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

Background: No studies have examined how journal clubs (JCs) are implemented in anesthesiology residency training programs. The goal of the study was to close this gap by (1) examining the format, content, and goals of JCs; (2) identifying features associated with higher resident attendance and JC success; and (3) examining program directors' perspectives on JCs.

Methods: A 41-question survey was sent to anesthesiology program directors. Answers were analyzed using multivariable logistic regression, multivariable linear regression, and exploratory factor analysis.

Results: Out of 117 surveys sent across the United States, 80 program directors responded (68.4% response rate). Of the 80 programs, 77 (96.3%) programs have a JC, with 93.2% of them existing for more than 2 years. Most JCs (62.5%) neither formally appraised articles before meetings, nor formally evaluated their JC (59.7%). Faculty alone organized 44.4% and moderated 69.9% of the JCs. The role of residents was primarily limited to presenting selected articles with faculty guidance (83.3%). The average resident attendance was 49.7%. A multivariable linear regression analysis identified mandatory resident attendance, faculty turnout of >5 members, and longer intervals between JC meetings as features associated with higher resident attendance. Only 49.3% of JCs were successful as defined a priori by resident attendance >50% and longevity of ≥2 years. Features associated with JC success based on multivariable logistic regression included mandatory resident attendance and complimentary food.

Conclusions: This largest survey of JCs in anesthesiology found that while JCs are widely established, half of them could be improved.

Background: Medical specialties have evaluated malpractice claims in residents, but to the best of our knowledge, malpractice claims have not been evaluated in anesthesiology residents.

Methods: The Westlaw legal database was queried for all malpractice litigation cases involving anesthesiology residents in the United States from January 1959 through December 2018. The cases were divided into 2 cohorts by year (before and after 1990) to account for the differences in patient safety features and monitoring available in the different time periods.

Results: Ninety cases were included in the analysis. The median (interquartile range) for inflation adjusted payments was $1 140 544 (0 to 4 158 589). There was no association between the year the claim was filled and the payment amount, Spearman rho = -0.17, P = 0.15. In contrast, for claims that occurred in the intraoperative period, there was a moderate negative association between the year of the claim and the inflation adjusted payment, Spearman rho = -0.45, P = 0.003. Payments were greater if the event occurred in the postoperative period, median of $4 250 000 (959 000 to 55 595 000) compared to events that happened in the intraoperative period, median of $1 039 000 (0 to 3 802 000) and preoperative periods, median of $212 000 (0 to $3 982 000), P = 0.02.

Conclusions: The reduction of liability across the years with malpractice claims that resulted from the intraoperative period suggest that the continued patient safety initiatives implemented by anesthesiology specialty has resulted in less liability to trainees and may stimulate future initiatives targeted to the postoperative period.

Introduction: Anesthesia residents are deemed competent based on subjective and objective metrics. Knowledge acquisition and procedural skill is often difficult to accurately measure. Inspecting tangible metrics of perioperative efficiency may provide a source for reliable evaluation.

Methods: Retrospective case-log database review yielded 3072 surgical cases involving residents over 5 years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status (ASA PS) classification, and inpatient versus day surgery status.

Results: After controlling for procedure duration time, inpatient status, ASA PS, surgeon, and attending anesthesiologist, resident training time had high statistical significance. In the fully adjusted model, 1 year of resident training was associated with a reduction in emergence time by 28 seconds. A 1-hour increase in procedure time was associated with an increase in emergence time of 34 seconds.

Conclusions: Although a statistically significant correlation between anesthesia resident training time and emergence time was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We caution the value of using perioperative metrics (e.g., emergence time) for evaluating anesthesia resident competency, until such metrics have undergone significant validation.

Background: Invited speakerships, such as speaking at grand rounds, are part of the pathway to promotion in academic medicine. This project sought to evaluate if the gender of invited grand rounds speakers at a major academic institution were distributed as expected based on the specialty workforce.

Materials and methods: Archived lists of speakers for grand rounds for the Mayo Clinic Department of Anesthesiology were obtained from 2007 through 2018. The Cochran-Armitage test and logistic regression models were used to analyze the change in proportion of invited women speakers over time. One-sample proportion tests were conducted to compare the proportion of women speakers to the expected percentage of available women speakers based on gender data from national organizations.

Results: Of the 122 invited external speakers, 28 (23%) were women. Men invited 104/122 (85.2%) of all the speakers, of which 21 (20.2%) were women speakers. There was not significant evidence the proportion of women speakers increased over time (P = .29). Women speakers comprised a lower proportion of external invited speakers compared to the proportion of women in the academic anesthesia workforce; however, this association was not statistically significant (P = .07). The percentage of new residents that were female increased over this time period (P = .001).

Discussion: The percentage of women invited to be grand rounds speakers did not increase over the study period. Intentional measures should be instituted to increase the proportion of women grand rounds speakers.

Background: The Accreditation Council for Graduate Medical Education (ACGME) mandates minimum numbers of cases in many specialties, including anesthesiology, but resident scheduling is often done on the basis of time spent on each rotation rather the number of opportunities for specific cases, risking uneven case distribution, particularly for low-volume cases. We used the neuroanesthesia rotation as a model to evaluate a system to more evenly distribute ACGME-mandated cases among residents and assessed the effects on their perceptions of their experience on the rotation.

Methods: In November 2018, we instituted a targeted operating room scheduling system at our institution by making specific daily assignment requests for anesthesia residents on the neuroanesthesia rotation. We used Shewhart control charts to analyze the variation in case distribution among all resident rotations (N = 91) from January 2018 to October 2019. We then surveyed residents who had experienced both systems (n = 15) and those who had experienced only the old system (n = 16).

Results: Shewhart p-charts of the proportion of ACGME-mandated cases assigned to each resident showed wide variation under the old scheduling system and a more even distribution under the new system. Residents reported significantly greater perceived fairness of case distribution and balance between their education and service obligations under the new system (response rates: 10/16 [62.5%] and 13/15 [86.7%]).

Conclusions: Targeted resident scheduling based on ACGME-mandated case numbers rather than solely time spent on a rotation is feasible and can improve resident perceptions of fairness and balance between education and service, a top priority of the ACGME.

Background: Novice anesthesiology residents must acquire new technical, cognitive, and behavioral skills as they transition into the high-stakes perioperative environment. Simulation-based education improves procedural skill and behavior, and it permits deliberate practice with feedback; exposure to uncommon, high-consequence events; assessment; reproducibility; and zero risk to patients. We introduced a 5-day, high-fidelity Simulation Boot Camp (SBC) in 2006 for first-year clinical anesthesia residents (CA-1s) and report over a decade of experience assessing its impact on self-efficacy, value, feasibility, and sustainability.

Methods: All CA-1s in our residency program participated in the SBC as part of orientation. Participants completed 2 individual high-fidelity simulations per day, each with a private debriefing session from an attending anesthesiologist in our simulation center. We measured their self-reported confidence, which we report as self-efficacy (SE), the belief in one's own ability to successfully execute a skill or behavior necessary for a desired outcome, for 25 basic anesthesia skills before and after course completion. Participants also completed a postcourse evaluation.

Results: Of the 281 CA-1s who participated in the course from 2006 to 2016, we collected data on 267 (95%). SE improved over the course of SBC for all 25 individual skills (P < .001) and remained stable over the decade-long period of study. Univariate analysis revealed a strong association between increased SE and male sex (P < .001), video gaming experience (P < .001), and completion of a prior residency (P = .018). Males were also more likely to report video gaming experience (P < .001). Multivariable analysis revealed that although women had lower SE than did men, they had a greater increase in SE attributed to participation in SBC (P = .041). Participants strongly agreed SBC was a realistic and nonjudgmental learning tool, built confidence, and should be mandatory. Most comments were positive, reflecting overall satisfaction with SBC.

Conclusions: SBC increases SE, is feasible, valuable to participants, and sustainable with remarkably consistency over the study period.

Background: Recent work has shown that understanding of work-related stress by family and friends is associated with increased resident well-being. However, it is often difficult for residents to communicate with their support persons (SPs), especially those who have minimal understanding of the medical field, regarding even the most basic functions of their role in the health care system. This study aimed to pilot test an innovative wellness event focusing on the social relatedness component of resident well-being.

Methods: The target population included 30 new residents at 2 anesthesiology residency programs and their SPs in 2017. The Family Anesthesia Experience (FAX) began with didactic presentations and a panel discussion about wellness topics. It concluded with a multifaceted simulation experience. Participants were surveyed before and after the event. Measures included SPs' understanding of residents' work and residents' stress, burnout, resilience, and social support levels. Student t tests, Mann-Whitney U tests, Wilcoxon signed-rank tests, and repeated measures analysis of variance were used to examine the impact of the event.

Results: Twenty-two (84.6%) of the 26 intervention clinical anesthesia year 1 residents who attended FAX completed the postevent surveys, and all intervention SPs (100%, n = 33) completed both pre-event and postevent surveys. The event was well received by the residents (100%) and their SPs (100%). Improvement in perceived understanding in the intervention SPs group (Pre: 1.44 ± 0.63, Post: 2.69 ± 0.33, P < .0001) was observed. Not all metrics of well-being for the residents achieved significance in change; however, decreased stress was observed compared with historical controls (Control: 1.91 ± 0.61, Intervention: 1.54 ± 0.42, P = .019).

Conclusion: The event led to improved SPs' understanding of the role of an anesthesiology resident.

Background: Transesophageal echocardiography can be a useful monitor during noncardiac surgery, in patients with comorbidities and/or undergoing procedures associated with substantial hemodynamic changes. The goal of this study was to investigate if transesophageal-echocardiography-related knowledge could be acquired during anesthesia residency.

Methods: After institutional review board approval, a prospective observational study was performed in two anesthesiology residency programs. After a 41-week didactic transesophageal-echocardiography-education curriculum residents' exam scores were compared to baseline. The educators' examination was validated against the National Board of Echocardiography's Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography.

Results: After the 41-week course, clinical anesthesia (CA)-3 exam scores increased 12% compared to baseline (P = .03), CA-2 scores increased 29% (P = .007), and CA-1 scores increased 25% (P = .002). Pearson correlation coefficient between the educators' exam score and the special competence exam percentile rank was 0.69 (P = .006). Pearson correlation coefficient between the educators' exam score and the special competence exam scaled score was 0.71 (P = .0045).

Conclusions: The 41-week course resulted in significant increases in exam scores in all 3 CA-classes. While didactic knowledge can be learned by anesthesiology residents during training, it requires significant time and effort. It is important to educate residents in echocardiography, to prepare them for board examinations and to care for the increasingly older and sicker patient population. Further work needs to be done to determine optimal methods to provide such education.