Needle in hand, Khloe Droddy nervously looks for the ideal way to enter a vein and place her first IV line. Thankfully, the arm belongs to a manikin, and she is being calmly coached by Wen Danh, MS, assistant director of the Anesthesiologist Assistant Program at the Indiana University School of Medicine.
Back in 2017, Danh was in Droddy’s place as part of the first cohort of the Master of Science in Anesthesia program. Today she is a Certified Anesthesiologist Assistant (CAA) and an enthusiastic instructor.
Since its inception, the program has produced 83 graduates, helping meet a critical need for anesthesia professionals — America’s population is aging at a time when many anesthesiologists are retiring. CAAs can manage anesthesia during surgeries with oversight from an anesthesiologist. That includes putting patients to sleep, keeping them stable during the procedure and waking them up afterward.
This anesthesia care team model, known as ACT, is being employed at a growing number of Indiana hospitals. It’s a collaborative approach with CAAs working alongside anesthesiologists to provide safe, high-quality and efficient patient care, explained Adam Lemmon, MD, vice chair of clinical affairs for the Department of Anesthesia and an IU-trained anesthesiologist.
“Our CAAs allow us the flexibility to cover our complex OR environment day in and day out,” he said. “The ACT model allows for strong coordination of care, optimizing patient flow and reducing delays or cancellations in surgical procedures.”
In 2022, the American Society of Anesthesiologists adopted a statement regarding anesthesiologist assistants, affirming that “CAAs help balance and supplement the perioperative workforce and actively contribute to increased quality, decreased costs, and improved service line expansion efforts in patient care.”
Indiana impact
More than 60% of IU’s Anesthesiologist Assistant program graduates stay in Indiana, working in Indianapolis hospitals and smaller hospitals throughout the state, including those in rural and medically underserved areas.
“It’s amazing to see how far it’s come from back in 2017, the first time I was in the OR,” said program director Richard Bassi, MMSc, MEd, CAA.
A career shifter who went from flying helicopters in the U.S. Navy to managing anesthesia in the operating room, Bassi became the fourth person to be licensed as a CAA in Indiana. “It’s a hidden gem of medical professions,” he said.
The profession has been around since the 1970s but has been gradually adopted by 24 of the 50 states. Danh’s home state of Illinois isn’t one of them.
Danh studied biology and chemistry at the University of Illinois Urbana but graduated with uncertainty about which type of health care career she wanted to pursue. She could have chosen to become an anesthesiologist, like her older sister, or another type of doctor. But after seeing the long hours and demands for case management outside of the operating room, Danh wasn’t convinced.
That’s when she heard IU was launching a program for anesthesiologist assistants. After shadowing Bassi, she was sold.
“Watching Rich give a medication and seeing the immediate effects on a patient’s blood pressure three minutes later was pretty fascinating,” Danh said. “Being able to do a lot of technical skills like intubation, placing an IV or arterial line — it was appealing to me that over a span of 28 months, that’s something I would be able to do as a CAA.”
After graduating with the first cohort of students in the program in 2019, Danh started working at IU Health University and Methodist hospitals. Program graduates like Danh now make up about half of Bassi’s CAA colleagues within IU Health, he said.
The program has a 100% job placement rate. “We’re sending people all over the country — New Mexico, Florida, Texas,” reported Bassi.
“Within the state, almost every place where CAAs are practicing, we have sent somebody. They work in Lafayette, Vincennes, Valparaiso, Merrillville, New Albany, Muncie. And we’ve had 41 of our grads stay right here on campus at University, Eskenazi and Riley (hospitals).”
Program graduates have been overwhelmingly successful with 100% passing the CAA certification exam — 98% on the first try. There’s something special about going to the breakroom at the hospital and talking with a former student-turned colleague, Bassi said.
As a CAA, Danh said she feels respected and valued by anesthesiologists, surgeons and other medical professionals involved in surgeries. A few years ago, she recruited her sister, Wen Chen, MD, to IU and has twice worked under her direction in the OR.
“I just thought it was so cool I got the opportunity to work with her — she’s always been my role model,” Danh said. “We had to explain to the patient that they would be working with two anesthesia professionals who look similar and have similar names.”
Plan CAA
The notion that becoming a CAA is “plan B” for people who couldn’t get into med school is outdated. Most have deliberately chosen the field to suit their values and professional interests. And it’s highly competitive.
Last year, 647 applications were received for the program’s 24 spots. The average applicant has a 3.8 GPA and a Medical College Admission Test (MCAT) score of 510 — just two points off the average for IU’s medical students.
“It used to be considered a good alternative to med school, but now it’s becoming as hard, or harder, than some medical schools to get into,” noted Bassi.
William Howard, MS, was interested in science and knew he wanted to pursue a health care career, but he ultimately decided the long educational timeline to an MD was not for him. As an undergrad at Butler University, he heard about IU’s Anesthesiologist Assistant program.
“It allowed me to enter the workforce sooner, performing an interesting job that utilizes science to help a multitude of patients every day,” said Howard, who is now assistant program director, along with Danh.
As lecturers in anesthesia, they both enjoy teaching technical skills to students during weekly simulations.
“We cover a wide variety of topics to help our students understand things like how anesthesia can impact patients with endocrine disorders, obstetrics, pediatric patients, trauma, neuro, transplant, critical care and much more,” Howard said of the curriculum. “I also help to facilitate problem-based learning discussions with other anesthetists or anesthesia residents to help our students take that knowledge and apply it to case scenarios they are likely to encounter while working in the hospital.”
As an anesthetist, Howard said, “you get to do something mentally challenging and stimulating every day as you help those around you who are going through a vulnerable time.”
That appealed to current student Gabriel Lika. A lifelong soccer player, Lika understands that team success requires more than technical skills — it demands mental agility to anticipate and adapt to sudden changes in the game. While pro soccer wasn’t his destiny, Lika carries that same perspective into his training to become a CAA.
“It’s a good mix of technical procedures and book knowledge, along with street smarts — you’re always thinking about what can go wrong and forming a back-up plan,” he said.
Back in the simulation center at Methodist Hospital, Danh explains how the diameter of a needle affects its flow rate. Then she demonstrates how to secure a tourniquet to the arm for quick release.
The program employs a teaching philosophy of hands-on learning: “watch one, do one, teach one.” Second-year students, like Lika, teach skills to first-year students, like Droddy, to solidify their own understanding.
Danh enjoys watching her students’ confidence grow over the course of the 28-month program — often seeing them on the anesthesia care team at her hospital soon after.
“Helping to improve the program and teaching courses to grow the number of CAAs has been very rewarding,” she said. “I want to make sure the next generation of Certified Anesthesiologist Assistants are able to fully take care of a patient comfortably and confidently.”
