Q: What attracted the current chief residents to the Duke Anesthesiology Residency Program and how do they like living in Durham?

Angela Li, MDAngela Li, MD
Chief Resident 2017-2018
Joined the program in 2014

The Basics

Hometown: A somewhat complicated answer to a simple question…I moved around a good amount and have lived at least half-a-decade in each of the following places: Toronto, Canada; Bloomington, Indiana; St. Louis, Missouri; and New York City, New York.
Where did you attend college? Washington University in St. Louis
What did you do, or where did you go, next? I spent a year in Boston teaching high school students.
Where did you attend medical school? Weill Cornell Medical School
What are your career goals? I plan to pursue a career in cardiothoracic anesthesia.

Reflections on the Duke Anesthesiology Residency Program

What were you looking for in a residency program? Although I knew prior to residency that I wanted to pursue a fellowship in cardiothoracic anesthesia, I wanted a program that not only excelled in cardiothoracic anesthesia but in all subspecialty fields of anesthesia so that I would receive the most comprehensive clinical training possible. I also wanted a smaller sized program with faculty truly dedicated to education and mentorship that was located in a livable city so that I could have a certain quality of life as a resident. Duke proved to have all of those things.

What are the strengths of the Duke Anesthesiology Residency Program? The relatively small size of the program compared with the surgical caseload – this unique environment allows for an incomparable training environment which allows you to find your niche in anesthesia and fosters strong relationships with attendings and personalized mentorship.

What is a funny or memorable experience from your time at Duke?
While going through routine precautions and lab tests after a needle stick injury, I found out that the physician taking care of me was my fiancé who is a hospitalist at Duke.

About Duke University and Durham

What’s best about living in Durham (and the Triangle)?
Life is easy and quality of life as a resident is high. As with any big change, I was hesitant to leave friends and family in New York City for Durham, but it turned out to be one of the best decisions I made for my overall well-being and happiness. The food and drink scene is amazing and rarely do you have to wait or need to make a reservation. My fiancé and I own and live in a three-bedroom townhouse with our little zoo family (cat named Graham and dog named Kona). We routinely escape to the outdoors for a hike in the evenings, and the cost of living allows us to afford weekend getaways to nearby cities as well as adventures to Patagonia, Iceland, Banff National Park, and upcoming trip to New Zealand on our vacations.

Based on your life, what advice would you give about moving to Durham?
Moving away from friends and family is hard but a place like Durham is truly a gem. Remember that you are choosing a location not only for the residency program but also for your everyday life as a resident. Choose a location that is not only fun to visit but easy to live in and truly offers the potential for a work/life balance. I moved to Durham only knowing my fiancé (a Duke IM resident at the time) and no one else and initially had the mentality that it would just be the place I trained during residency. However, Durham has truly become our home and our colleagues have become our extended family. Now it is hard to imagine ever leaving.

Chris KeithQ: What attracted the current chief residents to the Duke Anesthesiology Residency Program and how do they like living in Durham?
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Q: What was the main goal of this year’s American Board of Anesthesiology-accredited, month-long global health residency rotation in Ghana?

A: The goal of the trip to Ghana was to create a project that could show an incremental measurable gain in the delivery of health care. We arrived in Accra, Ghana at a very interesting time. We were working at Ridge Regional Hospital and there were three separate groups of trainees: first-year nursing anesthesia students, certified anesthetist (nurses) doing continuing medical educations (CME), and house officers who were doing a six-month anesthesia rotation.

It became apparent that there was huge deficit in people who would be qualified to lecture at the nurse anesthesia school associated with Ridge Regional Hospital. My project included providing required lectures to the house officers. Given their initial lack of excitement, I decided to pitch the idea to them of ‘flipping the classroom.’ Each day, a separate house officer would take one of the topics and give a 20-30 minute lecture on the topic. After the lectures, I would fill in the gaps for each topic. The house officers were immediately engaged and in a short time it became easy to see their excitement for the field of anesthesiology.

During the month, we were also charged with providing basic life support training for all trainees. The team provided this training for the SRNAs (40), certified anesthetists (30), and the house officers (7). During this time, I was able to locate the only working defibrillator in the hospital. There was a code earlier in the month and no one associated knew where the defibrillator was located.

This was also a month of growth. I participated in my first intraoperative code. The patient was a mother who was referred from an outside hospital due to sickle cell crisis (Hgb of 4 mg/dl) and fetal distress. The mother was rushed to the operating room but coded shortly after induction. Intraoperative ECG is not commonly used due to lack of disposable stickers and working cables. The patient did have a working pulse oximeter which allowed us to track oxygenation and was helpful for determining return of spontaneous circulation (ROSC). Without getting into the clinical specifics of the case, there was no access to non-invasive blood pressure, no stat labs, no defibrillator, no ECG, no intraoperative fetal monitoring, and no functioning post procedure ICU care.

After work, there were opportunities to debrief and see Ghana. We were invited to meet with a group of Americans living in Ghana, many of whom were just granted dual citizenship. Adam Flowe, Derrick King, and Kent Smith joined us for the last week of the mission trip. They helped with teaching and providing many valuable supplies. Kent was able to tour the hospital with the technical support staff and provide insight about ways to improve efficiency.

Overall the trip was a great success. I have grown so much as a global citizen, a human, and a physician. It is safe to say that quality anesthesia care is one of the largest health care disparities in Africa. Dr. Adeyemi Olufolabi (Duke) and Dr. Medge Owen (Wake Forest) are literally saving the lives of women and children around the world. Their work has forever changed Ghana.

Brian Rogers, MD (CA-3)

Chris KeithQ: What was the main goal of this year’s American Board of Anesthesiology-accredited, month-long global health residency rotation in Ghana?
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Q: Can you provide an example of the learning takeaways that Duke Anesthesiology residents gain from their global health mission trips?

A: In March, we spent a week in Jacmel, Haiti, providing anesthesia care and helping to improve the education of Haitian doctors and nurses caring for patients in the perioperative period.

Some very advanced equipment (stryker lap tower), some very basic equipment (fly paper) and a very tall Duke Anesthesiology faculty member (Dr. Aaron Sandler).

The days were long, mostly pushing 14 hours, but we worked with wonderful folks to take excellent care of very grateful people as they received the surgeries they needed, so time went by quickly.  We found ourselves in a very safe anesthetic environment, with the crucial monitors (including capnography), good availability of necessary medications, and even a videolaryngoscope, but there were a few bells and whistles we have grown used to at Duke that were missing which brought us out of our bubble and challenged us to expand our thinking about delivering a safe anesthetic.

Systems-based process improvement is a central part of Duke Anesthesiology residency training, whether at home or abroad.

Systems-based process improvement is a central part of Duke Anesthesiology residency training, whether at home or abroad.

Anu learned a lot and saw pathology she’d only read about such as thyroid storm, acute hypocalcemia, and the emergency airway management of an expanding neck hematoma!  She also adjusted to using an unfamiliar machine in an unfamiliar environment and relying on spontaneous respiration in our intubated patients (in order to avoid wasting expensive oxygen on driving the ventilator) during some long surgeries for huge parotid tumors, impressive goiters, and the laparoscopic (mostly) removal of the largest gall bladder either of us had ever seen.  The proudest moment of Aaron’s week might have been when Anu, after a ten-hour sevoflurane anesthetic with spontaneous respiration and no end-tidal agent monitor, managed a two-minute wakeup!

There was also the opportunity for improving the education of the Haitian providers, starting with nurses and nursing students, some of whom were caring for postoperative patients for the first time in their careers, and continuing with the Haitian surgeon who will be managing the facility’s two ICU/ventilator beds when they open in June.  He was especially hungry for practical advice on using arterial blood gas measurements to manage ventilator settings, a topic we were happy to talk about.

We both returned to Durham exhausted (as well as desperate for hot showers and a day without bug spray), but also remarkably refreshed.  We felt that we had a made a direct difference in some folks’ lives, both the patients undergoing surgery and the nurses and doctors who ended the week a little bit better educated than they were before.  And, on a personal level, we had been reminded of why we originally wanted to go into medicine.  Overall, not a bad outcome for our week in Haiti.

Aaron Sandler, MD, PhD, and Anushree Doshi, MD (CA-2)

Chris KeithQ: Can you provide an example of the learning takeaways that Duke Anesthesiology residents gain from their global health mission trips?
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Q: What role does the Duke Anesthesiology Residency Program play in global health?

Global Health - DARE BlogA: Dr. Brad Taicher takes us on his journey abroad to provide a snapshot of how our department and residency program make a real difference in the lives of others.

It’s March 11th and we’ve safely arrived in Guatemala City, Guatemala for the sixth time in as many years to help evaluate and care for a group children undergoing general and urologic surgeries. This year’s anesthesia team is comprised of Stephanie Jones (CA-3 resident), Dayna Seguin (CRNA) and Becky Motykiewicz (CRNA), as well as three local anesthesia residents who will anesthetize with us throughout the week (Drs. Miguel Gonzales, Amilkar Garcia and Yolanda Castaneda). On our first day, we saw 80 plus children come through the clinic to be evaluated by our surgical team for appropriateness, and by our anesthesia teams to ensure they are medically optimized, and plan for the week ahead.

Why Guatemala? It’s the poorest country in Central America, and one of the poorest in the world. The public health system in Guatemala is well developed, but bankrupt. It lacks sufficient resources to provide care for all in need, creating an enormous backlog of patients, many of whom have no chance of ever receiving the surgeries they need through the public health system. There are about 4.5 million people in and around Guatemala City; more than 90 percent of whom rely on the public system and only two significant public hospitals to handle major surgeries. These two hospitals are only provided enough funding to purchase supplies to do elective operations in the mornings for about half of the year. When they run out of supplies, it’s emergency surgery only. There is no pediatric fellowship training here for those who are interested, so when I’m here, I’m usually the only pediatric anesthesiologist in the country. Pediatrics is an interest for many here, but a job for few. And for perspective, Guatemala is a country of children with greater than 50 percent of the population less than 18 years old.

In the United States, we may encounter patients who lack the skills to cope with the stress of their surgical encounter. In Guatemala, it is the opposite; patients have overdeveloped coping skills secondary to the conditions of their upbringing and the ubiquitous violence. It is often said that Guatemalan children don’t cry because they have long ago run out of tears. Our mission brings hope to these individuals and families while simultaneously seeking a sustainable model by supplementing pediatric training for local providers and collaborating on research and quality improvement endeavors with local institutions.

In addition to Guatemala, Duke teams have traveled to Ghana, Haiti, Philippines, India, and countless other countries. We are grateful for the phenomenal support provided by our department, hospital, and university over the past six years and the opportunity to include our own trainees and CRNAs on our mission trips. We are excited to continue our collaboration here in Guatemala, and look forward to another successful trip!

Brad Taicher, DO, MBA

Guest BloggerQ: What role does the Duke Anesthesiology Residency Program play in global health?
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Q: Is leadership teaching offered for residents of Duke Anesthesiology? If so, what is the department’s preferred model?

Drs. Ashley Grantham and Jennifer HauckQ: What is leadership in anesthesiology?

A: Hauck: For the leadership development program for the residents, we use the Duke Healthcare Leadership Model as our guide. Each of the five core competencies (integrity, emotional intelligence, teamwork, selfless service, and critical thinking) and the core principle of patient centeredness are integral to leadership in anesthesiology.

A: Grantham: There are many different definitions of leadership. For our program, we felt that implementing a values-based approach to leadership was really important. The Duke Healthcare Leadership Model and our view of leadership in anesthesiology follow the servant-leadership model, where leadership is viewed as a type of service to others.

Q: Why is learning about leadership important for residents in anesthesiology?

A: Hauck: Residents are presented with leadership opportunities and challenges every day.  Whether aligning a team in the OR to help a patient, or leading a patient’s care team through a complex pain management plan, or leading a call team of residents and CRNAs, residents are continually called to lead. These leadership skills become even more critical as residents become fellows and attending anesthesiologists.

Q: Who has had an impact on you as a leader?

A: Grantham: I’ve worked with so many great leaders over my career. I respect Dr. Donna Petherbridge’s ability to connect with people and lead a diverse team at NC State.  From my doctoral advisor, Dr. Audrey Jaeger, I’ve learned how to challenge people to grow while remaining supportive as a leader. Here at Duke, I’m impressed with how many individuals exhibit leadership skills on a daily basis. The individuals helping with the leadership development program, including Drs. Joseph Doty, Nancy Knudsen, Anthony Galanos, Mark Stafford-Smith, and Brandi Bottiger, have had such a positive impact on me as we’ve worked to plan this curriculum.

A: Hauck: I have learned from so many great leaders in my education and training.  The first leader to inspire me was Dr. Erin Reid, a hematologist and professor of medicine at UCSD.  As her clinical trials coordinator, I admired her ability to influence others and bring teams of people together through her genuine investment in building relationships and by treating each colleague and patient with respect as an equal individual with a valued opinion. At Duke, Dr. Stafford-Smith has modeled and taught me how to use emotional intelligence to understand my team and to adapt my leadership approach accordingly. I have learned about resiliency and integrity in leadership from Dr. Dean Taylor, professor of orthopedics and founder of the Feagin Leadership Program.  I admire and appreciate the strengths and unique styles of the many leaders who have mentored me throughout my career.

Q: If you could describe leadership in three words, what would they be?

A: Hauck: To influence others.

A: Grantham: To paraphrase a Ralph Waldo Emerson quote, I would say a leader is “someone who inspires.” Leadership then becomes about selflessness, empowerment and transformation.

Q: How can residents build their leadership skills at Duke?

A: Hauck: Through the Leadership Development Curriculum, our residents will have the opportunity to reflect on their own leadership strengths and those of their team members. During their three years, residents will participate in nine workshops where they will learn and practice leadership skills, and then have the opportunity to apply these skills to their clinical practice.  While a curriculum will add structure to learning leadership, I strongly encourage residents to continue to learn to be the kind of leader they envision through relationships with mentors.

Ashley Grantham, PhD and Jennifer Hauck, MD

Guest BloggerQ: Is leadership teaching offered for residents of Duke Anesthesiology? If so, what is the department’s preferred model?
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Q: How is Veterans Affairs an integral part of Duke Anesthesiology’s Residency Program?

Dr. Dana Wiener is seen here doing warrior pose outside of the Durham VA Medical Center Blue Star Memorial. She participated in a yoga pose challenge for charity, which she unfortunately lost to another contender but won in authenticity since she takes care of warriors each day.

Dr. Dana Wiener is seen here doing the “warrior” pose outside of the Durham VA Medical Center Blue Star Memorial. She participated in a yoga pose challenge for charity, which she unfortunately lost to another contender but won in authenticity since she takes care of warriors each day.

A: “To care for him who shall have borne the battle and for his widow and his orphan” was declared by President Abraham Lincoln in 1865 at his second inauguration and remains the motto of the U.S. Department of Veterans Affairs (VA).  Though I am not a veteran (30 percent of VA employees are veterans), I have been proud to serve these amazing patients in my own way for almost 30 years at the Durham VA Medical Center. We are located right across the road from Duke University Hospital, but our learning environment is very unique.

Duke Anesthesiology’s Veterans Affairs Anesthesiology Service Division consists of 21 physicians and 17 full-time CRNAs, as well as physician assistants, nurse practitioners, health technicians, RNs and administrative personnel. We provide care in the operating rooms (OR) as well as non-OR sites, such as Gastroenterology (GI), Interventional Radiology, Electrophysiology Lab, Cardiothoracic (CT), Pain Clinic, Surgical Intensive Care Unit (SICU), Transesophageal Echocardiography (TEE) service, and 4B/Short Stay Unit.  With the aging veteran demographics in North Carolina, the conflicts in the Middle East and the health care needs in our country, the VA division’s workload is exploding. Last year, we performed more than 8,000 anesthetics; following the national trend, our non-OR cases comprised almost 30 percent of our caseload. Based upon standard productivity calculations, we are currently the fifth most productive VA anesthesiology service in the nation. We administer anesthesia for almost every specialty you can imagine, except for obstetrics and pediatrics. We are even increasing our workload in some minor specialties such as podiatry, oral surgery and radiation oncology.

Veterans Affairs is an excellent place to train due to many factors: complex patients and cases, variety and severity of disease, and unique patient medical issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use, geriatrics, and other disabilities related to military service. In fact, the VA is the largest provider of health care training in the United States. In FY 2014, VA clinical training across the nation involved more than 120,000 interns, residents, fellows and students in more than 40 professions. In Durham, the VA funds the salaries of eight of our anesthesiology residents and fellows annually.

The VA is also a leader in local and national research and innovation. Several members of our division participate in cutting edge research involving data analytics, epidemiology, quality and safety, chronic pain, opioid safety, post amputation pain, and other areas of perioperative medicine. Did you know that the first long-term successful kidney transplant was performed at a VA hospital and also that a Durham VA researcher developed the nicotine patch?  Our VA division is also administratively active. Anesthesiologists lead the Pharmacy & Therapeutics Committee, the Transfusion Committee, Critical Care Committee, and the Interdisciplinary Pain Clinic.

Despite all of these wonderful accomplishments, the VA still has a lot of work to do to fulfill President Lincoln’s plan. Our number one priority is increasing access for more than 11 million living veterans and to do it in a way that respects all of the unique needs and challenges that this population faces. As a distinctive microcosm of the Duke Anesthesiology Residency Program, the VA division rotation will expose residents to an awesome responsibility to assist the men and women who served our county and, quoting President Lincoln, “borne the battle.”

Dana N. Wiener, MD

Guest BloggerQ: How is Veterans Affairs an integral part of Duke Anesthesiology’s Residency Program?
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