Photograph: Virginia B. Hartridge, M.D., undated

The Mayo Clinic Department of Anesthesiology: Educators Internally, Leaders in Education Everywhere

The Department of Anesthesiology has played a major role within the institution in the Education Shield as well as in extramural education societies, on anesthesia-related boards, and in education regulatory organizations. In the next four Updates, I will describe the history and development of our department’s education programs and the contributions of our department members to institutional and national leadership in anesthesia and respiratory care education. Specifically,

• This week we will highlight the Rochester education programs in nurse anesthesia and respiratory care.
• In the coming week we will focus on the LaCrosse, Wisconsin nurse anesthesia program and the anesthesiology residency and fellowship programs in Florida and Arizona.
• In the third week we will describe the Rochester anesthesiology residency and fellowship programs.
• In the final week we will showcase department members who have played major education leadership roles within in the institution and nationally.

Nurse Anesthesia in Rochester

Edith Graham, soon to be Mrs. Charlie Mayo, trained good friend Alice Magaw in 1893 to deliver anesthesia. Alice subsequently trained 20 nurses, including colleague Florence Henderson, over two decades. These nurse anesthetists would provide anesthesia for the great majority of patients early in the institution’s first 35 years. Most of these nurses were trained “on the job.” As the field of anesthesiology evolved in the 1920s and 1930s, physicians such as Dr. John Lundy and nurse anesthetists such as Florence McQuillen advanced the training for nurses and developed a didactic curriculum. Florence would go on to become the first executive director of the American Association of Nurse Anesthetists and play a major role in developing training and certification standards for nurse anesthetists.

Dr. Lundy was the first director of the nurse anesthesia training program in his role as chair of the Section on Regional Anesthesia (and subsequent department designations). In 1940, he designated Dr. R. Charles (Charlie) Adams as the program director. Charles worked closely with Florence McQuillen to solidify the training program and curriculum for nurse anesthetists. Nearly all of the anesthesiologists in the 1940s participated in classroom instruction and nurses in training attended seminars and conferences given by the residents. Dr. Adams was followed in the director role over the subsequent 15 years by Drs. Harry (Tom) Seldon, John Osborn, Roger Ridley, and John Paulson.

The program blossomed in 1956 when Dr. Virginia Hartridge was appointed as education director. She organized a comprehensive curriculum and ensured that all trainees attended seminars and classes. Most importantly, in 1957 she recruited Robert (Bob) Johnson, CRNA to assist in providing nurse anesthesia education. After several years of building a more complete training program, Virginia and Bob formed a Nurse Anesthesia Education Committee in 1964. By 1970, Bob had been appointed as the nurse anesthetist director of the program. The dynamic duo of Virginia and Bob led the program together until 1974.

Here is a list of the outstanding anesthesiologists and nurse anesthetists who have served as medical and education directors of the nurse anesthesia training program since 1970:

• Medical Directors

1956-1974: Dr. Virginia Hartridge

1974-1984: Dr. Donald R. Krabill

1984-1987: Dr. Lawrence B. Perry

1987-1991: Dr. Robert L. Lennon

1991-Present: Dr. Beth A. Elliott

• Education Directors

1970-1988: Robert Johnson, CRNA

1988-1997: Edward Thompson, CRNA, MS

1997-2020: Mary Mariena, CRNA, PhD

2020-Present: Erin Martin, CRNA

Respiratory Care

The department’s current Respiratory Care program started in 1972 as the Inhalation Therapy program.  It was proposed by Drs. Paul Didier, Alan Sessler, Frederic Helmholz, Ken Makinen, and Gerald Needham.  They advocated for an associate degree program sponsored by the Rochester Junior College.  The proposal received funding through a Minnesota education grant.  The first class entered the two-year program in 1972.  In 1975, the program received initial accreditation by the American Medical Association’s Council on Medical Education and Joint Review Committee for Respiratory Therapy Education.  While most clinical rotations occurred in the Mayo-related hospitals in Rochester, an off-campus rotation at the Rochester State Hospital for airway management was arranged from 1972 through 1981 when the state hospital closed.  Today, the state hospital campus is the site of the Federal Medical Center.

Upon accreditation, the program changed its name to the Respiratory Therapy Program.  Key milestones in its development include increasing its scope of training in 1988 to include cardiovascular stress testing, pulmonary function testing, and participation in sleep medicine.  In 1999, the program transitioned to a baccalaureate degree-granting program in partnership with the Mayo Clinic School of Health Sciences and the General College of the University of Minnesota.  This relationship was further strengthened in 2011 when the University of Minnesota Rochester established its Bachelor of Science in Health Professions degree.  Graduates who earn this degree also receive a certificate from the Mayo Clinic School of Health Sciences in Respiratory Care.

Leaders of the Respiratory Care Program include:

• Medical Directors

1972-1987: Dr. E. Paul Didier

1987-2003: Dr. David J. Plevak

2003-2021: Dr. James Y. Findlay

2021-Present: Dr. Brendan Wanta

• Education Directors

1972-1976: Bernard Gilles, CRNA, RRT

1976-2006: Jeffrey J. Ward, RRT

2006-2022: Vanessa L. King, RRT

2022-Present: Stephanie J. Holst, RRT

Mystery Photos:

Last week’s Mystery Photos were Harold Michael Marsh, M.D. and Bradly J. Narr, M.D.

H. Michael (Mike) Marsh, M.D. was born in Australia on March 7, 1939.  He graduated from the medical school at the University of Sydney in 1964.  In doing so, he followed his grandfather (1912), his father (1936), and his uncle (1938) as alumni of that school.  He  subsequently trained in anesthesia at the medical school’s Royal Prince Alfred Hospital. 

In 1968, Mike was advised by Dr. Tim Cartmill, a Mayo-trained Australian cardiac surgeon, to go to Rochester.  He applied and received a Mayo scholarship to travel to Rochester and study Critical Care and Respiratory Care under the supervision of Dr. Alan Sessler.  After arriving in 1969, he also met and worked closely with Drs. Kai Rehder and Paul Didier and Bernard Gilles CRNA and Myron Ricks CRNA.  This team of newfound colleagues worked together clinically in the ICUs and also studied the effects of anesthesia, muscle relaxation, and gravity on pulmonary function and ventilation-perfusion matching during mechanical ventilation.  The research program was directed by Kai, with collaboration from Drs. Ward Fowler, Fred Helmholtz, and Robert Hyatt. 

Mike returned to Sydney in 1972 after a 6-month fellowship in cardiac anesthesia at Toronto’s Western Hospital, using that fellowship to accumulate enough money to pay for his return trip home.  The Mayo scholarship that supported his travel to Rochester did not provide funding for a return ticket.  Sounds like a good recruitment process, doesn’t it?

Upon his return to Sydney, he was made director of intensive care and charged to establish a general ICU.  Building, equipping and staffing a 5-bed unit for this 1,000 bed-hospital took him eighteen months.  During that time, he provided consultative services to all patients requiring intubation and mechanical ventilation for respiratory failure.  These patients were being cared for on open wards by non-specialized nursing personnel.  During that ICU’s first 18 month period using a Mayo-style practice, the 30 day mortality rate for its patients was reduced by 50%.

Mike returned to Rochester and Mayo Clinic in 1974.  Dr. Dick Theye invited him to join Alan Sessler, Paul Didier, and colleagues in the ICUs.  During the next 15 years his activities at Mayo included a mixture of clinical practice, research, education and administrative roles. While at Mayo, Mike became an oral examiner for the ABA, was very involved in a number of national societies, and developed our ACGME-approved anesthesiology fellowship in critical care medicine.  He was the program’s first director.

In 1989 Mike was recruited to Detroit, Michigan’s Henry Ford Health System as chair of the system’s Department of Anesthesiology.  His primary task was to apply for ACGME approval for renewal of the institution’s residency program.  The previous program had ceased in 1975 and his work entailed starting a research program and developing educational experiences in critical care and pain medicine.  For the research program, he started by recruiting our own Russell Van Dyke, Ph.D.   The Henry Ford residency program was approved in 1990 and has continued from that time. To this day Mike still provides a half-day teaching session for the program’s residents at each level of training.  During all of this, Mike became president of the Wayne County Medical Society and a board director in the Michigan State Medical Society.  He also served on the Michigan State medical Board for several years., rising to President and from there to board Membership on the Michigan State Medical Society Board for several Years.

In 1998 Mike transitioned to chair of the Department of Anesthesiology at Wayne State University.  The challenge for him was to bring together disparate elements within the Detroit Medical Center, a loose amalgamation of hospitals and anesthesia practices, and revitalize another failed residency program.  He supposedly retired in 2012 when our own Dr. Doug Bacon succeeded him.  By the way, the program continues but struggles at Wayne State as Detroit Medical Center is now under the management of  Venture Capital, a for-profit entity.  Neither Mike nor Doug are associated with Wayne State any longer.

In fact, Mike did not retire in 2012.  Instead, at Doug’s request, they moved together to St Joseph Mercy Hospital, Oakland in Pontiac, Michigan.  Here they started another residency training program, now Mike’s third in Detroit.  He served as the new program’s director for a period before stepping down.  He worked clinically part-time, primarily at St. Joseph Mercy Hospital, until November 23, 2023, completing a full 60 years of clinical practice and leadership. 

Mike’s beloved wife, Eleanor passed away several years ago.  They had three children.  Now at age 85 years, Mike enjoys watching his five grandchildren as they make their way to their future and meaningful careers and lives.

In Mike’s own words, “Being allowed to practice Medicine in any community is a profound privilege. It places one in a sacred position of trust with intimate access to the lives and confidences of other individuals. The Mayo philosophy and culture places emphasis on honesty, integrity, respect and accountability in serving the best interests of one’s patients, through practice, research and education. It was my great privilege to be accepted to train for two years at Mayo Rochester and then to be invited to return to serve as a Consultant in Anesthesiology and Critical Care Medicine for a further fifteen years in my mid-career.”

Bradly J. Narr, M.D. was born July 26, 1954 in Neosho, Missouri while his father was in the U.S. Army.  By the time he was 6 months old, the family had moved to Minnesota where he was raised and educated.  He earned his Bachelor of Science degree in Biochemistry at the University of Minnesota before completing medical school  at the same institution in 1980.  He came to train at the world-famous Mayo Clinic in Internal Medicine (1980-83) before switching career trajectories in 1983, chiefly because his YMCA basketball friends raved about their respective careers in Anesthesiology.   After Dr. Alan Sessler took him to breakfast in the Methodist Hospital Cafeteria in 1985, Brad was invited to join the Anesthesiology consulting staff where, for the first part of his career, he divided his clinical responsibilities between critical care and the operating theaters.

Brad rose to positions of leadership within the department and at Mayo, holding the Department of Anesthesiology chair role for 11 ½ years as well as serving as the vice-chair and chair of the Surgical and Procedural Committee between 2007 and 2021.   He is the only non-surgeon to chair this crucial Mayo committee.  Brad was also the first medical director of the 10-1 ICU at Methodist Hospital and the first medical director of the 7 MB DE ICUs at St. Mary’s Hospital, both units envisioned and built under his direction.  He also pioneered the creation of the Department of Anesthesiology Preoperative Evaluation Clinic which opened its doors in 1996. 

Within Mayo Clinic but outside the department, Brad has a distinguished career.  While serving as a member of Mayo Clinic’s Executive Operations Team, Mayo President and Chief Executive Officer Dr. John Noseworthy tasked Brad with solidifying Mayo Clinic’s US News and World Report #1 ranking . . . a remarkably successful and satisfying mission for Brad that led to more than a decade of the institution holding the top spot before the magazine switched its operational definitions and stopped awarding #1 positions.  Brad also led key efforts within Mayo Clinic, in the city of Rochester, and in the Minnesota Legislature to designate Mayo Clinic/Rochester as a Destination Medical Center in the state of Minnesota.  This designation will ultimately bring nearly $600 million of state investment into Rochester’s infrastructure needs as the Destination Medical Center’s $5 billion, 20-year plan and the city’s growth during that period come to fruition.

As he starts his 40^th year as a consulting staff at Mayo, Brad continues to practice in the Preoperative Evaluation Clinic that he helped establish.  His Internal Medicine and ICU backgrounds, coupled with his intimate knowledge of the Mayo surgical and procedural practice, help to facilitate patient access to the best surgical, procedural, and anesthetic care available anywhere in the world.   He recently was elected as a board member of the Anesthesia Foundation (The Anesthesia Foundation® – Helping Anesthesiologists Succeed).

Brad and his wife, Terry, have 4 sons and many grandchildren, all in MN.  He subscribes to the William Mayo quote; “there is no fun like work,” but his joy in life also revolves around his family.  He is an amazing physician and colleague.

Mystery Photo Contest Winner

Last week’s contest winner was Mindy Woodward.

This Week's Mystery Photos:

Reminder: We are now featuring two individuals each week for the Updates. To be placed into the Mystery Photo Starbucks contest, you will need to correctly guess at least one of the featured individuals. If you identify both of them, you will double your chances of having your name drawn.

Please email your response at warner.mark@mayo.edu within 3 days of this update.  I will also need your name and contact information.  All correct responses will be placed into a Monday morning drawing for a $10 Starbucks card.  Only one winner per individual over the 80 weeks of Mystery Photos.  If you win a weekly drawing, however, please keep submitting your responses.  An overall winner (with the most correct responses in the series of 80 Updates) will receive a $100 Starbucks card.