Update in the european anesthesia education

Abstract

Introduction In spite of the fact that each physician, all over the world, graduated a six or seven- year medical school, there is a permanent need for continuous learning, since medicine is a profession in permanent progress and each of us must assure adequate quality of patient care and also public accountability. In a bilingual book (English and Hebrew) published in 1992 (“Education and teaching in Anesthesiology in Israel) I wrote that “ society expects to see a specialist operating in the framework of modern, up to date medicine, and who is aware of the many innovations in every field”. Self learning or participation to scientific conventions and refresher courses proved to be valuable tools, but neither one can offer a real method for creating real up to date knowledge and skills. Recertification, as it is practiced nowadays in the USA, seems to be the closest framework to what the medical system is supposed to offer regarding the patient safety and modern care. But the question is how could we keep ourselves in good shape between two recertification examinations, which is held once every 10 years? Teaching means not only hard working gifted students but also, or mainly, good teachers, coaches and guides, who would be able to teach, to inspire and (why not?) to serve as role-models for their younger colleagues. These were the thoughts on which the 15-year Beer Sheva educational project was started in the early 90s. It was supposed to help closing the gap between the modern medicine practiced in the western hemisphere of the world and that part of Europe which was for almost half a century under the communist regime. The Beer Sheva project, entirely financed by the WFSA, exposed young Eastern Europe anesthesiologists to the modern aspect of our profession, by offering a direct view to daily activities of a busy up to date Israeli hospital. More than 160 young physicians took part to the project, 36 of them (22%) coming from the Republic of Moldova. The project did not include a follow up system in order to know what happened to each of those anesthesiologists who spent between one month and one year at Soroka Medical Center in Beer Sheva, but we do know that some of them became directors of anesthesia departments, chiefs of professional units, organizers of congresses and conventions. We also know that some 20-25% of them found the way to Western Europe and they are currently employed by a foreign department. We soon realized that in spite of the efforts and financial resources we could not completely close the gap between the two kinds of medicine practiced on both sides of the former Iron Curtain. The idea was to find a new way to implement modern medicine, techniques, organization and also mentality among the new generation of anesthesiologists in Europe, not only in former communist countries but also in some other regions of the continent. The permanent contact with our profession all over Europe showed very clearly that one of the feeble points of educating the new generation of specialists was the use of old method to teach new things. Once the needs for basic equipment and drugs have been solved and the access to up to date information ceased to be a problem, we felt that one has to take care of the system of teaching, the way the practical information is transferred and skills are taught. Method These thoughts created a new project, of “teaching the taecher”, an international institution (The International School for Instructors in Anesthesiology-ISIA) with the aim of preparing in a restricted number of countries, a group of instructors, who would be exposed to the modern ways of teaching theoretic and practical subjects, as well as main aspects of organizing our profession. The core of the established curriculum was to teach the new way of lecturing clinical subjects, based on description of real cases, but also including the evidence base data and basic sciences knowledge. Soon the curriculum was enriched by adding a long series of subjects related to educational skills and anesthesia organization items. The first ISIA course took place during the years of 2006-2007 , in Bratislava and Belgrade, three classes, each of one full week of presentations, skills teaching and discussions regarding various aspects of our profession. The “students” of ISIA 1 were all young anesthesia specialists from five countries (Moldova, Serbia, Slovakia, Poland and Bulgaria), four from each country, selected by their national societies of anesthesiologists. The admittance criteria were: full training in anesthesia, good commend in English and the obligation to attend all three classes (organized at intervals of six months each). But the most important point was each candidate commitment that after graduating the ISIA classes, similar national courses would be organized in their own countries. The ISIA faculty included Drs M. Dobson and Lesley Bromley, two very well known British anaesthetists, Mrs. Shirley Dobson, a very gifted specialist in the domain of education teaching, as well as some well recognized European experts in various fields of anesthesia and its domains of interest. The timetable included case presentations and discussions (prepared in concordance with the modern demands of clinical teaching), special sessions of teaching educational skills and also frontal lectures on topics related to the organization of our profession. Results All 20 students graduated the three classes of the 1st ISIA course and got a final diploma. At the end of the 3rd class all of them proved to be dedicated teachers, able to bring the knowledge obtained at ISIA to younger colleagues in their own countries. As a result, during the following 2 years similar courses have been organized in each of the participant countries and some 100 young specialists, all together, took part to these national courses organized by the ISIA 1 alumni. A possible and valuable fringe benefit of ISIA to be mentioned is that of creating a new generation of leaders in Anesthesiology, by helping the “students” to develop special personal features, like motivation, a significant degree of compulsiveness, capability to see problems of the others as well as ability to irradiate leadership. In the last two years nine out of 20 ISIA 1 alumni have been promoted in various professional and organizational positions, in all the five countries. The near future ISIA 2 is on its way. Next October twenty more students, from five more countries (Romania, Hungary, Slovenia , Macedonia and Greece) will take part to the new three-class cycle. ISIA 2 would be equally sponsored by the two international professional organizations :ESA and WFSA. The classes will be hosted in a nice Romanian resort area, with the excellent help of Prof. Daniela Filipescu from Bucharest and under the auspices of the Romanian National Society (president: Prof. S. Marinescu). One very important aspect of the next ISIA course is the fact that this time our faculty would include former ISIA 1 alumni, who would gradually take over some of the perennial faculty members tasks. It is our hope that in the future these young ISIA graduates will be able to replace the old generation of teachers and assure the continuation of this valuable project. Very recently (June 2009) the ESA-NASC committee decided to propose the creation of an “umbrella” teaching European organization, with the aim of coordinating the already existing projects in this domain, in order to avoid futile parallel activities. The new body, which would be called : THE EUROPEAN INSTITUTE FOR TEACHING ANESTHESIOLOGY (EITA) is supposed to start acting early next year and to take under its responsibility current teaching projects (like ISIA), but also initiating new ones, one example being an international center for teaching airway management skills. A British philosopher once wrote that the real difficulty in changing the course of any enterprise lies NOT in developing new ideas , BUT escaping from the old ones. The tremendous progress initiated on the European continent in the last years regarding teaching anesthesia seems to respond to this clever saying.