The journal of education in perioperative medicine : JEPM最新文献

Background: The American Board of Anesthesiology (ABA) In-Training Examination (ITE) is an annual assessment used to guide educational progress throughout residency in preparation for ABA certification examinations. Online question banks are commonly used as a study resource for these examinations; however, the relationship between question bank usage and ITE performance has not been well established.

Methods: We performed a retrospective review from July 2015 to July 2023 to examine the relationship between ABA ITE performance and question bank utilization among anesthesiology residents at MaineHealth Maine Medical Center during postgraduate years (PGY) 2-4. Question bank usage was measured by evaluating the total questions answered, percentage of questions answered in tutor mode, and percentage of questions answered correctly stratified by training and calendar year. Spearman correlation was used to explore the relationship between question bank metrics and ITE score, stratified by PGY.

Results: We observed significant relationships between the percentage of questions answered correctly and both ITE scaled score and national percentile ranking within each PGY. The correlation between percentage of questions answered correctly and ITE scaled score was (ρ = .49, p = .01) PGY-2, (ρ = .71, p =< .001) PGY-3, and (ρ = .48, p = .02) PGY-4. A similar trend was noted for the national percentile ranking; (ρ = .55, p = .003) PGY-2, (ρ = .71, p =< .001) PGY-3, and (ρ = .46, p = .02) PGY-4.

Conclusion: The percentage of online question bank questions answered correctly by anesthesiology residents was positively associated with higher ITE scores across PGY 2-4. The percentage correct of online question banks may be used as a predictive marker for ITE performance.

Introduction: The growing responsibilities of clinician educators in academic medicine necessitates structured training opportunities during residency. However, such programs are uncommon in procedural specialties. We developed the Anesthesiology Clinician Educator Residency Track (ACE Track) at Washington University School of Medicine to bridge this gap by fostering professional identity formation and preparing residents for careers in medical education.

Materials/methods: The ACE Track is a longitudinal program integrating didactic instruction, teaching, mentorship, and educational scholarship during the fourth postgraduate year. Participants engage in coursework on educational theory, lead medical student and resident teaching sessions, and develop scholarly projects under faculty mentorship. Residents receive protected time to focus on educational initiatives, and selection is competitive based on career interest and project proposals.

Results: Over 3 years, the ACE Track has enhanced participant career development, expanded educational programming, and strengthened the department's educational culture. Graduates have taken on leadership roles, developed curricula, and contributed to national education conferences. Survey data indicate increased self-perceived competency in educational skills, professional identity formation, and career clarity.

Discussion: The ACE Track is a novel program that equips anesthesiology residents with foundational skills in medical education. Positive participant feedback and increasing applications suggest its value in academic career development, offering a framework for clinician-educator training in procedural fields.

Introduction: Simulation training is an essential component of transesophageal echocardiography (TEE) education, particularly for novice learners. However, a critical limitation of current mannequin-based TEE simulators is their inability to emphasize the spatial relationship between the probe's position and the resulting ultrasound images. This limitation, referred to as the "black box" effect, can make it difficult to understand how probe manipulation affects image acquisition, including probe orientation, beam trajectory, and the intersection of the ultrasound beam with cardiac structures. As a result, educators may struggle to convey these critical spatial concepts using existing simulation tools.

Methods: A set of 3D-printed TEE training models was first developed to simulate the steps involved in TEE scanning procedures. They also provide beginners with an intuitive visual representation and a mental rotation process, enhancing their spatial awareness. Then, a pre-post pilot study was conducted among third-year clinical anesthesia (CA-3) residents. Three aspects of teaching quality were evaluated before and after the simulation training with 3D-printed models: TEE view-related knowledge, image quality on a mannequin-based simulator, and learners' confidence.

Results: A total of 10 residents were included in this study. The knowledge assessment score significantly improved after the session (56.0 ± 22.60 vs 93.5 ± 6.26, P < .001). Image quality scores of 8 out of 12 required TEE views were also improved. Using the models positively influenced trainees' confidence in understanding and memorizing basic TEE principles: omniplane angles and corresponding TEE views [1.00 (0.75, 1.25) vs 0.00 (-1.00, 1.00), P < .01]; orientation interpretation [1.00 (1.00, 2.00) vs 0.00 (-1.00, 1.00), P < .01].

Conclusions: A simulation training session with a set of 3D-printed TEE teaching models significantly improved TEE view-related knowledge, image quality, and learners' confidence among CA-3 residents.

Background: Escape games offer an innovative approach to teaching nontechnical skills essential for managing critical events. The primary aim of this study was to assess how an analog escape box activity affected anesthesiology residents' self-efficacy with 2 nontechnical skills: establishing role clarity and using closed loop communication.

Methods: In June 2024 and June 2025, a total of 38 anesthesia interns competed in teams of 4-5 to solve 5 riddles to open a locked box and take a team photo with an education program coordinator. Residents completed pretest/posttest surveys assessing their self-efficacy with establishing role clarity and using closed-loop communication and their satisfaction and perceived workload (mental/physical/temporal demand, performance workload, effort, and frustration). Changes in self-efficacy were analyzed using Wilcoxon signed-rank tests, descriptive statistics were calculated for perceived workload and satisfaction, and comments were analyzed with thematic analysis. The total cost of supplies was $325.56 for 4 escape boxes.

Results: Thirty (79%) of 38 residents completed surveys. Resident self-efficacy for establishing role clarity and using closed-loop communication both increased significantly (p < .001). On a 7-point scale of perceived workload, median mental demand (4.5), temporal demand (4.5), and effort (4) were moderate, whereas physical demand (3), performance workload (2), and frustration (1.5) were low. Mean satisfaction was 3.8 out of 5. Thematic analysis of resident comments revealed teamwork and engagement as key themes.

Conclusions: This study serves as a proof of concept that escape boxes are well-received and can improve residents' self-efficacy in establishing role clarity and using closed-loop communication.

Background: Research suggests stress in residency is increasing with burnout and maladaptive coping strategies contributing to negative psychosocial outcomes. However, details on how residents define their experience of stressful events in the context of their daily training are lacking.

Methods: Using a cross-sectional survey design, all clinical anesthesia residents in a large academic program were asked for a stressful event example experienced in the operating room over the past 30 days. Responses were reviewed by a panel, who developed a stress categorization system using a 3-round modified Delphi process. The finalized system was then applied to classify these stressful events reported by the residents. Additionally, thematic analysis was conducted to analyze the examples and identify themes.

Results: Seventy-two of the 96 residents surveyed (83%) reported experiencing a stressful event in the past 30 days. Forty-four residents provided examples, 41 of which were legible and categorizable. A stress categorization system was developed (the Stress Objectivity Scale), comprising 4 categories: mild, moderate, severe, catastrophic. Applying this system to the residents' examples, 1/41 (2%) were mild, 21/41 (51%) were moderate, 11/41 (27%) were severe, and 8/41 (20%) were catastrophic. Thematic analysis identified several key themes including trainee vulnerability, clinical complications, colleague conflicts, and positive coping strategies.

Conclusion: This research contributes to the limited literature on what constitutes a stressful event in anesthesiology residency by providing concrete examples and developing a severity-based classification system. The findings revealed a relatively high incidence of severe and catastrophic events within a 30-day period. Future research will focus on determining the impact of stressors over longer periods of training and on interventions designed to lessen negative consequences.

Background: Acquiring regional anesthesiology skills presents a unique challenge for novice residents as ultrasound hand-eye coordination is learned through manual dexterity practice while simultaneously interpreting critical sonoanatomy. We developed low-cost ballistic gel phantom models as task trainers for interscalene and adductor canal nerve blocks to train novice anesthesia residents.

Methods: We conducted a single group preimplementation/postimplementation cohort study with first-year clinical anesthesiology (postgraduate year 2) residents at the Mayo Clinic, Rochester. Residents attended a workshop that included lectures, ultrasound scanning, and gel phantom needling practice using 2 anatomic ballistic gel trainers. The initial costs for the interscalene and adductor canal trainers were $69.12 and $147.99, respectively, with each subsequent trainer costing $15.60 and $11.46. Surveys assessed knowledge and confidence before, immediately after, and at 1 and 4 months postworkshop and were analyzed using paired Wilcoxon signed rank tests.

Results: Eighteen residents participated, showing significant improvements in confidence (p < .001) and knowledge immediately following the workshop (p < .003). Average knowledge scores were sustained at 1 month (9 points [6,11]; p = .018) and at 4 months (8 points [7,10]; p < .025) despite minimal clinical exposure. Confidence remained significantly higher than preworkshop at 1 month (p = .005 interscalene block; p = .008 adductor canal block) though not sustained at 4 months (p = .053 interscalene block, p = .265 adductor canal block).

Conclusions: Comprehensive workshops incorporating anatomic ballistic gel trainers significantly enhance residents' confidence and knowledge in performing nerve blocks. This cost-effective approach supplements traditional training methods, bridging the gap between theoretical knowledge and practical skills.