Department of Anesthesia, Stanford, CA 94305
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THE GAS PIPELINE ANESTHESIA QUARTERLY GAZETTE Department of Anesthesia, Stanford, CA 94305 Patricia I. Rohrs, Editor March 2011 FROM THE CHAIRMAN At the Saturday dinner, we had video interviews BY RON PEARL, MD, PHD of each of the five prior Chairs discussing their RICHARD K. AND ERICKA N. RICHARDS PROFESSOR personal experiences leading the department. CHAIRMAN, DEPARTMENT OF ANESTHESIA [email protected] Although I did not have a video, I did provide comments on my own experience. During my first two decades as a faculty member at Stanford, I focused on clinical care, teaching, and laboratory and clinical research. Becoming a chair was never one of my aspirations. However, during the search for a new Chair, I met with the external candidates and was concerned that they did not appreciate what made our department so special. My decision to be a candidate was based on my view that the department’s future would involve building on, rather than discarding, those special attributes. ____________________________________ From the Chairman 1 It was my great pleasure to be the official host for From the Deputy Chief 3 th last October’s two-day 50 golden anniversary NIH Transformative RO1 Award 5 celebration of the Department of Anesthesia’s Center for Immersive and Simulation-based founding in 1960. You will read the article 50th Learning 6 Anniversary: A Celebration of Gratitude, Pride, and NIH Training Grant 7 Optimism elsewhere in this newsletter, but I want From the Residency Director 8 to share with you my impressions and some of Celebrations 9 the remarks I made in my role as host of this Graduation 9 special occasion. New Residents 10 First and foremost, the reunion weekend was a 50th Anniversary Celebration 11 time for celebration, for renewing old friendships Additions to Library 14 and for making new ones, creating new memories, Faculty Corner 14 and seeing what has changed and what has Transitions 22 remained the same at Stanford. My favorite parts of the weekend were those moments when I had ____________________________________ a chance to catch up with our alumni and learn My eleven years as Chair have been full of how their lives had developed, enriching the field fascinating, exciting, fulfilling change. When I and their communities. I am proud of our alumni became Chair in 1999, few medical students chose and all they have accomplished during their anesthesia as a career. Several years later, our careers. specialty was recruiting the best medical students in the country, but faculty were deserting academic anesthesia departments for higher The Gas Pipeline, Page 1 salaries in private practice. Many departments faster by combining people with different areas of simply devolved into clinical anesthesia service expertise, especially as we begin to tackle big departments. The same could have occurred at issues with outcomes research, genomics, and Stanford, except for the collective foresight of molecular biology. Dean Pizzo, the leaders of Stanford and Packard What makes a great academic anesthesia hospitals, and our surgical colleagues, all of whom recognized the importance of having a high- department? quality, academic anesthesia department, funding As just mentioned, a great academic anesthesia it accordingly, and allowing it to prosper and department needs to do these four things: provide thrive. outstanding clinical care, train the next generation During the past decade we have built on our of anesthesiologists, advance the field’s state of illustrious history by aggressively pursuing three knowledge, and develop leaders. I believe we have themes—growth, balance, and collaboration—all succeeded at all four. of which are key to remaining a great academic Provide outstanding clinical care—We provide anesthesia department. outstanding patient care, including the most complex and challenging patient populations, with Growth—During this decade, billings tripled to $100 million per year and collections to $40 results in perioperative care and in pain million per year. Our department now includes management that lead the country. We have 172 anesthesia attendings, 70 residents, and 24 contributed to the impressive outcomes achieved clinical fellows, who collectively cover over 80 at Stanford and the VA in such diverse areas as locations within four hospitals. Subspecialties general surgery, solid organ transplantation, adult have grown—30 fellowship-trained pediatric and pediatric cardiac surgery, obstetrical anesthesiologists, 14 cardiac anesthesiologists, 7 anesthesia, and critical care. Although the obstetrical anesthesiologists, 11 pain management emphasis has been on clinical anesthesia, our physicians, and 15 critical care physicians—and excellence comes from using research to develop new sub-specialties have proliferated, better methods for clinical care. Over the years, necessitating the renaming of the General OR we have made important contributions in adult group to the Multispecialty Division. In every and pediatric pain management, prevention of area, from obstetrical anesthesia to neurosurgery local anesthetic toxicity, development of pulse to airway management to pain to critical care, our oximetry, management of obstetrical and pediatric growth has allowed us to increase the number of patients, simulation for training and for faculty with dedicated subspecialty expertise, understanding cognitive processes, and the improving patient care and allowing us to advance development and use of almost every new the frontiers of knowledge. pharmacological agent in anesthesia. Balance—A great academic anesthesia Train the next generation—In the area of department needs to do four things: provide resident education, we consistently recruit the best outstanding clinical care, train the next generation medical students in the country, whether assessed of anesthesiologists, advance the state of by medical school transcripts, AOA membership, knowledge, and develop leaders of the specialty. board scores, or choice of residency program. We have used growth as an opportunity to Under the direction of Alex Macario as our progress in all these areas, hopefully using Residency Program Director, we have taken a advances in one area to drive advances in the leadership role in innovative approaches to others resident education, including blogs, tweets, simulation, interactive sessions, and now, with the Collaboration—As science and medicine have expertise of Larry Chu and other faculty, the use become increasingly complex, we have expanded of laser capture video and the best residency web intra- and inter-departmental collaborations site around. within Stanford and between faculties at Stanford and elsewhere. We clearly can progress much The Gas Pipeline, March 2011, Page 2 Advance the field’s state of knowledge— continue to lead anesthesiology. I thank you for Research advances over the past 50 years were all that each of you has contributed and hope that covered in Stanford Anesthesia 2010, 50th Anniversary you will continue your involvement with Stanford edition and in Dr. Steve Shafer’s excellent throughout the coming years.” presentation at the reunion’s scientific sessions, so ____________________________________ I will not comment further here, except to say that during the last decade’s growth the faculty FROM THE DEPUTY CHIEF careers of Martin Angst, Ed Bertaccini, Dave BY RICK NOVAK, MD Drover, Dave Gaba, Rona Giffard, Greg ASSOCIATED ANESTHESIOLOGISTS MEDICAL GROUP [email protected] Hammer, Elliot Krane, Bruce MacIver, Sean Mackey, Drew Patterson, and Jim Trudell have blossomed; and the faculty careers of Brendan Carvalho, Larry Chu, Dave Clark, Gary Peltz , and Dave Yeomans have taken root and been nurtured. And this is just a partial list! Develop leaders—Our alumni are leaders in both academic anesthesia and private practice. Our faculty and alumni have accounted for four presidents of the American Board of Anesthesiology, multiple ABA board examiners, three officers in the Foundation for Anesthesia and Education Research (FAER), over 30 members in the Association of University Clinical Case for Discussion: A 5-year-old male Anesthesiologists, more than a dozen chairs or is scheduled for tonsillectomy. The child is fearful vice-chairs of US departments and at least six in in the preoperative suite, and he is crying, other countries, editors of both major anesthesia agitated, and clinging to his mother. The patient journals, and presidents of almost every refuses to swallow oral midazolam. During the subspecialty society in anesthesia. Six of our preoperative interview, the mother reveals the faculty or alumni have been presidents of the patient’s interest in the cartoon show, SpongeBob California Society of Anesthesiologists, and Joe SquarePants. What do you do? Annis is an officer in the AMA. The majority of Discussion: You pull your smart phone out of our alumni have been leaders of their anesthesia your pocket, cue up YouTube, enter “sponge groups or hospital medical staffs. Our alumni- bob” into the search window, and select a leaders have made major contributions to SpongeBob SquarePants video. Once the video is improving patient care in their institutions; they playing on the screen, you hand the phone to the have served their communities, including the child. The boy immediately becomes calmer, and under-served populations; and they have taught grows absorbed and distracted with watching the and provided care in other countries. video. You are able to wheel the patient’s gurney Fifty years of accomplishment—Finally,