In many healthcare practitioner curricula, there is a disconnect between the teaching of basic science and its clinical relevance. Oftentimes, the material is taught months or years before its translational application becomes apparent. Moreover, we are asking students to synthesize diverse information when there are redundancies and gaps in the coverage of important topics.
The curriculum at the Master of Health Science in Anesthesia program is taught in a way so that the connections between the various layers of basic and clinical science—pharmacology, gross anatomy, physiology, monitoring, and applied pathology–are obvious for any given clinically-focused problem. Approaches to diagnosis (including physical exam, how basic science translates to laboratory testing, and imaging studies) and treatment, especially pharmacological, are also integrated. To accomplish this goal, we have organized the curriculum around a “learning funnel”, wherein topics introduced in a broad basic science perspective are sequentially addressed during learning discussion matrices and then reinforced in context as the student gains more knowledge about the anesthetic sciences. organized around particular diseases. Because students early in the Foundational phases of the program lack sufficient knowledge of clinical practice, formulating a relevant anesthetic plan could prove challenging – we view our learning curriculum as an inventive approach for marrying fundamental topics with their clinical relevance to train a better anesthesia provider.
At the same time, there is a need to show the interconnection between related pathology, their clinical significance, and their impact on an anesthetic plan, emphasizing that clinical problems seldom occur in isolation but rather within a common context of biological, environmental, and psychosocial determinants. Thus, it is appropriate to continue to organize teaching along lines that emphasize organ systems or specific pathology while we congruently cluster topics with respect to traditional anesthesia, surgical, and procedural sub-specialties.
Foundation Phase as Preparation for the Clinical (Integrative) Phase
Clinical immersion during the Integrative Phase of the learning curriculum can be psychically overwhelming, and it is not the time during which the additional demands of synthesizing a disparate group of facts should be occurring. Instead, we have crafted the curriculum such that upon completion of the Foundational Phase, students will be equipped with the basic education needed to understand common disease pathologies, appreciate how an anesthetic plan is iteratively developed with increasing clinical information, and synthesize patient data into care management and technical skills. While they will be building upon this foundation as they expand the depth and breadth of their knowledge and hone clinical skills, it should not be as if they are learning about particular illnesses (for example, the diagnosis and treatment of intraoperative hypotension) for the first time, which is, all too often, the present case when students are introduced into the clinical setting too early. Students will be able to “hit the ground running” when they enter the clinical phase, not learn it for the first time so that they can make maximal use of their time in the operating room and perioperative setting.
One Class at-a-Time
In a traditional format, classes are often taught without much thought to the coordination of testing schedules, resulting in poor attendance at the courses for which no exam is imminent. While similar subjects, such as cardiovascular and pulmonary, are grouped together by semester, the connections between course content are not always apparent. The overall schedule can be unpredictable from week to week, resulting in unnecessary student anxiety and complicated coordination of lectures, rooms, testing schedules, etc. for faculty. A guiding principle of our curriculum is that (perhaps with the exception of the introductory fundamental material taught concurrently during the Immersion weeks), the learning content is grouped together in blocks along with a progressive framework from basic core knowledge to application of that content contextualized for anesthesia, culminating in extensive patient care in the clinical setting, all interwoven with immersive simulation-based experiences to reinforce classroom instruction. The curriculum is presented to the learner with a regular schedule of activities within a week as well as from week to week and detailed down to individual class learning content.
Integrated Comprehensive Testing
Throughout the block curriculum, and extending from start to completion of the program, students must complete regular comprehensive examinations in order to progress within the curriculum. While testing philosophy and practices vary somewhat by individual course within the program, the comprehensive examinations are predictable and relevant, with the primary intent to help unify the MH.Sc. in Anesthesia curriculum. Each individual exam test is low stakes, in that a failure or poor performance on one exam will not result in delay or dismissal, but is intended to guide learning, provide feedback and identify knowledge gaps. To reflect both real-world preparations and improve readiness for the national certification exam, questions are in board format, such that they include a clinical scenario, take advantage of multimedia (i.e. photographs of skin findings, imaging studies, electrocardiograms, audio clips of heart sounds, etc.), and require a second- or third-order level of abstraction to arrive at the correct answer.
Comprehensive exams are administered through a computer portal, accessible anywhere with an internet connection. Individual questions are assigned ‘meta tags’ in which the primary subject matter, corresponding to the national certification exam blueprint is determined, as well as other relevant data. Analysis of performance results are detailed enough to identify learner performance trends, curricular gaps, and predictive assessment of student success. Students, faculty, and administrators have real-time access to the data, such that, at any given time, a student’s performance can be plotted temporally and performance on specific topics can be evaluated. Such data proves particularly valuable when students are preparing for the national certification exam so that more attention can be devoted to studying areas of weakness. Similarly, for students running into academic difficulties, it is useful to determine trends in academic performance which could aid in the identification of non-academic stressors.
Block Structure of the Curriculum
Clinically focused graduate-level anesthesia programs don’t lend themselves to physiologic-based or pathologic system-focused learning; the compressed didactic time horizon and breadth of subject matter in anesthesiology prevents cohesive translation of learning. However, we have developed a progressive curriculum that introduces foundational basic science knowledge in discreet coursework which is gradually applied with an anesthesia context and culminates in creative application and synthesis of knowledge in clinical anesthesia management.
Development of the learning structure of the MHSA program followed a process of curriculum mapping, which makes possible the identification of where within the curriculum learning objectives are addressed. This alignment of the curriculum and learning objectives involves clarification of the relationship between what students do in the courses, what the faculty expect them to learn, and what skills are required of the graduate to competently practice as an Anesthesiologist Assistant.
Learning content organization via a curriculum map can best be thought of as a two-dimensional grid of rows and columns. The rows would, grossly, correspond to courses within the curriculum, such as Anatomy, Anesthesia & Co-Existing Diseases, Practical Skills Lab, etc. The columns would represent learning objectives, content outlines, and practice skills emblematic of particular disciplines that would be taught. One way to look at the organization of our curriculum would be that much of the traditional material taught to AA students will continue to be taught but taught in a highly integrated fashion.
The Foundational Phase of the curriculum consists of three blocks of fundamental courses and the remaining three blocks in the Integrative Phase. The first block corresponds to the basic core knowledge upon which application and integration build, such as pharmacology, anatomy, and physiology, combined with clinical skills teaching in the basic technical aspects of the anesthesia profession such as airway management and intravenous catheter placement. The second block introduces a clinical skills ‘boot camp’ in preparation for the initial clinical immersion. The final block of the Foundational Phase introduces disease-focused courses requiring physiological integration and incorporating subdisciplines of pathophysiology, which prepare the learner to think iteratively in anesthetic plan development, which is reinforced with crisis management and non-technical skills lab experiences.