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

Background: Ultrasound is a modern foundational tool used by anesthesiologists for peripheral nerve blocks. Clinicians performing hands-on ultrasound training on patients presents unique challenges, and the use of human anatomical donors has become a common substitute. With that, whereas ultrasound training sessions are common, they do not often include basic science anatomy reviews. This study explores an anatomist-led clinical anatomy review and physician-led ultrasound training session for first (n = 7) and second (n = 11) year anesthesiology residents.

Methods: Residents attended a 2-hour anatomy review on prosected anatomical donors by anatomists prior to physicians facilitating an ultrasound-guided peripheral nerve block training session on undissected donors. The session covered the interscalene, supraclavicular, femoral, sciatic, and transversus abdominis plane ultrasound-guided peripheral nerve blocks. Data was collected using presurveys and postsurveys and assessments and analyzed.

Results: The session was found to be useful and significantly improved the residents' confidence across 14 domains related to the anatomy and approach to ultrasound for the given peripheral nerve blocks. All the participants (18, 100%) felt it was very useful having undissected anatomical donors side by side to dissected ones during the session. Knowledge acquisition also improved based on the significant increase in score on the 8-question assessment (p = .003).

Conclusions: The residents found this activity valuable and useful, especially learning from both undissected and prosected donors. With this approach, residents could compare the ultrasound image to the physical anatomy, which led to an increase in the residents' knowledge and confidence.

Background: Accurate self-assessment is critical for self-directed learning and clinical competency development. Identifying factors that influence resident's competency-based assessments is imperative to address potential disparities and foster an equitable training environment. However, studies on the relationship between demographic characteristics, such as gender and race, and self-assessment are scarce. This study aims to examine the alignment between residents' self-assessment and faculty evaluation of clinical competencies and investigate the gender- or race-related discrepancies in assessment.

Methods: This retrospective study analyzed Accreditation Council for Graduate Medical Education milestone scores and self-assessments from clinical anesthesiology residents at a single site over 6 academic years (December 2015 through June 2021). Semiannual Clinical Competency Committee (CCC) assessments and resident self-assessments were compared to measure assessment alignment. Data were analyzed using mixed-effects analysis of variance and Tukey test.

Results: The sample included 17 773 subcompetency ratings from 117 residents with no significant gender or race effects on CCC scores. Self-assessment scores showed a significant gender-race interaction in professionalism milestones (p = .025) with female white residents rating themselves lower than their female nonwhite (mean [95% confidence interval or CI] =14.26 [13.23, 15.30] versus 16.37 [15.15, 17.61], p = .049) and male white peers (mean [95% CI] = 14.26 [13.23, 15.30] versus 16.15 [15.41, 16.89], p = .020). Residents generally overestimated their competencies compared to CCC scores (p range: < .0001 to .702) with notable improvement in assessment alignment over time (p range: < .0001 to .002) except for interpersonal and communication skills (p = .091). White residents' medical knowledge assessment alignment was better than the nonwhite residents (mean difference, 95% CI = .22 [.03, .40], p = .027).

Conclusions: Our study investigated the underexplored area of the roles gender and race play in residents' competency assessments. The findings suggest that further research is warranted to explore the impact of personal characteristics on competency assessment and to develop targeted interventions for improving competency assessment and reducing potential biases.

Background: In medical education, vertical integration (VI) refers to integration between the clinical and basic sciences. Mixed reality (MR) refers to a rendered experience in which virtual and "real" elements are perceived simultaneously by a learner. The Microsoft HoloLens2 is a novel headset that allows the rendering of an MR environment and facilitates a live 2-way broadcast to (a) remote environment(s). We present here a mixed-methods study that extends previous work of ours examining the feasibility, usability, and efficacy of MR in the clinical education of medical students, specifically teaching pain pathways in a clinical context.

Methods: A series of 7 interactive bedside tutorials on pain pathways and their relevance to postoperative pain management was delivered by a single teacher (K.J.M.) using the HoloLens2. Each tutorial included interaction with a patient during the postoperative period and a group of 5 medical students who were situated in a remote lecture theater within the hospital complex. The tutorial used insertion of virtual artifacts, including diagrammatic examples of pain pathways often superimposed on or positioned adjacent to the patient. Student feedback was elicited using a modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions (ETELM-LP) tool.

Results: This was a prospective, observational study that used both qualitative and quantitative methods. Seven patients and 35 students participated across 7 separate tutorials. The mean System Usability Scale score for medical students was 72.5 (interquartile range 62.5-80.0) and for the clinician was 70.5, indicating favorable usability. The modified ETELM Questionnaire using a 7-point Likert scale demonstrated MR contributed to achieving the learning objectives of the tutorial (median = 6, range 5-7), and was superior to a lecture supported by computer- projected slides. There was disagreement among students regarding the value of the MR tutorial in comparison with a live patient encounter (median = 4, range 3-5). Patients consistently rated communication with the clinician highly (median = 7, range 6-7) and favored the MR tutorial over small group bedside teaching (median = 7, range 6-7).

Conclusions: We demonstrated within our institution that bedside clinical teaching of pain pathways using the Microsoft HoloLens2 and MR is both feasible and effective, and could enhance vertical integration of basic and clinical material within a medical undergraduate curriculum. This study's collaborative application development model, involving tutors, facilitators, and curriculum experts, sets a precedent for future educational technology in health care. Further evaluation of the usability of the device in this context is planned, and future research may evaluate the generalizability of our findings to other elements of medical education.

Background: Residency occurs for most physicians during the childbearing years. As residents face demanding work schedules, the training experiences may be further stressed by parenthood. There is a perception that residents who take parental leave are less academically productive.

Methods: We obtained the names of anesthesia residents from Mayo Clinic graduating classes of 2016 to 2021. Google Scholar, EMBASE, and PubMed were used to search for publications by the names of residents. Gender and leave of absence data for each resident during residency were identified. A set of logistic regressions was used to examine leave from work related to the residents' publication outcomes.

Results: Of the 149 residents included in the study, 49 (32.9%) took parental and 19 (12.75%) took other types of extended leave (≥ 5 days). Those who took parental leave did not differ in likelihood of being published compared with those who took other types of extended leave (P = .066) or no leave (P = .447). No relationship was found between taking parental leave with total number of publications, first author publications, second author publications, or original research publication after controlling for gender, graduation year, or total number of days of leave.

Conclusions: Taking parental leave did not adversely affect scholarly output among anesthesiology residents at a single multi-site institution.

Background: Belongingness is an individual sense of "connection" or "acceptance" from others, created through an interaction between an individual and their surrounding environment, and impacts medical education. How anesthesiology interns develop a sense of belongingness within anesthesiology is poorly understood. This study explores the pathway and mechanisms by which anesthesiology interns develop a sense of belongingness.

Methods: Semi structured interviews were conducted with 23 anesthesiology trainees during the 2023-2024 academic year. A constructivist, qualitative approach rooted in grounded theory was used to generate a middle-range theory on the development of belongingness among anesthesia interns.

Results: The authors identified 4 primary facets of anesthesiology interns' Belongingness Journey described as (1) Stepping into liminality, (2) Cohesion with(out) contact, (3) Purpose-driven belonginess, and (4) Perceived self-actualization. As trainees entered the liminal space of internship, multiple mechanisms destabilizing their sense of belongingness emerged, described here as performing normalcy and managing otherness. Interns combated destabilization by widening their social networks, most often to include other interns, and less frequently to include clinical anesthesia residents and faculty mentors. Alignment with purpose appeared protective, and to enhance this alignment, interns turned to multiple strategies including reframing and deliberate engagement. Upon crossing the threshold into their next year of training, interns described a sense of self-actualization and renewed belongingness despite entering a perhaps equally liminal space.

Conclusions: Anesthesiology interns' idiosyncratic lived experiences track along a belongingness journey. Knowledge of this pathway may help to inform the creation of future professional development and belongingness curricula.

Background: Central venous catheter (CVC) placement is a technically challenging skill. Routine assessment tools, including checklists and global rating scales, require subjective expert evaluation. We hypothesized that motion analysis could be used to objectively assess skill retention in CVC placement by comparing the performance of anesthesiology residents immediately after training and 7 months later.

Methods: After learning to perform CVC placement on a mannikin, 12 first-year anesthesiology residents each performed a "baseline" trial with electromagnetic motion sensors on the dorsum of their dominant hand and base of their ultrasound probe. Seven months later, they each performed a "follow-up" mannikin trial with an identical setup. For each trial, sensors recorded participants' path length, translational motions, and rotational sum. Time was recorded for each trial as well. We defined skill retention as performance within 1 standard deviation or less of the entire cohort's average at baseline (threshold). We compared the number of residents who met the threshold, which indicated less excessive motion and therefore better performance, at baseline with the number at follow-up using McNemar's test across each metric for each sensor.

Results: For path length, translational motions, and rotational sum of the probe, significantly more residents met the threshold at baseline than at follow-up (P < .04). No significant differences were detected for any metrics of the dorsum or time.

Conclusions: Motion analysis can objectively assess skill decay in anesthesiology residents performing CVC placement. Residents exhibited skill retention in tasks involving their dominant hand and skill decay in tasks involving the ultrasound probe (nondominant hand).

Background: Based on a review of anesthesiology education articles published in 2021, the authors conducted a critical appraisal to describe trends in the literature, highlight innovations in the field, and identify high-yield articles for clinician educators in anesthesiology.

Methods: After a database search (3 Ovid MEDLINE databases, Embase.com, ERIC [via FirstSearch], PsycINFO [via EBSCOhost], and PubMed), abstracts were screened by 2 independent reviewers based on inclusion criteria. Articles representing publications in both anesthesiology-specific journals and general medical education journals were included via manual search. Three randomly assigned raters reviewed and scored each quantitative article using a rubric. Two raters scored qualitative studies using a separate rubric designed for qualitative studies. Each article also received an overall quality rating used to create an additional list of recommended articles.

Results: The database search identified 1141 articles and an additional manual search identified 1497 articles. Of these, 67 articles met the inclusion criteria (61 quantitative, 6 qualitative). This article reports and summarizes the top 13 quantitative articles and top 2 qualitative papers.

Conclusions: This year we did not see as many articles describing curriculum to teach learners procedures, a topic heavily present in previous years. Also, analysis revealed an increase in articles focused on nontechnical skill education and a trend toward how to assess learner performance. Finally, 2 articles focused on gender issues in anesthesiology, an emerging area of interest.

Background: Despite national recognition of diversity, equity, and inclusion (DEI) training in graduate medical education, the current landscape of DEI curricula across anesthesiology residencies is poorly understood. We surveyed anesthesiology residency programs to evaluate how DEI education is implemented and assessed.

Methods: We conducted a cross-sectional survey of all 164 Accreditation Council for Graduate Medical Education-accredited anesthesiology residency programs. The survey was developed, and data were collected using the Research Electronic Data Capture (REDCap) tool. Program characteristics and departmental attitudes toward DEI were collected on a 5-point Likert scale. Univariate and bivariate analysis models were used to generate a descriptive report of responses. Content analysis was used to identify additional themes from open-ended responses.

Results: Fifty-three (32%) program directors responded to the survey. As their primary practice setting, 71.7% of programs were university-based, 18.9% community-based university- associated, and 9.4% community-based programs. A DEI curriculum was reported in 64.2% of programs with the median year of implementation in 2020 and the median hours spent per academic year on DEI content was 2.0 to 3.5 (range, 1-20). Of programs without a DEI curriculum, 68.4% indicated interest in implementing one. Of those with a DEI curriculum, common learning activities were case-based discussion, web-based learning, classroom learning, and simulations. The most common barriers to implementation included educational expertise, time for residents, and time for faculty. Only 11.5% (n = 3) of programs assessed outcomes from their curricula, most using pre-post surveys.

Conclusions: This study found that the presence of a DEI curriculum in anesthesiology residencies is relatively new, heterogeneous, and nonstandardized, and that outcomes are rarely measured.

Background: The Objective Structured Clinical Examination (OSCE) allows for residency training programs to assess clinical competencies. OSCEs can assess periprocedural skills but are challenging to implement because of their cost and time-intensive nature, especially in subspecialty areas such as regional anesthesia. The objective of this pilot project was to develop and implement an OSCE to assess important competencies in the field of regional anesthesia with focus on periprocedural and communication skills such as the ability to obtain informed consent, select appropriate equipment, and manage complications.

Methods: Three scenarios were developed after a needs assessment of the institution's regional anesthesia curriculum. No injections were performed, and focus was given to competencies required for effective and safe regional anesthesia practice outside of procedure-specific and technical competencies. We describe the development of the scenarios, exam format, setting and performance, and development of the scoring tool. Statistical analysis was performed to evaluate the reliability of the project by measuring interrater reliability and internal consistency reliability.

Results: Three scenarios were developed with a grading tool containing 64 checklist items and 5 global rating scores. Sixty-one percent of checklist items (39 of 64) showed moderate or better interrater reliability and all global rating scores showed moderate or better agreement. All scenarios showed moderate or better internal consistency reliability.

Conclusions: This pilot project details the development of a regional anesthesia OSCE that offers a valid, reliable, reproducible, cost-effective, and feasible method to assess periprocedural and communication competencies required for successful regional anesthesia practice.