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

Background: Traditional medical simulations leverage stressful scenarios to potentiate memory. Augmented reality (AR) simulations provide cost-effective experiences using holograms instead of mannequins. This study investigated the physiologic response to AR simulations.

Methods: This was a noninferiority, controlled trial at an academic, pediatric hospital in Northern California among health care workers randomized to AR or traditional, in situ medical simulations. The primary outcome investigated parasympathetic tone. Biometric sensors assessed parasympathetic tone as respiratory sinus arrhythmia (RSA). A difference in RSA of less than 10% between groups was considered noninferior. Secondary outcomes explored usability, ergonomics, satisfaction, and recall with the System Usability Scale (SUS), ISO 9241-400, Simulation Design Scale (SDS), and an electronic questionnaire 5 months after the intervention, respectively.

Results: A total of 111 participants were enrolled and 106 analyzed. Both groups experienced a decrease in mean RSA from baseline to during the simulation (P < .001 for both groups). Subsequently, there was an increase in RSA from the simulation period to the recovery period (P < .001 for the AR group and P = .035 for the traditional group). Regarding secondary outcomes, the mean SUS score of 70.5 suggested good usability, 65.38% of AR participants reported feeling comfortable using the headset, and satisfaction in both groups was similar except for differences in use of real-life factors. The recall assessment was completed by 12 AR and 15 traditional participants, with similar scores between the 2 groups (P = .4).

Conclusions: AR simulations produced a noninferior change in parasympathetic tone compared with traditional simulations. Future investigations may explore the effectiveness of AR simulations for developing nontechnical skills during remote training. (Registration: Clinical Trials Registry NCT05674188.).

Background: In 2014, The American Board of Anesthesiology introduced the Basic Examination as a graduation requirement for second-year anesthesiology trainees. The exam's validity has been supported by evidence demonstrating enhanced performance on other standardized exams; however, an assessment's validity is inseparable from decisions made on its behalf. This study aimed to understand the usage and implications of the Basic Exam within training programs to construct a comprehensive validity argument.

Methods: Semistructured interviews were conducted with a sample of 20 program directors from Accreditation Council for Graduate Medical Education-accredited anesthesiology training programs. Thematic analysis was performed by a 3-member team.

Results: A 56-item codebook was developed and applied to the 20 transcripts, yielding 1941 coded segments organized into 7 themes. Theme 1 highlights varied programmatic policies, including dismissal (1a). Theme 2 addresses the perceived purposes of the exam: as a tool to "weed out" residents unlikely to achieve board certification (2a), a data point supporting remediation (2b), and a distinguishing accomplishment of physician anesthesiologists (2c). Theme 3 captures programmatic implications for recruitment (3a), operations (3b), and curricula (3c). Theme 4 confirms that residents are studying for the exam, emphasizing targeted test preparation (4a). Theme 5 discusses resident implications, including stress (5a) and clinical distraction (5b). Themes 6 and 7 explore the implications of failure and equity concerns, respectively.

Conclusions: This study identifies a significantly underdeveloped validity argument supporting dismissal based on Basic Exam results and explores implications to guide future validation efforts.

Background: To decrease the risk of device mismanagement when using manual external defibrillators (MED), we created and piloted an online simulation to build and assess skills in using an MED.

Methods: Subject matter experts from anesthesiology, critical care, and nursing developed an online, interactive simulation-based curriculum for the MED device used at the VA Health System (R Series, Zoll) following the successive approximation method. Content was from the 2020 American Heart Association advanced cardiac life support (ACLS) guidelines and product manufacturer recommendations. Instructions for ACLS providers on how to correctly place defibrillator pads and perform synchronized cardioversion, defibrillation, and transcutaneous pacing were included. During the pilot study, 22 users from one institution completed a pre-assessment (baseline ability to place pads, perform the 3 defibrillator tasks), watched instructional videos and engaged with an interactive tutorial, and, in the post-assessment, must have correctly completed each task independently. The assessments tracked "pass/fail," number of attempts, and the time to complete each task.

Results: Feedback from users was positive. Completing the simulation-based curriculum resulted in improved device management on a simulated device. Wilcoxon signed-rank tests showed no significant change in time to place defibrillator pads, but there was a significant reduction in time to perform a cardioversion (median [interquartile range] = 31.31 [34.23] vs 20.10 [13.92] seconds; P = .001), defibrillation (19.79 [19.24] vs 15.54 [6.22] seconds; P < .0001), and pacing (39.51 [30.72] vs 20.07 [10.59] seconds; P < .0001).

Conclusions: The online simulation-based curriculum was well received and should be particularly useful for those who do not have ready access to in-person MED training.

Background: The clinical applications of point-of-care ultrasound (POCUS) have proliferated across multiple specialties with technologic advances. POCUS education in residency programs has challenged educators to develop a POCUS- based clinical practice curriculum. The level of exposure needed to achieve POCUS competence is evolving with programs adopting diverse POCUS training initiatives. Our study aims to evaluate our POCUS curriculum and use evaluation results and survey feedback to optimize and improve trainee competence.

Methods: Twenty-one anesthesiology residents participated in a baseline POCUS and a 2-week POCUS exam comprising 65 questions (50 cardiac, 10 lung, and 5 abdominal). Technical competence in lung and cardiac ultrasound was assessed by POCUS supervisors using validated tools. The Rapid Assessment of Competency in Echocardiography (RACE) Scale was used to assess image generation and interpretation domains. The American College of Emergency Physicians - Council of Residency Directors (ACEP-CORD) guidelines measure technical skills for lung ultrasound. Resident perception to POCUS education and training was based on a survey.

Results: Score comparisons between the baseline and 2-week post course multiple-choice exams did not show a statistically significant change in performance. The technical competency assessment demonstrates that Image Generation Scores on the RACE Scale were highest for images in the parasternal long-axis view and lowest for the subcostal view and inferior vena cava view. Results of the resident perception survey showed a strong interest and motivation to learn ultrasound and strong desire for more exposure and training with ultrasound.

Conclusions: Anesthesiology programs have incorporated POCUS training; however, training methods are not uniform. This study aims to provide a road map for residents-in-training to integrate POCUS skills into clinical practice.

Background: Incorporating intraoperative ultrasound education into anesthesiology graduate medical training may benefit both trainees and the field of anesthesiology.

Methods: This study describes the successful integration of intraoperative ultrasound training into an existing Focused Cardiac Ultrasound (FoCUS) curriculum. A retrospective analysis of educational logs from 4 postgraduate year 4 anesthesiology residents (exam n = 160) was conducted to determine the most accessible intraoperative FoCUS views, success rates of image acquisition by surgical region, and impact of abdominal insufflation and Trendelenburg positioning on success rates.

Results: Parasternal views had the highest probability of successful image acquisition (parasternal long axis [PLA] odds ratio [OR] = 16.36 and parasternal midpapillary short axis [PSA] OR = 21.98 compared with subcostal 4-chamber [SC]). Extremity surgeries offered the highest success rates (52% for SC to 92.5% for PLA), whereas thoracic surgery had the lowest (9.1% for SC to 63.6% for PSA). Trendelenburg positioning increased the odds of successful image acquisition in PLA or PSA views (OR, 3.58; 95% confidence interval, 1.4-9.11).

Conclusions: Integrating intraoperative ultrasound education into existing FoCUS curricula is feasible. Educators should consider emphasizing parasternal views, which are the most accessible to anesthesia clinicians, consider the higher success rates in extremity surgeries for complete examinations, and recognize that Trendelenburg positioning may enhance image optimization.

The authors propose an educational innovation in graduate medical education, the creation of an Education Ombudsperson. Although this role has been implemented for faculty and students within the medical field, it has not been described in residency programs. The Ombudsperson for house staff is distinct from institutional or programmatic leadership. His or her primary role within a department is to foster psychological safety, wellness, advocacy, and professionalism in residency or fellowship programs. This manuscript describes the process for selection, visitor consultation, escalation pathways, and examples of concerns addressed proactively. The Ombudsperson can complement the role of the Program Director, Chair, and Designated Institutional Official in a collaborative model that addresses challenges in the learning environment.

Background: Expanding the physician workforce in underserved areas is imperative for addressing healthcare disparities. The creation of new residency training programs has assisted in these efforts. However, anesthesiology training programs are infrequently studied in this regard. Our objective was to compare the geographical distribution of newly accredited anesthesiology training programs with new surgery, obstetrics, and family practice programs with respect to health professional shortage areas (HPSAs) and medically underserved populations.

Methods: The locations of residency training programs accredited between 2014 and 2024 were identified by querying the Accreditation Council for Graduate Medical Education and Fellowship and Residency Electronic Interactive Database Access System. Whether the postal address of the training program corresponded to a medically underserved area or population was then recorded. HPSA and maternal care target area (MCTA) scores were also collected as an indicator of poor access to primary care or maternal care for the postal addresses of each program. Bivariate US maps qualitatively compared the geographical distributions of newly accredited training programs, analysis of variance and t tests were used to compare HPSA and MCTA scores, and χ² tests were used to compare the percentage of programs in medically underserved areas.

Results: Forty-eight anesthesiology programs became accredited between 2014 and 2024, as well as 127 surgical, 360 family medicine, and 68 obstetrical programs (total = 603). States with higher HPSA scores tended to have a relatively lower numbers of newly accredited anesthesiology and surgery programs. The mean HPSA and MCTA scores for anesthesiology programs were comparable to those for family medicine and obstetrical programs, respectively (P > .5). There was no statistically significant difference noted among the distribution of anesthesia, surgery, family medicine, or obstetrical training programs in medically underserved areas (P > .5).

Discussion: The geographical distributions of new anesthesiology and surgery training programs are qualitatively similar. Like family medicine and obstetrical training programs, newly accredited anesthesiology training programs are in HPSAs with comparable need priorities as evidenced by statistically similar HPSA and MCTA scores. However, with only roughly one-third of all newly accredited family medicine, obstetrical, surgery, and anesthesiology training programs in medically underserved areas, substantial work is still needed.

Conclusion: States with higher HPSA scores tend to have a relatively lower number of newly accredited anesthesiology and surgery programs. The locations of newly accredited anesthesiology training programs are similar to those of newly accredited family medicine and obstetrical trainin

Background: The primary aim of our study was to identify candidate characteristics that predicted a successful outcome for applicants to anesthesiology residency programs in the 2024 Main Residency Match. The secondary aim of our study was to assess the impact of gold and silver signals on the application process.

Methods: The Baylor Scott & White Research Institute institutional review board approved this study. Study investigators created a REDCap survey by consensus that included questions about demographic and academic characteristics for participants in the 2024 Match who applied to anesthesiology residency programs. A link to an invitation to participate in our study was posted to 2 social media platforms. The survey was accessible from March 19, 2024, to March 28, 2024.

Results: One hundred and fourteen matched and 23 unmatched applicants completed the survey. Matched applicants reported a higher mean US Medical Licensing Examination Step 2 score than unmatched applicants (252 versus 245, P < .01) along with more interview invitations (11 versus 6, P < .01). Matched and unmatched applicants submitted a mean of 44 and 55 applications to residency programs without a gold or silver signal, respectively, that resulted in a median of 1 interview invitation for both cohorts.

Conclusions: The results of our study indicate that matched applicants had higher self-reported US Medical Licensing Examination Step 2 scores and interview invitations than unmatched applicants. Additionally, applications to programs that did not receive a gold or silver signal yielded only 1 additional interview invitation and resulted in a high financial cost to the applicant.

Background: Critical care education is an important, mandatory component of residency training in anesthesiology. Currently, there is no accepted national standardized curriculum, and a prioritized critical care content outline would be beneficial to the creation of a pragmatic standardized residency curriculum. The modified Delphi method is a recognized method for establishing consensus in medical education.

Methods: We developed a prioritized critical care content outline using the modified Delphi method. Topics were selected from critical care topics included in the Program Requirements for Graduate Medical Education in Anesthesiology and the American Board of Anesthesiology Content Outline. Panel members rated critical care topics on a 9-point Likert scale (1 = not important, 9 = mandatory). Consensus was defined as ≥75% rating the topic as very important to mandatory for inclusion (Likert scale 7-9). Topics with >80% consensus were removed from subsequent surveys and included in the final list, and topics with <50% were removed. Members were asked to select the ideal timing of topic delivery during residency (Foundational-Early Residency, Intermediate-Mid Residency, Advanced-Late Residency).

Results: A total of 158 panel members who were contacted using national anesthesiology organization email lists completed the initial round, 119 (75%) completed the second iteration, and 116 (73%) completed the third. Response rate on the first survey was (22/55) 40% for anesthesiology critical care program directors, (18/132) 14% for core anesthesiology residency program directors, and (77/1150) 7% for the remaining respondents. Trainees (n = 41) were not included in response rate calculations. Most participants (103/158, 65%) had completed both core anesthesiology and subspecialty critical care medicine training and most (87/158, 55%) had formal roles in medical education. Forty-one (26%) responders were currently in training. All panelists worked in institutions with graduate medical education (GME) learners. Fifty-eight of 136 (43%) topics met consensus for inclusion. Most consensus topics (50/58, 86%) were recommended to be delivered early during residency with the other 8 topics to be delivered in the middle of residency.

Conclusions: We developed a prioritized critical care content outline for anesthesiology residents that includes highly recommended critical care topics with ideal timing for inclusion in residency. This outline provides the first step in developing a pragmatic standardized curriculum to guide faculty and programs in critical care education.