Anesthesia and analgesia最新文献

Background: Empathy is a crucial part of the therapeutic relationship. Inadequate patient-physician communication can result in misunderstanding, reduced patient satisfaction, poor compliance with recommended interventions, and increased malpractice risk. Despite its importance, empathy among anesthesiology trainees remains under explored. This observational study used validated tools to evaluate trainee empathy in the pre-anesthesia setting from different perspectives.

Methods: Participating anesthesiology trainees were observed as they conducted pre-anesthesia patient encounters. First, they completed self-evaluations using the Jefferson Scale of Empathy (JSE) and the Resident Wellness Scale. Additionally, patients who were 18 years or older completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) after their pre-anesthesia interview with the anesthesia trainee. A non-anesthesiologist physician evaluated the interactions between patients and anesthesia trainees with the Jefferson Empathy Scale for Observers (JSEO). Quantitative analyses of closed questions (including empathy scales) included descriptive statistics, correlations, and multivariable linear regression analysis. Open-ended questions were analyzed using thematic analysis.

Results: Twenty-four trainees completed 151 observed patient pre-anesthesia encounters with at least 5 observations per trainee. There was a modest, negative correlation between average time (seconds) in patient interaction and trainee wellness (r = -0.421, P = .041), and a moderate negative correlation between the trainee empathy subdomain "walking in the patient's shoes" and year in training (r = -0.451, P = .021). Male trainees spent more time during the consultation (mean time ± SD = 396 ± 80 seconds vs. 323 ± 50 seconds, P = .035) and had higher mean ratings from patients (JSPPPE rating 33.1 ± 3.00 vs 32.2 ± 3.00, P = .020) than female trainees. On multivariable analysis, predictors of highest empathy ratings were male gender (JSPPPE: P = .022) and the year of training (JSE: P = .013; JSEO: p =0.023). Thematic analysis of patient and observer comments suggests a discrepancy in perceived empathy, with patients less likely to perceive positive behaviors as empathetic, but an emphasis on importance of information delivered in the pre-anesthesia encounter.

Conclusion: Patients found male trainees and trainees earlier in training to display higher levels of empathy which differed from observer ratings. Qualitative evaluation may offer insights into our understanding of patient-perceived empathy in anesthesiology trainees. The discrepancy between patient, trainee, and observer ratings suggests that perceived empathy in anesthesiology pre-anesthesia interviews may be driven by different factors than in other specialties, particularly information exchange and efficiency of communication.

Background: Competency-based medical education (CBME) relies on criterion-referenced assessments to track residents' progression toward independent practice. The Accreditation Council for Graduate Medical Education (ACGME) Milestones serve as a structured framework to evaluate trainee performance, yet concerns have been raised about potential demographic differences in Milestone ratings. This study examined gender and race differences in Milestone ratings among anesthesiology residents.

Methods: We conducted a retrospective cohort study of 4997 residents from 141 anesthesiology programs graduating between 2017 and 2019. Milestone data from ACGME were linked with the Association of American Medical Colleges demographic data. Three-level mixed-effects models were conducted to estimate the differences in baseline Milestone ratings and growth trajectories, and predict marginal means of ratings at graduation by gender and race across 25 subcompetencies.

Results: At baseline, no significant differences in Milestone ratings were observed by gender or race. However, underrepresented minorities in medicine (URiM) residents demonstrated slower growth in ratings over time, resulting in significantly lower scores across all subcompetencies at graduation. Gender-based growth trajectories over time did not differ significantly between male and female residents, but by graduation, women received significantly lower ratings in 7 of 25 subcompetencies, primarily in patient care (PC) and medical knowledge (MK) competencies. The largest differences were observed in MK-1. Effect sizes for other subcompetencies were smaller, suggesting limited practical differences overall.

Conclusions: These findings highlight that comparable Milestones ratings at baseline, yet modest but cumulative differences over time may lead to meaningful differences at graduation, particularly in MK-1 for URiM residents.

Background: Postoperative nausea and vomiting (PONV) remain a significant consideration in perioperative care; however, the incidence and risk factors of PONV in transgender patients are poorly understood. This study investigated the rates of PONV in transgender patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients. We postulate that exogenous testosterone GAHT reduces the risk of PONV while exogenous estrogen GAHT increases the risk of PONV.

Methods: This retrospective cohort study was conducted using the TriNetX database. Patients were divided into 2 groups: transgender and cisgender. Separate analyses were performed for hysterectomies (transgender male [assigned female at birth, AFAB] versus cisgender female), orchiectomies (transgender female [assigned male at birth, AMAB] versus cisgender male), and augmentation mammoplasties (transgender female [AMAB] versus cisgender female). Propensity score matching was performed for age, race, and ethnicity (White, Black, Hispanic, or Latino), which were treated as social and demographic variables as recorded in the database, nicotine dependence, and tobacco use. The primary outcome was the administration of a rescue antiemetic, defined as droperidol, promethazine, dimenhydrinate, metoclopramide, and prochlorperazine, on the day of or day following surgery.

Results: Following hysterectomy, there was a significant difference in the risk of rescue antiemetic use between transgender males (AFAB) taking testosterone GAHT (62.11%, 1031 of 1660) and cisgender females (65.90%, 1094 of 1660) (P = .0227). Following orchiectomy, there was a significant difference in the risk of rescue antiemetic use between transgender females (AMAB) taking estrogen GAHT (51.15%, 445 of 870) and cisgender males (36.78%, 320 of 870) (P < .0001). Following augmentation mammoplasty, there was a significant difference in the risk of rescue antiemetic use between transgender females (AMAB) taking estrogen GAHT (53.29%, 356 of 668) and cisgender females (43.71%, 292 of 668) (P = .0005).

Conclusions: Transgender female (AMAB) patients on estrogen GAHT required rescue antiemetics more often than cisgender males and cisgender females after orchiectomies and augmentation mammoplasties. Transgender male (AFAB) patients on testosterone GAHT required rescue antiemetics less often than cisgender females after hysterectomies. These findings underscore the need for individualized perioperative care and antiemetic prophylaxis to promote equitable anesthetic care for transgender patients. This study's retrospective design limits causal inference and is subject to coding errors and residual confounding. Prospective studies with detailed perioperative and hormonal data are needed to validate these findings and clarify how the timing, dosage, and duration of GAHT influence PONV risk.