Aditee P. Ambardekar, M.D., MSEd

“The ladder of success is best climbed by stepping on the rungs of opportunity,” Ayn Rand said. I am a pediatric anesthesiologist, have a Master’s degree in Education, and currently serve as the Director of Medical Student Education, Associate Residency Program Director, and Co-Director of the Simulation Program for the Department of Anesthesiology and Pain Management at UT Southwestern Medical Center (UTSW). By embracing opportunity and using it to enrich my personal and professional life, I have accomplished so much in such a short period of time.

In my first appointment as an attending anesthesiologist and Assistant Professor at The Perelman School of Medicine at the University of Pennsylvania, I had the privilege to contribute to the graduate medical education mission in the Department of Anesthesiology and Critical Care Medicine at The Children’s Hospital of Philadelphia (CHOP). My mentor encouraged me to transition into the role of fellowship director for the pediatric anesthesiology program and lead the education mission for our medical students, residents, and fellows. By making the most of this opportunity, I was, for the first time, introduced to the world of medical education—something that would drastically shape my professional career.

My passion to teach medical students, residents, and fellows emerged and led me to pursue a Master’s in Education. Functionally it would give me the credentials to lead the fellowship in a way that was ideologically sound. Intellectually I was excited to learn theory and methodology that would undoubtedly stimulate new thought and interesting discussion. In the end, the journey through my master’s coursework opened up possibilities I would have never imagined and made me aware of the academic and research potential that I now saw for myself.

The adult learning theory and concepts I discussed in my Master’s coursework resonated as I considered them in the context of simulation-based education. As a simulation educator who develops high-fidelity, in-situ simulation curricula for faculty and trainees, I take pride in the innovative methods I use to teach. I was able to substantiate CHOP’s institutional application to the American Society of Anesthesiology to become a national simulation center which provided a team training curriculum to satisfy the Maintenance of Certification needed for board recertification of practicing anesthesiologists. This vast endeavor was realized in December 2013 after months of logistical and curricular planning and CHOP’s Simulation Center now offers

the simulation-based course both locally and nationally. Similarly, I was able to negotiate support and resources to develop an annual pediatric anesthesiology boot camp that hosts the fellows in programs from the Mid-Atlantic states for a full day of hands-on, simulation-based education. Through these efforts, CHOP’s simulation team received recognition for providing innovative learning methodologies on the national stage.

Subsequently, my journey led me to the Department of Anesthesiology and Pain Management at UT Southwestern Medical Center (UTSW) where I was recruited to enhance and support the educational mission. I dedicated my energy to revamping the anesthesiology curriculum for undergraduate medical education (UME) while also playing a key role in supporting graduate medical education (GME) and continuing medical education (CME) inside and outside the simulation lab. I was named the Director of the Medical Student Education Program as well as the Co-Director of the Simulation Program and was empowered to expand and enhance the anesthesia curriculum for the medical students.

Most urgently, I saw a need to integrate technology into medical student education to relate to a generation of millennial learners. I developed and facilitated low-fidelity and high-fidelity simulation sessions for students in our elective rotations. My goal for our third- and fourth-year medical students was to help them develop mental constructs to manage airways, hypoxemia, and hemodynamic instability in situations that would become all too familiar to them as future interns, regardless of their chosen specialty. Also integrated into the simulation curriculum was a significant team-training component, which is crucial as these soon-to-be physicians entered their residencies and interacted with a variety of healthcare providers. Using high-fidelity simulation fostered an environment to educate the medical students on this critical topic and was a cornerstone of every simulation we developed and facilitated. It is exceptionally challenging for today’s medical students to learn these technical and non-technical skills in real crises in our clinical environment. With the necessary paradigm shift of patient-centered, quality care in which errors or patient harm is monitored closely, our medical students deserve a learner-centered, safe environment in which to develop these very skills we expect them to have upon graduation.

My philosophy for clinical teaching stems from an understanding of adult learning theory and has shaped how I engage medical students on their rotations. Experiences must be relevant, deliberate, and learner-guided to be meaningful. Every student has his or her own motivations for enrolling in a course with individualized goals and expectations. I firmly believe it to be my responsibility as Course Director and mentor to explore these motivations, assign students to preceptors and experiences in which they are able to achieve their goals, and ensure through regular bi-directional feedback that the experience continues to be productive. Students appreciate this mindset and recognize our department’s “focus on education and making the most of the anesthesia rotation so that [they] can take what [they] learned into [their] respective specialties next year,” as stated by a student on our anonymous end-of the-rotation feedback.

Our success with the simulation curriculum was noticed by the medical school, and I was given an opportunity to be part of the curriculum reform process at UTSW. Having a seat at the table was both an honor and vital responsibility. I advocated for inclusion of a simulation-based methodology and was able to demonstrate its utility and our successful track record within the institution. I felt strongly these clinically naïve students deserved an activity in which we educators could demonstrate the application of their basic science curriculum to clinical practice and introduce effective team behaviors at a very impressionable stage. This all would occur in a safe learning environment in which they would achieve progressive autonomy without harming patients. The most challenging aspect of such a curriculum, however, was balancing the naiveté of the participants with the tasks of an experiential activity meant to be engaging. We successfully integrated clinical scenarios such as diagnosis and management of shock, tension pneumothorax, and elevated intracranial pressure into the curriculum. The large class of 240 medical students was separated into small groups of 7 to 9 students to maximize hands-on learning. Survey data collected after each of the six simulation scenarios with greater than 95% response rate demonstrated exceptionally high ratings by student learners (data available upon request) and demonstrated that students felt safe and supported, received material at the appropriate level of training, and were able to understand the clinical relevance of basic science material.

Expertise in simulation has had an unanticipated benefit in my abilities to teach in the clinical workspace. Crucial to the success of any simulation experience is the ability of the simulation educator to guide a learner-directed reflection. It is through this reflective process, as Kolb has described, that adult learners assimilate new knowledge and expertise gained by experience. I have used the very strategies we use in simulation to provide reflective feedback for my resident and fellow learners not only in the simulation lab, but also at the bedside. As such, I am able to maximize learning through reflection and providing good quality feedback in real time. Such feedback is desired by our trainees and yet many faculty are ill-equipped or resistant to provide it. At departmental, institutional, and national meetings I have been invited to disseminate these

concepts to help empower faculty and learners to engage in feedback and enhance these efforts that are so vital to the educational process.

Changing paradigms in medical education require rigorous examination of our current state. It is through inquiry and educational research that we can be sure we are providing our learners the most effective learning opportunities. As educators, we have this responsibility. Equipped with the skills acquired during my Master’s in Education, I have several research projects underway at various stages of progress. Those begun while at CHOP, namely the development of simulation curricula for anesthesiology residents and fellows, are in the data analysis and publication phase, respectively. Since joining the department at UTSW, I have begun two additional research studies—one is a survey of four, large academic anesthesiology departments to understand faculty teaching behaviors and barriers to effective clinical teaching. Another project involves understanding the better of two cognitive aids to inform novice learners of airway management skills using high-fidelity simulation. Both of these projects are currently in the manuscript-writing phase. Finally, we have recently demonstrated that teaching 240 clinically naïve medical students is logistically feasible at the appropriate level of complexity. This will be a unique and powerful cohort on which to ask questions about how simulation-based education impacts clinical skill acquisition. I do believe that in the coming years I will have impactful contributions to educational research in the field of simulation-based methodologies such that we can impact educational reform and innovation in an evidence-based way.

Inherent in my role as educator, female anesthesiologist, and academician is the necessity to mentor the future and young physicians seeking their own paths in their professional life. My exposure to our pre-clerkship students in the simulation curriculum as well as through the directorship for medical student education necessitates a gentle and honest guidance sought by those who I have the privilege of educating. Very recently, I met Hannah, a student who had just completed her pre-clerkship phase. I relayed the very information written here about openness to experience opportunities made available to you. In a timely email, I received from her this week she states, “I wanted to write to let you know that in this time period filled with a lot of self-doubt, I reflect on our conversation often as evidence of what pushing myself to do can lead to, namely potentially affecting the world as positively as you are able to [by being open to] more opportunities.” I have had the privilege of meeting with, listening to, and learning from many students like Hannah. Several have opted to pursue anesthesiology while many have re-visited with me to talk about work-life harmony, academic progress, and various other aspects of their professional careers. Several female residents and junior faculty within our department and my field feel comfortable discussing the unique challenges we face as female physicians. While my own harmony, professional trajectory, and academic maturation have been far from perfect, I do believe others can learn from my insights, mistakes, and journey.

Very recently, my world has come full circle. I still remain dedicated to undergraduate medical education and the students who are incredibly impressionable, energetic, and enthusiastic. I believe very much in innovative learning using simulation methodology. However, with my efforts in teaching and mentoring students along with my background in education, our department realized the potential synergy with resident education and conferred the role of Associate Program Director for Anesthesiology Residency. This is a very exciting time to be in graduate medical education at UTSW. Changing ACGME regulations, the institution of educational Milestones, and a change in focus to competency-based education will require experienced and knowledgeable leadership. Furthermore, I have been selected as an Oral Board Examiner for the American Board of Anesthesiology and have a seat on the Accreditation Council for Graduate Medical Education (ACGME) Anesthesiology Review Committee (RC), a group of ten academic anesthesiologists who operationalize ACGME mandates for anesthesiology residencies and fellowships. All of this gives me an opportunity to not only represent UTSW on the national stage but to affect change at the national level in anesthesiology residency education as well as board certification, a responsibility I take very seriously. This seems to be a perfect opportunity to utilize what I have learned in my master’s coursework and beyond to make a difference within my department, in our institution, and nationally.

Docēre, the latin root for doctor, means to teach. At the heart of what we do as physician educators is teach our patients, their families, and our future physicians. However, most practicing physicians have no formal training in the methods, the theory, and practical aspects of being an effective teacher. I remain dedicated to developing sound, relevant, and innovative curricula, mentoring those students, residents, and junior faculty with whom my journey resonates, and disseminating the skills and knowledge necessary to be the best doctors we can be as it is a privilege and honor.