THE TEACHERS

Anesthesiology is taught by physician anesthesiologists, the experts in the field, and other expert individuals in related disciplines, examples of whom include pharmacologists, physiologists, biomedical engineers, pediatricians, and neurosurgeons. Full-time anesthesiology faculty positions in U.S. medical schools in 2002–2003 numbered 5073.^[25] Anesthesiologists represent 5.6% of the clinical teachers and 4.6% of all American medical school teaching faculty.^[25] The 5073 anesthesia faculty members in medical schools bore the major responsibility for teaching some or all of the 66,677 enrolled undergraduate medical students, the 4887 graduate trainees in anesthesiology residency training programs, and many of the approximately 98,258 physician house staff trainees.^{[10] [25] [26]}

Clinical care, teaching, research, and administration are major roles assumed by faculty. For anesthesia faculty, clinical care is the prime activity for obvious reasons.

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Little specific information exists about the teaching credentials or qualities of anesthesiologists, unlike the situation for other physician groups. ^{[28] [29]} These descriptions can be used to infer what does or could characterize anesthesiology teachers. Physician teachers in general are not trained as educators.^[28] They have not had formal training in educational psychology or methodology.^[28] Physicians who teach do not use the educational resources available.^[28] When faced with a new or difficult educational assignment, physician teachers rarely read the medical education journals, nor do they consult educational experts, even though they might consult a cardiologist, for example, when treating a difficult patient.^[28] Physician teachers, for the most part, mimic their own teachers, who also had little or no formal training as educators. ^[28] Although we would not trust a general surgical resident to perform a complicated neurosurgical dissection and achieve a good outcome for the patient, we do entrust an anesthesiology trainee to faculty who have limited educational expertise in the hope of achieving a good learning outcome.

What characterizes a good teacher? Effective clinical teachers who are able to succeed at the bedside teaching encounter display specific actions noted by their students and themselves.^[29] Table 85-1 presents a schema that was developed by observing internists teaching internal medicine residents and medical students. The similarity of the attending anesthesiologist teaching at the bedside in the intensive care unit or in the operating room is striking.

A teaching responsibility that anesthesiology faculty might consider is how to blend their "expert" status as anesthesiologists with their "novice" status as teachers. As the experts, teachers of anesthesiology can define educational objectives based on the competencies that they believe newly trained anesthesiologists need. Having set the objectives, the teacher can direct the educational process by selecting the appropriate learning activities and then designing tests that assess the learning. As described, the "authoritarian" teacher, the expert, determines the educational ends that must be met, defines the means to those ends, and requires conformity to these ends by the student.

Although anesthesiology faculty provide education using this type of curriculum design, few if any know that they are using Tyler's model, nor do they realize that there might be equally good alternatives.^[30] Dewey's progressive education offers one such alternative.^[31] This philosophy of education elevates students to a level where they can join in a partnership with the teacher. For students of anesthesiology, the adult learners described previously, this type of student-teacher relationship may make good sense.

An example of these two philosophies put into action clarifies their differences. Let us consider teaching/learning how to manage a patient who is being mechanically ventilated in the operating room. A Tylerian teacher might lecture to residents on how to use the ventilator. It is hoped that the residents will remember what they heard and be able to put what they learned into action. In contrast, a teacher using Dewey's approach might create a patient simulation exercise in which residents can "experiment" with differing ventilator setups to infer what might occur clinically. A much more meaningful learning environment might be provided by the simulation—coupled with the anesthesiologist faculty member's reactions to and guidance about how the residents tinkered with the ventilator—than might be provided by the lecture format. In addition, a teacher using Dewey's philosophy might be more likely to encourage students with previous experience, such as residents who have used different types of ventilators during their internship, to share their know-how with other, less experienced peers.

This chapter is discussing the component parts of the question "How shall who teach what to whom for what purpose now and in the future?" It should be obvious that individually studying the component parts of the question is an artificial separation for teaching purposes.

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