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

Background: The shift to virtual interviews during the COVID-19 pandemic has elevated the vital role of Accreditation Council for Graduate Medical Education residency program websites in conveying information to applicants. The purpose of our study was to assess the recruitment, education, and diversity and inclusion content on websites for anesthesiology residency programs. Second, we aimed to test the hypothesis that the content scores of websites are higher in programs with more National Institutes of Health funding, in programs that are university-based versus community-based, and in larger programs, as measured by number of residents.

Methods: Two independent reviewers evaluated the websites of the 159 anesthesiology residency programs accredited by the Accreditation Council for Graduate Medical Education for the presence (yes/no) of 12 recruitment, 6 education, and 8 diversity and inclusion criteria. Multiple linear regression was used to determine which program factors were most associated with total website content score.

Results: Anesthesiology residency program websites contained a mean of 12.9 (SD = 3.4; range, 3-21) of the 26 study-defined criteria. The most common recruitment, education, and diversity and inclusion criteria were, respectively, program description, rotation information, and community demographics. Controlling for program factors, a university-based affiliation (P = .016) was associated with higher website content scores.

Conclusions: There is large variation in the recruitment, education, and diversity and inclusion content on anesthesiology residency program websites nationally. Since program websites averaged only half of criteria, this may provide an impetus for programs to modify their websites, which may inform applicant decisions about which programs align with their training and career goals.

Background: Eye-tracking measures attention patterns, which may offer insight into evaluating procedural expertise. The purpose of this study was to determine the feasibility of using eye tracking to assess visual fixation patterns when performing an ultrasound-guided regional anesthesia procedure and to assess for differences between experienced, intermediate, and novice practitioners.

Methods: Participants performed an ultrasound-guided sciatic nerve block 3 times on a fresh cadaver model while wearing eye-tracking glasses. Gaze fixation and dwell time on each location were compared between participants. Eye-gaze paths were used to derive a measure of entropy, or how often participants switched gaze fixations between locations.

Results: Five attending anesthesiologists, 5 third-year anesthesiology residents with prior ultrasound-guided regional anesthesia experience, and 5 medical students completed the study. Individuals with more experience were more likely to successfully perform the sciatic nerve block (5/5 attendings, 5/5 residents, 0/5 students; P = .002) and performed the procedure faster (average: attendings 62.6 seconds, residents 106.4 seconds, students 134.4 seconds; P = .089). Participants were progressively faster with practice (Trial 1: 41.8 seconds, Trial 2: 29.2 seconds, Trial 3: 28.9 seconds; P = .012), and the average number of eye shifts per trial decreased from 10.8 to 6.5 to 6 (P = .010). Attending physicians spent significantly less time fixating on the ultrasound monitor compared to trainees (P = .035). Average visual entropy progressively decreased from Trial 1 to Trial 3 (P = .03) and with greater experience (P = .15). There was a strong correlation between entropy and time on task (r(16) = 0.826, P = .001).

Conclusions: Experienced providers make fewer back-and-forth visual fixations, spend less time in the procedure, and demonstrate less entropy during ultrasound-guided regional anesthesia procedures. Mobile eye-tracking has the potential to provide additional objective measures of performance that may help not only determine procedural competence but also distinguish between levels of proficiency.

Background: The unique characteristics of the millennial generation has promulgated changes in the workplace and in academia. A lack of national standards necessitates that anesthesia faculty create educational content for anesthesia clerkships. Assessing expectations before an anesthesia rotation would provide data to accommodate millennial medical students' needs and preferences for learning.

Methods: A 16-question survey using Qualtrics software was created, with input from millennial medical students, to query preclinical medical students at the Oakland University William Beaumont School of Medicine on their educational expectations of an anesthesia clerkship.

Results: Seventy-four surveys were completed, with 34 (46%) of 74 from first-year and 40 (54%) of 74 from second-year medical students. Daily feedback (44 [59%] of 74) and written exams (43 [58%] of 74) were preferred methods of evaluation. No lectures, observing in an operating room, and performing procedures on real patients were the preferred format for instruction. Two (23 [31%] or 74) to 3 (33 [45%] of 74) weeks was the preferred duration of an anesthesia rotation.

Conclusions: This study demonstrates that millennial medical students have preconceived educational expectations of an anesthesia clerkship, and identifies learning preferences that differ from the implemented anesthesia curriculum currently described in the literature.

Background: The COVID-19 pandemic caused a rapid pivot from in-person to virtual residency interviews across the United States. We present a survey we conducted about the attitudes and opinions of anesthesiology program directors with regard to the 2021 virtual interview process.

Methods: This was a 13-question online survey disseminated to 142 anesthesiology residency program directors in February 2021, asking them to compare the most recent interview cycle to their experience with prior cycles.

Results: There were 46 (37%) respondents. Generally, respondents saw an increase in applicants and reported perceiving worse interpersonal relationships with applicants, significantly so in programs with small resident classes.

Conclusions: Past research has focused on the benefits of virtual interviews for the applicant, but these should be evaluated in tandem with increased difficulties for the interviewers.

Introduction: Transesophageal echocardiography (TEE) is increasingly used for intraoperative management during orthotopic liver transplantation. Proficient TEE use requires skill and knowledge to accurately assess the hemodynamic status and guide clinical management. Currently there are no TEE educational tracks specifically focused on perioperative liver transplant management and barriers to obtaining basic certification exist.

Methods: A 4-hour simulation-based learning (SBL) course was provided to improve liver transplant anesthesiologist TEE knowledge and skill. Learners received training and education using a TEE simulator in small groups focusing on basic image acquisition, relevant anatomy, hemodynamic calculations, and pathology germane to the liver transplant period. Knowledge assessment and survey responses were assessed at the beginning and completion of the course. Learners completed TEE examinations with simulated pathology during high-fidelity simulations following the course.

Results: Seventeen anesthesiologists completed the course. The median baseline knowledge assessment score was 55.0% (37-70). The median postcourse knowledge assessment score improved to 95.0% (94-100) (P < .001). All anesthesiologists were able to identify TEE pathology during high-fidelity simulation. Survey responses yielded significant median score improvement in all areas assessed using a 5-point Likert scale.

Conclusions: A small group, simulation TEE course delivered over 4 hours can increase knowledge and skill in TEE use for liver transplant anesthesiologists.

Introduction: Leaders in anesthesiology are promoting increased involvement of anesthesiologists in perioperative medicine (POM). Academic leaders are calling for a corresponding increase in resident and medical student education in this evolving medical discipline. Formalized POM programs are new to most academic anesthesiology programs, and very little has been written about development of these programs for anesthesiology residents or medical students. We describe the creation of a longitudinal medical student clerkship in POM using established curriculum design methods with minimal capital resources.

Methods: This is a descriptive account of the process of clerkship design. It includes a qualitative analysis of participants' satisfaction with the novel clerkship.

Results: Design and implementation of a new, advanced medical student clerkship in POM using no additional capital resources was successful. Medical students indicated appreciation for the unique longitudinal design. Students also demonstrated understanding of the expanding role of anesthesiology in perioperative care of patients, a primary goal of the educational process.

Conclusions: The principles of the American Society of Anesthesiology's Perioperative Surgical Home can be taught systematically and successfully to advanced medical students with little additional expenditure of departmental resources.

Background: This prospective study investigated whether in-person interviews affected interviewer assessments of anesthesiology residency applicants at an academic medical center, and which applicant characteristics influenced interview performance.

Methods: Eighteen faculty members involved in residency recruitment between November 2019 and January 2020 documented preinterview (after full application review) and postinterview scores of the applicants on a scale of 1 to 5. Faculty also reported the relative contributions of specific interview characteristics (personality, physical appearance, professional demeanor, discussion regarding academic/scholarly activity, and level of interest in the specialty) to their postinterview assessments. Mixed-effects models were used to assess whether interviews changed faculty assessment of applicants, and what the relative contributions of applicant characteristics were to faculty assessments.

Results: A total of 696 interviews were conducted with 232 applicants. The postinterview scores differed significantly from the preinterview scores (estimated mean difference, 0.09 ± 0.02; P < 0.0001). The characteristics most affecting postinterview scores were positive impressions of applicants' personalities (marginal mean change in postinterview score, 0.259; 95% confidence interval, 0.221-0.297) and negative impressions of applicants' professional demeanor (marginal mean change, -0.257; 95% confidence interval, -0.350 to -0.164).

Conclusions: In-person interviews significantly affected residency applicants' scores. Personality and professional demeanor influenced scores more than did other characteristics examined. Further studies are needed to clarify the relevance of in-person interviews to the assessment of residency applicants.

Background: For the 2019-2020 interview season, the anesthesia residency program at Augusta University offered candidates a choice between in-person (IP) and video conference (VC) interviews to accommodate a greater number of qualified candidates.

Methods: The same applicant selection criteria were used for both interview types. However, we modified the informal interactions with residents, campus tours, and interview formats for VC interviews. We sought to compare the 2 methods by analyzing the respective costs, benefits, and match results.

Results: Of 159 candidates interviewed, we ranked 127 and matched with 12. The IP (n = 135) and VC (n = 24) groups were similar in gender distribution but not by the type of medical school, with more international medical graduates interviewing by VC than IP. There was no statistically significant difference between the 2 interview types for being ranked (81% of IP, 71% of VC) or matched (6% of IP, 17% of VC). US Medical Licensing Examination Step 1 and Step 2 scores and type of medical school did not affect the likelihood of being ranked or matched. Program costs per candidate were higher for the IP group ($431 for IP, $294 for VC).

Conclusion: Our single-center study indicates that the interview type did not affect the likelihood of a candidate being ranked by or matched to our program. Further, VC interviews were more cost-effective and time-effective than IP interviews. Our findings suggest that VC interviews are a viable alternative and should be an option for residency interviews.

Background: Most postgraduate medical education occurs in hospitals in an apprenticeship model with actual patients. Creating a work shift schedule must account for complex factors, including hospital needs, work-hour restrictions, trainee qualifications, and case distribution in order to fairly allocate the resident workload. In this study, we report the first successful implementation of an equitable, computer-generated scheduling system for anesthesiology residents.

Methods: A total of 24 residents at a single, urban training program were surveyed in 2015 to rank work shift difficulty. Shifts were categorized and translated into a weighted point system by program leadership based on the survey results. An automated and modifiable scheduling system was created to incorporate rule-based assignment of prerequisites and evenly distribute points throughout the academic year. Point values were retrospectively calculated in 2014, and prospectively calculated from 2015 to 2018. The equality of variance test was used to evaluate the variation of the SD of monthly average point distributions year-over-year and within each class of trainees.

Results: Year-over-year analysis revealed that post-point system implementation, call point distribution trended toward reduced variance in all 4 years, with significant reductions of 63% in 2016 (SD 4.9, P < .01), and 57% in 2017 (SD 5.8, P < .01). Analyzed by class, first-year trainees' SD decreased by 73% in 2016 (SD 2.5, P < .01), by 67% in 2017 (SD 3.1, P < .04), and 65% in 2018 (SD 3.3, P < .02) compared with the pre-point system year in 2014. The second year clinical anesthesia resident class SD decreased by 56% in 2015 (SD 5.9, P < .01), 41% in 2016 (SD 7.9, P < .02), and 49% in 2017 (SD 6.9, P < .01).

Conclusion: The computerized point system improved work distribution equity year-over-year and within trainee cohort groups.