Navigating the complex dynamics of anesthesiologists' professional identity formation in the context of their specialty training program: a phenomenographic perspective.

BACKGROUND: A specialty training program is crucial for shaping future specialist doctors, imparting clinical knowledge and skills, and fostering a robust professional identity. This study investigates how anesthesiologists develop their professional identity while navigating unique challenges specific to their specialty. The formation of professional identity in anesthesiology significantly influences doctors' well-being, teamwork, and ultimately patient care, making it a crucial aspect of anesthesiology education. Utilizing a phenomenographic approach, the research explores the learners' personal experiences and perspectives of professional identity formation in their specialty training programs, providing valuable insights for enhancing future anesthetic educational programs. METHOD: The data for this phenomenographic study were collected through semi-structured interviews with anesthesiology trainees and specialists, guided by open-ended questions. The interviews were conducted at a Swedish university hospital, and participant selection used purposive sampling, providing rich and diverse data for analysis after 15 interviews. Iterative analysis followed the seven-step phenomenographic approach. The research team, comprising qualitative research and anesthesiology education experts, ensured result validity through regular review, discussion, and reflective practices. RESULTS: The study reveals three fundamental dimensions: 'Knowledge of Subject Matter,' 'Knowledge of Human Relations,' and 'Knowledge of Affect.' These dimensions offer insights into how anesthesiologists comprehend anesthesiology as a profession, navigate interactions with colleagues and patients, and interpret emotional experiences in anesthesiology practice - all crucial elements in the formation of professional identity. The findings could be synthesized and further described by three conceptions: The Outcome-Driven Learner, the Emerging Collaborator, and the Self-Directed Caregiver. CONCLUSION: The study uncovers differing learner understandings in the development of anesthesiologists' professional identity. Varying priorities, values, and role interpretations highlight the shortcomings of a generic, one-size-fits-all educational strategy. By acknowledging and integrating these nuanced learner perspectives, as elucidated in detail in this study, the future of anesthesia education can be improved. This will necessitate a holistic approach, intertwining both natural sciences and humanities studies, focus on tacit knowledge, and flexible teaching strategies, to guarantee thorough professional development, lifelong learning, and resilience.

Anesthesiologists' conceptions of learning anesthesia in the context of their specialty training program: a phenomenographic study.

BACKGROUND: Training anesthesiologists poses challenges and complexities, particularly in defining and teaching excellence in anesthesia. Existing anesthesia curricula primarily emphasize the acquisition of knowledge, practical skills, and professional competencies, often neglecting the development of intangible skills like tacit knowledge. Despite efforts to establish learning goals through carefully describing competencies, there is a risk of oversimplifying the intricate aspects of professional anesthesia practice. Therefore, the objective of this study is to gain a deeper understanding of the genuine curriculum of a specialty training program in anesthesia. This will be achieved by exploring the perceptions of learners with different levels of experience within the program. METHODS: This study employs a phenomenographic research approach to explore the conceptions of anesthesiology trainees and specialists, specifically from a student's perspective, regarding what constitutes an excellent anesthesiologist i.e., what to learn, and the learning process associated with it. RESULTS: This study identified three different conceptions of learning anesthesia within the context of a specialty training program: "Learning Competencies of Anesthesia," "Learning Work as an Anesthesiologist" and "Learning Being an Anesthesiology Professional." These conceptions ranged from a relatively instrumental view of education and self-responsibility for learning to a perspective of continuous personal reflection and development integrated with professional interaction. The three conceptions can be described in six dimensions describing the variation in approach to learning and the conceptualization of an anesthesiologist. Relationships between the conceptions and the dimensions were represented in a descriptive framework, showing the hierarchy of increasing understanding. CONCLUSION: This study has uncovered diverse learner perspectives among anesthesiologists at various experience levels concerning their understanding of the role of an anesthesiologist and the associated learning process. These distinct understandings can be categorized into different groups and presented in a descriptive framework that encapsulates the fundamental elements and important educational aspects of an anesthesiologist's progression through a specialty training program in anesthesia. By recognizing and integrating these diverse perspectives, anesthesia education can be enhanced, ultimately resulting in improved preparation of future anesthesia curriculum, teaching and assessments.

Heterogeneous complement and microglia activation mediates stress-induced synapse loss.

Spatially heterogeneous synapse loss is a characteristic of many psychiatric and neurological disorders, but the underlying mechanisms are unclear. Here, we show that spatially-restricted complement activation mediates stress-induced heterogeneous microglia activation and synapse loss localized to the upper layers of the mouse medial prefrontal cortex (mPFC). Single cell RNA sequencing also reveals a stress-associated microglia state marked by high expression of the apolipoprotein E gene (ApoE high ) localized to the upper layers of the mPFC. Mice lacking complement component C3 are protected from stress-induced layer-specific synapse loss, and the ApoE high microglia population is markedly reduced in the mPFC of these mice. Furthermore, C3 knockout mice are also resilient to stress-induced anhedonia and working memory behavioral deficits. Our findings suggest that region-specific complement and microglia activation can contribute to the disease-specific spatially restricted patterns of synapse loss and clinical symptoms found in many brain diseases.