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

Background: Natural language processing is a collection of techniques designed to empower computer systems to comprehend and/or produce human language. The purpose of this investigation was to train several large language models (LLMs) to explore the tradeoff between model complexity and performance while classifying narrative feedback on trainees into the Accreditation Council for Graduate Medical Education subcompetencies. We hypothesized that classification accuracy would increase with model complexity.

Methods: The authors fine-tuned several transformer-based LLMs (Bidirectional Encoder Representations from Transformers [BERT]-base, BERT-medium, BERT-small, BERT-mini, BERT-tiny, and SciBERT) to predict Accreditation Council for Graduate Medical Education subcompetencies on a curated dataset of 10 218 feedback comments. Performance was compared with the authors' previous work, which trained a FastText model on the same dataset. Performance metrics included F1 score for global model performance and area under the receiver operating characteristic curve for each competency.

Results: No models were superior to FastText. Only BERT-tiny performed worse than FastText. The smallest model with comparable performance to FastText, BERT-mini, was 94% smaller. Area under the receiver operating characteristic curve for each competency was similar on BERT-mini and FastText with the exceptions of Patient Care 7 (Situational Awareness and Crisis Management) and Systems-Based Practice.

Discussion: Transformer-based LLMs were fine-tuned to understand anesthesiology graduate medical education language. Complex LLMs did not outperform FastText. However, equivalent performance was achieved with a model that was 94% smaller, which may allow model deployment on personal devices to enhance speed and data privacy. This work advances our understanding of best practices when integrating LLMs into graduate medical education.

Background: Faculty development is important but often limited by conflict with ongoing responsibilities. The Oregon Health & Science University Department of Anesthesiology & Perioperative Medicine schedules more faculty physicians to work on Wednesdays, with nonclinical time in the morning and a clinical assignment in the afternoon, to facilitate a resident physician academic half-day (AHD). We designed a novel faculty development course to run in the mornings of the AHD using Kern's 6-step approach to curriculum development and hypothesized that it would be feasible and satisfactory.

Methods: A needs assessment was performed. Two experts in medical education developed the curriculum and sought faculty with medical education training to lead sessions. Five participants completed pre-intervention, daily session, and post-intervention surveys. Satisfaction was evaluated by surveys. Feasibility was evaluated by session attendance and surveys. Kirkpatrick's model for program evaluation was used, and a thematic analysis was performed.

Results: All participants responded "Strongly Agree" to all participant satisfaction post-intervention questions. All participants were able to meet the >50% attendance goal, only missing sessions when pre-call, post-call, on vacation, or ill. All participants reported changes in behavior and reported developing their clinician educator professional identities. One participant reported re-affirming their commitment to academic medicine.

Conclusions: This faculty development pilot course provided during work hours was feasible, and participants were highly satisfied. In addition, thematic analysis suggests that the course helped faculty develop a clinician educator professional identity and changed their behavior. Future work will include a qualitative study to understand the impact on participant behavior and professional identity formation.

Background: High-stakes yet clinically infrequent procedures are challenging to teach. Escape rooms may offer an innovative solution through game-based learning. There is limited guidance on how to design an escape room focused on physical puzzles. We designed and implemented a procedure-focused escape room to teach high-stakes procedures to anesthesiology residents.

Methods: We selected 5 procedural skills relevant to anesthesiology residents through a modified Delphi technique: fiberoptic intubation, rapid infuser setup, intraosseous line placement, flexible bronchoscopy, and supraglottic airway exchange. We designed associated skills stations and linked them in sequence using an elaborate series of puzzles, locks, keys, and codes. The total cost of puzzle equipment was $169.53. After pilot testing, we implemented the escape room from July to November 2022. We assessed residents using a single group pretest-posttest study design.

Results: Forty-three of 55 (78%) eligible anesthesiology residents participated in the escape room. Thirty-one residents completed the surveys. Resident self-efficacy significantly improved for each of the 5 procedures. Twenty-six of 27 (96%) residents preferred the escape room over a typical procedural skills workshop.

Conclusions: This pilot study demonstrated the feasibility of a procedure-focused escape room for teaching high-stakes technical skills. We identified 3 lessons in procedure-focused escape room design: set participant caps intentionally, optimize resource usage, and maximize reproducibility. Participating in a single escape room session significantly increased resident self-efficacy. Residents strongly preferred the escape room format over a traditional procedural skills workshop.

Background: Women are underrepresented in the anesthesiology physician workforce. Additionally, recruitment of women into the specialty has been stagnant over the past 2 decades. Current evidence is lacking regarding how and why women navigate the career-exploration journey to find anesthesiology. The purpose of this study was to investigate the phenomenon of women choosing a career in anesthesiology, specifically identifying facilitators and barriers to career choice and professional identity formation.

Methods: Using constructivist grounded theory, we explored the self-reported experiences of women anesthesiology trainees, including resident physicians and senior medical students. Seven resident physicians and 4 medical students participated in the study. Through semistructured interviews, data collection, and iterative analysis, the authors identified codes and emerging themes, thereby advancing the understanding of the career-choice journeys of women anesthesiologists.

Results: Iterative analysis revealed 6 themes related to career-choice journeys for women in anesthesiology. Three emerging themes have been previously described in career-choice reviews (specialty characteristics, gender awareness, and pathway support). Additionally, 3 novel themes emerged from our study population (hidden curriculum, learning environment, and mystery behind the drape).

Conclusions: The findings of this study highlight factors and experiences that impact career-choice decisions for women who choose anesthesiology. Only in understanding the how and why of women physicians' journeys can we hope to build on this knowledge, thereby striving to develop educational, clinical, professional, and personal experiences that support women along their professional journeys to ultimately find anesthesiology.

Background: The primary aim of this study was to identify and stratify candidate metrics used by anesthesiology residency program directors (PDs) to develop their residency rank lists through the National Resident Matching Program.

Methods: Sixteen PDs comprised the participants, selected for diversity in geography and program size. We used a 3-round iterative survey to identify and stratify candidate metrics. In the first round, participants listed metrics they planned to use to evaluate candidates. In the second round, metrics from the first round were ranked by importance, and criteria were solicited to define an exceptional, strong, average, marginal, and uncompetitive candidate for each metric. In the third round, aggregated results were presented and participants refined their rankings.

Results: Of the 16 PDs selected, 15 participated in the first and second survey rounds, and 10 in the third. Eighteen candidate metrics were indicated by 8 or more PDs for residency selection. All 10 PDs from the final round identified passing Step 1 of the United States Medical Licensing Exam (USMLE) and the absence of "red flags" like a failed rotation as key selection metrics, both averaging an importance score of 4.9 out of 5. Other metrics identified by all PDs included clerkship evaluation comments, USMLE Step 2 scores, class rank, letters of recommendation, personal statement, and program and geographical signals.

Conclusions: The study reveals key metrics anesthesiology residency PDs use for candidate ranking, which may offer candidates insights into their competitiveness for anesthesiology residency.

Background: Providers' unconscious biases reinforce health disparities through negative direct patient care and interactions with colleagues.

Objective: We created a workshop grounded in Critical Race Theory and the importance of different intersectionalities to improve medical trainees' self-assessment of their implicit biases in curated facilitated spaces.

Methods: A total of 44 UCSF first-year clinical anesthesiology residents (CA-1) (95% response rate) and 23 surgery residents in their research year (77% response rate) participated in this workshop over 4 separate sessions in September 2020 and 2021. Quantitative data from a pre-/post-workshop survey was analyzed via a paired t test to evaluate our workshop's effectiveness. Feedback on efficacy was obtained by coding themes from our survey's open-ended questions.

Results: The workshop was evaluated positively by a total of 65 of 67 participants in the post-workshop survey. On a 5-point Likert scale, participants self-reported they agreed that their unconscious biases affect their clinical interactions from a pre-workshop mean of 3.3 (SD ± 1.32) to a post-workshop mean of 3.9 (SD ± 0.87, P = .008).

Conclusion: Our findings suggest that this workshop was effective for perioperative residents and can be extrapolated to all residents by tailoring the workshop to their respective work environments.

Background: Academic inquiry is foundational to the advancement of medicine and resident training and must be demonstrated to the Accreditation Council for Graduate Medical Education. Past attempts at increasing publication rates have failed to identify educational best practice models. Our aim was to increase resident publication rates via culture and value changes that are universally implementable, affordable, effective, and sustainable.

Methods: In 2018, a multifaceted initiative was implemented to shift departmental values and foster a culture of academic productivity. This culture change stressed the value of scientific publication through frequent, consistent messaging from department leaders. In addition, residents were provided the freedom to choose their scholarly activities. In this retrospective cohort innovation, resident authors were identified for 4 academic years before and after the intervention and publication rates were determined (2014-2018 vs 2018-2022). Resident authors and publications per resident per year were compared using descriptive statistics and Student t test.

Results: The pre- and postintervention groups included 38 and 37 residents, respectively. Resident-authored publications increased from 7 preintervention to 24 postintervention, representing 343% of baseline. Mean ± SD publications per resident per year similarly increased 357% from 0.183 ± 0.16 to 0.654 ± 0.11 postintervention. Unpaired t test analysis demonstrated a significant difference in total publications per year (P = .002) and authorship rate (P = .003).

Conclusions: A multifaceted academic initiative resulted in a threefold increase in resident publication rates. This initiative demonstrates that local advocacy by leaders, freedom of choice for authors, and supportive departmental culture are driving factors in publication rates.