Future planning for the delivery of adequate anesthesia care is complicated by the complexity of the current delivery system and the expected declining numbers of operative procedures resulting from health care reform. An understanding of the forces and impediments to change in anesthesia education, the context of professional development, and current clinical practice dynamics is essential to development of innovative changes in current educational systems to meet future needs for both society and the professions.

A survey of 10 expert anesthesia educators utilizing the Professional Values Inventory, the Role Specific Competency Inventory, and semi-structured telephone interviews provided data from which recurrent themes within the complex context of anesthesia practice and education which might impact on educational change were identified.

The concerns of physician and nurse educators centered on the effect of physician dominance, compromise of competency development, change in the role of educators and learners, and the economics of marketplace and/or legislative health care reform. Development of an educational process for production of a single blended anesthesia provider would require consideration of issues such as service orientation, candidate and admission criteria, curriculum and faculty development, accreditation, and process development. The degree of possibility of development of such a provider would depend on sufficient pressure from external forces and acceptance by Certified Registered Nurse Anesthetists and board certified anesthesiologists that both medical and nursing perspectives are equally important to anesthesia care and that those perspectives could be blended educationally. Policy considerations included concerns about tractability of the professional and educational barriers to implementation of the suggested educational change, the need for development of innovative reimbursement methods for a blended provider, and need for governmental intervention to produce further exploration of the concept through establishment of funds for pilot projects.