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

Background: Clinician-educators in academic settings have often had no formal training in teaching or in giving feedback to trainees. We implemented a Clinician-Educator Track within the Department of Anesthesiology with the initial goal of improving teaching skills through a didactic curriculum and experiential opportunities for a broad audience of faculty, fellows, and residents. We then assessed our program for feasibility and effectiveness.

Methods: We developed a 1-year curriculum focusing on adult learning theory, evidence-based best teaching practices in different educational settings, and giving feedback. We recorded the number of participants and their attendance at monthly sessions. The year culminated in a voluntary observed teaching session using an objective assessment rubric to structure feedback. Participants in the Clinician-Educator Track then evaluated the program through anonymous online surveys. Qualitative content analysis of the survey comments was performed using inductive coding to generate relevant categories and identify the main themes.

Results: There were 19 participants in the first year of the program and 16 in the second year. Attendance at most sessions remained high. Participants appreciated the flexibility and design of scheduled sessions. They very much enjoyed the voluntary observed teaching sessions to practice what they had learned throughout the year. All participants were satisfied with the Clinician-Educator Track, and many participants described changes and improvements in their teaching practices due to the course.

Conclusions: The implementation of a novel, anesthesiology-specific Clinician-Educator Track has been feasible and successful, with participants reporting improved teaching skills and overall satisfaction with the program.

Background: This learning opportunity was designed to provide an interactive, virtual, educational anesthesiology program for interested medical students and to offer an opportunity to learn more about an institutional culture through a question and answer (Q&A) with program faculty preceptors for the 2020-2021 anesthesiology residency application cycle. We sought to identify if this virtual learning program was a valuable educational tool through a survey.

Methods: A short Likert-scale survey was sent to medical students before and after participation in a session using REDCap electronic data capture tool. We designed the survey to assess the program's self-reported effect on participants' anesthesiology knowledge, and whether the program design was successful in creating a collaborative experience while also providing a forum to explore residency programs.

Results: All respondents found the call useful in building anesthesiology knowledge and networking, and 42 (86%) found the call helpful in deciding where to apply for residency. Overall, 100% of respondents found the call useful, collaborative, engaging, and important to define critical thinking skills.

Conclusions: The framework used for this program-virtual asynchronous and synchronous problem-based learning-can be applied broadly with potential benefit to medical student participants challenged by the cancellation of clinical rotations.

Background: Beginning an unfamiliar rotation can be challenging as residents must expand their knowledge and skills to meet new clinical expectations, work with a new team of providers, and sometimes care for a new patient demographic. This may detract from learning, resident well-being, and patient care.

Methods: We implemented an obstetric anesthesia simulation session for anesthesiology residents prior to their first obstetric anesthesia rotation and measured the effect on residents' self-perceived preparedness.

Results: The simulation session increased residents' feelings of preparedness for the rotation and increased residents' confidence in specific obstetric anesthesia skills.

Conclusions: Importantly, this study shows the potential for the use of a prerotation, rotation-specific simulation session to better prepare learners for rotations.

Background: The move toward telemedicine has markedly accelerated with the COVID-19 pandemic. Anesthesia residents must learn to provide preoperative assessments on a virtual platform. We created a pilot telemedicine curriculum for postgraduate year-2 (PGY2) anesthesiology.

Methods: The curriculum included a virtual didactic session and a simulated virtual preoperative assessment with a standardized patient (SP). A faculty member and the SP provided feedback using a checklist based on the American Medical Association Telehealth Visit Etiquette Checklist and the American Board of Anesthesiology Applied Examination Objective Structured Clinical Examination content outline. Residents completed surveys assessing their perceptions of the effectiveness and helpfulness of the didactic session and simulated encounter, as well as the cognitive workload of the encounter.

Results: A total of 12 PGY2 anesthesiology residents in their first month of clinical anesthesia residency training participated in this study. Whereas most (11/12) residents felt confident, very confident, or extremely confident in being able to conduct a telemedicine preoperative assessment after the didactic session, only 42% ensured adequate lighting and only 33% ensured patient privacy before conducting the visit. Postencounter survey comments indicated that the SP encounter was of greater value (more effective and helpful) than the didactic session. Residents perceived the encounter as demanding, but they felt successful in accomplishing it and did not feel rushed. Faculty and SP indicated that the checklist guided them in providing clear and useful formative feedback.

Conclusions: A virtual SP encounter can augment didactics to help residents learn and practice essential telemedicine skills for virtual preoperative assessments.

Background: We performed a multistep quality improvement project related to neuromuscular blockade and monitoring to evaluate the effectiveness of a comprehensive quality improvement program based upon the Multi-institutional Perioperative Outcomes Group (MPOG) Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) metrics targeted specifically at improving train of four (TOF) monitoring rates.

Methods: We adapted the plan-do-study-act (PDSA) framework and implemented 2 PDSA cycles between January 2021 and December 2021. PDSA Cycle 1 (Phase I) and PDSA Cycle 2 (Phase II) included a multipart program consisting of (1) a departmental survey assessing attitudes toward intended results, outcomes, and barriers for TOF monitoring, (2) personalized MPOG ASPIRE quality performance reports displaying provider performance, (3) a dashboard access to help providers complete a case-by-case review, and (4) a web-based app spaced education module concerning TOF monitoring and residual neuromuscular blockade. Our primary outcome was to identify the facilitators and barriers to implementation of our intervention aimed at increasing TOF monitoring.

Results: In Phase I, 25 anesthesia providers participated in the preintervention and postintervention needs assessment survey and received personalized quality metric reports. In Phase II, 222 providers participated in the preintervention needs assessment survey and 201 participated in the postintervention survey. Thematic analysis of Phase I survey data aimed at identifying the facilitators and barriers to implementation of a program aimed at increasing TOF monitoring revealed the following: intended results were centered on quality of patient care, barriers to implementation largely encompassed issues with technology/equipment and the increased burden placed on providers, and important outcomes were focused on patient outcomes and improving provider knowledge. Results of Phase II survey data was similar to that of Phase I. Notably in Phase II a few additional barriers to implementation were mentioned including a fear of loss of individualization due to standardization of patient care plan, differences between the attending overseeing the case and the in-room provider who is making decisions/completing documentation, and the frequency of intraoperative handovers. Compared to preintervention, postintervention compliance with TOF monitoring increased from 42% to 70% (28% absolute difference across N = 10 169 cases; P < .001).

Conclusions: Implementation of a structured quality improvement program using a novel educational intervention showed improvements in process metrics regarding neuromuscular monitoring, while giving us a better understanding of how best to implement improvements in this metric at this magnitude.

Background: Bootcamp-style education involves short, intense educational sessions and is a proven educational modality in anesthesia medical education. However, rarely has it been used with senior anesthesiology residents and never in exposing these residents to a curriculum aimed at care of the trauma patient. The purpose of this study was to design and implement an experiential bootcamp to prepare anesthesiology residents to take senior trauma call at a Level 1 trauma center in the Southeastern United States.

Methods: Before taking senior trauma call, 21 postgraduate year 3 anesthesiology residents took part in an 8-hour trauma bootcamp that combined flipped classroom-style education with immersive, procedural, and augmented reality simulation facilitated by subject matter experts. Before and after the bootcamp, residents completed 17-item confidence and 20-item knowledge questionnaires developed by the study authors. Results were compared before and after the bootcamp to determine overall change in confidence and knowledge levels pertaining to caring for trauma patients and taking senior trauma call. Additionally, residents completed an evaluation measuring their perceptions of the benefit of the educational offering.

Results: Statistically significant increases were seen in 16 out of 17 confidence questions (P < .001) and 12 out of 20 knowledge questions (P < .001). Additionally, respondents indicated that they found the content to be valuable and likely to improve their care delivery within the clinical setting.

Conclusions: Following this bootcamp, postcourse surveys demonstrated that residents' knowledge and confidence increased significantly through simulation combined with a flipped-classroom approach in preparation for senior trauma call.

Background: Feedback from faculty to residents is important for the development of the resident. Effective feedback between faculty and residents requires trust between the two parties. An agreement between faculty and residents was developed to determine whether it would improve resident satisfaction with feedback.

Methods: Groups of faculty and residents met to discuss expectations and barriers to feedback. Based on this information, the two groups developed a Feedback Agreement that was edited and approved by the entire Department of Anesthesiology. The Feedback Agreement was presented in meetings with the faculty and the residents. To assess satisfaction with feedback, the Accreditation Council for Graduate Medical Education resident survey was used, as it assesses resident satisfaction with various aspects of the program, and was compared before and after the agreement.

Results: The satisfaction scores with feedback before the Feedback Agreement were statistically lower than scores for the specialty and for all residents in training programs. Satisfaction rose from 53% of 76 respondents (average score of 3.5 in 2020 to 2021) to 74% of 78 respondents being satisfied or extremely satisfied (average score of 4.0 in 2021 to 2022; P = .03). This score was not statistically different from residents in Anesthesiology programs or all residents in training programs.

Conclusions: The development of a Feedback Agreement improved resident satisfaction with faculty feedback as assessed by the Accreditation Council for Graduate Medical Education resident survey.

Background: Faculty development programs are essential to the educational mission of academic medical centers as they promote skill development and career advancement and should be regularly evaluated to determine opportunities for improvement. The context, input, process, and product (CIPP) framework evaluates all phases of a program and focuses on improvement and outcomes. The aim of this study was to use the CIPP framework to evaluate the Stanford Anesthesiology Faculty Teaching Scholars Program.

Methods: Using the CIPP framework, a survey was developed for alumni (2007 to 2018) of the program, followed by structured interviews, and each interview was deductively coded to identify themes.

Results: Twenty-six of the 54 (48% response rate) participants in the program completed the survey, with 23 completing their projects and 17 of those projects still part of the anesthesiology training program. Seventeen survey responders went on to educational leadership roles. Twenty-five of the 26 survey responders would recommend this program to their colleagues. Fifteen structured interviews were conducted. Using the CIPP framework, themes were identified for context (reason for participation, previous experience in medical education, and resident education impact), input (benefits/negatives of the lecture series, availability of resources, and adequacy of nonclinical time), process (resident participation, mentorship, and barriers to implementation), and product (project completion, education sustainability, positive/negative outcomes of the program, and suggestions for improvement).

Conclusions: The CIPP framework was successfully used to evaluate the Teaching Scholars Program. Areas of improvement were identified, including changing the program for input (add education lectures customized to faculty interests) and process (formally designate an experienced mentor to faculty).

Background: The novice anesthesiology trainee is required to assimilate the technical and nontechnical skills required to safely perform a rapid sequence induction (RSI). Acquisition of this core competency is traditionally achieved using operating room-based experiential learning, which may be associated with significant gaps in early trainee preparation. We conducted a study to explore the role of a new, customized, high-fidelity simulation-based training program designed to address this gap in RSI training. We then assessed mean performance scores of participants in the simulator and 4 weeks later.

Methods: This observational study assessed participants' performance in the simulator on the day of training and in the workplace 4 weeks later. There is no universally agreed checklist or cognitive aid incorporating nontechnical skills and planning for unanticipated difficult airway management in RSI, so we applied a new scoring checklist developed by 6 experts using the modified Delphi technique.

Results: Our task scoring checklist included nontechnical skills and consisted of 37 weighted parameters with a maximum performance score of 171. On the day of training, mean performance score was 105 (SD of 16). At the workplace evaluation 4 weeks after simulation training, the mean performance score of participants had increased to 140 (SD of 14.5; P = .001). The 95% confidence intervals for the simulator and workplace participant scores were 92 to 118 and 128 to 152, respectively.

Conclusions: The results suggest that this simulation-based training in RSI was associated with an improvement in RSI performance in novice trainees and may complement the current system of workplace-based training.