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

The COVID-19 pandemic has forced organizers of traditional in-person continuing medical education conferences to transition to a virtual format. There are both advantages and disadvantages to this change in format. When planning a virtual meeting, several factors require consideration, including costs, virtual platforms, sponsorship, networking, and meeting logistics. This manuscript describes the authors' experiences of transforming the Society of Education in Anesthesia 2020 Fall Meeting into a virtual conference and explores the lessons learned and future impacts of this new medium.

Background: Research has demonstrated that active learning, spaced education, and retrieval-based practice can improve knowledge acquisition, knowledge retention, and clinical practice. Furthermore, learners prefer active learning modalities that use the testing effect and spaced education as compared to passive, lecture-based education. However, most research has been performed with students and residents rather than practicing physicians. To date, most continuing medical education (CME) opportunities use passive learning models, such as face-to-face meetings with lecture-style didactic sessions. The aim of this study was to investigate learner engagement, as measured by the number of CME credits earned, via two different learning modalities.

Methods: Diplomates of the American Board of Anesthesiology or candidates for certification through the board (referred to colloquially and for the remainder of this article as board certified or board eligible) were provided an opportunity to enroll in the study. Participants were recruited via email. Once enrolled, they were randomized into 1 of 2 groups: web-app-based CME (Webapp CME) or an online interface that replicated online CME (Online CME). The intervention period lasted 6 weeks and participants were provided educational content using one of the two approaches. As an incentive for participation, CME credits could be earned (without cost) during the intervention period and for completion of the postintervention quiz. The same number of CME credits was available to each group.

Results: Fifty-four participants enrolled and completed the study. The mean number of CME credits earned was greater in the Webapp group compared to the Online group (12.3 ± 1.4 h versus 4.5 ± 2.3 h, P < .001). Concerning knowledge acquisition, the difference in postintervention quiz scores was not statistically significant (Webapp 70% ± 7% versus Online 60% ± 11%, P = .11). However, only 29% of the Online group completed the postintervention quiz, versus 77% of the Webapp group (P < .001), possibly showing a greater rate of learner engagement in the Webapp group.

Conclusion: In this prospective, randomized controlled pilot study, we demonstrated that daily spaced education delivered to learners through a smartphone web app resulted in greater learner engagement than an online modality. Further research with larger trials is needed to confirm our findings.

Background: Prior studies have demonstrated gender differences in language used in letters of recommendation (LOR) for residency applicants. No previous studies have investigated linguistic gender differences in LOR specifically in the field of anesthesiology. The objective of this study is to determine whether there are potential gender biases in the language of LOR written for anesthesiology residency applicants.

Methods: Letters sent through the Electronic Residency Application Service in application for a single training program in the Northeast in 2019-2020 were divided into self-identified male and female groups. The letters were deidentified, converted to machine-readable text, and input into software to analyze differences in language use. Differences in language use and word count between the 2 groups were compared.

Results: Included in this analysis were 316 applicants (113 female applicants and 203 male applicants) who submitted a total of 1132 letters, 409 of which were letters written for females and 723 were written for males. Analysis of 4 document characteristics and 19 psychological construct word categories showed that males had a higher frequency of tentative notations (P < .0110), while females had a higher frequency of ability notations (P < .0449). No other meaningful differences were found.

Conclusions: While our results demonstrated 2 differences in language use between male and female anesthesiology residency applicants for LOR, it is reassuring that LOR are relatively free of linguistic bias. Future research should focus on identifying other areas of the specialty's recruitment process in order to recognize and mitigate gender differences in anesthesiology.

Background: The Objective Structured Clinical Examination (OSCE) is part of the American Board of Anesthesiology (ABA) certification process. A simulated OSCE can aid examination preparation, but the COVID-19 pandemic prevented in-person simulation training. Therefore, we adapted our in-person simulated OSCE (SOSCE) as a Zoom-based telesimulation OSCE (ZOSCE), permitting examinees to participate remotely. Comparing this process with historical in-person SOSCE cohorts, we hypothesized that this telesimulation-based format would still be well received by the trainees as a substitute when it was not possible to provide in-person practice and formative assessment. Subsequently, the ABA proposed a virtual-format OSCE.

Methods: We conducted our 7-station ZOSCE according to the ABA content outline for all graduating third-year clinical anesthesia residents (CA-3) in 2020. From a main meeting room, the facilitator paired each CA-3 with a faculty proctor, assigned them to their own breakout room for each station, and rotated standardized patients in. The faculty proctor observed the CA-3's performance in real time using an assessment tool with objectives graded on a 0-2 scale. At the conclusion of the ZOSCE, proctors reviewed the assessment tool with the CA-3 and provided personalized global feedback. Assessment tool scores were used to calculate performance data for the study group that were compared with a SOSCE historical cohort from 2017 and 2018. All parties completed a Likert-style evaluation specific to the ZOSCE.

Results: A total of 22 CA-3 residents participated. Mean performance scores ranged from 82.2%-94.9% (minimum = 38%, maximum = 100%). Compared with the historical SOSCE cohort, ZOSCE scores for 5 of 7 stations were not different, but scores in communication with professionals (P = .007) and ultrasound (P < .001) stations were lower. Overall, CA-3 participants rated the learning experience positively and felt it was a reasonable substitution for in-person simulation, with responses similar to those of a historical in-person SOSCE cohort.

Conclusions: A telesimulation-based practice ZOSCE for formative examination preparation for the ABA OSCE resulted in similar institutional scoring for most stations compared with in-person SOSCE, but some stations may be better practiced in person or require modifications. The virtual format may permit flexible scheduling during nonclinical times or for learners in remote locations. These findings have implications for future formative exercises and the formal summative examination process.

Background: Cricothyrotomy is a final recourse for salvaging a difficult airway, yet most anesthesiology providers have little training, exposure, or comfort with the procedure. Pig tracheas are frequently used for training, but are single use and require special handling and storage. Other simulation models, such as mannequins and cadavers, are costly. Advances in 3dimensional (3D) printing have improved accessibility and decreased costs. This research project sought to determine whether an inexpensive 3D-printed task trainer was noninferior to pig tracheas for teaching surgical cricothyrotomy skills.

Methods: Anesthesiology residents were enrolled in an institutional review board-exempted, unblinded, randomized, controlled, single-institution, noninferiority trial. Participants were trained in the scalpel-finger-bougie technique for surgical cricothyrotomy. Participants were randomized to practice 5 repetitions on either a pig trachea or the 3D model and were assessed on time to cricothyrotomy completion on a pig trachea before and after practice.

Results: Demographic characteristics of the 25 workshop attendees were similar between study arms. Overall mean (SD) improvement in speed was 9 (12) seconds (P = .001). Postpractice times were similar between groups (analysis of covariance estimated difference of -0.1 seconds [95% confidence interval, -9.4 to 9.2]; P = .55). The 3D model was noninferior to the pig trachea at the prespecified noninferiority margin of 10 seconds (P = .017).

Conclusions: The 3D model was noninferior to pig tracheas for improving the time to completion of a surgical cricothyrotomy. A 3D-printed model offers a viable alternative to pig tracheas for emergency airway simulation that is inexpensive, reusable, and readily modified to simulate challenging airway anatomy.

Background: Social media remains a growing platform for physicians to facilitate learning, network, and disseminate information. The Coronavirus Disease 2019 (COVID-19) pandemic has challenged traditional medical student recruitment and outreach. Instagram is a platform that can be used by residency programs to increase engagement and as a potential recruitment tool. The authors present social media failed and successful strategies used to increase engagement and gain new followers.

Methods: In June 2020, an initiative began to use Instagram on a more frequent and intentional basis. Three different strategies were implemented during the pandemic: mirroring Twitter posts, increasing multimedia, and leveraging Instagram Stories. The outcomes of interest included number of followers and engagement on posts. Data were collected October 2020.

Results: After June 1, 2020, the @mayoanesthesia account gained 1000 followers through 127 days, an average of 4.26 new followers each day. Before June 1, there were 24 total posts over 3.3 years with a total of 458 followers. Three different strategies were implemented at different times during the pandemic. During the mirroring Twitter posts period, the mean number of interactions per post was 14.5. During the second phase after separating the Twitter and Instagram strategy, the mean number of interactions per post increased to 57.8.

Conclusion: Residency programs can creatively, yet methodically, use Instagram posts to increase social media engagement during resident recruitment season during the COVID-19 pandemic and likely beyond.

Background: Junior faculty in academic medicine often struggle with establishing their careers, resulting in low promotion and high attrition rates. Fellows also grapple with the decision to pursue careers in academic medicine. We report on the implementation and evaluation of a novel faculty and fellows exchange program that promotes career development.

Methods: In 2017, the University of California San Francisco created a reciprocal faculty exchange program called the Visiting Scholars in Pediatric Anesthesia Program (ViSiPAP). ViSiPAP expanded to involve 17 institutions across the United States. Fellows from 3 of the institutions were paired with faculty mentors to create Fellow/Faculty ViSiPAP. An initial postparticipation survey was sent after each exchange, and a follow-up survey in 2020 assessed ViSiPAP's impact.

Results: Fifty-three faculty participated in ViSiPAP and gave 66 presentations, and 20 fellows from 3 institutions gave 20 presentations. The initial postparticipation survey response rate was 88%, and the follow-up survey response rate was 74%. Survey responses indicated that ViSiPAP enhanced fellow and faculty well-being, improved didactic conferences, and provided opportunities for networking and collaborating. The follow-up survey indicated that participation in ViSiPAP led to 45 online academic publications, 39 additional invited presentations, and 8 authorships in peer-reviewed academic journals.

Conclusions: ViSiPAP is a successful professional development program for both fellows and junior faculty in pediatric anesthesia. Our program successfully introduced the participants into the pediatric anesthesia community and jumpstarted academic careers. Participation in ViSiPAP led to increased scholarly output and assisted with faculty promotion. This combined fellow/faculty exchange program is a novel approach to professional development and is broadly applicable to other disciplines in academic medicine.

Background: Program directors (PDs) play a crucial role in the competitiveness of the residency selection process and in mentoring the next generation of physicians. With this mandate comes the need to evaluate PDs on their own academic performance. We aimed to evaluate the distinguishing characteristics of anesthesiology residency programs with a focus on academic productivity of PDs and to investigate how these characteristics affect the Doximity program rank.

Methods: We identified anesthesiology program rankings from 2019 Doximity standings and divided them into quartiles (Q1-Q4). PD academic history and bibliometric indices (H-index, number of publications and citations) were collected through program websites, PubMed, Scopus, Google Scholar, and Accreditation Council for Graduate Medical Education (ACGME) websites.

Results: A total of 152 active anesthesiology programs and PDs were identified across the United States. Among the 152 PDs, 32% (n = 49) were women and 68% (n = 103) were men. There were differences between the Q1 versus Q2 programs in all of the variables other than PDs' number of fellowships. However, Q2 versus Q3 and Q3 versus Q4 programs had fewer identified differences. Each of the assessed PDs' bibliometric indices showed weak correlation with the program rank; however, there were stronger correlated factors of program rank, such as the program's original ACGME accreditation date (rs = 0.5, P < .0001) and female resident percentage (rs = 0.36, P < .0001) with moderate positive correlation. Additionally, the program size (rs = 0.77, P < .0001) and the number of ACGME-approved fellowships provided by the program (rs = 0.75, P < .0001) had a very strong positive correlation.

Conclusion: This study shows that program rank in the growing field of anesthesiology correlates with program size, female residents' percentage, ACGME approval date, number of ACGME-approved fellowships, as well as PDs' research productivity.