Dr. Matt Sherrer (Host 1): Welcome in to another edition of the Fresh Flow podcast. I'm Matt. He's Mitch. Mitchell, how are you today, buddy?

Dr. Mitchell Tsai (Host 2): I'm good. I think we're like halfway through the summer crush, right?

Host 1: Yeah, absolutely, man. I'm going to brag on us today, which I don't do very often, but we've actually done something really smart here lately. And that's bringing in real podcasters, right? Because if you want to be smart and learn something, bring in people that actually know what they're talking about and just hope something rubs off on you, right? So, I'll take a moment to brag on us for that.

Host 2: No, I fully agree with you. I think when we introduce our guest tonight, I think we just both step off and go from there.

Host 1: I'll go take a break and she can take it from here. Now, we want to welcome in Allie Bechtel today. Allie is a practicing anesthesiologist in New Zealand coming to us from an entirely different day than we are in. I'm still wrapping my mind around the bending of space, time that's happening here. So, she is in New Zealand. And you guys may recognize her name, because she is the Director of the Anesthesia Patient Safety Podcast for the Anesthesia Patient Safety Foundation. So, very successful podcast, hundreds of episodes. Allie, thank you so much for doing this and thank you for being here with us today.

Dr. Allison Bechtel: Oh, thank you so much for having me. It's very exciting to be on the other side of the podcasting host-guest relationship. So, it's really cool to be here.

Host 1: Is it more nerve-wracking being on that end or the host end?

Dr. Allison Bechtel: Oh, absolutely. I was preparing for this for a while. I told my whole family, I was like, "Guys, I'm really nervous." And they were like, "Why are you nervous? You've done hundreds of podcasts." And I said, "Well, it's so different when I'm the guest and I'm not working with my usual materials," so...

Host 2: Well, we try to throw you softballs, right?

Host 1: So speaking of softballs, first one, you are educated here in the United States, trained in the United States. Actually, part of your training at Emory, not far from me. How in the world did you end up practicing in New Zealand? There has to be a cool story there, right?

Dr. Allison Bechtel: Well, I had a friend who was an obstetrician who moved her family to New Zealand for a one year locum's position. And when she came back, she just could not stop raving about her year in New Zealand and how amazing it was. I'd never been to New Zealand, my husband's never been there, but we thought, "Oh, that sounds cool." But we had a new baby at the time, so it wasn't a good fit for us then. But kind of as the years passed and our kids entered primary school, when our youngest was in kindergarten, and then through the pandemic, when everything kind of slowed down and we spent a lot of time at home with the family, we were like, "Oh, we really like this." And then, when things like started ramping back up again, we said, "Oh, well, is there anywhere we could go where we could have maybe more family time and a little bit better balance?"

And so then, we thought about New Zealand again. And it's a place that since I trained in the United States, I can move to practicing in New Zealand through a couple of pretty complicated steps. They look through your history of practice. You do a couple interviews and then a whole year of supervision followed by a worksite-based assessment.

But ultimately, it was a good fit for us to move over here. I applied to a couple of positions and finally found the job on the West Coast of the South Island of New Zealand. So, I'm at a very small hospital. We have three operating theaters, one of which is mostly used for endoscopy procedures, four beds in our critical care unit; a really small, but dedicated team in the hospital. It's one of those places where like everyone kind of knows each other's names. And I really enjoy that part. So, we found this job, we thought it'd be a good fit for the family. We told our kids and family. And we kind of thought it was going to be a two-year move. We said, "Well, we don't know how we're going to like it. So, let's just go for two years and then come back to the States." But I don't think we had been here very long, probably about a year. And we said, "This is a really good fit for our family." And so, we've been here now two and a half years. And we try to get back to the States about every year to see our friends and family back there, because it's hard. That's the hardest part is just being away, so far away from family. But the benefits of work-life balance and just kind of a totally different trajectory of career and pathway. You know, it just feels really good to be doing something so different.

Host 2: Well, I want the audience members, people who are listening to notice that Allie said theaters and not operating rooms. And so, obviously, acclimated. So, you've been there for a while. I know a couple of colleagues who've gone over there, but one of my colleagues Klick, John Klick, he's our ICU Division Chief, and he commented on sort of the regionalization of healthcare delivery. And so, you're living in a different healthcare environment. Can you tell us about the system in terms of from the Anesthesiology or Anesthesia perspective in New Zealand, how is it different than the United States? How is it better? How is it not as good? Or just compare and contrast, you know, what do you enjoy about it?

Dr. Allison Bechtel: Well, it is definitely different. And some of that I'll have the caveat of I have now only practiced in New Zealand at my current hospital, which is a small rural hospital in Greymouth, New Zealand, so I can't speak to the larger centers, except for the fact that we do transfer a lot of our patients to Christchurch, so I have worked with some of the anesthetists in Christchurch, and then just my experience at conferences.

But there is definitely some regionalization in New Zealand. I think largely just because the population numbers are so vastly different, where we just don't do as many cases of a certain type because we just don't have that same number of patients. And, you know, there's the idea in medicine that you have to do a certain number of procedures to feel proficient at that procedure. And so, having the people doing more of the procedures at the bigger, busier centers and then sending the patients to those centers seems to make the most sense.

You had the example of like the ECMO service in New Zealand, and I just did some looking this up too, because we definitely do not have ECMO at my institution. But in New Zealand the first case of ECMO was done in 1993. And then, since 2005, they established the National ECMO service in Auckland. I was able to find some data from 2014. But in 2014, there were 31 adults and seven children placed on ECMO with 17 patients needing to be retrieved by the mobile ECMO service. But this is in contrast to in the United States. There was over 5,000 cases of ECMO in 2014 in the United States. So, it's just the number scale is so different. And so, when sometimes thinking about like even Anesthesia trainees, like how are they getting enough cases when there's just so many less patients in the country.

But from a personal, like practicing perspective, we see it a lot at our hospital because in Greymouth, we're the biggest hospital and the only hospital for the West Coast of New Zealand, serving a population of about 33,000. But people live as far as three to five hours away from the hospital. And in our town, we have general surgeons who live here, and work primarily at Greymouth Hospital. And then, we also have some obstetricians and gynecologists, and then four anesthetists. And so, that makes up the heart of our theater service. But we are still able to provide services such as orthopedic surgery with joint replacements, urology, more complicated gynecology, surgery, and pediatric and adult dentistry by having those folks fly into our hospital, provide care, and then fly back to the city that they come from. And so, it helps us to be able to provide a service to our patients, but we just can't maintain that service consistently. And then, it's always interesting because we're very dependent on the weather too. So, sometimes the plane just cannot get to us. And then, that changes the whole dynamic in the theaters. We might have to cancel a list or shift patients around. And the same is true with patients. Sometimes they just can't get to the hospital because there's a road closed. And these were things that I never would have thought about in the United States because it just doesn't seem to happen quite as regularly. But here, we're kind of always checking the weather and have that in the back of our mind as well.

And the other really interesting thing, because in the States, I worked at the University of Virginia, so we were the large referral center. And now, I'm sending patients to a referral center. And so, it's just interesting being on the other side of things, where we're calling the ICU in Christchurch to say, "Hey, we have this patient that we need to send to you, and just making sure that that handover is clear and effective, but also, you know, has to be a good teamwork relationship, because we need them to accept the patients. And they want to make sure that we're transporting the patients safely. And so, we have a pretty good relationship as far as that goes too.

Host 2: I think those are all great comments, Allie. I mean, right now with 40% of the American hospitals sort of struggling financially, a lot of them are rural, right? And how do you establish those rural services so you can still take care of the population and deliver care that you need to? And I'm going to echo Govindarajan at Tuck Business School down in Dartmouth, right? We tend to believe that American medicine has everything to teach the rest of the world, but what does the rest of the world have to teach us? And I think that's an important lesson.

Dr. Allison Bechtel: Yeah. And it's definitely interesting, because the other experience here is I work in the public healthcare system. But in New Zealand, they have like the public system that is funded by the government, and then a private system as well. A lot of anesthetists who live in the cities will work a couple days a week in public, a couple days a week in private. But because I live a three-hour drive away from the closest city, it's not really feasible to do a day in private. And I quite like my work-life balance here in Greymouth. But I think that's also a fairly different experience to say, okay, it would be like being in the United States and working a couple days a week, maybe in an academic center and doing teaching and then going into like a really busy private center for a day, which I know a lot of people do. I just had never had that experience. So, there's just different opportunities for different types of practice too.

Host 1: Interesting. Well, Allie, I mentioned it at the beginning. You've been with the Anesthesia Patient Safety Foundation for a while, directing the podcast, hundreds of episodes. Again, how did that role come about? How did you get plugged into the APSF? And then, how in the heck did you find yourself hosting their podcast?

Dr. Allison Bechtel: Oh, great question. Do you mind? I might just introduce the APSF first for people who might not know about it.

Host 1: Incredible organization. Yeah, go ahead.

Dr. Allison Bechtel: And if you have listened to the Anesthesia of Patient Safety Podcast, we have talked about the whole foundation on the show as well, but it was first launched in 1985. And then since then, it's really grown from just being more in the United States space to being an international voice for anesthesia patient safety with a kind of multidisciplinary role as well. And the real goal of the foundation is that no patient shall be harmed by anesthesia care. And they use that mission statement. We use that mission statement at the APSF in everything we do. And it really drives people in the APSF family to work so hard to improve patient safety.

And there's lots of different things, resources from the APSF. There's the quarterly publication which, Matt and Mitch, you have some articles in as well, which is really exciting. But there's also some other good opportunities for education. There's patient safety research grants. The conferences put on by the APSF are really great. There's also advocacy campaigns and a real drive to help whenever there's a question about patient safety, like when the COVID pandemic first started, I think a lot of people, that's when they turn to the APSF as a leader, saying "How can we keep patients safe and how can we keep Anesthesia professionals safe too?"

So, I first started with the APSF actually in 2020, so right kind of in the middle of the pandemic. And the APSF wanted to expand from the newsletter to start working into the podcast space, because podcasts were becoming more popular. And I just saw a call out on social media that the APSF was looking for a podcast director. And I had previously done a podcast through OpenAnesthesia called Keys to the Cart, but that project had just wrapped up. So, the timing was really great. And I was like, "Oh, I need to fill the podcast void." So, I applied. I had to do like an audition show. And then, I got the position and got to work really closely with Dr. Marjorie Stiegler, and Dr. Mark Warner was a big supporter of the podcast.

And then, the wonderful thing about the APSF is they didn't just say, "Okay, do the podcast." We had lots of support from the whole communications team to really help kind of make it happen. And the idea with the Anesthesia Patient Safety Podcast is to kind of be just a different way to consume the newsletter and all the great resources by the APSF for folks who might not have time to sit down and really read through all those articles. But if you can listen for about 15 to 20 minutes a week, you can get a sense of what is the latest in perioperative anesthesia patient safety. And then, maybe, hopefully, you might even listen to it and then say, "Okay, let me go read the article as well for some more followup too."

Host 1: Very cool. Yeah. And a tremendous organization, as you said, kind of the lifeline for a lot of us during COVID trying to figure out how to navigate the waters. And then, if I'm not mistaken when we talk about anesthesiologists and anesthesia professionals in general, really leading the charge in patient safety, if I'm not mistaken, when the National Patient Foundation was formed, I'm pretty sure they just basically openly emulated the Anesthesia Patient Safety Foundation, just cementing our place as leaders in patient safety.

Dr. Allison Bechtel: Yeah. And we've made huge strides in, you know, the past. Since 1985 to now, we really have improved patient safety. But even if you just read the latest newsletter articles, there's still work to do to improve anesthesia patient safety. And some of them are very simple strategies and some are much more complex ideas. So, still more work to do, but we have come a long way.

Host 2: So, Allie, I'm going to push you a little bit here. Repenning and Sterman, MIT, they came up with this concept of the capability trap. And if you get a chance, it's on YouTube. It's a video about how a lot of organizations will boost performance just to make themselves look better. But when it comes to like quality and all the measures that we think about in healthcare, these are all sort of short term, right? And so, going back to quality and safety, going back to anesthesia as sort of the leader of patient safety, we've led, we know that. I mean, Matt said that we've been emulated, right? But how are we going to do better, right? What does patient safety 2.0 look like?

Dr. Allison Bechtel: Oh, that's such a good question. And I do think it's something that we are constantly thinking about with the APSF. And so, I mean, there are a lot of opportunities. I think probably the best place to start is with looking at the APSF newsletter even just our most recent newsletter. The June newsletter covers one of the articles about wrong drug, wrong route tranexamic acid for local anesthetic drug error and the devastating, you know, effects when that happens. But this is a never event. And so, you know, from a, short term perspective, we often would think, "Okay, let's just work on our labeling," like do better with labeling, or, you know, we kind of blame the Anesthesia professional for just not paying close enough attention. But really, it's a bigger issue. And what we know, and if you're listening to the podcast about this article or reading the article, is there is a way to prevent this from ever happening again. We need to make sure that all tranexamic vials and ampules are removed from the operating theater. It should be an easy step. But they need to be replaced then with infusion bags of tranexamic acid, 1,000 milligrams in 100 mLs. That step is not as easy. It's going to cost a little bit more money, although much less money than any drug error would cost, and does take some work because FDA approval for certain infusion bags and like whether or not your compounding pharmacy can put it together. But that is a really important step for patient safety. And if we did that, we would never see that drug error again. And then, 10 years from now, we'd look back and say, "Oh my gosh, can you believe that used to happen?" So, I just think we do need to be kind of constantly thinking about, "Well, what is next? How can we move from making just small changes or trying to make Anesthesia professionals better at patient safety and more making our systems more reliant. And I think education is an important part of this too. Anesthesia patient safety education kind of just goes quietly along with anesthesia trainee education. But we might need to have like a little bit more dedication to that for Anesthesia trainees and Anesthesia professionals, once you're out in practice to say listening to the podcast, reading the newsletter, are you providing safe anesthesia as well, and how can you make your hospital or institution or the whole system safer?

Host 2: I think, you know, it does start at residency. I still remember one of my mentors, David Smail, who, you know, he said, "If we made all the labels the same color, you'd have to work a little bit harder to figure out what you were giving." And, you know, that's an interesting construct. I think what you're talking about with the TXA and the infusion bag, you know, that goes back to Thaler and Sunstein, right? Asymmetric paternalism. How do you structure the system? And it's the same thing with organ donation rates, right? They're great in Belgium and in Europe, because you have to opt out of donating your organs when you get your driver's license. While in America, you have to opt in. And then, so how do you build those systems?

And then, you know, the past doesn't necessarily predict the future, right? Yeah, we can put it in a hundred mL bag, but what's the next drug we're not supposed to give in a hundred mL bag, right? And so, it's this ongoing discussion of how do we do better and how we build better systems. I firmly believe that technology is probably going to get us to 80-85% there. But in terms of the human element, we're always going to need that. And I think my favorite story is from aircraft maintenance on the commercial aviation side, right? They work eight, 10, 12-hour shifts. And then, your first two hours, when you're awake, aware, doing the job, which you're supposed to do, you can operate at the highest level that you possibly can. And so, for aircraft mechanics, they're able to do the most complex tasks. They get to sign off on their own work. And the next two hours, you have to have somebody else check on your work, right? And then, the next fourth and fifth, six hours, two people are going to check on your work. And then, while the last two hours in your shift, you're going to be polishing the tires on the airplane. How do you take that construct and actually put it into our work cycle? Because we know we get tired, right? The night float system and the work hour regulations really didn't affect anesthesia providers in the sense that we knew that working more than 24 hours is not the smartest thing, but we can probably do better.

Dr. Allison Bechtel: Yeah. Oh, that is a great analogy, and so interesting to think about, like having people like check your work, especially the longer that you've been working. And the other thing is thinking about like the Anesthesia workforce, like how can we help Anesthesia professionals to practice safe anesthesia? Well, one thing is to make sure that they are kind of healthy and resilient as well. So, having a good work-life balance, whatever that means for them, but coming into work rested. There was an interesting article from the February APSF newsletter about time from Glass to Mask. This is from aviation as well, where they have like eight-hour window from your last alcoholic drink, until your shift, and there's no such policy like that in Anesthesia. But should there be, just keeping the parallel with aviation and anesthesia?

And then, I also think the focus on teamwork and communication, because when you have a good team relationship, I think that helps you to practice safer. Well, we know it helps you practice safer anesthesia, but then, you're happier, people like coming to work when they like the team that they work in, and they're better able to take good care of their patients.

Host 2: I mean, Allie, you're a cardiac anesthesiologist by training, and I did cardiac anesthesia for the first 15 years of my career here, and I fully agree with you, right? When the perfusionists and the cardiothoracic surgeons are working with you, it's much easier and it's just much smoother because everybody's sort of on the same page.

Dr. Allison Bechtel: Stress levels are lower because you're not scared to speak up about something.

Host 1: So Allie, we love asking questions about the future here. Mitch just asked one. Anytime we've asked people on the podcast about the future, you always end up talking about artificial intelligence, generative AI, natural language processing, large language models, et cetera, et cetera. And so, I said generative AI. When I was reading your CV, I came across something called generative retrieval. I had no idea what that was. I started to think about reproductive endocrinology, and if there's some sort of tie in there. What in the heck is generative retrieval? What is it? And then, how do you see its utility in resident education and beyond?

Dr. Allison Bechtel: Oh, such a good question. I was like, "Oh, I know they're going to ask about that. But when I was at the University of Virginia, I was part of the Anesthesia Education Research Group. And this is one of our projects. It was really fun, and it's such an interesting idea. And basically, we kind of took the idea that the amount of information that Anesthesia residents are expected to learn has been increasing. You know, now, residents need to learn transesophageal echo, and transthoracic echo, and bedside ultrasound. And now, I also want them to learn all about anesthesia patient safety. But at the same time, clinical training hours have decreased, so we really need an education system that's effective and efficient to help meet these demands. And so, we took the concept that repeated testing, even self-testing, can help improve long-term retention of information due to the practice of retrieval from memory. And the idea that this may extend to unsuccessful retrieval attempts that can help improve future learning processes.

So, we looked at generative retrieval with an attempt to retrieve and produce an answer from memory based on cues as part of this learning process. And how that all worked in the study was we took learners. And the standard practice group would just kind of watch a video clip of a transesophageal echo with an unlabeled anatomy like an arrow pointing to an anatomical feature, and they would watch that clip with the unlabeled arrow, and then they'd watch a followup clip where it was labeled. But in the generative retrieval group, they would watch the clip with the unlabeled arrow, and then they'd have to verbally say what they thought that anatomical feature was, the aortic valve. Or they could say, it could be completely wrong, but then they would see the labeled clip as well. So, they do a whole study session like this. And then, we would test their retention at one week, one month, and then for longer term retention after six to nine months. And we found that medical students and Anesthesiology residents who were inexperienced in TE, so they hadn't yet been taught any other TE, they had improved learning and retention of this basic cardiac ultrasound, which is great.

And then, we also found that they really enjoyed it. So, they found it to be effective. They enjoyed the process and they were satisfied with the generative retrieval process, which was cool. But then, we repeated the study a couple of years later, looking at fourth year medical students learning regional anesthesia on the ultrasound anatomy. And at that time, we actually didn't find any differences between the generative retrieval group and the standard of practice group. But we had some ideas for this. So, we thought, well, these fourth year medical students were quite stressed about it being fourth year, and the timing in the year, and trying to match into residency spots. So then, this called in the whole idea of motivation to learn and engagement in the learning process, because if they weren't going into Anesthesia, they were like, "Well, why do I need to learn this?" And so, it was just all very interesting.

But I did look to see, have there been any updates, because our last article was published on this in 2019. And it does look in education resources, they're doing some work on generative learning and retrieval practice. So, it's like two different concepts that they put together. And generative learning involves like the construction of coherent mental representations of the learning content that's been integrated with your prior knowledge. And then, the retrieval practice is consolidating these constructed mental representations from your memory. And newer work, like just this year, it seems that doing the retrieval before generation sequence may lead to improved retention and decreased cognitive load. So, I found that to be really interesting. But the overall idea is that there's a lot for Anesthesia trainees to learn in education, so they definitely have to be effective learners.

Host 2: So, Allie, I'm glad you didn't use the term for the fourth year medical students, but I think it's called senioritis, but I could be wrong there. But no, I think from an educational just framework, the term that comes to mind is sort of interweaving, right? Always constantly revisiting what you're doing and you're going to get better at it, because you have a skeleton that you're going to hang more material on it so you actually have a fuller skeleton and you know what you're doing.

And I think that's one of the shifts that we've seen here at my institution when we switched to the night float system. I'm a dinosaur, but you know, when I was a resident, I covered obstetrics overnight call as a resident for two and a half years, right? And everybody thought I was crazy. But, you know, you come out as an attending and you're comfortable up on Labor and Delivery. And it's very different now when sort of those rotations you only do for two months, and you cover it for two weeks on night float, and that's pretty much your experience and, you know, you don't get that constant sort of feedback forcing you to do the generative retrieval and generative learning to make sure you know what you're doing. So, that's interesting stuff.

Host 1: People still think you're crazy too, by the way. Just bringing that up.

Host 2: Crazy old dinosaur. Yeah, I probably believe it. You know, Allie, part of the other work that you've done is sort of about just gender disparities, you know, patient care delivery and then sort of the faculty and the future of our specialty in Anesthesiology.

One of Matt's colleagues, she recently published a paper using bibliometrical analysis showing that non-white female anesthesiologists are sort of not connected to the topography of specialty. What's your experience and, you know, what's your perspective? How do we do better? And, you know, I think ultimately this is going to affect patient safety. You know, it's been shown that when you have more female representation in any group or organization that you're working with, you get, definitely cognitive diversity, right? And that generates or engenders sort of this patient safety. So, where does this all end up in terms of what you think?

Dr. Allison Bechtel: Yeah, a little caveat, this is just what I think. No, it is a great question. And there really are some amazing people doing work in the space. I thought that article was really interesting. From a historical perspective, my mom won't like that I use that word, but my mom is an anesthesiologist. And when I talk about the gender gap in Anesthesia, she would say, "Oh man, it's definitely different and better now." So from her perspective, you know, we have made huge strides too.

I think people are really working on it. But in some respects, I wonder, you know, at what point do we have to say, "Okay, we need there not to be a gender gap too." You know, and I do think we kind of just need to change the narrative. Because looking at this article, and then even just if you do a quick Google search like gender gap in Anesthesiology, you get all these recent articles. So, it's clearly still a problem. But I thought, "Well, let me see what happens in New Zealand and Australia." Because a lot of times, the studies are done with New Zealand and Australia anesthetists to help increase the number size. But there actually was just a study published in April of 2024 by Stewart and colleagues, Does Gender Still Matter in the Pursuit of a Career in Anesthesia? And then, an editorial by Carter and colleagues that said, Still a Boys Club: A Qualitative Analysis of How Gender Affects a Career in Anesthesiology in Australia and New Zealand. And some of the results from the study are really interesting and will not be surprising to anyone who's read some of the survey results from the United States because they just sound quite similar, but women respondents described a need to make a choice between career and family, which was not described by men, as well as a stigmatization of part time work, a lack of access to more challenging work, and negative impacts of parental leave. And women respondents also described a sense of marginalization within anesthesia due to this "boys Club Mentality," a lack of professional respect and insufficient structural support for women in leadership. And so, we do see it kind of over here now where I live as well. But there does seem like we're starting to get to the point where we're talking about how do we switch the narrative?

And so, there was another study, I think it was from 2020 by Pearce and colleagues, that looked at gender effects in Anesthesia training. And they concluded that the main factor in the gender confidence gap was actually overconfidence in men and a possible unconscious bias in procedural access. And so, that's important, because it really shifts from what we often hear is that, "Well, women are underconfident too." And so, the authors state in their conclusion that improving women's confidence, we need to change the narrative from improving women's confidence to one where supervisors need to be aware of inherent or unconscious biases when they're supervising trainees. We need to support women in specialty training by facilitating equal opportunities to perform procedures and increased awareness that confidence level may not be an indicator of competence for men or nor should it be a benchmark for women. And I really thought that was great, because it's just like a different way of looking at it.

Host 1: Yeah, I'm not going to say where, but I've had a discussion recently about we call it the bro culture, still a bro culture that exists in the anesthesia world. And then, do you want to talk about collective intelligence article in the APSF. Hey, what are the three things that contribute to collectively intelligent teams? Conversational turn taking, social sensitivity, and number three, females. The more females you have on your team, the more collectively intelligent your team. Likely because females are generally more socially sensitive than men. But just super interesting that a direct link to the number of females on your team.

Dr. Allison Bechtel: Yeah. That article is really great. And then, you know, if you have more collectively intelligent teams, we'll have improved patient safety.

Host 1: That's the hope. That's the hope. So, going back to podcasting, you've done podcasting for a while, but you've also written, talked on social media. You mentioned Marjorie Stiegler as being kind of a part of your intro into the APSF. Where does social media and podcasting fit in this educational world? This is the new day. We have new learners. Where does all of this fit into? What traditionally has been more of a didactic model?

Dr. Allison Bechtel: Oh, well, I think it is definitely pretty well established as part of anesthesia and healthcare organizations. So, we definitely need to embrace it. It's such an easy and quick way to consume the most up-to-date information. Now, the caveat is we have to be really careful where the information is coming from as well. But if we just look at the podcast sphere, the first podcast I listened to in Anesthesia was the ACCRAC podcast by Jed Wolpaw. I actually got to be on that podcast last year, which was just kind of surreal, because I've been listening to it for years. But man, there's a lot of great education on that podcast. And I think that should be required listening for all Anesthesia residents.

But I just think we need to be like more flexible in our education, and this helps because just Instead of having these like sit-down didactic sessions, which you may or may not remember anything when you walk out of the room, having these additional education resources so not just ACCRAC, but also OpenAnesthesia has some great podcasts and video podcasts out there for education. And these are the Fresh Flow Anesthesia podcasts, you know...

Host 1: Thank you. Thank you. Thank you. We'll send the money to your Venmo after we're done here.

Dr. Allison Bechtel: But these can all be consumed when you're going out for a walk or going for a run or commuting to the hospital. And I think that's just really important because people want to be more efficient in how they work through the day. And I think the other thing is, the nice thing about the Anesthesia Patient Safety Podcast is that this allows, like, if we say, "Okay, Anesthesia resident trainees, you guys, we hope you all listen to podcasts. And we hope they all listen to the Anesthesia Patient Safety Podcast, because it'd be a great way to get 15 minutes of anesthesia patient safety education every week." And then, hopefully, make them interested in say, "Well, what else can we do to improve patient safety going forward?" And same thing when they listen to like the interesting conversations on the Fresh Flow Podcast, like what else is there in Anesthesia? It just kind of helps people have this like much bigger perspective inside of just what's happening at their own institution.

Host 2: So Matt, you know, I think this is our 12th episode. Is that correct?

Host 1: It is. It is indeed.

Host 2: You know, we're coming to the end of the year and it's sort of like TV, we get to take the rest of the summer off and make more money acting in movies. But, you know, the first person we had on this podcast was Alex Macario, and he was my mentor and my perioperative management fellowship. But kudos to Alex. You know, he's becoming the President of the American Board of Anesthesiology. And even back then, I won't tell you how many years ago, I was hanging out with him, but he talked about the ivory towers in Academic Anesthesiology, right? And why is it that if we're going to learn about fentanyl, we're not learning it from Tim at Utah. If we're going to learn about paralytic agents, we should be learning it from Ron Miller, right? And social media, podcasts, this sort of platform allows a sort of this flattening, right? Thomas Friedman, right? How do we flatten the earth so that everybody gets to learn a little bit better? But they were ahead of their times.

And then, the other shout out I want to make out too, is that I can't think of his name. His first name's Chris, but he was the Program Director at Stony Brook for the longest time. I think you've used it, Allie, it's the board stiff for TEE. But for a long time on YouTube, he had Mr. So and So's Neighborhood, and he did these YouTube lectures on respiratory cardiac physiology, sort of like, pushing the envelope and how we educate our residents and educate the future. So, I just wanted to throw that out there.

Host 1: What I heard Mitch say is that was a flat earther. Did you catch that? I want that to be out there for everybody to know.

Host 2: That's coming from the guy in Birmingham.

Host 1: Man, low blow. Well, Allie, we appreciate you doing this. I want to encourage you to keep going with the APSF mission with the Anesthesia Patient Safety Podcast. It's great things that you guys do. It's a wonderful organization. And I just think so incredibly highly of all of the people there and all the efforts. So, keep doing what you're doing. We certainly appreciate it. And we appreciate you being here with us today.

Dr. Allison Bechtel: Oh, thank you so much for having me. This has been great.

Host 1: All right. Well, Mitch, we did it, man. We got through a season. We said we wanted to finish a season and, look, we've gotten here and we've done it. So, I do want to take a moment to thank our sponsors, which is my boss, Dr. Dan Berkowitz; my employer, UAB Medicine and the Association of Anesthesia Clinical Directors. Thanks to everyone at those institutions for their support. This has been a blast and we hope to continue to do it. It's been a good time. Mitchell, congrats, buddy. We did it.

Host 2: You too. Season two on Hulu.

Host 1: All right. You all have a great rest of the day. See you. Thanks for tuning in.