Anaesthesia Education (Initiatives & Action plan; after SWOT)

Today our department had organised second meeting (after the previous one a month ago) and discussion for the next four years, what we are going to do after we finalised the list of things or outcomes we would like to see it happens. Some presentatives of nurse anaesthetists and technicians are also invited to participate the meeting.

In the undergraduate anaesthesia education team; we, the whole participants at the meeting, agreed to improve the way we teach our beloved medical students. The problem is we need to change our ways of thinking, we have only two weeks to teach them, but we cannot teach all aspects of our specialty, we do not have time to teach them to become a new anaesthetist, so we must change ourselves as well, just remember to teach them only the main objectives we have written before; such as preoperative evaluation and preparation, basic airway management skill, acute postoperative pain control, oxgen therapy. The way we communicate among ourselves should follow the principles of Medical education, we have to look back to OLE; objectives, learning process and evaluation.

Not only we have to change ourselves, we do have to emphasise these aforementioned objectives to our students as well, endotracheal intubation is not the only thing they should learn from us, they should seek their ways to gain more experience elsewhere during their time in other departments, endotracheal intubation is just the beginning part of anaesthetics administration; our medical students have to be well informed about this.

Our action plans include the emphasis of medical education among our consultants by either send newcomers to educate or invite education experts to our departments for fresh up our middle or senior consultants. Extend the medical student study time by the use of new media especially the electronic learning, so that we can assess the access and follow our students whether or not they log in and the process they have logged in. While the assessment of learning outcomes should be the self-assessment after they finish their time with us, especially three main skills; preoperative evaluation and preparation, open patient airway by mask and endotracheal intubations, also we have to see how they evaluate our department when they have graduate the medical school as well, how they judge us and think about competency in some skills such as CPR, lumbar puncture, and endotracheal intubation.

Time is running, the wind of change is coming.

How to get start

As we are searching for the curriculum elsewhere for our beloved medical students, we ran across "The Anaesthesia UK" site, it shows common questions about the role of anaesthetists as a profession. It can envision our medical students every routine day what we really do or care for our patients.

Be informed from this lovely website link. Access to the site by the title link.

Ventiltor setting: Perioperative ventilator workshop

Although it is a long weekend nationwide, but our department has arranged a conference about the perioperative ventilator setting. Today Aug-14 is the beginning day of the 2-day workshop, the topics started with basic and advance modes of mechanical ventilation. Patient care and monitoring of the patients who require ventilator support, the problems of ventilator-patient dyssynchrony, and special patient groups: neurologic, traumatic chest, transportation, and perioperative ventilator setting and complications.

When it was nearly the end of the day, we discussed about perioperative care by anaesthetists, because we can attenuate perioperative respiratory complications by using the lower oxygen concentration during the induction time, we can use FiO2 of 0.8 instead of 100% oxygen. We talked about within the next five years ventilator setting in the OR would catch up the ITU/ICU, actually, there are papers about ASV (adaptive support ventilation) using in the OR, and recent paper was published in European J of Anaesthesiology about this mode in 2009.

We will pose some photo of the workshop, as well as some slides later on, don't forget to update and tune in.

Journal club for June and July 2010

This is another platform for the fellow level, there is a regular meeting organised by the team of CVT anaesthesia, and there are journal club, Morbidity & mortality conference, and HA topic. One member of the asked me whether or not she can put the lists of the journal they have read here, so that they would know what had been discussed at the conference. Here are the lists for the month of June and July for this 2010 academic year.

1. (Wed 9) Anesthesia for patients with pulmonary hypertension
2. (Wed 16) Protecting the Brain During Aortic Surgery: An Enduring Debate With Unanswered Questions
3. (Wed 23) An Entirely Subcutaneous Implantable Cardioverter–Defibrillator

For the month of July 2010:

1. (Wed 14) Lumbar Cerebrospinal Fluid Drainage for Thoracoabdominal Aortic Surgery: Rationale and Practical Considerations for Management
2. (Wed 21) Neurological Damage Related to Cardiac Surgery

Anaesthesia Education (SWOT analysis)

There was a departmental wide conference organised yesterday (2010-07-27) to learn about ourselves, how we are, where we really stand, and what we are going to be for the next four years, in order to give a momentum to move forward. Strength-Weakness-Oppertunity-Threat analysis was aimed in four major areas: service, government, education and research.

Education in our department of Anesthesiology has some weaknesses as well as strengths, however, we are committed to improve ourselves to serve our dear customers; medical students, residents and fellows, and anaesthesia nurse students, at the best quality learning; education and training they should deserve during the time they spend their time with us.

For medical students; the curriculum has just been changed for 2 years, so there might be a minor change for that, but the anxiety level among them will be in our minds to look for.

For residents and fellows; there may be more short courses organised for them, more specialty training courses, we will look for the future trend in our specialty for the Kingdom as well.

The earlier we change, the better quality of education we should get, hopefully.

How we learn

From today edition of Bangkokpost (2553-07-13) in the education section, there is a very interesting and important Quote of the week by William Glasser. It says:

"We learn
10% of what we read;
20% of what we hear;
30% of what we see;
50% of what we both hear and see;
70% of what is discussed;
80% of what we experience personally; and
95% of what we teach to someone else"

Therefore, our beloved medical students should be encouraged to speak out and actively participate in activities assigned for them, such as bed side teaching, problem based learning, and even team based learning.

Another useful link

In order to gather important information regarding the specialty of Anaesthesia, the BMJ, British Medical Journal, has been an undispensible source of essential and up-to-date data and knowledge. Under the useful collections in www.bmj.com, you can have important topic in the patient care under anaesthesia specialty especially the pain management and other related topics.

While the collections of intensive care have four major sub-headings, mechanical ventilation, and intensive care for neonate, paediatric and adult patient separately.

Hope that you will get up to today medicine for safety of our patients from this wonderful and useful link, click at the topic for the link.

A very useful link for medical student

When I search the internet for more informations about how medical students will be taught in anaesthesia rotation, I learn that in the USA like our department, they are rotated to the department for two weeks.

While many departments show the curriculum and evaluation form, I ran across the department of anesthesiology at the University of Wisconsin which offers three case descriptions in the topics of acute pain management, paediatric anaesthesia, and emergency anaesthesia with the emphasis on haemodynamic monitoring and inotropes. Not only the case descriptions which you should have tried to learn, but the department also have two handouts for medical students in the topics of paediatric anaesthesia and local anaesthetics and regional anaesthesia.

Have a look at the link and try to figure out the cases by clink at the topic above.

Medical education: Lifelong learning

We were advised to join the 11th Thai medical education congress, held at Chulalongkorn University on 27-29 March, and it had covered many interesting subjects from adding public health into med student curriculum, and how to teach that topics.

There were also workshop/ discussion about the making OSCE, however, one thing that we have agreed with and we have done is "Lifelong Learning". Since 2009 we have formed the group of teachers to three each to look after 10 upto 12 students in two week slot. We knew that we cannot let them know all the department of Anesthesiology would be, we hope that they can find their way out, since we have just shown them small windows of this busy department. The aim of preoperative evaluation and preparation is also an example of lifelong learning, because the patient who need anaesthetics can be anywhere in the hospital, we hope that our students have understood this goal and can apply our anaesthetist's way of thinking to the patient care process.

Photo of the gang

These are photo taken from the Brussels trip that the ICU gang went, on the way we passes Flugaphen Frankfurt am Main, catched ICE to Koln, and stopped in Paris.

Anaesthesia and Intensive Care, the Gang's all here

We, a small family and the gang of eight, had gone to Bruxelles to attend the 30th Annual Congress of International Symposium on Intensive Care and Emergency Medicine. We gained some new knowledge about patient care such as fluid management, complications in abdominal patients, kidney injury, fluid responsiveness, sepsis and septic shock, and much more. I think approximate half of the invited speakers at the congress are actually anaesthetists which we are so proud. The new knowledge would be definitely beneficial to our patients and to our beloved medical students. Here is a sample of photo taken there which I have to credit to Max, the newest member of our gang.

More photo are to come, having problems with the wifi at home.

Examination MCQ

Finally, the MCQ for our medical students for this academic year have been finalised, after spending a whole day just to create new 10 MCQ, beleive it or not. However, we would love to thank those who submit some new ideas for this year exam pool. Work hard again next year somewhere around happy new year.

More photo of the past

Teaching Med Students in June 1992.



Learning climate of the case discussion in 1992, the old version style presentation.


Brachial plexus anaesthesia with the paraesthesia technique.

Yesterday once more

The fifth year medical students in their anaesthesia rotation back in the Year 1992.


Skilled lab teaching how to intubate the trachea at that time.





This photographs in this series was back in the year 2538 (1995), when I became one of the newest instructors in the department. It has resurrected to life again because we go back to teach the fifth year medical students again. Look at the way we taught them in a skill-lab for airway management and intravenous cathether placement. The red-rubber endotracheal tube is now the story of the past, so is the group discussion, because we are now let the students have their presentation about preoperative evaluation and preparation one by two assessors. While the brachial plexus anaesthesia was not required to teach to medical students any more, and we are now in the nerve stimulator and ultrasound guided block, so patient co-operation during brachial plexus anaesthesia to get paraesthesia has decreased its presence.

The 2010 Academic Year

The academic year of 2010 will be the second year after the faculty board has revised the new curriculum for medical students. We are in the preparation process to welcome new medical students to experience their time in our department. The handbook for each student has already been prepared, the manual guide has just been revised, the rotation and teaching schedule has been settled, however, the examination has not yet been prepared.

We are in the process of making our own version of the manual of anaesthetics for medical students, hope that we can make it useful for the upcoming new students.

The first day

We would like to utilise the technology of web blog for education propose, since the time slot for the 5th year medical student to experience the time in Anaesthetics or Anesthesiology has been reduced for a 4-week to 3-week and finally a two-week time, we hope that this blog platform would help them understand what we try to inform them. We are a committee for medical education and members of medical staff of Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.