https://www.edsurge.com/news/2020-05-05-researcher-behind-10-000-hour-rule-says-good-teaching-matters-not-just-practice. 

This episode originally released on From the Head of the Bed in February of 2017. Denham Ward, MD, PhD joined me to talk about expertise in anesthesia. At the time of this recording, Dr Ward was the director of the Academy at Maine Medical Center Institute for Teaching Excellence and professor of anesthesiology at Tufts University School of Medicine. He is Emeritus Professor and Chair of Anesthesiology and Emeritus Professor of Biomedical Engineering at the University of Rochester. This podcast focuses on developing and maintaining expertise over a career in anesthesia. Highlights range from defining expertise, specialization in anesthesia, types of problem solving and clinical decision making, deliberate practice, grit and how to teach and coach the development of expertise in trainees as well as experienced clinicians. We touch on Ericsson’s ideas on deliberate practice and the 10,000 hour rule for expertise, Dreyfus’ conceptions of skill acquisition from novice-advanced beginner-competent-proficient-expert, Kahneman’s System 1 and System 2 ways of thinking, Moulton’s “when to slow down,” Gawande’s ideas on the benefit of getting coached to improve our performance even well into our careers and more. “The difference between medicine and music is… musicians practice, practice, practice and then they go to Carnegie Hall for one evening…  We’re essentially at Carnegie Hall every day.”  Denham Ward, MD, PhD “Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” Anders Ericsson References: Benner, P. (1982). From novice to expert.  The American Journal of Nursing, Vol. 82.  Retrieved from http://www.healthsystem.virginia.edu/pub/therapy-services/3%20-%20Benner%20-%20Novice%20to%20Expert-1.pdf. Dreyfus HL, Dreyfus SE. (2005).  Expertise in Real World Contexts. Organization Studies, (26)5: 779-792. Retrieved from https://www.pdx.edu/sites/www.pdx.edu.unst/files/UNSTArticleDreyfus.pdf Duckworth, A. (2016). Grit: The power of passion and perseverance (Vol. 124). New York, NY: Scribner.  Retrieved from http://www.simonandschuster.com/books/Grit/Angela-Duckworth/9781501111105. Screen shot by author. Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Screen shot by author. Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939 Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81. Gawande, A. (2011). Personal best. The New Yorker, (30). 44.  Retrieved from http://www.newyorker.com/magazine/2011/10/03/personal-best. Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux. Kaminski, J. (Fall, 2010). Theory applied to informatics – Novice to Expert. CJNI: Canadian Journal of Nursing Informatics, 5 (4), Editorial. Retrieved from http://cjni.net/journal/?p=967. Moulton, C. E., Regehr, G., Mylopoulos, M., & MacRae, H. M. (2007). Slowing down when you should: a new model of expert judgment. Academic Medicine: Journal Of The Association Of American Medical Colleges, 82(10 Suppl), S109-S116.

In this episode Dr Cynthia Farina and I talk about the mid-to-late phase of your career as a CRNA.  Every stage of your career has unique challenges & opportunities. There’s so much attention focused on getting into CRNA school, the SRNA/resident/training phase and becoming a new CRNA… this conversation is for the part of your career farther down the road. Dr Farina is a CRNA from Michigan whom, at the time of this recording (December 2019), served as the chair of the American Association of Nurse Anesthetists’ (AANA) Health and Wellness Committee and the Michigan Association of Nurse Anesthetists Wellness Committee. Dr Farina completed her Bachelor of Science in Nursing at the University of Michigan, Ann Arbor and then her Master of Science in Nursing in the anesthesia track from Oakland University in 1996.  She then returned to the University of Michigan to complete her Doctor of Nursing Practice degree. Cindy practiced full-time at a large suburban teaching hospital, where she also served as a clinical and didactic instructor in the Oakland University-Beaumont Graduate Program of Nurse Anesthesia.  Cindy has a strong interest in creating and sharing educational material on personal and workplace wellness for CRNAs and SRNAs. In her most recent work, she has explored the topic of career phases and transitions for nurse anesthetists. You may contact Cynthia Farina, DNP, CRNA, CNE at: [email protected] or via her LinkedIn profile at www.linkedin.com/in/cynthiafarina AANA Thrive: Resources for Career Stages

I caught back up with Eric Carlson, CRNA to discuss his recent retirement and advice he has for anesthesia providers still in the thick of it. Eric was interviewed by Kristin Lowrance, MSN, CRNA way back in 2015 for our podcast “From the Head of the Bed.” We just re-released that podcast as #28 – Can’t Intubate, Can’t Oxygenate (CICO) during stat C-section: a case study with Eric Carlson, CRNA on Anesthesia Guidebook. If you haven’t listened to it, it’s a harrowing story of how he managed this incredibly difficult airway and situation. I wanted to catch back up with Eric following his retirement and today you’ll hear us reflect back on that podcast he & Kristin did several years ago. I was surprised by what he had to say about it. We also take a look back on Eric’s career… what influenced his decision to go into anesthesia, how to look for your first job in anesthesia and what influences where you work throughout your career. Eric spent most of his career in a tertiary care facility with over 800 inpatient beds and 50 operating rooms. We touch on how challenging it can be to keep pace with a very demanding practice setting and walk through an article by Judy Thompson published in the AANA Journal in late 2020 titled “the certified registered nurse anesthetist as a late career practitioner” that looks at whether anesthesia providers should have mandatory retirement ages or cognitive testing as part of recredentialing. The link to that article is here: Thompson, Judy. (2020). The certified registered nurse anesthetist as a late career practitioner. AANA Journal. Retrieved from: https://www.aana.com/docs/default-source/aana-journal-web-documents-1/thompson-r.pdf?sfvrsn=ea716ae2_4 We also talk about how Eric planned financially for retirement and tips for practicing anesthesia providers on how to get there. You’ll hear him discuss the last case he ever did and what it’s been like to step over to the other side… beyond the OR and into retirement. Eric served as a preceptor for Kristin and me during our anesthesia training at Western Carolina University and we were always impressed with the depth of his knowledge, the sense of being anchored & unflappable that comes from deep competence, his willingness to teach and kindness as a preceptor. Eric is a remarkable human being and I think you’ll really enjoy hearing from him as we look back over his career and the advice he’d give to folks who are still in the thick of it. This podcast is absolutely relevant for SRNAs or anesthesia residents. It can be profoundly helpful to hear from someone who is way down the road when you’re just getting started. It’s like seeking out the village elder when you’re preparing to begin your own journey & adventure. Listen to his stories. Hear this wisdom in his voice. The following interview was posted by the North Carolina Association of Nurse Anesthetists in an email on 15 May 2015 to members titled “Spotlight on CRNAs” where a North Carolina CRNA is introduced at greater depth to the membership. Of note, Eric was interviewed by Dustin Degman, CRNA, who has also contributed to our podcast in the Combat Trauma Anesthesia series. In the interview, Dustin talks with Eric about his experience with the difficult airway case that he speaks to in the show featured on this page. This interview is posted with the permission of the NCANA. Eric Carlson, CRNA Interviewed by Dustin Degman, CRNA You were recently on the podcast “From the Head of the Bed” where you explained a case that, I guess you could say, changed the way you practice today. You got to give your history, the beginning of the scenario, and there was a moment that you said “I had a difficult airway case”. I must tell you that I was completely locked-in at that moment. Nothing was going to distract me from listening to the next 25 minutes. What I want to ask is, what about that event changed you most, either as a person or in practice? This is a challenging question to answer. I am sure the event changed me both as a person and a CRNA practitioner. At the time of the event, I was very early in my career and riding high in self confidence. The event changed my level of confidence and reinforced the significance of the risks we take as CRNAs performing our job every day. I had to actively work on rebuilding my confidence over the ensuing months, slowly, I was able to regain some of the loss, but for better or for worse, I probably did not get back to the level I had been. In the long run, I think it made me a better CRNA because I realized that bad things can occur in our line of work at any time and you always need to have a back-up plan in mind. Be prepared for the unexpected. As a person, the event may have made me a more humble individual and helped me realize that we are all susceptible to very challenging occurrences in our profession. People, who know you, know that you are a wonderful provider. Your patients, colleagues, and the st

This podcast was originally published on March 1, 2015. In this episode Kristin Lowrance, MSN, CRNA talks with Eric Carlson, CRNA about a case where he was called for a stat Cesarean section and after a rapid sequence induction, he could not intubate or oxygenate the patient. The case was at 2AM and Eric was the only anesthesia provider in house. The other on-call anesthesia provider was at least 20-minutes away. Eric walks us through what happened next and how they proceeded with the decision to simultaneously rescue the baby and perform an emergency percutaneous cricothyrotomy, followed by surgical cricothyrotomy. Kristin and Eric talk about the decision making and challenges involved in this case and advice for other anesthesia providers when it comes to emergency airway management. It’s a harrowing story that had lasting impacts on everyone involved in the case. It’s a story of leadership in emergencies, profoundly difficult decision making and an example of why we should train for failed airways in our day-to-day, week-to-week work lives: we have to be ready when disaster strikes. I recently caught back up with Eric following his retirement from anesthesia. In episode 29 of Anesthesia Guidebook, the podcast that follows this one, Eric reflects back on both this case and the impact that telling this story had on his own life and career. We will also talk about retirement, take a look back over his career and hit on advice he would give to anesthesia providers who are still in the thick of it. Be sure to check the next episode out to hear more from Eric! Below are links to key resources for difficult airway management. The Vortex Approach – real-time airway crisis cognitive aids. Chrimes, N., Bradley, W. P. L., Gatward, J. J., & Weatherall, A. D. (2019). Human factors and the ‘next generation’airway trolley. https://doi.org/10.1111/anae.14543 Difficult Airway Society American Society of Anesthesiologist’s Difficult Airway Guidelines

This episode outlines the overnight transition to same-day surgery & discharge for total knee patients at Maine Medical Center. Surgeon Adam Rana, MD was informed on a Tuesday afternoon in December 2020 that elective cases requiring overnight hospital stays were being canceled effective immediately. He reached out to physician anesthesiologist Ryan Mountjoy, MD, along with others, and the very next day they implemented a new anesthesia plan that got patients discharged safely the same-day of surgery. These patients experienced equivalent pain scores post-operatively while remarkably requiring less opioid refills. The length of stay was slashed from 42 hours to 12 hours. These physicians, along with physician anesthesiology resident and lead author Derek Bunch, DO and others, have submitted this story as a proof of concept for the American Society of Regional Anesthesia and Pain Medicine (ASRA) and will present this story at other national anesthesia and surgical meetings. Dr Bunch was unfortunately unable to join us on the podcast due to working overnight call during the wee-hours of the morning when we recorded this episode but hopefully he’ll agree to come on the show in the future to talk about this or other regional anesthesia topics as he prepares to head off for his regional fellowship later this summer. Dr Bunch’s write up is provided below courtesy of the authors with select table data following: The introduction of a multimodal clinical pathway for outpatient total knee arthroplasty in the COVID-19 era.Download Table 1: Pre and Post Surgical Medications Night PriorMorning ofDischargeCelecoxib 200 mgCelecoxib 200 mgCelecoxib 200 mg BID x 3d, then daily until complete (disp #14)Pregabalin 50 mg  Acetaminophen 1000 mgPregabalin 50 mg BID x 3d, then nightly until complete (disp #14)Acetaminophen 1000 mg Acetaminophen 1000 mg TID  Oxycodone 5mg 1-2 tab q 4h PRN (disp #42)Patients received oral analgesics before and after total knee arthroplasty as part of a multi-modal pain management plan. Table 2: Anesthesia Protocols Previous anesthesia protocolNew anesthesia protocol 0.5 or 0.75% bupivicaine spinalSpinal 60mg 2% mepivicainePostoperative adductor canal 20cc 0.5% ropivacainePreop adductor canal with 10cc 0.5% bupivicaine, 10cc 13.3% liposomal bupivicaine Preop iPACK block 20cc 0.2% ropivacainePosterior injection by surgeon (bupivacaine 120mg, epinephrine 300mcg, morphine 8mg)Posterior injection by surgeon (bupivacaine 50mg, epinephrine 100mcg)Propofol sedationPropofol sedationTable 2 highlights the differences between the standard practice and the new anesthesia protocol for same-day discharge for total knee arthroplasty at Maine Medical Center. Table 3: Demographics and Outcomes  Next day kneeSame day KneeNumber of patients4849Average LOS (hrs)4212Number of patients needing IV hydromorphone post op1511Number of patients needing oral opioids post op4132Average pain score in hospital3.93.8Average pain score at 2 weeks3.33Number of patients filling narcotics following surgery2520Total number of narcotics refills following surgery4927Table 3 highlights preliminary data comparing a cohort of patients from one year prior to the study period when patients were shifted to same-day discharge from total knee surgery. “Average age was 63 for both groups and average ASA scores were comparable (2.3 for next day knee patients and 2.2 for same day knee patients).” D. Bunch. Dr Adam Rana’s bio as quoted from his website: “Dr. Adam Rana is a Board Certified, Fellowship-Trained Orthopedic Surgeon who specializes in minimally invasive hip and knee replacement surgery with specific training in the anterolateral muscle sparring approach to the hip, custom partial and total knee replacement surgery as well as revision hip and knee replacement surgery… Dr. Rana earned his Bachelor’s degree with Honors in Economics and Biology from Colby College where he graduated Cum Laude. While at Colby, Dr. Rana spent two summers in Minneapolis, MN at the Hennepin County Orthopedic Biomechanics Laboratory… [and] was actively involved in research projects relating to biomechanics in hip and knee replacement systems.” He attended SUNY Downstate Medical Center for medical school and “subsequently completed his Orthopedic Surgical Residency at the Boston Medical Center… After residency, he completed a fellowship in Adult Reconstruction, Arthritis, and Joint Replacement Surgery at the Hospital for Special Surgery (HSS) in New York City.” Dr Rana is widely published in peer-reviewed journals as well as medical text chapters and frequently presents on orthopedic surgery at state and national meetings. He is actively involved in the American Academy of Orthopedic Surgeons, the American Association of Hip and Knee Surgeons and the New England and Maine Orthopedic Associations. He currently serves as the director of the Joint Replac

Paul Samuels, MD is a pediatric physician anesthesiologist who works with SmileMD to provide mobile anesthesia for dental offices. We talk about the unique characteristics of working in a mobile anesthesia setting for pediatric dental cases. Topics include: skills required to excel as an anesthesia provider in a mobile, pediatric settingpreoperative screening of patientspatient safety during anesthesia in dental officesprevention and management of emergencies in mobile anesthesiawho makes up the anesthesia care teamhow medications are handled, including controlled substancestypical anesthesia plans including mask induction, IV placement & airway managementconflict management and other challenges unique to work in unfamiliar settingshow documentation & billing is managedthe benefit of mobile anesthesia services for pediatric patients and outpatient dentists You can hear the overwhelming enthusiasm Dr Samuels has for caring for healthy pediatric patients in an outpatient dental setting. His years of experience as a pediatric physician anesthesiologist in a large tertiary care center not only gives him a wealth of experience to bring to an outpatient setting, but also sets him up for a really enjoyable day taking care of healthy kids for dental procedures. SmileMD is a mobile anesthesia service currently operating at dental offices in Ohio, Illinois and Kentucky. You can learn more about SmileMD through their website here, or through this podcast with founder Dr Navin Goyal. Conflict of Interest Statement: SmileMD reached out to me with the invitation to connect with Dr Samuels to conduct this interview on mobile anesthesia. No financial exchange was made between SmileMD and Anesthesia Guidebook or Jon Lowrance as part of the development of this podcast.