#296 How We Build Safer Anesthesia Teams, One Trainee At A Time

A small air bubble, a missed monitor cue, a late call for help—tiny moments that can change everything. We sit down with Dr. Max Feinstein to unpack how real-world anesthesia education builds safer clinicians, why attention is our most precious resource, and how culture—not heroics—prevents harm. From clear talk about morbidity and mortality to practical tactics like just-in-time simulation and curated literature, we map out a grounded approach to training that sticks under pressure.

For new attendings, the leap to autonomy can feel surreal. We talk through imposter syndrome, the virtue of asking for help early, and how to choose a practice that backs safety over production pressure. Want red flags? Proceeding with non-NPO patients or brushing off new chest pain are hard stops. You’ll also hear about Dr. Feinstein’s current research in blood and transfusion management for cardiac surgery, his YouTube channel that demystifies anesthesia for learners and patients, and a nonprofit close to his heart, Heart Care International, supporting care for kids with congenital heart disease.

If you care about anesthesia safety, team culture, and teaching that actually changes behavior, this conversation will give you tools you can use on your next case. Subscribe, share with a colleague who mentors trainees, and leave a review with your top strategy for reducing OR distractions—what works best for your team?

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/296-how-we-build-safer-anesthesia-teams-one-trainee-at-a-time/

© 2026, The Anesthesia Patient Safety Foundation

Transcript

Setting The Stakes For Trainees

Max 0:00

At a foundational level, when I'm working with a trainee, especially a junior trainee, one of the biggest priorities for me is being able to convey a sense of gravity to that person and to just help them really understand the risks for morbidity and mortality.

Sponsor Recognition

Challenges In Anesthesia Education

Alli Bechtel 0:21

Hello and welcome back to the Anesthesia Patient Safety Podcast. I'm your host, Allie Bechtel. When I'm not podcasting about patient safety, I provide patient care as an anesthesiologist. This is the second part of our interview with Dr. Max Feinstein. You may have seen him on YouTube, bringing you into the operating room to educate about anesthesia care. And if you haven't yet, please go check it out over on YouTube. We're not on video today, but he's joining us on the podcast to talk about education in anesthesia and making the transition from training to practice for anesthesia professionals. So stay tuned. Before we dive further into the episode today, we'd like to recognize Nihon Coden, a major corporate supporter of APSF. Nihon Coden has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, Nihon Coden. We wouldn't be able to do all that we do without you. And now we are returning to my conversation with Dr. Max Feinstein. We're going to shift gears now and just talk about anesthesia education. I know that that is also one of your passions. I saw that you received the Excellence in Teaching Award from the Mount Sinai Hospital Institute for Medical Education. That's really cool. So what do you see as the challenges for educators in anesthesia today?

AI’s Promise And Pitfalls

Max 1:54

The biggest challenge that I see right now for educators specifically working with trainees is the rapid change of pace of medical knowledge dissemination. And what goes hand in hand with that is obviously artificial intelligence and the role that that plays. The reason that I think it is such a big challenge is that, at least at this point, the risks of hallucination from AI poses a serious risk to us being able to get accurate information. I have no financial ties with open evidence or ChatGPT for people who aren't familiar with open evidence. It's, I think of it like Chat GPT, but specifically for medical professionals. And it draws from peer-reviewed journals and not just all of them, but a curated set of journals that tend to be higher quality. But even with that in place, I have seen open evidence cite papers in ways that aren't true citations. And so I think at this point in time, that is a real problem.

Distractions And Patient Safety

Speaker 3:03

The other really big challenge that I see in terms of education is related to distractions in the operating room, particularly from personal devices, cell phones. And some significant portion of that time is spent mentally being elsewhere, in addition to being a patient safety issue, first and foremost. It also, I think, is an education issue because that ends up being less time that they're looking at small details, looking maybe for changes in the EKG or listening for sounds that might have changed in the operating room, like maybe the bear hugger overheated and now it's turned off. So I think the distractions are a real issue as well in terms of education.

Teaching Safety With Real Consequences

Speaker 1 3:54

I know it's definitely a challenge. We've talked about it before on the podcast, and it is one of the focuses of the APSF as a patient safety issue. On one hand, we need our cell phones as the smartphone that has information about drugs and mechanism of action and doses and as a quick lookup. But when they are distracting from patient care and seeing those subtle changes on the monitor or sounds in the operating room, that that's when it can affect patient safety negatively too. Well, when we put education and patient safety together, things can get interesting too. So, how do you educate about patient safety?

Building Skills And Just-In-Time Training

Curating Evidence For Daily Practice

Speaker 4:33

At a foundational level, when I'm working with a trainee, especially a junior trainee, one of the biggest priorities for me is being able to convey a sense of gravity to that person and to just help them really understand the risks for morbidity and mortality. Specific examples that I might use, especially in PED's anesthesia and taking care of patients with congenital heart disease, is talking about how if there's a small air bubble that gets entrained into an IV, that that could cause this patient to have a devastating stroke, or to use terms like this patient could die if the following happened. And I'm really careful about how I use those terms anywhere, and especially when I'm talking with patients. But when I'm talking with trainees, I do try to use language like that to help them understand exactly how central our work is to keeping patients safe. In terms of other aspects of that, I do try to ask trainees what sort of modalities for monitoring they're not familiar with or procedural techniques they aren't familiar with or would like some more experience with. I think that plays a really integral role in helping an anesthesia professional be a safe provisioner of anesthesia is just having more tools in their wheelhouse. So if a resident isn't familiar with video laryngoscopy, then I'll try that or fiber optic and so forth. And along those lines, one of the specific strategies that I like to use for procedural skills is this concept called just in time teaching, which entails, and this can be hard to pull off, but entails trying to simulate that procedure within a short period of time prior to actually doing it. I find this to be most practical with airway management. So if I'm able to have the trainee go with me to the SIM lab and we can do an intubation on the simulated baby before they intubate or attempt to intubate their first baby, I think that the literature demonstrates that that goes a pretty long way toward increasing success rates. And ultimately, I think that translates to better patient safety. One of the other aspects of educating around patient safety that's really important to me is having this living document of literature that I think is really important. So I have a document that I keep, and I've got a one-liner for every article that I've found that informs some aspect of my practice. And this is something that makes it really straightforward to just share evidence-based information with trainees when I say, hey, this is the reason why we give decadron, for example, at the beginning of the case, as opposed to peri-emergence. And I can cite a paper and show that to them. And I think that goes a long way towards patient safety as well, just having anesthesiologists who are referring to literature for their daily practice and instilling that in trainees early on.

Speaker 1 7:47

Wow, that sounds great. What an amazing resource. And it keeps you up to date with the literature and it helps to provide this curated information out of all of the information available. It kind of gives a focus there, which sounds like it would be really helpful.

Speaker 8:05

I'll just say I can't take credit for that idea that was inspired by one of my attendings when I was in residency. His name's Jane Dyber sent. So gotta give credit where it's due.

Transitioning From Trainee To Attending

Speaker 1 8:14

Nice. That is awesome. Well, since we were just talking about education and trainees, and now that you are out in practice, another thing that we wanted to talk about today is that transition from training to practice. This is a critical moment in anesthesia professionals' career. So can you tell us a little bit more about your transition from training to practice? And why is this an area of interest for you?

Speaker 8:40

So this was a recent transition for me. I I have been in practice for almost exactly a year at this point. And it became something that I'm passionate about now because it was such a striking experience. I just remember for the first couple months, really, that I was an attending, I remember just walking around and having this feeling of disbelief just pervade everything that I was doing. I guess like imposter syndrome, but more along the lines of, I can't believe that I am an attending now, and I can't believe that everyone else is just acting like this is a normal thing. Because for everyone else, life just went on as normal. The CA2s became CA3s. My coworker who'd been attending for 25 years has now been there for 26 years. And it just felt like such a huge transition to me that it was it was almost unbelievable. I think that because for me it was so impactful, it is something that I have an eye towards when I'm working with senior residents and fellows who are getting ready to enter practice. So I do like to spend a lot of time talking with senior trainees about what they can expect and how they might navigate challenging situations when they're in independent practice.

Finding A Supportive Safety Culture

Speaker 1 9:54

Well, I've been out in practice for over a decade now, which is crazy. But I still remember having that similar feeling when I started as an attending anesthesiologist, that surreal feeling of, oh, I'm an attending now and this is totally normal, but there's still a lot of new experiences when you first make that transition to practice. So when you're talking with senior residents about that transition from training to practice, how do you envision that trainees can make sure that they're joining a practice with a safety culture?

Speaker 10:28

I will preface my answer by saying that my bias is that I've only worked in academic centers before. So I'm not able to speak to other practice environments. Having said that, I think that the most important aspect of practice that someone should look for while they're interviewing somewhere is how much of a sense they get that there is collegiality among the faculty that work there, and whether this is a place where you can ask for help. You can ask questions, you can get assistance putting together an anesthetic plan or just making sure that the idea that you have makes sense and that it's not the type of culture where you are expected to not ever need help with anything, and that somehow that might be viewed as a weakness. And so what I really try to instill in the trainees I speak with is that in my view, a strong junior faculty member is someone who does not have reservations about asking for help and making it clear that there's something that they're not certain about and want some extra input as opposed to someone who comes into practice and they seem extremely confident. I personally would be a little bit concerned that that person might not ask for help when they need it. And that ends up becoming a patient safety issue.

Speaker 1 11:58

Absolutely. Some of the mentors that I really looked up to and still do were excellent at calling for help when needed. And they very much knew when they needed an extra set of hands in the room. Now, drawing on your experience from this past year, because it's great, it's right in your recent past. So I think you can speak to this. But what did you find were some of the important considerations for keeping patients safe during anesthesia care, especially as a brand new attending anesthesiologist?

Music Break: Airway To Heaven

Speaker 12:30

We have already touched on what I think one of the most important aspects of that is, which is just making sure that you ask for help early, you do it as often as you need to. As I said, I'm a year into practice at this point. I still will ping my colleagues and ask them to double check an anesthesia plan. Or if there's a patient who's particularly sick and I'm concerned about them, I'll ask for another set of hands for induction. So I think that's an important strategy. The other idea that comes to mind is just making sure that you're practicing in an environment where if you do have a safety-related concern about anything that you'll be taken seriously. So, again, my bias being an academic, I think it's probably a little bit easier for me to flag a concern and postpone a case for a safety-related issue as opposed to maybe a private practice where there's a very heavy production pressure. But I would be very concerned about being in a practice environment where there is an expectation that if a patient is not adequately NPO, then we continue with the case anyway. Or if the patient has new onset chest pain, that we're not postponing the case. Those are the types of situations that I would advise people to run far away from and never look back.

Speaker 1 13:47

All right, now we're gonna move outside of the operating room. So I saw that you played drums in a band of fellow anesthesiologists. So, how's your band doing? And do you have any upcoming gigs that people can hear you at? And then I have one final question related to your band. And have you decided on a name yet?

Speaker 14:07

The name was Airway to Heaven, which it was a beloved band of mine. And I regret to say that very recently, due to professional changes, people left town. And so the band has largely been dissolved. I play drums, our singer is still here, and we're looking for a bass player and a guitar player. So if anyone is in the New York City area and interested in joining our band, we are recruiting. Your question of how our band is doing, uh, we're in the recruitment phase. And do we have any upcoming gigs? Not at this point. But if we're able to recruit with your help, then I'll report back.

Speaker 1 14:50

Well, I had an idea because we would love some new music for the Anesthesia Patient Safety podcast. So you're welcome to submit um some music for us. Maybe we can use it as our new theme song.

Speaker 15:03

I appreciate the invitation. And just as soon as we have a full compliment, I'll get back to you.

Speaker 1 15:08

Well, before we wrap up for today, what's next for any of your research or projects?

Speaker 15:14

As far as projects go, this is probably not the answer that you're looking for. I professionally at work take care of babies. I don't know how to take care of babies otherwise, but my wife and I are expecting next week. So my next personal project is going to be figuring out how to raise a baby. Um, from a professional standpoint, my research recently has veered towards blood management and specifically transfusions and uh product management around cardiac surgery. So look forward to more research related to those topic areas.

Speaker 1 15:57

That's great. And congratulations and good luck with your new project starting next week. Uh, is there anything else that you want to share that we haven't talked about already?

Speaker 16:08

The only other topic that I'd mention is just a charity that I feel um really passionate about, which is called Heart Care International. So it's a nonprofit organization. They do mission work for congenital heart disease. And it's a great organization to get involved with if that is an area of care that you're interested in, and also a great organization to donate to, in addition to, of course, the Anesthesia Patient Safety Foundation.

Speaker 1 16:36

We're gonna have some links and information in our show notes, but can you just tell everybody how they can watch your anesthesia videos?

Speaker 16:43

The easiest way would be to just search my name on YouTube, Max Feinstein. Or honestly, there are not very many people who are making videos about anesthesiology. So if you just type in anesthesiologist, I'll show up probably on the first page.

Speaker 1 16:59

Oh, that's great. All right. Well, we'll be watching your videos and cannot wait to see what else you have in store.

Speaker 17:07

Thanks again for the opportunity to be on the podcast, and I look forward to coming up with some music to share on the podcast at a later date.

Closing, Resources, And APSF Program

Speaker 1 17:16

Sounds great. We can't wait. Thank you so much to Max for joining us on the show for this podcast series. If you have any questions or comments from today's show, please email us at podcast at apf.org. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apSF.org for detailed information and check out the show notes for links to all the topics we discussed today. We are excited to announce the 2026 APSF Trainee Quality Improvement Patient Safety Recognition Program. This program hosts tracks for physician anesthesiology residents, nurse anesthesia students, and student anesthesiology assistants. Eligible participants include current trainees and those who graduated in the immediately prior academic year. This is your chance to demonstrate your program's work in patient safety and QI initiatives. The winner in each track will be notified around August 1st, 2026, and the APSF will sponsor the winners to attend the 2026 Stolting Conference in National Harbor, Maryland to share your work and network with attendees. Here's how to submit your work. You may independently determine the best media for submitting your project summary. Acceptable formats include a document or an audio or video recording. The submission deadline is June 1st, 2026, so you have some time to get organized and excited to submit your best work and support the APSF vision. Check out the show notes for more information about the submission process. You can also email traineeqi at apsf.org with any questions. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.