The Power of Adventure: Reflections on the Challenges, Contrasts, and Similarities of Anesthesia at UCSF vs in Australia

The Anesthesia Department has several visiting faculty members from Australia. Curious to know more, we reached out to learn about their backgrounds, what led them to UCSF, and what the future holds. Many thanks to Craig Beaman, MBBS, Edward Bender, MBBS, Deahnne Levas, MBBS, and Bernadette Wilks, MBBS for their willingness to share their experiences and contribute to this interview. Answers have been edited for clarity.

Professional Background and Expertise

I’m curious to hear about your journey! Can you share a brief overview of your background and area of expertise?

Bender: I was born on the island of Tasmania, Australia, where I studied medicine after receiving a Bachelor of Nursing degree. Since completing my degree, I have worked for several years as a junior doctor in various critical care roles in most states of Australia, eventually settling in Victoria to complete my training in anesthesia. I completed the ANZCA [Australia and New Zealand College of Anaesthetists] training program in early 2024 before arriving, so this is my first attending role.

Levas: I did my training primarily at Gosford Hospital on the Central Coast of New South Wales. It’s a great regional hub with a close-knit anesthetic department and a reputation for throwing big end of year parties. I completed my fellowship at Prince of Wales and Sydney Children’s Hospital which I absolutely loved. Pediatric anesthesia was a complete surprise to me because I initially found it very intimidating and scary (the kids can always sense your fear!). What I found was the more experience I gained in it, the more fun I could bring to my day through being playful, musical, and upbeat! I plan to continue my career in pediatric anesthesia here at Benioff Children’s in the coming months.

Wilks: Medicine was not my original aspiration. I initially pursued a career as a professional ballet dancer, later transitioning to the study of film, which included a period at the esteemed Rhode Island School of Design in the United States. The decision to enter the field of medicine is still somewhat enigmatic; nonetheless, the idea persisted, ultimately leading me to my current role as an anesthesiologist.

What motivated you to specialize in anesthesia?

Wilks: It represents an ideal blend of procedural ability and a profound comprehension of the human body as an interconnected system. I appreciate the immediacy of the role, which allows me to concentrate intently on one patient at a time.

In what ways has your experience in your home country shaped your perspective, and how does it compare to what you’ve seen since working here?

Beaman: The system here from a personnel perspective is quite different to Australia because we don’t have CRNAs. In Australia we have a dedicated anesthetic nurse for every OR, we generally have an anesthetic room adjacent to the OR for doing procedures etc., and when we supervise residents it tends to always be in a 1:1 capacity not 1:2. All these changes took a little while to adapt to, but they have definitely improved my ability to be self-sufficient and to supervise multiple locations at once. 

Wilks: Key differences are the number of higher acuity patients, the complexity of the surgeries, and caring for up to three patients at once.

Experience at UCSF

What specifically drew you to UCSF/our department?

Bender: I always aspired to a fellowship abroad and was introduced to the opportunity of the UCSF assistant professor role by colleague and dear friend Craig Beaman. I had previously visited San Francisco and the prospect of living in the city was motivation enough. But further research and collegial accounts of UCSF only bolstered my motivation.

Levas: I’m originally from Sydney, Australia but attended medical school in “FNQ” (Far North Queensland), which allowed me to experience a lot of rural and indigenous medicine before moving back home to pursue an aesthesia training. The big draw for me was having family in the Bay Area. My sister-in-law and my three little nieces live here, and it’s been incredible to be able to spend so much time with them.

Beaman: I moved here with my wife and two children (aged 2 years and 10-weeks old when moving), which had its challenges. We wanted to come over to experience living in a different country, working in a completely different healthcare system, and to gain experience working at a large and advanced hospital like UCSF.

Wilks: While volunteering in Zambia, the onset of COVID-19 caused my return to Australia. Upon my arrival, it became clear that my first plan to spend a year at Oxford was ill-advised, especially given the pandemic’s profound impact on the NHS. During this period, I learned of an opportunity to work as an international anesthetist at UCSF without the requirement of additional examinations. Coincidentally, I was in Darwin with my former colleague Gregory Leeb, who was preparing to leave for UCSF in a few months.

How has your experience been so far working with the faculty, learners, and staff here?

Beaman: I have been working for approximately eight months now and thus far have really enjoyed it. Like anywhere, some days are better than others and the last-minute changes in roster or working location can often be frustrating, but thankfully that doesn’t happen too often, and we get exposed to some interesting cases along the way. My colleagues have all been supportive and lovely to work with, which has definitively helped with the transition.

Wilks: I am deeply impressed by the depth of knowledge and skills that American anesthesia residents acquire in such a relatively brief training period. In Australia, the training duration is twice as long, yet the acuity of cases is notably lower than that at UCSF. Within just a couple of years here, I have encountered clinical scenarios that I would likely not experience throughout an entire career in Australia.

Cultural Exchange and Collaboration

How do you think your international perspective contributes to the learning environment here?

Wilks: I have had the privilege of working in 40 hospitals across five countries. Each experience has allowed me to learn from my colleagues, and I consistently find opportunities to share my own insights in return. The parallels between the American and Australian healthcare systems significantly enhance the value of knowledge exchange. In fact, in Australia, anesthetists with international experience are often regarded favorably during job interviews, as departments recognize the advantages of having staff who have broadened their perspectives through time spent abroad.

Have you noticed any significant differences in medical practices or patient care between your home country and here?

Bender: This role has been both eye-opening and often challenging, highlighting many similarities and differences. While many aspects, such as drugs, ventilators, lines, and airways, are familiar—sometimes making me feel like I’m back in Australia—the job also differs significantly at a fundamental level, requiring adaptation. For example, in Australia, an anesthetic nurse is always present in the OR, providing support similar to a scrub nurse for the surgeon, which greatly helps the physician. Training in Australia involves over three years as a junior doctor before entering a program, followed by four years of training and a mandatory fellowship year. Supervision is also different, with generally only one or two operating rooms in Australia, and no equivalent to a CRNA. In terms of equipment, there’s no TCI pump or HFNP here, which are both mainstays of practice in Australia. The working hours in Australia are typically 40 per week, with dedicated non-clinical time (about 25%). Perioperative assessment and optimization is much more established there as well, reflecting our more conservative approach in Australian practice. This experience has not only enlightened me about these differences but also deepened my admiration for the adaptability of my colleagues here. Lastly, the healthcare system in Australia, being socialist, has its own implications for access, patient demographics, and resource allocation.

Impact on Learners and Faculty

Are there any teaching methods or practices from your home institution that you’ve shared with the team here?

Wilks: Australians and Brits have subtly different approaches to airway management, and these varied techniques equip airway providers with a broader array of tools. I have integrated the airway skills I got at UCSF into my own repertoire, thereby enhancing my competence in managing even the most challenging airway situations.

Staff I work with have enjoyed some of my Australian vernacular:

• “Put a bung on it” = place an Alaris cap directly onto the IV and don’t have the ‘dangles’
• “The IV has tissued” = the cannula has extravasated and the fluid is now running into the tissue
• “The patient is a bit average” = the patient is incredibly sick, ASA 3+ve
• “Block trolley” = “block cart” (didn’t think this one need explaining–but there you go!)

Contribution to Global Health

How do you think international exchanges like yours contribute to global health initiatives?

Wilks: I am undoubtably a better anesthetist even after such a brief time at UCSF, which in turn helps my patients, my colleagues, and my sense of job satisfaction.

What advice would you give to other international faculty members considering a similar experience?

Wilks: Seize every opportunity that piques your interest and embrace it. The diverse range of clinical and nonclinical work available allows you to tailor your experiences to align with your personal goals and life stage. You may find that you are in a unique environment where practicing the art of saying “no” to opportunities is necessary (unless you have the secret to not needing to sleep)!

Personal and Cultural Insights

What has been the most surprising or interesting aspect of living and working in this country?

Wilks: My experiences have been quite diverse: attending Burning Man, navigating life as a patient following three major limb injuries, and marrying an American I met here within less than two years. I have also greatly appreciated the unique opportunity to merge my backgrounds in design and medicine as the faculty lead of the new anesthesia website. Furthermore, my ongoing work at the Hypoxia Lab offers an unparalleled experience, deeply rooted in the history of UCSF and focusing on both anaesthesia and health equity.

What do you enjoy most about your current experience outside of the department?

Bender: Aspirations outside of work included exploring the local national parks, tapping into the rich music and art culture, learning some Spanish, and attending Burning Man, all of which have exceeded my expectations.

Levas: Since moving to SF, I have been playing tennis at the Golden Gate Park courts which are beautiful with the added bonus of having tennis on TV when you’re done playing. My big hobby this year is traveling! I am trying to see and do as much as possible while in the US and so far, have loved travelling up and down Highway 1, skiing in Tahoe, and dancing in Nashville. Next stop: the Canadian Rockies!

Future Collaboration and Goals

What are your goals for the rest of your time here? Looking ahead: what does the future hold for you?

Bender: My primary goal professionally here was to seek exposure to the field of anesthesia and healthcare in another developed country in the hope of making myself a more rounded and adaptable practitioner. Though I’m grateful for the adventure and growth offered by this adventure in the United States and UCSF, matters at home dictate I will not be able to stay as long as I might have hoped. I will return to Australia sometime in 2025 with a lot of respect for my hard-working UCSF peers, and a renewed gratitude for the help from my anesthetic nurse colleagues.

Beaman: My hope is that the pathway between my hospital in Australia and UCSF will remain open and that more people will take up the opportunity to come over, as overall it has been a positive experience.

Wilks: I’m staying! I married an American at the end of 2023.

Photo: Left to Right - Gina McCartin, Ted Bender (squatting), Bernadette Wilks (in wheelchair), Matthew Aldred, Clara Gomez-Sanchez, Alex Goswell, Craig Beaman, and Deahnne Levas.