THE STUDENTS

The simplest answer to the question "who learns anesthesiology?" is "those who will provide anesthetic care to patients." Included are the anesthesiologist, nurse anesthetist, and dentist who administers anesthesia for dental procedures. ^{[2] [3]} Also to be included are the many varied paramedical personnel who participate in patient care activities related to primary anesthetic care: the anesthesia technician, anesthesia aide, postanesthesia recovery room nurse, physician assistant, surgeon assistant, respiratory therapist and aide, intensive care/critical care/emergency room/trauma nurse, perfusionist, emergency medical technician/paramedic, cardiopulmonary technologist, pulmonary function technician, and blood gas laboratory technician.^{[2] [3]} Each of these occupations is intimately related in some way to the body of knowledge that constitutes the practice of anesthesiology.

In a much broader sense, the entire medical community can be considered appropriate learners of anesthesiology. Medical students, for example, are appropriate candidates for learning a core of anesthetic knowledge and skills, specifically those essential for the training of all physicians. Basic central nervous system, cardiovascular, and pulmonary diagnostic monitoring, emergency airway management, and the clinically applied pharmacology of local anesthetics are some of these essentials. Medical students, graduate physicians, and paramedical personnel of many types are appropriate learners because all are often faced with the task of educating the lay public about anesthesiology. Who learns anesthesiology, therefore, are those who practice it or perform related duties that require some understanding of the subject.

Another way to address the question of who learns anesthesiology is to answer, adult learners. What describes an adult learner?^[4] How are adult learners unique? Adult learners are those with strong motivation to participate in a set of experiences, for example, a curriculum, to learn a specific discipline. The discipline they want to learn is one that they are interested in or need to know, or both. The resident actively seeks out education in anesthesiology. The sixth grader (a child learner), in contrast, does not seek out education in arithmetic. Adult learners participate in life-centered situational learning in the area or areas in which relevance is most likely.

Adult learners enter the learning activity with a wealth of previous experience. They therefore view the current educational experience in light of their background. An internist who enters an anesthesiology residency in preparation for a career in intensive care medicine has a rich resource background in medical practice. Adult learners can capitalize on this previous learning. At the same time, however, the previous learning may color how the current learning takes place. The key for the teacher is to acknowledge the adult learner's expertise and build the new education on it rather than downplay it and, in essence, "reject" the adult learner.

Working together in a mutual peer relationship with the teacher, adult learners are self-directed. Whereas child learners need a set of directions that originate from the teacher, adult learners initiate their own activities. Because adult learning is goal oriented toward relevant

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Strong commitment and specific intentional attachments uniquely characterize adulthood. Marriage and child rearing are examples of such commitments and attachments. At the same time that adults make commitments, their lives are evolving and they pass through many critical life stages (e.g., assuming financial responsibility, coping with the illness or death of a parent). These strategic choice points in life have an impact on adult learning. The decision by an anesthesiology resident, for example, to extend education an additional year to learn a subspecialty or to participate in research training may be based on the total financial debt incurred for medical education up to the time of residency and the need to repay that debt, weighed against the acuteness of the family's financial needs.

Inherent differences among people tend to increase with aging. Adult education must provide for difference in style, time, place, and pace of learning among adult learners. The time factor for learning is especially crucial for adults. Adults perceive that time passes more rapidly, that is, there is less time available to learn, or to do anything for that matter. With time perceived to be in short supply, adult learners tend to be selective in their learning to use what time they have more efficiently. The anesthesiology resident may devote time to learning in the operating room and weekly departmental case conference but may choose to skip the journal club to spend time with the family.

Recognition of the special traits that adult learners possess allows the anesthesiology educator to provide an educational program acceptable to the student rather than one that is rejected. Assessing the needs of the adult learner and using these needs as a springboard from which a curriculum is designed is more likely to result in a good educational outcome than to impose on the learner what the teacher alone thinks is right.