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Keith Baker, MD, PhD, believes that there are no shortcuts when it comes to teaching and learning, a philosophy that he has aspired to deeply instill in the education and training practices within the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital.
“My goal has always been to develop the next generation of anesthesiologists who seek to attain expert performance,” says Dr. Baker. “To do this, you have to always reinvest in your ongoing professional growth. It’s not that you finished residency and you're done, but rather every day is an opportunity to become a little better than you were the day before.”
The department’s Vice Chair of Education since 2008 and prior director of the Mass General Anesthesia Residency Program for 15 years, Dr. Baker shares more about what drew him to teaching, the successes and challenges that residents at Mass General face, and how the residency program has evolved since his time as a Mass General anesthesia resident.
Q. What brought you to Mass General?
While in medical school, I aspired to be a clinician-scientist. I obtained a PhD in neurobiology and was particularly interested in the fundamentals of how ion channels work in the brain and other tissues. In both my time as a resident at Mass General and as junior faculty, I had the opportunity to conduct basic science research, studying the ion channels that are responsible for the rhythmic beating of the heart. I enjoyed that work until I was given the tremendous opportunity to become involved in residency education.
Q. Tell me about the moment that you said “yes” to becoming a leader in education. Why did you choose to pivot in this direction?
Dr. Warren Zapol proposed the idea to me, and I went for it. He was a man who could clearly see into the future, and he felt that I had something to bring to education at Mass General. I was passionate about being able to influence trainees early on, as residents. I really wanted our residents to attain a deeper understanding of what they're doing as doctors.
When I was a trainee, medicine was more practical in its approach to things, with little emphasis on the sophisticated knowledge of the theory behind everything we do. There's a lot that we can do to deepen our understanding of why we do what we do. In addition, there is significant evidence available that can be used to improve patient care. Across the country, we have performance improvement opportunities in medicine that are not being taken advantage of. Addressing that gap between ‘what is’ versus ‘what could be’ has been a big driver for me.
Q. How has your experience as a teacher intersected with your work as a provider?
Something that always has motivated my approach to teaching is that I won't be here one day, and I really want the next generations to deliver fantastic care—the kind of care that that I would want for myself or my loved ones. I don't think that happens for people spontaneously; they need guidance and coaching. I think I'm able to model the kind of care that I want residents to engage in because I try and deliver the same health care for my patients. I'm fairly critical of my own performance, and I think reflecting on my own performance and always asking how I can be a little bit better is simply living out the same thing I ask of our trainees.
I am also very forgiving and accepting of new residents who can't do things right away because that's a normal part of learning. There are no shortcuts in learning, and I know that first-hand. This gives me a lot of empathy towards new learners.
Q. Since being a resident and leading innovation in training at Mass General, how has the Anesthesia Residency Program evolved over the years?
Substantially. The level of supervision today is much higher than it used to be. From a patient's perspective, our trainees now render higher quality care because of faculty supervision. Supervision does not mean telling residents what to do all the time. Rather, we want our residents to have more opportunities to engage with faculty so that the resident can make decisions themselves that lead to safe, high quality care. This level of autonomy is a key part of professional growth and it also helps to motivate residents.
I also think a huge difference from when I was a trainee to now is the level of production pressure—the tension between taking time to educate and to learn something new, and moving the cases along more quickly, to get the patient into the operating room, etc. Production pressure is a serious threat to education today.
Q. Interesting! How is the department working to counter that?
The most effective thing that has been done so far has been the launch of NOS days on which unassigned residents can choose to work one-on-one with any unassigned faculty members. This fosters an ideal teaching and learning environment while maintaining operating room efficiency. On NOS days, the faculty member can help look after patients and keep cases moving along while the resident has time and space to learn new things throughout the day.
Q. What do you consider to be your successes as the director of education?
The thing I'm most pleased with is the cultural adoption of a learning orientation amongst the trainees and faculty members. When challenges or difficult cases arise, we approach them with an improvement mindset. We welcome people not knowing or understanding everything from the start. We simply use that as an opportunity to identify areas to work on and then help people improve their knowledge and performance as they go forward.
I do not think there's enough of this in medicine today and we as a department have made a point of adopting it as the norm. It helps the trainees to feel comfortable with trying new things, and it helps the faculty be more supportive of residents when they don't know an answer. It creates a mindset that you'll be learning throughout your career.
Q. What would you say is unique about training at Mass General?
First, our colleagues are extraordinary. My Mass General colleagues not only know a vast amount of information, but they also know it at a very sophisticated level. Also, our providers really aspire to deliver the best care. Between the resources available at Mass General and the aligned belief in unparalleled patient care, this place is extraordinary. Lastly, we have an academic depth here that is simply second to none.
Our residency is not made to be easy. It is made to grow you professionally while also providing all the elements of support—both personal and professional—that you would need to be successful in your career and life. We make it a priority to be mindful of all aspects of a resident’s life and provide support to those who need it or may be facing challenges in their personal life.
Q. In a few words, what is your philosophy on education and training?
Every day, you should find a way to get a little bit better than you were the day before. The great mistake is resting on an adequate performance level. It's very comfortable to do that rather than continuously reinvesting in your own professional development.
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