The vast majority of my career has been devoted to the education of medical learners: colleagues, residents, fellows, and students of all kinds. Teaching in a mid-sized anesthesiology residency program with a small faculty and a large clinical load has produced time constraints which often meant that choices had to be made as to where to direct ones energy. For me those choices were easy. Any medical school, residency or fellowship has 3 main goals. 1) To produce clinically competent physicians, 2) to provide those physicians in training with an extra-clinical curriculum which will augment their competency and expand their knowledge base, and 3) add to current global understanding through research, publications, and presentations. To my mind, they must be prioritized in that order. I think of myself first and foremost as an educator both clinically and didactically. When conflict arose between devoting time to the discharge of my duty as a teacher, and devotion of time to publication; teaching always came first. In addition to teaching at my home institution I have lectured to medical professionals of all levels at conferences at the regional, state, national, and international level. Along with teaching the full breadth of clinical practice to physicians-in-training I have devoted significant time to instilling in them the nuances of scientific method. Through small group discussion and particularly in Journal Club I have trained residents and medical students in the important aspects of study design, identification of variables, logical deduction, and the ability to critically analyze a journal article for the validity of conclusions.
Early on after entering into academic medicine I was placed in charge of the department of anesthesiology’s medical student clerkship. The curriculum I structured for this course (and still administer) was one of assigned readings reinforced by small group didactic sessions. The clinical side of this course to be accomplished with one-on-one assignments with faculty in the OR and completion-of /or participation-in essential anesthesia procedures. Over the years this curriculumhas evolved by taking into account generational changes in learning styles and newer technologies, but has retained the interest and enthusiasm of the students. The last major change to this curriculum was the incorporation of procedural and clinical simulations.
After instituting the initial version of the clerkship curriculum I spent the next year under the tutelage of our then department Chair, Michael Nugent (a former chief of Cardiac Anesthesiology at the Mayo Clinic), learning more advanced cardiac anesthesiology, and working with the Medical College of Ohio cardiologists to master transesophageal echocardiography. In 1994 I took over the reins of the division of Cardiothoracic Anesthesia, and in 1997 was able to institute the curriculum for a fellowship in cardiac anesthesiology at the then Medical College of Ohio. Although this fellowship was felt to be a strong program by all involved, it proved to be short-lived. We abandoned the fellowship in 2002 when decreasing case numbers (occasioned by overall decreases in cardiac surgeries and a diminution of the referral base by new programs in outlying hospitals) threatened to cause dilution of the cardiac anesthesia experience for residents in the core program. We were; however, able to utilize the lessons learned in the course of the fellowship to improve the educational structure and teaching for the core program residents.
In 2013, I was asked by our new chairman to step into the role of Program Director for the anesthesiology residency. In undertaking this role I instituted several major changes to that curriculum. We switched the core text, moved to an electronic medium for the required and optional references, revamped the didactic lecture schedule, put in place a rotating visiting professor series, and instituted a step-wise residency-year appropriate simulation training curriculum in clinical and procedural teaching. For several years I had come to believe that medical education has almost universally lacked some aspics of more esoteric teaching that would be ideally suited to the simulated clinical environment. One such untapped areais that of situational awareness.Many see this as an innate talent rather than a teachable skill. In 2015 our department laid the ground work for a simulation based course on this subject. The course is intended to measure, and hopefully to teach, the residents skills in situational awareness.The course was inspired by and is organized in much the same way that police academies inculcate observational skills in their officers-in-training.
My major clinical interest has been the care of patients during cardiac surgery and throughout the perioperative period. I have been the Chief of Cardiothoracic Anesthesia at the University of Toledo College Of Medicine (formerly the Medical College of Ohio) since 1994. The majority of my publications have been in this area. One of my strongest interests is in the use of transesophageal echocardiography (TEE) in the perioperative setting. I have been a strong advocate for this technology in clinical practice. I was among the first group of physicians to be awarded certification in this field by the National Board of Echocardiography. Our institution, under my leadership as Chief of the Division of Cardiothoracic Anesthesia, is one of the few in the world that can state that they have utilized TEE in all cardiac cases with an amenable patient since 1994. This put us among the small vanguard of institutions that adopted this technique across the spectrum of cardiac surgery at that early date. I have instructed many fellows, residents, and medical students in the utility, technique and interpretation of this technology.
Throughout my career I have had a strong interest in the ethical side of medical care. For Fourteen years I took an active role in the ethics committee of an international society: the Society of Cardiovascular Anesthesiologists (SCA). I was appointed to act as the chair of that committee from 2013 – 2015. Our mandate was to advise the SCA Board of Directors on all ethical concerns involving the society, and all ethical complaints tendered to the president or Board of Directors. During that time issues included several situations involving ethics related to the publication of research. We were further tasked with the oversight and policing of all conflicts of interest in all of the SCA educational programs. In 2014 I was invited to lecture at the annual SCA meeting on the ethics of donation for transplantation. The lecture was titled “What is the dead donor rule, and should it be abandoned?”