THE CURRICULUM

The table of contents from any standard anesthesiology textbook provides a broad outline of what to teach in anesthesiology. Similar to a medical school course outline, anesthesiology is a mix of the fundamental basic sciences applied to clinical practice as they relate to specific pathophysiologic disease entities. Patients with these problems are encountered in preoperative, intraoperative, and postoperative settings; therefore, the content is taught as it specifically applies to these different patient environments. This framework of basic and clinical science is used for teaching anesthesiology to all health professionals, with particular emphasis placed on the areas most pertinent to the particular group being taught (e.g., detailed teaching about the mechanics and clinical application of ventilators is provided to student respiratory therapists).

An accepted uniform content outline exists and has been agreed on for teaching physician anesthesiologists.^[32] The major outline headings are listed in Appendix 2 . Few teachers would be at a loss to define the content of anesthesiology teaching. Anesthesiology education, however, is not limited to content teaching alone.

The three major areas for teaching/learning all subjects are cognitive, psychomotor, and affective. For anesthesiology, it appears that the cognitive teaching/learning area is well defined. It is the responsibility of the anesthesiology teacher, however, to go further than just listing the content topics. Teaching in the content area requires attention to increasingly complex cognitive functions. Described by Bloom, ^[33] teaching/learning in the cognitive domain for any topic addresses the following:

1. Knowledge—recall
2. Comprehension—understanding
3. Application—use of abstractions
4. Analysis—break down; seeing the relationship of parts
5. Synthesis—put together; creating a new entity
6. Evaluation—judgment of value

Knowing the facts about pulmonary function is obviously much more basic than being able to apply them to the management of a multiple-trauma patient maintained on a ventilator. Teachers of anesthesiology serve students well by considering the more complex aspects of cognitive learning.

A general taxonomy of psychomotor skill teaching/learning for universal application to all educational settings does not exist because of the great variability in this type of domain among disciplines. A broadly accepted, standardized outline of psychomotor skill learning for anesthesiology also does not exist. There are many psychomotor skills that anesthesiologists and other related health care professionals need to learn. Perhaps a major challenge for teachers of anesthesiology is to codify the fundamental and supplemental psychomotor skills that must be taught and learned. This process is beginning to occur with the introduction of practice parameters or practice guidelines developed by medicine in general and anesthesiology in particular.^{[34] [35] [36] [37] [38] [39] [40]}

Affective teaching/learning deals with feelings or emotions. The taxonomy of affective learning addresses the following^[41] :

1. Receiving
2. Responding
3. Valuing
4. Organizing
5. Value complexing

Although we actively and consciously teach in the cognitive and psychomotor areas, we are much less aware of our affective teaching. Even though we may not be aware of it, however, we are constantly teaching in the affective arena by the role modeling we perform. Earlier in this chapter an example of how affective teaching/learning takes place was described. In the real-life setting, the aggressive, passive-aggressive, or passive posture of the anesthesiology teacher interacting with the surgeon provides a lasting lesson in the affective domain for the resident anesthesiology learner.

Thinking about affective learning results in arriving at the goals for such learning and permits the development of teaching plans to achieve the goals. Only if we decide how we believe that we as anesthesiologists and health care professionals in related fields need to behave in relation to others will we be able to teach professionalism and these psychosocial skills to our students.^[42]

Another example of the importance of affective learning concerns our approach to the teaching task. When our students sense our own enthusiasm about and commitment to a particular topic, their attitudes about it follow suit. In similar fashion, if we as teachers are negative about some aspect of learning, we can expect our students to mimic these feelings. The charge that teachers of anesthesiology must accept is that they must be conscious of the emotions that they display and prospectively decide on the values that they wish to teach because affective teaching and learning occur all of the time.

Defining the areas of learning (i.e., what to teach) makes it possible for the teacher to devise methods to evaluate the success of the teaching endeavor. For anesthesiology education of physicians, the ABA examination and certification protocol evaluates the three areas of learning. The written examination tests cognitive learning, though perhaps at its more simple levels. Psychomotor and affective learning is evaluated in an ongoing manner by the anesthesiology faculty of residency training programs and is attested to by the faculty granting a certificate of clinical competence to successful learners. The oral examination evaluates cognitive learning, one hopes at its more complex levels. In addition, the oral examination may assess affective learning, although such assessment is accomplished in an unsystematic approach.