Oct 29, 2018, 21:26 PM by Vivian H.Y. Ip, MB, ChB, FRCA, and Kristopher M. Schroeder, MD

This year, the ASRA-hosted World Congress in New York was truly an inspirational event with different world experts sharing their knowledge and experiences in regional anesthesia and pain medicine. Such a phenomenal event no doubt took years of preparation and a great deal of hard work. For a number of providers, ASRA has provided invaluable world-class educational resources, tools for academic advancement, and opportunities for collaboration. Recently, Dr. Kris Schroeder and I (Viv Ip) had the pleasure to interview Dr. Vincent Chan, chair of the 2018 World Congress, to unravel his secrets of success as a leader and role model in the field and his thoughts on the opportunities for member involvement in ASRA.

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ASRA shall remain the voice and engine to advance the science and practice of regional anesthesia and pain medicine by promoting high-quality research and educational activities. ASRA shall stay true to its mission.

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Dr. Chan is a well-recognized world leader in regional anesthesia and pain medicine and an active ASRA member. He was ASRA president from 2009–2011, and he received the prestigious Gaston Labat Award in 2016 and Distinguished Service Award in 2017. It was evident from the interview that Dr. Chan has great vision with regard to how advancement of regional anesthesia and pain medicine might benefit patients and the direction that ASRA should take in the upcoming years. He passionately pursues research and is committed to educating and advancing the career of the next generation of anesthesiologists, both within and outside ASRA.

 

Schroeder: What has allowed you to be so successful as an academic anesthesiologist? How is your nonclinical time structured?

Chan: Nonclinical time and resources provided by my department has supported my academic activities to do research, teaching, and administrative work. I started with a half day of academic activities a week, then earned my way to get one day a week and then more later. This is based on academic productivity that is judged by a departmental academic committee. I now have one to two days per week to do academic work, but nonclinical time is not protected. Lost time is banked and hopefully will be reassigned later.

 

 

Ip: Were you provided with start-up funding?

Chan: Like everyone else, I needed to apply for small start-up university funds to support new projects in the beginning. The department provided no financial support.

 

 

Ip: What was your mentorship structure like? What made these mentors successful?

Chan: We have no formal mentorship program, but people usually look to senior faculty and investigators for help. When I started, I was fortunate to work under the mentorship of Dr. Frances Chung in Toronto. She is a good role model to learn from, especially in being innovative, hardworking, persistent, inquisitive, and not afraid to challenge old dogma. She always encourages me to think outside the box.

 

 

Ip: In mentoring junior faculty now, what do you try to instill in them and how do you help them achieve greatness?

Chan: Every junior faculty is different. Provided that they are truly interested to grow and work hard, I will challenge them to think and generate new ideas. Once a new project is set to go, I will support them by providing advice and guidance along the way and the necessary research support such as research staff, equipment and some funding. I have built a regional anesthesia and acute pain research program in which all regional anesthesia investigators have access to the program research staff and equipment independent of their level of funding. Junior staff are supported for at least two years without monetary contribution to the research program. This is a great way to kickstart a research career.

 

 

 

Schroeder: How has ASRA involvement contributed to your success? How did you initially become involved with ASRA?

Chan: I was involved in ASRA as a trainee member in the late 1980s when I was a fellow at Brigham and Women’s Hospital in Boston. Dr. Ben Covino was the chair at that time, and he was an ASRA board member who introduced me to ASRA.

ASRA has allowed me to get involved in the society’s educational activities, first in abstract presentation, then in weekend workshops as an instructor, and later on in annual meeting workshops and finally in meeting plenary sessions. Involvement in those activities has allowed me to meet other colleagues across the country and around the world. I was able to share ideas and exchange knowledge with colleagues about regional anesthesia practice. Also, ASRA has assisted me in the beginning of my research journey by providing me with some start-up grants for initiation of clinical studies.

 

Ip: What led you to become a very early adopter of ultrasound guidance for regional anesthesia? What sort of resistance do you recall early on from practitioners who believed in landmark-based techniques? How did you promote the technique? How much data do you believe is required before new techniques and technologies are employed?

Chan: I have been interested in regional anesthesia since my residency training, particularly the challenges it posed to most practicing anesthesiologists. I believe that if regional anesthesia is to be as popular as general anesthesia, it must be as easy, consistent, reliable, and effective as general anesthesia. Its practice must change from an art form to a science-based skill set.

Then I read the preliminary studies of ultrasound for peripheral nerve blocks and thought it might be a promising tool for nerve visualization. I embarked on a series of ultrasound studies, first in volunteers and then in patients, to show that ultrasound could indeed localize nerves, visualize a needle, and observe local anesthetic spread around the nerves. This was the beginning of my ultrasound journey.

Key barriers to early adoption of ultrasound-guided regional anesthesia (UGRA) were lack of equipment, cost of equipment, and lack of ultrasound training. But we also saw resistance to changing from traditional methods to a new, unfamiliar technology, a common barrier in medicine.

Changes take time to happen. If something is good, people will recognize it eventually once they have tried it for themselves. A good tool must produce consistent success in the hands of any practicing anesthesiologist. But the prerequisite is to learn the basic skills to use ultrasound properly. Thus, my primary focus at the outset is to teach ultrasound skills, which I find most effective in the small group, hands-on workshop setting. Another effective approach is to teach the teacher, which helps to multiply proper adoption of UGRA more rapidly.

Most practitioners do not need randomized, controlled trials to convince them that a technology or technique is useful. Most important is their own clinical experience and success with UGRA. Once they use the technique and realize that it works well, they will not let go. But again, to do so, good teaching is paramount.

 

 

Schroeder: What are you most proud of in your academic career or your most rewarding accomplishment? What do you see as the next step in your career? 

Chan: I am most happy to see that regional anesthesia has become the standard of care for providing surgical anesthesia and postoperative analgesia in many hospitals and that the change has benefited patients. Furthermore, regional anesthesia is no longer used only by an elite few but rather by everyday practicing anesthesiologists.

The next step is to continue exploring and teaching new ultrasound applications, such as the use of point-of-care ultrasound in the perioperative setting. The goal is to expand our scope of application beyond ultrasound- guided interventions to include diagnostic ultrasound for patient evaluation and management. My future plans include more clinical studies and teaching.

 

 

Ip: Who has influenced you the most?

Chan: Many colleagues at work and in ASRA have influenced my thinking, research focus, and clinical practice over the years. However, these people come and go. One person who has offered me the most support and encouragement throughout my adult life is my wife, Anne. Without her unyielding and unconditional support of my time spent in medicine, I could not have possibly managed all my research and teaching activities.

 

 

Schroeder: What direction do you see regional anesthesia and pain management going? What should researchers and clinicians be working to improve?

Chan: I feel that regional anesthesia has reached a plateau. New regional anesthesia approaches are now moving from a nerve target-based, accuracy-based, and perineural injection-based practice to a fascial plane, non-nerve, target-based practice. Proponents of the techniques hope that a relatively easy-to-perform, less-invasive injection far from main nerve targets can reliably promote sufficient local anesthetic spread and penetration to reach nerve targets and achieve neural blockade. I find those injection goals a bit far-fetched and unrealistic. Without the ability to influence and monitor the extent of local anesthetic spread and penetration in the fascial compartment, and without a clear objective endpoint that distinguishes a successful block from a failed block, I have serious doubt that many facial plane blocks will ever be consistently successful and reliable.

I hope that future studies will examine factors that influence local anesthetic spread pattern in the fascial compartment, factors that promote local anesthetic penetration to reach nerve targets in sufficient amount, and the physical and dynamic properties of fascial planes in different body regions that govern injectate spread. Also, research should critically evaluate the real analgesic benefits of plane blocks. Is the analgesia they provide equivalent to a few oral analgesic tablets? Should plane blocks be done routinely or mainly as rescues?

I also hope that future regional anesthesia and pain studies will evaluate both short- and long-term functional outcomes that go beyond pain scores and opioid consumption.

 

 

Ip: How do you encourage innovative ideas and challenge underlying beliefs or assumptions, especially when mentoring trainees and junior faculties?

Chan: I find that trainees or junior colleagues often ask interesting questions. They are not afraid to challenge conventional dogma and practice. My approach is not to downplay or minimize an idea that sounds foreign or odd at the outset. Rather, we will brainstorm with other research colleagues and discuss as a group to see if the idea is worth investigating.

 

 

Schroeder: What role do you see ASRA playing in the future? Specifically, how can ASRA help address the current problems with opioid dependency and abuse?

Chan: ASRA shall remain the voice and engine to advance the science and practice of regional anesthesia and pain medicine by promoting high-quality research and educational activities. ASRA shall stay true to its mission.

With the current opioid epidemic, ASRA uses its publications to regularly highlight ways and initiatives to combat opioid dependency and addiction. “Fighting the Opioid Epidemic in Our Community,” by Drs. Chad Brummett and Kristin Bennett, is an example. ASRA also provided comments on the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain. These important topics have also been covered in ASRA’s Spring and Fall annual meetings in special symposia. Our Regional Anesthesia and Pain Medicine journal regularly features articles that promote opioid-sparing strategies, including regional anesthesia and multimodal analgesia. Finally, the patient education area of the ASRA website provides useful pain management information as well as an opioid facts brochure that addresses opioid addiction, how to use opioids safely, and safe disposal of opioids.

 

Schroeder: What is ASRA doing well? Where are the greatest opportunities for junior faculty involvement in ASRA?

Chan: ASRA has implemented an associate faculty program to include junior faculty in workshops during its annual meetings and weekend pain and regional anesthesia ultrasound courses. Another exciting area of growth is the number of special interest groups (SIGs), which has now grown to 14. The newly formed Women in Regional Anesthesia and Pain Medicine SIG is an indication of ASRA’s awareness of gender representation and equality in the society. I am sure ASRA will continue to invite more junior colleagues to contribute to its publications and webcasts and will regularly feature innovative research projects conducted by junior faculty.