A career in cardiac anaesthesia in India: The heart of the matter

Global Cardiac Anesthesia Workforce Assessment: A Cross-Sectional Observational Survey Study

OBJECTIVE

The primary aim of this survey was to assess the demographics, training background, practice setting, and work environment of cardiac anesthesiologists globally.

DESIGN

Cross-sectional study of the global cardiac anesthesia workforce. A multilingual web-based survey was conducted between June 1 and December 31, 2023.

SETTING

The survey was distributed via cardiac anesthesia societies, special interest groups, and social media using a non-probabilistic sample and with snowballing techniques.

PARTICIPANTS

Anesthesiologists actively practicing cardiac anesthesia.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In total, 3,430 participants from 99 countries responded. Results were summarized as descriptive data comparing geographical regions, and noticeable differences for individual countries were assessed. Most of the workforce (85.9%, n = 2,913/3,390) that responded to the survey were between 31 and 60 years of age. Australia/New Zealand/Oceania (51.1%, n = 48/94) and Asia (45.2%, n = 606/1,341) had the largest percentages of respondents working in the above 50 years of age group. Globally, 48.4% (n = 1,347/2,780) of respondents reported having completed an accredited adult cardiac fellowship, and 42.7% (n = 918/2,148) replied to have had only informal training "on the job." When it comes to transesophageal echocardiography, 44.6% (n = 1,240/2,780) of the global workforce reports not having had any formal training. Large differences in training background were noticed by country and region. Most of the workforce (43.3%, n = 1,149/2,652) indicated working between 41 and 60 hours per week. However, more than one of four (26.8%, n = 711/2,652) cardiac anesthesiologists work between 61 to 80 hours, and one out of ten (10.5%, n = 279/2,652) has a workload of more than 81 hours per week. A majority (68%, n = 1,778/2,609) of cardiac anesthesiologists evaluated their compensation/salary as less than adequate or just adequate but not enough to save for retirement. Regarding work-life balance, there was a significant variation in how practitioners assessed their personal situations. Almost half (46.3%, n = 1,185/2,560) of the workforce consider making changes to reduce their workload, and only 23.1% (n = 592/2,560) evaluated their work-life balance as just right. A validated, non-proprietary single-question item assessing emotional exhaustion as one of the three established criteria for burnout was incorporated into the survey. The overall prevalence of burnout, i.e. emotional exhaustion, among cardiac anesthesiologists was 31.7% (n = 827/2,609). In the regression analysis, an increase in clinical work hours (OR = 1.28; CI [1.16, 1.42]; p < 0.001), the number (OR = 1.05; CI [1.02, 1.08]; p < 0.001) and type (OR =1.09; CI [1.0, 1.19]; p = 0.03) of cardiac call, all increased the odds for burnout. Compared to taking all cardiac call in the hospital, taking no cardiac call at all, significantly decreased the risk for burnout. Similarly, compared to compensation that was perceived as less than adequate, i.e., even needing a second income, higher compensation assessment was associated with an increasingly lower risk for burnout. Other factors mitigating burnout risk include older age groups (OR = 0.78; CI [0.67, 0.90]; p < 0.001), and a more positive outlook on work-life balance (OR = 0.88; CI [0.85, 0.92]; p < 0.001). The geographical region had a small but significant association with burnout (OR 1.12; CI [1.06, 1.18]; p < 0.001). Asia, as the geographical region of practice, had the highest odds for burnout overall (41.3%, n = 342/829) and also the most respondents (15.6%, n = 129/829) in the highest answer option category, i.e., feeling completely burned out.

CONCLUSIONS

A global survey of the cardiac anesthesia workforce found inconsistency in the training, job satisfaction, and daily practice of cardiac anesthesiologists. The rate of burnout was high, and many respondents would like to make work-related changes to improve work-life balance.

Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India

OBJECTIVE

Many previous surveys have demonstrated a high incidence of burnout among anesthesiologists. The current survey was designed to estimate the incidence and understand the factors associated with burnout among cardiac anesthesiologists in India.

DESIGN

Members of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) were invited to participate. The survey consisted of two sections: the initial section collected demographic data, work patterns, and factors associated with burnout perception. The second part assessed emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (LPA) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

SETTING

Web-based survey.

PARTICIPANTS

Members of IACTA.

INTERVENTIONS

None.

MEASUREMENT AND RESULTS

A high score on EE (≥27 and/or DP ≥10) identified those at high risk for burnout. A high risk of burnout in addition to LPA ≤33 was defined as burnout syndrome. Of the 2,262 IACTA members surveyed, 325 (14.35%) responded. Among them, 162 (49.8%) were classified as at high risk of burnout, and 91 (28%) met the criteria for burnout syndrome. Logistic regression analysis identified factors associated with a high risk of burnout, including <5 years of experience (odds ratio [OR] = 3.53), insufficient external support (OR = 2.87), limited personal time (OR = 1.96), and considering leaving cardiac anesthesia (OR = 3.61). Factors contributing to burnout syndrome were <5 years of experience (OR = 3.83), inadequate workplace colleague support (OR = 1.84), and considering leaving cardiac anesthesia (OR = 2.43).

CONCLUSIONS

The burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for various stakeholders to be sensitized and institute necessary measures to reduce the burden and impact of burnout.

Revolutionizing Cardiac Anesthesia: A Comprehensive Review of Contemporary Approaches Outside the Operating Room

This review article provides a comprehensive examination of the evolution of cardiac anesthesia, emphasizing contemporary approaches beyond the traditional operating room (OR) setting. Tracing the historical roots of cardiac anesthesia from its inception in the mid-20th century, the narrative explores the significant paradigm shift driven by technological advancements and changing procedural approaches. The review highlights the emergence of non-OR environments, such as hybrid operating rooms, catheterization laboratories, and electrophysiology labs, as integral spaces for cardiac interventions. Key findings underscore the importance of patient selection, preoperative assessment, and specialized anesthetic management in optimizing outcomes. Implications for the future of cardiac anesthesia include the potential for enhanced patient-centered care, reduced complications, and improved resource utilization through the integration of advanced technologies. The call to action involves encouraging ongoing research and fostering collaboration among healthcare professionals to refine protocols further, address challenges, and propel the field toward continued innovation in contemporary cardiac interventions.

Heterogeneity Among Countries in the Subspecialty of Cardiovascular Anesthesia in Latin America: Survey Results

OBJECTIVES

To evaluate demographics, workload, training, facilities, and equipment in cardiovascular anesthesia (CVA) in Latin America (LA).

DESIGN

A descriptive cross-sectional study with data collected through a survey.

SETTING

A multicenter, international web-based questionnaire that included 37 multiple-choice questions.

PARTICIPANTS

Physicians and specialists in anesthesiology who regularly participated in cardiovascular surgeries and were members of the scientific societies of the Latin American Confederation of Anesthesiology.

INTERVENTIONS

None MEASUREMENTS AND MAIN RESULTS: A total of 484 completed questionnaires were collected. A total of 97.8% of the respondents had a university degree in anesthesiology. Most did not receive formal training in CVA, and only 41.5% received formal training. Moreover, most of them were trained in their own country, and a smaller percentage were trained abroad. Half of the respondents reported receiving <12 months of training. A third part of the respondents had received training in transesophageal echocardiography. Only 5.8% of the respondents worked exclusively in CVA, and a high percentage dedicated <60% of their weekly work hours to this subspecialty. A total of 80.6% of the centers had <3 cardiac surgery operating rooms. Only one-third of the centers performed heart/lung transplantation, venoarterial extracorporeal membrane oxygenation, venovenous extracorporeal membrane oxygenation, and ventricular assist device implantation.

CONCLUSIONS

A significant lack of training programs in anesthesiology practice and complex procedures in medical centers in LA are evident. Thus, basic accredited programs should be developed in medical centers in LA.

The changing face of postgraduate anaesthesia teaching curriculum: Need of the hour!

The speciality of anaesthesiology is evolving rapidly. The recent pandemic witnessed anaesthesiologists as the front-liners catering not only as critical care physicians but also as trainers and even administrators. Today, anaesthesiologists are required to have not just sound clinical knowledge but also proficiency in skills and techniques and aptitude for leadership. The recently introduced competency-based postgraduate training programme for anaesthesiology in India with its specific learning objectives envisages the creation of competent specialists with a broad range of skills who are competent not only to handle effectively medical problems but also acquire the basic teaching skills, communication skills and leadership qualities. The curriculum marks a paradigm shift from university-based, passive, teacher-centric to student-centric, active teaching-learning methods including problem-based and self-directed learning. The mindset, lack of adequately trained faculty, infrastructure, learning resources and time constraints form the major impediment in the successful implementation of the new curriculum.