Pro: Integrated Five-Year Anesthesiology Residency Should Be Implemented Widely

Subspecialty Training in Pediatric Anesthesiology

Expertise in Pediatric Cardiac Anesthesia Begins With Well-Designed Training Programs

Residents in anesthesia training programs throughout the world are required to document their clinical cases to help ensure that they receive adequate training. Current systems involve self-reporting, are subject to delayed updates and misreported data, and do not provide a practicable method of validation. Anesthesia information management systems (AIMS) are being used increasingly in training programs and are a logical source for verifiable documentation. We hypothesized that case logs generated automatically from an AIMS would be sufficiently accurate to replace the current manual process. We based our analysis on the data reporting requirements of the American College of Graduate Medical Education (ACGME). We conducted a systematic review of ACGME requirements and our AIMS record, and made modifications after identifying data element and attribution issues. We studied 2 methods (parsing of free text procedure descriptions and CPT4 procedure code mapping) to automatically determine ACGME case categories and generated AIMS-based case logs and compared these to assignments made by manual inspection of the anesthesia records. We also assessed under- and overreporting of cases entered manually by our residents into the ACGME website. The parsing and mapping methods assigned cases to a majority of the ACGME categories with accuracies of 95% and 97%, respectively, as compared with determinations made by 2 residents and 1 attending who manually reviewed all procedure descriptions. Comparison of AIMS-based case logs with reports from the ACGME Resident Case Log System website showed that >50% of residents either underreported or overreported their total case counts by at least 5%. The AIMS database is a source of contemporaneous documentation of resident experience that can be queried to generate valid, verifiable case logs. The extent of AIMS adoption by academic anesthesia departments should encourage accreditation organizations to support uploading of AIMS-based case log files to improve accuracy and to decrease the clerical burden on anesthesia residents.

Breaking Silos: The Team-Based Approach to Coronavirus Disease 2019 Pandemic Staffing.

Fellowship Training in Adult Cardiothoracic Anesthesiology: Navigating the New Educational Landscape as a Result of the Coronavirus Crisis

The Fellowship Experience in Adult Cardiothoracic Anesthesiology—Strategies for Applicants and Fellows to Navigate the Coronavirus Crisis

The growth and promulgation of Advanced Practice Providers (APPs) across the entire spectrum of healthcare delivery has been profound, and APPs are increasingly common members of emergency department (ED) care teams. Emergency APP workforce growth is outpacing that of emergency physicians with little to suggest that this trend will subside. The evolution of the deployment of APPs in emergency care has been dramatic; initially, emergency APPs were deployed to lower acuity patients or environments-minor injury and illness and in conjunction with an emergency physician-hence the now antiquated description of APPs as "physician extenders."

This study compared the practices of anesthesia, anesthesia critical care, surgical critical care, and medical critical care departments that have training programs for the length of time they withhold enteral feeding from intubated patients before seven scheduled procedures: 1) extubation; 2) tracheostomy; 3) abdominal surgery; 4) nonabdominal surgery; 5) magnetic resonance imaging or computerized tomography; or placing the patient in the 6) Trendelenberg or 7) prone position. One-time survey of 297 anesthesia and critical care training programs in the United States. Eighty programs responded (27%). We compared the median hours of withholding enteral feeding of intubated patients according to training program type for each of the procedures. None of the programs withheld enteral feeds from intubated patients scheduled for magnetic resonance imaging/computerized tomography scans, nor for the Trendelenberg position (median = 0 hour). A significant difference among program types was found for extubation, with anesthesia departments having significantly longer times (median = 6 hours) compared with anesthesia critical care (median = 4 hours), surgical critical care (median = 2 hours), and medical critical care (1.5 hours) departments (chi = 8.77, df = 3, p = 0.032). For scheduled tracheostomy, surgical critical care departments reported shorter times (median = 4 hours) than did all other surveyed departments (median = 6 hours) (chi = 7.28, df = 3, p = 0.063). Differences in opinion exist among specialty training programs about the length of time necessary for withholding enteral feeding from intubated patients before scheduled procedures, especially extubation and tracheostomy. To resolve physician conflicts and to best serve these patients, best practice guidelines for withholding enteral feeding from intubated patients before scheduled procedures need to be developed jointly by the critical care specialties.

Introduction: Advanced Practice Providers (APPs) are a well-established part of the multidisciplinary critical care team, but the scope and utilization of APPs vary dramatically between hospitals. This survey captures current demographic, workflow, and utilization trends in the Society of Critical Care (SCCM) APP community. Methods: This was a cross sectional REDCap survey emailed to 2775 SCCM physician assistant or nurse practitioner members in April 2021. There were 578 responses (20.8%) with 60 non-APP respondents excluded for a sample size of 518. Statistical analysis was performed via SPSS. Results: Of the 518 respondents, there were 149 (28.8%) physician assistants and 327 (63.1%) nurse practitioners. Most respondents (n=371, 72%) were female. 248 APPs (48.1%) worked for large hospitals (>500 beds) and most (n=343, 66.2%) worked in an academic setting. Of the surveyed, 447 (86.3%) reported greater than 2 years of ICU experience. Formal onboarding was common (n=354, 68.6%) and was most likely to occur in academic medical centers (n=233 of 354, p< 0.001). Onboarding was usually completed in under 6 months (n=310, 87.8%). Most APPs (n=409, 79.3%) did not pursue post-graduate fellowships. Most units had full time APP coverage (n=361, 70.1%) including weekends and holidays (n=427, 82.8%). Daytime APP to patient ratios were less than 1:10 (n=377, 75.7%); nighttime ratios were 1:11 or greater (n=328, 72.9%). The majority of APPs performed arterial lines (n=425, 82%), central venous catheters (n=410, 79.2%), temporary dialysis catheters (n=318, 62.4%), and point-of-care ultrasound (n=295, 56.9%). APPs most frequently billed critical care time (n=314, 60.6%) and procedures (n 333, 64.3%). A quarter of respondents (n=137, 26.4%) reported that they did not bill. APPs did not routinely have their billing measured (n=212, 41.5%) and many (n=106, 20.7%) did not know if productivity measures were utilized in their group. Conclusions: APPs are experienced members of the critical care team heavily utilized in large academic hospitals. Current APP roles are mostly clinical and unit-based, with emphasis on procedures and episodic care. Additional research will better quantify APP productivity and value since metrics are inconsistent and many APPs do not currently participate in billing.

First, Do No Harm: Less Training ≠ Quality Care

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Is The Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow Survey A Valid Tool to Assess General Surgery Residency Programs Compliance With Work Hours Regulations?

Letter: Evaluating the Role of Advanced Practice Providers in Neurosurgery.

Critical Care During the Coronavirus Crisis—Reflections on the Roles of Anesthesiologists in Meeting the Challenges of the Pandemic

Successful Integration of Advanced Practice Providers Into a Pediatric Academic Community Intensive Care Unit