SNACC TEACHER OF THE YEAR

An Interview with Dr. Shobana Rajan, MD, the Winner of the 2020 SNACC Teacher of the Year - Lifetime Educator Award

Priscilla Nelson, MD

Priscilla Nelson, MD
Assistant Editor, SNACC Newsletter

The SNACC Teacher of the Year Award recognizes a person who exemplifies a career dedicated to teaching and mentoring health care professionals or basic scientists in the areas of perioperative neurosciences. Dr. Shobana Rajan, with a strong track record in neuroanesthesiology education and training, was awarded the 2020 SNACC Teacher of the Year - Lifetime Educator Award. She works as the Associate Director, Neuroanesthesia and Vice Chair, Education at the Allegheny Health Network, Pittsburgh, PA, USA.  She is a member of the SNACC Board of Directors and Chairs the Trainee Engagement Committee.

Shobana Rajan, MD

What is the current setting that you're working in?
I work at Allegheny General Hospital, which is part of the Allegheny Health Network in western Pennsylvania (Pittsburgh), with a practice focused on neuroanesthesia and general anesthesia. I serve as the Vice Chair for Education in the Department of Anesthesiology. I help with online curriculum modalities, organize residents' lecture schedules, and teaching programs.

What do you like most about teaching and how do you convey that to your residents?
On my first day in medical school (which seems like so many years ago!), my professor in anatomy told us, “a doctor ceases to be a doctor when a doctor ceases to be a student.” That sentence has reverberated in my mind for so many years, and now I see how true it is.

I understand that as a physician, we are committed to lifelong learning.  So, when I teach my residents, I always try to talk about fundamental science in anesthesiology - how things work, how drugs work, and the pathophysiology of the diseases - so that a basic understanding is created. I believe that when we lay foundations in the minds of the trainees, it can lead to lifelong learning. I get excited when I know that I am teaching foundational principles. I try to educate through interactive discussions and use different teaching modalities like electronic quizzing and flipped classroom models. Sometimes I send a podcast the day before, and then I do a mixed media format on the lecture day. I think the residents look forward to this because they find it more exciting than simply a didactic lecture. I also find it exciting to use new modalities for teaching, which tend to be more interactive. I try to teach the fundamentals in an exciting way, which hopefully the residents will remember for a long time.

Can you tell us about your best mentor educator and what you have adopted from that experience as a mentee?
This is a difficult question because I have had so many mentors along the way who contributed to my career trajectory, particularly because of the connections SNACC affords.
When I first came to the United States, I interviewed for a fellowship position in anesthesia at the Cleveland Clinic. That is when I met Dr. Rafi Avitsian. I was stunned by his timeliness and efficiency at work, and I adopted many of those aspects from him. He also made me feel comfortable in a new workplace, which is always challenging, particularly when you first come from a different country. He has been a great mentor from the early stages of my career in the USA.

Subsequently, as I got more involved with the SNACC, I found that one of the values of SNACC membership is excellent mentorship. I met Drs. Jeffrey Pasternak and Deepak Sharma both of whom have offered me outstanding guidance. When I first came up with the idea of having a special interest group in anesthesia education, they enthusiastically supported me and provided insight and feedback. They helped me write goals, missions, and a vision for the project so that it would get approved by the Executive Committee of SNACC at that time. We now have a highly successful productive Training Engagement Committee, which originated from the special interest group.

Another person I wanted to mention is Dr. Jane Easdown, who helps SNACC and the Society for Education in Anesthesia (SEA) collaborate. She has also given me steadfast support with all my educational endeavors.  I first had the opportunity to work with her on a survey about perceived barriers to a career in neuroanesthesia amongst anesthesiology trainees. She helped me figure out the survey responses and missing aspects. I have been working on the International Council for Perioperative Neuroscience Training (ICPNT) over the last two years, and I have been fortunate to be associated with Dr. Andrew Kofke, who is the chair of this council. I have learned a lot about education in perioperative neuroscience, various aspects of international collaboration, and have been offered exceptional support and career guidance.

I also want to say that my mother has been an important mentor of mine.  She was a single mom because my father passed away very early when I was a kid.  She has had significant leadership roles in our community, and I have learned how to lead by example from her. She has always been upbeat, enthusiastic, cheerful, and I have learned a lot about leadership from her.

What is your most memorable educational moment in the past year?
When I initially attended SNACC meetings as a trainee, I felt the need to reach out to all the senior leaders of SNACC to gain their perspectives on neuroanesthesiology. But I always found it hard to reach out to them because I was a trainee, and I did not know them personally. Since a new trainee could get lost at a SNACC Annual Meeting because they don't know anyone, when we formed the Trainee Engagement Committee, I felt like we should have a trainee engagement welcome reception so that the trainees could feel welcomed and connected.

This year, because of COVID, I was anxious whether the reception was going to be possible.  The Executive Committee approved it to be held virtually, and we had a very successful trainee reception. The reception had electronic fun quizzing and breakouts with SNACC leadership for more personalized interactions. Our goal is that this might create awareness and interest in the trainees for neuroanesthesia. I was stressed about the reception initially and so when it happened successfully (virtually), it was a very memorable thing.

What do you see as the biggest difference in education since you were a resident?
I did my first residency in India in anesthesia about 20 years ago, and then I worked as an attending there for ten years, where I taught and trained residents. Then I came to the United States and did a second residency. As I was sitting with my other residents who, of course, were many years younger than me, I had an opportunity to assess education and teaching from a different perspective -- through their eyes.

I found that there were a lot of differences in what newer trainees perceived as good teaching compared to when I was a resident for the first time around. I noticed that they did not want the attendings to talk simply about things they could easily find from Google or read from books. During traditional lectures, the residents (including me!) were frequently zoning out. But what I found very interesting was that they loved the problem-based learning discussions, and they loved it when the attendings talked to them from their experience, which was not something you can read from books.

I have applied those principles to my teaching now and I think the residents appreciate that. Trainees enjoy quizzes as a modality of learning since it makes them more focused. That is one reason we created the neuroanesthesia monthly quiz, which is published on the SNACC website.  The quiz has been successful because it has been beneficial not only to the trainees but also to the faculty and members of the SNACC who use it for operating room teaching.  I want to mention that the quiz team members are all dedicated and committed educators who, without fail, post the quiz every month.

As we move into this period that is more focused on diversity and inclusion, how do we as educators tackle these challenges and anesthesia? And do you think that our metrics need to change to address the differences in learning?
Diversity and inclusion is becoming more and more important in the workplace and also in residency training. When we have a diverse and inclusive residency class, everyone feels safe and comfortable sharing and interacting with educators who should be inclusive in their approach to teaching. The presence of unconscious bias towards the underrepresented minority trainees might push the trainees to become more reclusive and not feel supported.  Increasing awareness of this can be helpful.  For example, I personally have interacted with trainees who might have felt that way and who might have been struggling. I reach out to make them aware of their strengths and try to focus on the specific development of those strengths.  I have found that their trajectories then become steep, and those residents can become extremely confident and do much better.

I do not think we should change the metrics. The metrics should be constant. But how we assess them, how we interact with the trainees, and how we develop them should be different and maybe more individualized.

What is your best advice you would have for women especially, regarding education and academics?
I think as women, we struggle for work-home balance. We want to stay on top of our careers, but at the same time, we want to handle our responsibilities at home with equal commitment. This is always hard for us because we often think about our responsibilities at home when we are at work and then about our responsibilities at work when we are at home. It is easy to get exhausted thinking, “oh, there's so much to do.”

But work-life integration skills are particularly important.  I have tried to do this but I have not always been successful. I try to compartmentalize and keep work at work and when I come home to focus on what I need to do at home completely.  Partitioning might be necessary, I think. This is another crucial reason to have supportive mentors. SNACC has been offering a lot of mentorship and support to women during their early career growth through programs such as the Women in Neuroanesthesiology Neuroscience Education and Research (WINNER).

I see a lot of women saying, “oh, I will let my kids grow up, and then I'll focus on my career.” I think a lot of time can be lost when that happens. When you have only 10 or 15 years left in your career, you are struggling to do so many things. Trying to keep both work and home separate and rationing and planning time for both would make sense.