Medical Anesthesia Consultants

Developing a Positive Perioperative Attitude

December 12, 2019 | 5:48 am | Info Articles
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It’s good to see how one’s own character traits might impede a lot of the big issues anesthesia specialists face in the operating room, especially in crisis situations. By taking the best and the worst of human personalities and analyzing how those instincts come out in crisis situations, we can then work on modifying them.

Developing a Positive Perioperative Attitude

To help apply such techniques into anesthesia training, Adam Schiavi, PhD, MD, an assistant professor of anesthesiology at the Johns Hopkins University School of Medicine – along with colleagues Christina Miller, MD, and Robert S. Greenberg, MD – modified the Federal Aviation Administration’s Hazardous Attitudes Survey scenarios to reflect perioperative crises.

According to the survey, five hazardous attitudes can lead to team failure in a crisis:

  1. Invulnerability
  2. Anti-authority
  3. Macho
  4. Impulsivity
  5. Resignation


“All of these attitudes have a positive aspect that is necessary for us to do our jobs,” said Dr. Miller. “But it’s when one particular characteristic takes over in a detrimental way that things can get derailed in a crisis situation.”

After taking the modified survey, the 66 participants (36 men and 30 women, including 34 anesthesiology and 32 surgery residents) then participated in a series of workshops comprising small group discussions and role-playing of the various attitudes in clinical scenarios. Drs. Schiavi and Miller reported at the 2019 annual meeting of the International Anesthesia Research Society that the most prevalent attitude demonstrated by the group was impulsivity, followed by invulnerability, macho, anti-authority and resignation.

“Having people recognize which responses are appropriate and which are inappropriate is important,” Dr. Miller said. “Also, making people realize that these responses correspond with a broader personality or hazardous attitude type is equally important.

As Clyde Matava, MD, an assistant professor of anesthesia and the director of eLearning and Technological Innovations at the University of Toronto, states, “Communication and team performance correlate with patient outcomes, so being able to reflect on our role as a team player is a big part of that success.”

Collaborating on Life-long Learning

Participation in continuing professional development (CPD), in both formal and informal contexts, is an important component of clinical practice. Thus, developing a lifelong learning stance and a reflective approach to clinical practice is critical for anesthesia specialists.

CPD is viewed as a necessary component of competent professional practice: from an individual perspective in terms of keeping up to date with knowledge advances, managing a positive, professional attitude and changes to clinical practice, and an institutional perspective in terms of improved health outcomes for patients.

Drawing on the work of David Boud and Paul Hager propose an alternative conceptualization for thinking about professional development using the metaphors of “participation,” “construction,” and “becoming.” This perspective, they argue, is more productive, in that it recognizes the intricate relationship between work practice and learning, and it positions CPD as an ongoing (lifelong) process: one that is situated in practice and is collaborative in nature.

Maintaining Professional Competence in Health Care

The progression of learning across the spectrum of professional practice is critical to meet the ever changing needs of contemporary health care provision. With the shift towards an outcome-driven approach, a shared understanding of the terminology associated with competency-based medical education (CBME) is critical. In simple terms, competence can be defined as the ability to do something successfully. Yet, this definition fails to capture the complexities of what professional competence in a health context actually entails. Ronald Epstein and Edward Hundert provide a useful definition, noting that it involves “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.”

If we return to Boud and Hager’s metaphors of professional development as “participation,” “construction,” and “becoming,” then in the context of pain management, the promotion of deliberate practice, lifelong learning, and self-regulation are key considerations in CPD activities. This helps drive continuous efforts to improve performance, involving the identification of goals, motivation, monitoring and evaluating clinical practice, seeking feedback and problem solving.

Anesthesia specialists should seek out CPD that provides them with these opportunities, so they embrace a more deliberate approach to their professional practice, personal attitude and in the process to develop their expertise in pain management.


Aviation Management Tool Identifies Hazardous Perioperative Attitudes. anesthesiologynews.com

Continuing Education in Pain Management: Using a Competency Framework to Guide Professional Development. journals.lww.com