Deborah Culley, MD, chair of Anesthesiology and Critical Care, wears a white coat and smiles with her hands folded and resting atop a glass railing.

New Chair Deborah J. Culley, MD, Shares Her Vision for the Future of the Department of Anesthesiology and Critical Care

At the close of a landmark year for critical care physicians this March, Deborah J. Culley, MD, has just arrived from Boston to embark on a new role as chair of the Department of Anesthesiology and Critical Care at the Perelman School of Medicine. The internationally renowned neuroanesthesiologist has worn many hats over the past 25 years, most notably as an associate professor at Harvard Medical School, executive vice chair for the Department of Anesthesiology Perioperative and Pain Medicine at Brigham and Women’s Hospital, and director and former president of the American Board of Anesthesiology (ABA). At Penn, Culley takes the helm in a role held by Lee A. Fleisher, MD, from 2004, until moving on to a position in the federal government last year as chief medical officer for the Centers for Medicare and Medicaid Services.

In early spring, though she is only weeks into the role, Culley has plenty to say about the future of Anesthesiology and Critical Care at Penn: Whether focused on its patients or physicians, she has a vision for a department that doesn’t just do well but is well.

What initially sparked your interest in anesthesiology and critical care?

I had always planned to become a neurologist or a neurosurgeon because of my fascination with the brain. Anesthesiology wasn’t on my radar until my third year of medical school, when I had the chance to work with a team that let me intubate and monitor anesthetic care from start to finish. I learned quickly that there is little in clinical work that is as rewarding as being an anesthesiologist, simply because you touch people at very difficult times in their life.

You’ve played a pivotal role in establishing links between anesthesia and postoperative cognitive dysfunction in older patients. How did you decide to take your research in this direction?

In my second year of residency, I treated a middle-aged patient who told me that after the last time he had been anesthetized, he didn’t have the same cognitive function for a period of months. This encounter sparked an interest in the connection between anesthesia and post-operative delirium, cognitive dysfunction, and other long-term effects. One of my proudest professional moments was the publication of my first manuscript on the effects of anesthetics on the aged brain. It was something that hadn’t really been done before, although the field has expanded tremendously since then. Surprisingly, most data from human studies suggests it’s the surgical procedure, not the anesthetic, that has these negative effects. Now we’re looking for biomarkers to be able to predict post-operative delirium and allow diversion of precious resources to patients at the greatest risk.

How do you view the role of new technologies in advancing patient care?

It takes many years of experience to readily identify patients with a higher risk of adverse outcomes to anesthesia and critical care. I’d like to get to the point where we use artificial intelligence (AI) and machine learning to analyze electronic medical records and gauge that risk. If we can identify these risk factors, we can ask a higher acuity physician to care for a more vulnerable patient and find ways to mitigate risk pre-operatively. Thankfully, we have experts at Penn who can help with this mission. It’s a matter of combining skill sets to enhance patient care in a cost-efficient manner.

What appealed to you about the opportunity to join Penn Medicine in this new role?

It was a few things. First of all, it’s Penn. It’s a wonderfully integrated system where you have Wharton, the Perelman School, and all these other leading institutions in one place. As a result, Penn Medicine is a remarkably forward-thinking healthcare system. Another major factor is that Dr. Jameson and the rest of the leadership team took a holistic approach to success. I expressed early on that one of my top priorities was having the freedom to visit my adult children and grandchildren back in Boston every other weekend. I was encouraged to do so at Penn out of the recognition that my leadership success depends on being a fulfilled person, not just a skilled professional.

How will the opening of the new Pavilion inpatient building at HUP this fall impact your department?

There are some wonderful things that will come out of our move to the Pavilion. One of the first things that comes to mind is that we will be able to keep patients in the same hospital room from intake to discharge. In most hospitals, you have a pre-op and a post-op center. Patients meet one nurse in pre-op and a different one in post-op. By removing that typical pre- and post-op divide, we expect higher levels of patient satisfaction, stronger connections between patients and staff, and more family involvement.

What are some other goals you have for your new department?

The most immediate one is to ensure a seamless transition into the Pavilion.

I also spend a lot of time thinking about ways to champion diversity — whether it’s gender, race, ethnicity, sexual orientation, or background — among our faculty, residents, CRNAs, and staff in a way that makes people feel safe at work. There’s a real need for more open dialogue.

Finally, I want to shine a spotlight on wellness, especially after we spent much of the past year in lockdown. I want to help the members of the department identify those things that help them stay well and take care of themselves in a holistic way. For me, that’s making a trip to see my family several times a month. For someone else, that may be exercising or going out to a nice dinner more often.

The people inside this department have worked tirelessly in dangerous circumstances over the past year. They’ve demonstrated incredible resilience, but I want the department to be more than resilient. I want it to be whole and well.

— Interview by Ashley Rabinovitch

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