Alumni Notes: Q & A with Maher J. Albahrani, MBChB

By combining the experience, skills and insights gained, and mentorship received at one of the best training centers in the world, I was inspired to adopt a similar structure of training in Oman.

- Dr. Albahrani

Why anesthesiology?

During my undergraduate training in the UK, I always wanted to be an internist, but after graduation I realized my passion in anesthesiology, especially when no other Omani doctor wanted to join this challenging field. Anesthesiology is unique in integrating complex medical knowledge with procedural skills to provide holistic and meticulous care of patients. This was demanding for others but not for me. I found the practice of anesthesiology quite rewarding; every day offers an opportunity to expand knowledge and refine skills to ensure patients’ safety and comfort during some of the most vulnerable moments in health care. This always gives me a profound sense of accomplishment.

You credit your fellowship training at Duke Anesthesiology to shaping your approach to anesthesiology and impacting the way you operated/practiced when you returned to your home country of Oman. How so?

At Duke Anesthesiology, I was fortunate to have high level mentors supervising a group of highly enthusiastic and intellectual fellows in a positive and rewarding environment. This dedicated and hard-working environment had a great influence on my future career in anesthesia. Duke Anesthesiology is renowned for its cutting-edge research, patient safety and quality improvement initiatives that greatly inspired my approach to anesthesiology practice in my country.

What specific aspects of your training profoundly impacted your ability to advance the practice of anesthesiology in Oman?

Training at Duke Anesthesiology provided me with a solid foundation in both the technical and soft skills necessary to be an effective leader in the field. The ability to manage anesthesia for complex cardiac cases, heart and lung transplantation, minimal invasive cardiac surgery and critical care management of a variety of medical and surgical cases, has nourished my confidence and advanced knowledge.

In addition, exposure to research and fostering connections with experts in the field, all provided me with the skills to improve the quality of anesthesia services and patient outcomes in my country.

And, what personal qualities did you rely on to achieve such an ambitious goal?

Having good leadership and communication skills and being adaptable and open to change helped me the most in navigating various challenges. At the same time, commitment, hard work and critical thinking were important traits that helped in achieving these goals.  

What key lessons did you learn at Duke that equipped you to assume the role as the only Omani anesthesiologist in Oman when you returned from training?

Besides the advanced clinical and problem-solving skills, making critical decisions and working under pressure during the training prepared me for the responsibilities and leadership role I took upon returning to Oman.

And, what did this specific role teach you?

It taught me adaptability, resilience and perseverance, as well as the ability to analyze complex situations and make sound decisions.

What challenges did you face once you returned to Oman, and how did you draw on your drive and training to overcome them?

At that time, anesthesia, intensive care and pain management were undervalued in the country, with shortages in human resources, equipment and advanced technology. With the exception of cardiac anesthesia, there was a lack of qualified expertise in all other subspecialties across the country, leading to either lack of services or suboptimal practice.

To overcome these challenges, I founded the Oman Society of Anesthesia and Critical Care in 2004, which promoted ongoing education and the transfer of knowledge and skills to existing anesthesia providers. In the same year, I established an anesthesia residency training program for young Omani doctors, which helped in shaping the next generation of anesthesiologists in the country. The subsequent step involved reaching out to key stakeholders in the Ministry to advocate for the acquisition of state-of-the-art equipment, medications and advanced technology to improve anesthesia services. Moreover, while training in the United States, I recognized the significance of respiratory care. Hence, I established this service in all hospitals in Oman by recruiting practitioners and training Omani staff in this important field, which proved vital during the COVID-19 pandemic. These collective initiatives transformed anesthesiology practice in the country.

In what ways were you able to establish yourself as a respected leader, particularly at a young age, and climb the ladder so quickly in Oman?

I planned my professional development soon after completing my undergraduate training by deciding to pursue postgraduate training in the best centers in the United States and subspecializing in areas of high need in my country. In 2004, I was appointed the director of anesthesiology at the Royal Hospital where my leadership role began by developing anesthesiology services across the country and establishing the anesthesia society and the residency training program. This led to more significant opportunities for collaboration with the medical community in Oman and on an international scale. This dedication and commitment to excellence set me apart early in my career, with building a reputation as a reliable and effective leader.

How were you able to transition from your initial training to establishing a successful residency program in Oman?

By combining the experience, skills and insights gained, and mentorship received at one of the best training centers in the world, I was inspired to adopt a similar structure of training in Oman. I started the anesthesiology residency training program in 2004, and in 2007, the official Oman Medical Specialty Board was established in which I led the anesthesiology program for another 10 years. This was accomplished by customizing the program to align with the specific needs and resources in Oman while maintaining international standards of education and practice. I was privileged to be supported by qualified faculty members with diverse expertise, which helped in obtaining accreditation from relevant bodies to ensure its credibility and quality.

How has that program impacted patient care?

Training a new generation of anesthesiologists has contributed to the cultivation of more qualified professionals, ensuring the delivery of consistent and reliable anesthesia services. We currently have 44 residents in the program. Among the 62 who have already graduated, 38 residents have resumed fellowship training in North America and the UK, thus enriching our hospitals with a wealth of knowledge, skills and innovation upon their return. Presently, we have Omani consultants in all subspecialties of anesthesiology, critical care and pain management, some of whom hold leadership positions in their respective departments.

How significant was your establishment of the anesthesiology-led transesophageal echocardiography (TEE) service in the operating room in Oman, and how did your own training in TEE contribute to this development?

In Oman, the intraoperative TEE was led by the cardiology team. Training in TEE at Duke Anesthesiology provided me with such valuable knowledge, expertise and accreditation; by leveraging this training, I was able to establish an anesthesiology intraoperative TEE service in the Royal Hospital with confidence and effectiveness. Through the procurement of  dedicated equipment and the establishment of training in this modality, anesthesiology led intraoperative TEE became a standard of care for every cardiac surgery case in Oman.

What challenges did you face in training others and what lessons did you learn from those teaching experiences?

Teaching TEE requires mastering complex equipment and acquiring skills in obtaining and interpreting echocardiographic images accurately. This was challenging for TEE novice anesthesiologists, particularly in maintaining patient safety during critical moments of anesthesia. Initial limited resources added to these challenges. Having been the sole expert in TEE at that time, I learned to be patient and persevere to accomplish this goal of TEE standardization in cardiac surgery, especially in a TEE novice environment.

Name some critical steps in developing anesthesiology departments across Oman, and how have you transformed those departments?

After acquiring trust of the higher authority in the Ministry of Health, I began by studying the resource needs of each department with an emphasis on the operating rooms and the intensive care units. This enabled me to develop a strategic plan that outlined specific goals and objectives for departmental improvement. Following that, we proceeded to upgrade our facilities, human resources, equipment, and technology. Additionally, we organized a range of continuous educational activities, including courses, workshops, and local and international conferences, which helped in disseminating knowledge and skills among our team.

What strategies did you use to lead your team, the Royal Hospital and ICUs in Oman through the COVID-19 pandemic?

Being in the position of assistant director general for medical affairs during the pandemic laid a great responsibility to navigate the challenges posed. Various dedicated teams and task forces were formed, and we ensured effective communication by maintaining transparency during meetings to disseminate information and address any concerns. Resource management during the pandemic was a global challenge. We developed strategies to ensure adequate availability and proper utilization of medical equipment, supplies and personnel. Supporting the mental and emotional well-being of our health care staff was a high priority and was managed by a dedicated team. Due to rapidly changing circumstances and evolving scientific information, we had to be adaptable to different waves of the pandemic by adjusting workflows and protocols to respond to the evolving situation. We could not have succeeded without support from the higher authorities in the Ministry and collaboration and coordination with other health care facilities. Furthermore, we promoted research initiatives by our clinical scholars sharing their work with peers on regional and international platforms.

Core insights from your many leadership roles in Oman?

Having a clear vision for the organization and developing strategies to achieve goals is essential. I learned that strong communication skills are vital for conveying expectations, fostering collaboration and ensuring a cohesive team environment. I also believe that every health care organization should have “people-centered care” strategies for staff and patients alike. Empowering your staff and providing them with opportunities for professional development, along with staff satisfaction, contribute to the overall success of the organization. Prioritizing patient safety and quality of care should also be at the forefront of departmental and hospital management.

What essential strategies and actions do you consider fundamental for addressing national health challenges and achieving success?

First, identify the key health challenges and formulate evidence-based policies to address these challenges. Other strategies include prioritizing preventive health care measures, investing in health care infrastructure and health information systems, supporting professional development, and engaging communities in decision-making and health promotion activities.

How did mentorship influence your path to success?

Mentorship in anesthesiology and critical care at a prestigious institution like Duke had a profound impact on my career. The guidance and support that I received from my mentors during and even after my return to my country helped me to successfully navigate the challenges and offered insights into my career paths to reach my professional goals. This mentorship contributed to my personal growth by building confidence, resilience and leadership skills that were essential for my success.

What do you believe are necessary qualities of a good mentor?

It is essential for a good mentor to have a solid foundation of experience, skills and knowledge in order to provide valuable insights and guidance to their mentee. They should have effective communication skills and be committed to the mentorship relationship by inspiring their mentee to strive for excellence. I believe a good mentor should also be supportive and available to provide guidance as needed and should demonstrate empathy and respect for their mentees’ perspectives, challenges and goals.

Considering your accomplished career, what is your philosophy on work-life balance?

I believe in establishing clear boundaries between work and personal life to avoid burnout, and maintaining a healthy separation between the two is essential. This balance can be achieved by identifying priorities, efficient time management and prioritizing self-care activities to maintain physical and mental well-being, and hence, productivity and satisfaction.

What advice do you have for aspiring anesthesiologists?

My advice is to focus on academic excellence and build a strong foundation of knowledge and skills, and to invest in professional development, continuous learning and research. It is also important to engage in professional networks and connect with colleagues and professional organizations to expand opportunities and exchange knowledge. Additionally, to make patient-centered care a strategy and to prioritize work-life balance for good well-being and satisfaction.

Last year, the key word in “Alumni Notes” was curiosity. What are the key words of your journey from Duke to Oman?

Opportunity and transformation. BP

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