Tag: wellness

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Anesthesia Education Personal Finances Preparing for Grad School/Residency Wellness

#102 – Marriage + Anesthesia School with Brad & Madisson Marcum

Brad & Madisson Marcum join me to talk about the dynamics of being married and going to anesthesia school together. They met in nursing school, had divergent paths professionally for a bit, with Brad starting nurse practitioner school and Madisson considering anesthesia school. They ended up sharing the same goal of becoming CRNAs and we talk through their approach to applying together, getting into the University of Evansville together and working through the program alongside one another.

In episode 15, I talked with Jenny & Robert Montague about what it’s like for the significant others of anesthesia residents. Jenny has her Master of Science in Nutrition and works as a Registered Dietitian and supported Robert and their 2 kids while he attended the University of New England’s anesthesia program.

In epsisode 50, I caught up with Lein & Nate Woodin to talk specifically on parenting in anesthesia school. Nate is a family therapist and supported Lein and their 2 kids while she went through the University of New England’s anesthesia program.

In this episode, Brad & Madisson Marcum talk about what it’s like to both get into and work through anesthesia school together. We’re planning for this to be the first in a series of conversations with them as they progress through their program. They’re just finishing their first year of training and have yet to start clinicals. I plan to touch base with them down to the road to see how that phase of the program goes.

Folks are often making difficult decisions around when to do anesthesia school. For a couple in my program, the husband went through school 2 years ahead of his wife, who was in my class, and they overlapped for just one semester. A local couple here in Portland stacked their programs end to end with one of them fully completing the program and a semester after that, the other starting anesthesia school. That stretched their anesthesia training experience to a full six years as a couple.

My hope is that this conversation with Brad & Madisson helps you and your partner think through the considerations around what you want to do or how it’s going for you if you’re currently in a program.

Brad hails from Salem, Illinois and spent 5 years as a critical care Registered Nurse in the cardio thoracic & transplant ICUs at Mayo Clinic prior to starting anesthesia school in the University of Evansville’s DNAP program. His clinical interests are regional anesthesia and opioid sparring anesthetic techniques with an emphasis on pharmacology and pharmacogenetics.

Madisson is from Effingham, Illinois and also spent 5 years as a critical care Registered Nurse in the trauma surgical ICU at Mayo Clinic in Rochester prior to anesthesia training. Her clinical interests are regional anesthesia and difficult airway management.

They are focusing their doctoral project on the functionality and effectiveness of virtual reality training in anesthesia programs and plan to utilize Peter Stallo’s SIMVANA VR platform for research. You may remember my conversation with Peter in episode 96 on SIMVANA and virtual reality in anesthesia education. It’s a fascinating discussion on what will likely become a central element to anesthesia education in years to come.

Long term, Brad & Madisson intend to become involved in medial mission trips and create a pediatric charity foundation to provide basic necessities to children in need in their local area following anesthesia school.

Brad and Madisson Marcum

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Anesthesia Education Preparing for Grad School/Residency Wellness

#99 – The Effects of Anesthesia School Didactic Formatting on Resident Wellbeing – Cassie Capps

Cassie Capps, BSN, SRNA joins me to talk about the effects of didactic formatting in anesthesia training on resident wellbeing including stress, anxiety, confidence and academic performance. Her specific focus is on the mix of online versus in-person course work for nurse anesthesia trainees.

Cassie overviews what the literature says about this topic and is looking for YOU to join her efforts by completing a very quick survey about your experience at the end of this podcast.

The survey HAS CLOSED.

Cassie is completing her Doctor of Nursing Practice in anesthesiology at the University of Arizona and this study is part of her doctoral work. Prior to anesthesia training, Cassie was a CVICU Registered Nurse for 8 years and worked in the cath lab for 5 years before that. Prior to nursing school, Cassie completed a Master’s degree in music with a focus on Piano Performance & Pedagogy. She continues to teach piano on the side while completing her doctorate in anesthesiology at the University of Arizona.

Her unique experience with anesthesia school included moving through her program as a single mom of an 11 year old daughter. She also continues to play a big role in the lives of her two former stepdaughters who are now young adults.

This podcast is coming out on December 26, 2023. I hope you’ve had an amazing year and am thrilled to bring this episode to you. Please take a moment and complete the survey and help Cassie get some solid data for her project. Stay tuned because I plan to reconnect with Cassie in a couple of months after she’s crunched the numbers and see what she’s learned.

REFERENCES

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Baqutayan, S. M. S. (2015). Stress and Coping Mechanisms: A Historical Overview. Mediterranean Journal of Social Sciences; Vol 6, No 2 S1 (2015): March 2015. https://www.mcser.org/journal/index.php/mjss/article/view/5927/5699

Berry, G. R., & Hughes, H. (2020). Integrating Work-Life Balance with 24/7 Information and Communication Technologies: The Experience of Adult Students With Online Learning. The American journal of distance education, 34(2), 91-105. https://doi.org/10.1080/08923647.2020.1701301

Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI database of systematic reviews and implementation reports, 13(10), 21-29. https://doi.org/10.11124/jbisrir-2015-2380

Centers for Disease Control and Prevention. (2022). Poor nutrition. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm

Columbia University. (2022). How sleep deprivation impacts mental health. https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health

Conner, M. (2015). Self-Efficacy, Stress, and Social Support in Retention of Student Registered Nurse Anesthetists [Article]. AANA Journal, 83(2), 133-138. http://ezproxy.library.arizona.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=102321364&site=ehost-live

Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2020, 3/22/21). FAQ’s and statement regarding meeting clinical requirements. https://www.coacrna.org/coa-statement-regarding-coronavirus-disease-2019-covid-19/

Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2022). List of accredited educational programs. https://www.coacrna.org/wp-content/uploads/2022/07/List-of-Accredited-Educational-Programs-July-18-2022-1.pdf

Day, C. M. F., Lakatos, K. M., Dalley, C. B., Eshkevari, L., & O’Guin, C. (2022). The Experience of Burnout in the SRNA Population and Association With Situational and Demographic Factors. AANA Journal, 90(6), 447-453. 

Desmet, P., & Fokkinga, S. (2020). Beyond maslow’s pyramid: Introducing a typology of thirteen fundamental needs for human-centered design. Multimodal technologies and interaction, 4(3), 1-22. https://doi.org/10.3390/mti4030038

Freitas, F. A., & Leonard, L. J. (2011). Maslow’s hierarchy of needs and student academic success. Teaching and learning in nursing, 6(1), 9-13. https://doi.org/10.1016/j.teln.2010.07.004

Griffin, A., Yancey, V., & Dudley, M. (2017). Wellness and thriving in a student registered nurse anesthetist population. AANA Journal, 85(5), 325-330. 

Hale, A. J., Ricotta, D. N., Freed, J., Smith, C. C., & Huang, G. C. (2019). Adapting Maslow’s Hierarchy of Needs as a Framework for Resident Wellness. Teaching and Learning in Medicine, 31(1), 109-118. https://doi.org/10.1080/10401334.2018.1456928

Harwood, K. J., McDonald, P. L., Butler, J. T., Drago, D., & Schlumpf, K. S. (2018). Comparing student outcomes in traditional vs intensive, online graduate programs in health professional education. BMC medical education, 18(1), 240-240. https://doi.org/10.1186/s12909-018-1343-7

Hoffman, H. J., & Elmi, A. F. (2020). Comparing Student Performance in a Graduate-Level Introductory Biostatistics Course Using an Online versus a Traditional in-Person Learning Environment. Journal of statistics and data science education, ahead-of-print(ahead-of-print), 1-10. https://doi.org/10.1080/10691898.2020.1841592

Imus, F. S., & Burns, S. (2015). What to Consider Before Beginning Graduate Education: A Pilot Study. AANA J, 83(5), 345-350. https://www.ncbi.nlm.nih.gov/pubmed/26638456

Imus, F. S., Burns, S., & Weglarz, D. M. (2017). Self-efficacy and graduate education in a nurse Anesthesia program: A pilot study. AANA Journal, 85(3), 205-216. 

Institute for Healthcare Improvement. (2023). How to improve. https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx

Kondo, M. C., Jacoby, S. F., & South, E. C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & place, 51, 136-150. https://doi.org/10.1016/j.healthplace.2018.03.001

Lowrance, J. (2023). Anesthesia Guidebook. https://anesthesiaguidebook.com

Malek-Ismail, J. (2021). Thriving in the First Semester of Graduate School: A Process of Rebalancing and Self-Determination. The American journal of occupational therapy, 75(S2), 7512520410-7512520410p7512520411. https://doi.org/10.5014/ajot.2021.75S2-RP410

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. 

Mesisca, J., & Mainwaring, J. (2021). Stress, Anxiety, and Well-being in Nurse Anesthesia Doctoral Students. AANA J,89(5), 396-402. https://www.ncbi.nlm.nih.gov/pubmed/34586993

Montag, C., Sindermann, C., Lester, D., & Davis, K. L. (2020). Linking individual differences in satisfaction with each of Maslow’s needs to the Big Five personality traits and Panksepp’s primary emotional systems. Heliyon, 6(7), e04325-e04325. https://doi.org/10.1016/j.heliyon.2020.e04325

National Center for Education Statistics. (2021). Table 9. Unduplicated headcount enrollment at Title IV institutions, by control of institution, student level, level of institution, and distance education status of student: United States, 2020–21. In: U.S. Department of Education.

Osaili, T. M., Ismail, L. C., ElMehdi, H. M., Al-Nabulsi, A. A., Taybeh, A. O., Saleh, S. T., Kassem, H., Alkhalidy, H., Ali, H. I., Al Dhaheri, A. S., & Stojanovska, L. (2023). Comparison of students’ perceptions of online and hybrid learning modalities during the covid-19 pandemic: The case of the University of Sharjah. PLoS One, 18(3), e0283513. https://doi.org/10.1371/journal.pone.0283513

Palmer, L., amp, J. M., Ren, D., & Henker, R. (2014). Comparison of Nurse Anesthesia Student 12 Lead EKG Knowledge, Interpretation Skill, Satisfaction and Attitude: Traditional Instruction vs. Asynchronous Online Video Lecture. Journal of Online Learning and Teaching, 10(3), 420-n/a. https://ezproxy.library.arizona.edu/login?url=https://www.proquest.com/scholarly-journals/comparison-nurse-anesthesia-student-12-lead-ekg/docview/1650489030/se-2?accountid=8360

Papaleontiou–Louca, E., Esmailnia, S., & Thoma, N. (2022). A Critical Review of Maslow’s Theory of Spirituality. Journal of Spirituality in Mental Health, 24(4), 327-343. https://doi.org/10.1080/19349637.2021.1932694

Pecka, S. L., Kotcherlakota, S., & Berger, A. M. (2014). Community of inquiry model: Advancing distance learning in nurse anesthesia education. AANA Journal, 82(3), 212-218. 

Polit, D., & Beck, C. (2020). Nursing Research. Philadelphia, UNITED STATES Wolters Kluwer Health. 

Pressman, S. D., Gallagher, M. W., & Lopez, S. J. (2013). Is the Emotion-Health Connection a “First-World Problem”? Psychological science, 24(4), 544-549. https://doi.org/10.1177/0956797612457382

Wilson, J. T., Gibbons, S. W., & Wofford, K. (2015). Process Improvement: Addressing Attrition from the Uniformed Services University of the Health Sciences Nurse Anesthesia Program. AANA J, 83(5), 351-356. https://www.ncbi.nlm.nih.gov/pubmed/26638457

Worthen, M., & Cash, E. (2022). Stress Management. StatPearls [Internet], Jan. 2022. https://www.ncbi.nlm.nih.gov/books/NBK513300/

Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. Excli j, 16, 1057-1072. https://doi.org/10.17179/excli2017-480

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Wellness

#94 – Shorts – Cue Ball

All right what’s up folks this is Jon Lowrance and it’s May 16, 2023.

This is episode 94 – and I’m calling it “shorts: cue ball.” 

And I don’t mean shorts like the things you wear but shorts like, this will be brief and there will be more episodes like this to come… you know, shorts.

But first… updates!  

Maine Medical Center will the at the AANA Annual Congress in Seattle this August. We’ll have a table in the exhibition hall and a couple of our CRNAs will be there to tell yall about our sweet gig and you can ask questions and see if where we’re headed is similar to where you want to head. Maybe you can join us. And we’ll join you. And we’ll move in the same direction. If you want practice a wide range of case types as part of a clinically excellent and supportive team while living in a super cool town that’s just big enough but doesn’t come with the downsides of huge metro areas, come check us out!

In other news, this fall I’m back on the teaching circuit… well, circuit might be a little generous – I’m teaching at 1 conference this year which is the New England at the Cliff House 2023 Encore Symposium in Cape Neddick, Maine.  The dates are October 16 – 19.  You can check out the other folks who will be presenting at the conference and register at Encore’s website, which is e-s-crnas.com.  Look for “New England at the Cliff House 2023 Encore Symposium” and again the dates are October 16-19.  This conference usually sells out by July.  Part of the reason is the location… the Cliff House is an iconic resort built in 1872 on a 70-foot cliff overlooking the Atlantic Ocean.  So if a fresh cool ocean air, granite cliffs and near by sandy beaches are your thing, this might be a great get-away to come get your learn on.  If you come, we’ll get the chance to talk about practical pharmacology for anesthesia providers, leadership in emergencies, best practices in neuromuscular blockage, monitoring & reversal, ERAS, airway management & a run down on what’s new in anesthesia… so much!  It’s going to be fantastic.  Encore Symposiums – October 16 – 19 – Cliff House.  I hope to see you there!   

All right, with that let me tell you about Neil deGrasse Tyson, the famed astrophysicist, and his take on cue balls. This will blow your mind…

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Anesthesia Education Business/Finances Personal Finances Wellness

#79 – The Future of Healthcare with Navin Goyal, MD & Saket Agrawal, CEO with OFFOR Health

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I’m really excited to bring you this episode on the future of healthcare with Dr Navin Goyal and Saket Agrawal of OFFOR Health.

This is episode 79 of anesthesia guidebook and it’s coming out on June 24, 2022.

This is one of the most interesting conversations I’ve had with contributors to this show.  Navin & Saket are here to discuss what the future looks like – or what it could look like – for physicians in healthcare.  They hit on something that’s not talked about very much in medical school or residency programs or every around the OR amongst your colleagues, which is “what more can you do” as a physician anesthesiologist?  What else is out there?  Graduating from medical school and completing your residency is really just the beginning – or as Navin puts it – fills one particular bucket in your career.  But there are other possibilities out there and now more than ever, he and Saket want to share with you how physicians can engage in new ventures and roles both in the healthcare sector and beyond as a way to leverage the value you bring as a highly trained clinician.

They unpack this story and create this invitation to look beyond your clinical practice through sharing the story of OFFOR Health and the path they’ve been on as business partners. 

So let me tell you a little about each of them and then we’ll get to it…

Navin Goyal, MD

Navin Goyal, MD is a physician anesthesiologist and a co-founder of SmileMD, a mobile anesthesiology startup that is aiming to change the accessibility of anesthesia to small practices. He is also a co-founder of Loud Capital, a venture capital firm that provides financial support to early-stage startups as well as value-added services such as business development and guidance in scaling sales operations.

Navin received his MD from the University of Cincinnati College of Medicine and trained in anesthesiology at the University of Chicago Medical Center.

Saket Agrawal 

Saket is the CEO of OFFOR Health, a company that brings access to specialists closer to home by partnering with local dentists and medical offices to deliver specialized care. Saket became CEO of OFFOR Health in 2016 after working for years in the technology space in Silicon Valley. 

Sakate graduated from The Ohio State University with training in computer science and engineering, earned his MBA in North Carolina, and worked in tech in San Francisco for nearly 10 years before SmileMD’s mission drew him back to Columbus.

So one of the contextual frameworks we worked off of in planning this discussion was physician anesthesiologist burnout.  Navin is going to share with you his own story of being over a decade into his clinical practice at a large academic medical center when he began to feel bored with the daily grind and started wondering what else was out there.  We talked before we recorded this about the MedScape 2022 Physician Burnout & Depression survey.  Now this is a survey I’ve been following for several years and sharing in my own talks at anesthesia conferences on wellness.  Each year, Medscape surveys around 13-15,000 physicians across 29 specialities and reports data on burnout, what contributes to burnout and how to mitigate it.  In their 2022 survey, they reported that 47% of physicians reported feeling burnt out last year.  

We certainly know the pandemic has created an incredible degree of stress on everyone’s lives – not just healthcare providers – and has served as a huge lever or catalyst for individuals across sectors to re-evaluate what they’re doing and why.  Physician anesthesiologists, along with CRNAs & other healthcare providers, are right in the middle of this cultural upheaval.  

And that’s another reason why I’m so pumped to bring you this talk.  Navin & Saket talk about what motivated them to create OFFOR Health and provide novel solutions – not only for patients in need – but for providers who are looking to shake things up in their own professional lives. 

You may remember back in episode 26 I spoke with Paul Samuels, a pediatric physician anesthesiologist about mobile pediatric dental anesthesia.  In that episode, he unpacked the nitty gritty of what SmileMD is all about – which an OFFOR Health company – along with the specific anesthesia considerations for practicing in mobile, pediatric dental settings.  Be sure to check that episode out if you want to hear a little more on SmileMD.

Stay tuned for lots of amazing things coming your way on the podcast… I’ve got several more shows on the business of anesthesia headed your way in the coming weeks along with one on the McLott Mix for opioid free anesthesia with Mr Jason McLott himself and ton of more content in the editing phase right now.  

As always, I’m stoked to hear from you.  Thank you so much for those of you who have reached out through email, Facebook, Instagram, Twitter – or even in person for all the SRNAs at the University of New England here in Portland, Maine.  

And with that, let’s get to the show!

Resources:

OFFOR Health

SmileMD

Anesthesia Guidebook episode on SmileMD: #26 – Mobile, pediatric dental anesthesia with Paul Samuels, MD

Physician Underdog, a book by Navin Goyal, MD

Beyond Physician – a professional development platform for physicians

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Anesthesia Education Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#78 – Thrive in Training: how to transition to practice

This episode covers advice for the last six months of anesthesia training, transitioning out of training and into the first six months of your anesthesia practice.

The year encompassing your last six months of training through boards and your first six months of practice is epic!  

There’s a huge learning curve you encounter during your first six months of anesthesia practice following the “completion of training.” Finishing training is a bit of a misnomer given that the best providers keep training… keep practicing and developing towards true expertise and mastering their craft.

This was the first solo episode I produced on From the Head of the Bed, meaning just me and the mic. I originally published this on February 1, 2016, about 8 months after I completed anesthesia training and passed boards. At the time, I wanted to do a show on transitioning to practice before the lessons of that time faded from my immediate memory.

I think there’s three big aspects of the last six months of anesthesia training: completing your research/thesis/DNP or residency project, securing a job and passing boards. For CRNAs, we must pass boards before we begin work. For physician residents, you may start working as a board-eligible physician anesthesiologist and work towards completing boards after you make that transition to practice.

I speak a bit about wrapping up training in this episode from the experience side of things… your co-residents will likely scatter to take jobs all across the nation after training. Try to connect with them in the final months and thank your program faculty. They pour a ton of effort into developing you as a provider and launching you into the world. A little gratitude goes a long way towards helping them know their work is appreciated.

The first six months of your practice brings a massive learning curve as you’re finally charged with putting all of the pieces together on your own. This is an important time where you must answer the following questions concerning your actual practice:

  1. Why do I do what I do?
  2. Why do I not do what I don’t do?

Sounds simple enough, but you must clarify your decision making around clinical judgments and interventions finally for yourself and not because your program faculty or preceptors prefer you to do or not do something. My encouragement is that you frame your decision making on the latest evidence for best practices and not simply because you taught one way to do things. You must continue to evolve your practice after graduation.

I hope you enjoy this show. As always, drop your comments or questions on the website, social media or in an email to me. If you haven’t already, please take 3-5 minutes and drop a review on Apple podcasts. You rating, but especially your written review, helps push the podcast out to more people and helps those individuals trust the show.

I mentioned this article in the podcast:

Assante, J., Collins, S., & Hewer, I. (2015). Infection Associated With Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review. AANA Journal, 83(4), 281-288.

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Business/Finances Personal Finances Wellness

#73 – Midlife Van Life: reinventing work-life balance with Kyle & Jen Steen

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 protective against burnout.

(*Swensen, S. J., & Shanafelt, T. (2017). An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety, 43(6), 308-313.)  

I wanted to share Kyle & Jen’s story with you as an opportunity for you to re-evaluate where you’re at, where you’re headed and whether you need to make changes so you can take a step in the direction of being more fully alive.  LOTS of people go into anesthesia because it’s an amazing field and a fascinating type of hands-on, brainy kind of work that can be very rewarding and a service to others, but also, because the income allows us to pursue other things in our lives.  This podcast is an invitation for you to re-calibrate your story.  I hope you enjoy it and what it does to you as much as I have! 

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Anesthesia Education Preparing for Grad School/Residency Wellness

#72 – Thrive in Training: finding balance with Temima Luchansky & Maya Kelkar

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 nurse anesthesia student in the Gonzaga University/Providence Sacred Heart Medical Center Nurse Anesthesia Program. She’s from Atlanta, Georgia and her nursing background is in the pediatric ICU at Children’s Healthcare of Atlanta. The PICU is where she became passionate about healthcare provider wellness, after seeing high levels of burnout and compassion fatigue among her colleagues, and she was involved in wellness initiatives in her unit and for the hospital. She continues to promote wellness among anesthesia providers as one of the student representatives to the AANA Health & Wellness Committee. She also remembers citing From the Head of the Bed in her grad school interview and is THRILLED to be on the podcast.

Resources

AANA SRNA Wellness website

Wondering When to Ask for Help? Check this out from AANA…

Check out #54 – Hardship in Anesthesia School where I talk about my own path in anesthesia training and offer insights for how to keep moving even when the path gets incredibly difficult.

NWI-Six-Dimensions-ToolDownload
Stress-Anxiety-and-Well-being-in-Nurse-Anesthesia-Doctoral-StudentsDownload

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Anesthesia Education Anesthesia Equipment and Technology Human Physiology and Pathophysiology Preparing for Grad School/Residency Wellness

#71 – Thrive in Training: destroying didactics with Jenny Finnell, MSN, CRNA

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-what
  • the 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.

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.

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Anesthesia Education Preparing for Grad School/Residency Wellness

#70 – Thrive in Training – Growth Mindset with Jenny Finnell, MSN, CRNA

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

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Anesthesia Education Preparing for Grad School/Residency Wellness

#69 – Thrive in Training: how to start strong

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 mindset
  • dialing in didactics
  • crushing clinicals
  • developing time management
  • avoiding landmines and overcoming set backs
  • dealing with hardship in anesthesia training
  • financial management
  • preparing for and acing exams and boards
  • tips for the job hunt
  • transitioning 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 strong
  • should you work or moonlight during training?
  • advice for starting clinical
  • how to socializing (or not) in the OR as a resident
  • how to recover from novice mistakes and keep going
  • goal 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! 

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Anesthesia Education Preparing for Grad School/Residency Wellness

#68 – Thrive in Training: how to prepare for anesthesia school

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 mindset
  • dialing in didactics
  • crushing clinicals
  • developing time management
  • avoiding landmines and overcoming set backs
  • dealing with hardship in anesthesia training
  • financial management
  • preparing for and acing exams and boards
  • tips for the job hunt
  • transitioning 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).

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Anesthesia Education Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#67 – How to Thrive in Training

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 mindset
  • dialing in didactics
  • crushing clinicals
  • developing time management
  • avoiding landmines and overcoming set backs
  • dealing with hardship in anesthesia training
  • financial management
  • preparing for and acing exams and boards
  • tips for the job hunt
  • transitioning 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!

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Anesthesia Education Preparing for Grad School/Residency Wellness

#58 – How to Recharge & Create Rhythm in Your Life

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:

  1. Tarantur, N., Deshur, M. (2018).  Anesthesia professional burnout – a clear and present danger.  APSF Newsletter. 33(2), 43-44.
  2. Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. AANA journal, 79(2). 
  3. 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. 
  4. 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.  
  5. Raj, K. S. (2016). Well-being in residency: a systematic review. Journal of graduate medical education, 8(5), 674-684.  
  6. 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.
  7. 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/. 
  8. 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

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Wellness

#56 – Guided Relaxation with Matt Zinder, MS, CRNA, CH

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 care@tenpercent.com, 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

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Wellness

#55 – How to Be Well During the Pandemic – Matt Zinder

#60 – Peace of Mind During COVID19 Pandemic with Matt Zinder, MS, CRNA, CH
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: zinderllc@gmail.com  

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 care@tenpercent.com, 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

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Anesthesia Education Clinical Tips Preparing for Grad School/Residency Wellness

#54 – Hardship in Anesthesia School

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

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Anesthesia Education Preparing for Grad School/Residency Wellness

#53 – Overcoming Setbacks in Anesthesia Training

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

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Anesthesia Education Preparing for Grad School/Residency Wellness

#52 – SRNA Wellness in COVID-19 with Adrienne Chavez & Kelly Gallant

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/thrive
The 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

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Preparing for Grad School/Residency Wellness

#51 – Provider Wellness with Christine Hein, MD

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 and a trained volunteer will respond to you anytime of day or night. It’s a free service. That number is 741-741. Put it in your phone. Post it in your break rooms & locker rooms. And don’t hesitate to text the number. Help is available – just a text message away.

And with that, let’s get to the show…

Quotes:

“As health is more than the absence of disease, joy in work is more than the absence of burnout.” – Jon Lowrance

“300-400 physicians each year in the United States commit suicide… essentially two medical school classes of physicians each year.”  Christine Hein, MD

“I think that it has professionally been probably the most satisfying experience of my career – to be involved in [Provider Wellness].”  Christine Hein, MD

“[Resilience is] the capability of a strained body to recover its size and shape after deformation caused especially by compressive forces.”  Christine Hein, MD

Dr Hein completed Dr Hein completed medical school at Dartmouth in 2001 followed by her residency in emergency medicine at Maine Medical Center where she was Chief Resident in her final year. At the time of this recording, she served as the Associate Medical Director for the Department of Emergency Medicine and the Director of Provider Well-being and Peer Support at Maine Medical Center as well as the Director of Emergency Medicine for MaineHealth.  She is an Associate Professor of Emergency Medicine at Tufts University School of Medicine and is well-respected as a medical educator, receiving in 2009 the American College of Emergency Physicians National Teacher of the Year award.  Her research interests include burnout, resiliency, critical care and women’s issues in medicine.  Outside of work, Dr Hein is married, has five children and is an avid marathoner, completing over 23 marathons including posting highly competitive times in the Boston Marathon.

*”It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” – Theodore Roosevelt

Resources:

AANA Health & Wellness and Peer Assistance Website

Attending:  medicine, mindfulness and humanity Ronald Epstein, MD

TEDTalk:  Everything you think you know about addiction is wrong by Johann Hari

Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303.Raj, K. S. (2016). Well-being in residency: a systematic review. Journal of graduate medical education, 8(5), 674-684.

Swensen, S. J., & Shanafelt, T. (2017). An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice. The Joint Commission Journal on Quality and Patient Safety, 43(6), 308-313.

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Business/Finances Clinical Tips Personal Finances Preparing for Grad School/Residency Wellness

#29 – On Retirement with Eric Carlson, CRNA

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 students really look up to you. Is there something you would like to share about being a great mentor?

I appreciate the feedback and compliment. I consider myself very fortunate to have made the decision to become a CRNA more than 30 years ago. We all have many forks in the road when we have to make a choice that could affect the rest of our lives. When I had been a nurse for five years, I began to consider what specialty I may want to pursue to fulfill my desire to have a career pathway I may enjoy for the long term versus bouncing from one subspecialty to another. As an ED nurse at a teaching hospital, I was exposed to CRNAs both directly helping out in difficult cases, and assisting/teaching new Anesthesiologist residents with different tasks in the ED. These episodes spurred my interest so I talked to the Chief CRNA and learned more about the profession. That conversation led to my decision to pursue becoming a CRNA versus my other consideration of becoming a flight nurse. To this day, it was one of the best decisions I ever made. I am very proud of my profession and can honestly say I still love my job after three decades. I still tell my students they have chosen one of the coolest careers they could ask for. I guess my enthusiasm spills over.

I find the NCANA to have some of the most motivated members I have ever met. I feel like they bring out the best in me and am so thankful for the work that they do for our profession. You have been involved with the board and different committees for the past 15 years. Why did you choose the government relations committee for this term?

I was involved with the NCANA in the early 2000s. I decided to take leave from the active involvement in order to devote time to my family and help my wife raise our two children. Now that my children are grown, I have the opportunity to participate in the NCANA once again. Overall, the NCANA is under appreciated by the majority of its members, the active members serving on the Board and Committees are doing a lot of work that most members are never aware of. These dedicated members are volunteering their time and efforts to help preserve our profession and our livelihoods. Major changes can take place in the laws and regulations that govern our profession. These changes could directly effect our day to day job description, if the NCANA is not keeping watch over the potential changes in the laws and regulations then who is? We could go to work one day and find that our scope of practice has been completely redefined and we would be at a loss to change it at that point. One role of the NCANA, and the primary role of the Government Relations Committee is to monitor and respond to activity of the North Carolina General Assembly, the Board of Nursing, and the Board of Medicine that may effect our profession. Being part of this committee has allowed me to learn more about the importance of its function.

Any sound advise you would like to pass on to students who are about to graduate and become members of the NCANA?

Yes, be proud of your accomplishments and your career choice! Be active in the NCANA, so you and others can continue to enjoy the many rewards of being a CRNA. Someone has to take the helm, if not you….then who?

In the past 30 years, you have witnessed significant changes. We now typically use the ultrasound for central line placement, new adjuncts in airway management, and a significant increase in monitoring, e.g. pulse oximetry. What was the biggest adjustment for you as a provider? And, was there anything that occurred during your practice where you said “This is really going to change the way we do anesthesia”?

When I first started anesthesia school, we had to fight for the one automated non-invasive blood pressure machine in the department. The practice of anesthesia was full of many risks at that time, and still is today. The primary change has been technology allowing us to identify a problem before it becomes a crisis. The first time I used a pulse oximeter, I was annoyed by the beeping. At the time, I had no idea how much technology would change the practice of anesthesia.

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