Anesthesia Residency Training Research Articles

Development of obstetric anesthesia core competencies for USA residency programs through a Delphi process.

The standard for anesthesia residency training in the USA mainly relies on the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, a framework that lacks specific directives for subspecialties including obstetric anesthesia. We aimed to identify core competencies in obstetric anesthesiology that can be adapted to different residency training programs to help improve the quality of training and accountability of the institutions within the USA. We identified a preliminary list of competencies from review of existing competency-based obstetric anesthesia training curricula and practice guidelines. We used a modified Delphi methodology to achieve expert consensus among members of the Society for Obstetric Anesthesia and Perinatology education committee. The panellists were asked to evaluate the importance of each competency using a five-point Likert scale, with consensus after two rounds defined at 80% agreement. The responders were also asked at which level of training each competency should be attained. The Delphi rounds had 75% response rate and derived 94 competencies that were categorized under the six ACGME domains: patient care (38), medical knowledge (45), system-based practice (two), practice-based learning and improvement (five), interpersonal communication skills (two), and professionalism (two). We generated a residency training competency list for obstetric anesthesiology through expert consensus. This list can be used by residency training programs to develop a structured competency-based curriculum with tangible milestones, thereby reducing heterogeneity in the standard of training.

Telemedicine in Anesthesiology: Using Simulation to Teach Remote Preoperative Assessment.

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

Development of a Cardiac Point-of-Care Ultrasound Curriculum for Anesthesia Residents in Brazil: It is Time to Act.

Although the use of cardiac point-of-care ultrasound in anesthesia is well established, with strong evidence supporting its benefit while managing hemodynamically unstable patients during the perioperative period, there is a lack of standardized curriculums incorporating this diagnostic modality as part of the anesthesia residency training. This report aims to describe a FOCUS curriculum based on adult learning theories, and to suggest its implementation as part of the anesthesia residency training considering the learners' (i) previous experience with ultrasound, (ii) level of training in anesthesia, (iii) and other challenges that can impact the organization and delivery of this project.

Identification of Sleep Medicine and Anesthesia Core Topics for Anesthesia Residency: A Modified Delphi Technique Survey.

Sleep disorders affect up to 25% of the general population and are associated with increased risk of adverse perioperative events. The key sleep medicine topics that are most important for the practice of anesthesiology have not been well-defined. The objective of this study was to determine the high-priority sleep medicine topics that should be included in the education of anesthesia residents based on the insight of experts in the fields of anesthesia and sleep medicine. We conducted a prospective cross-sectional survey of experts in the fields of sleep medicine and anesthesia based on the Delphi technique to establish consensus on the sleep medicine topics that should be incorporated into anesthesia residency curricula. Consensus for inclusion of a topic was defined as >80% of all experts selecting "agree" or "strongly agree" on a 5-point Likert scale. Responses to the survey questions were analyzed with descriptive statistical methods and presented as percentages or weighted mean values with standard deviations (SD) for Likert scale data. The topics that were found to have 100% agreement among experts were the influence of opioids and anesthetics on control of breathing and upper airway obstruction; potential interactions of wake-promoting/hypnotic medications with anesthetic agents; effects of sleep and anesthesia on upper airway patency; and anesthetic management of sleep apnea. Less than 80% agreement was found for topics on the anesthetic implications of other sleep disorders and future pathways in sleep medicine and anesthesia. We identify key topics of sleep medicine that can be included in the future design of anesthesia residency training curricula.

Mock Oral Board Examination in Nurse Anesthesia Education.

Despite its widespread use in anesthesia residency training, mock oral board examinations (MOBEs) are not included in the pedagogy of most nurse anesthesia programs (NAPs). A small-scale study was conducted to assess the use of MOBEs in this setting. The investigational cohort consisted of 10 second-year students in a master's program in nurse anesthesia. MOBEs were scored according to a common rubric, and final scores were reconciled by raters. Responses from pretest and posttest questionnaires, as well as scoring data, were analyzed. MOBEs were administered in a problem-free manner to nurse anesthesia students and was perceived by these students as a valuable addition to their curriculum. There was pass-fail agreement among the raters related to clinical analysis, fund of knowledge, and communication skills, and the scoring was characterized by elements of internal consistency. MOBEs are feasible in an NAP, and well accepted by students. MOBEs have significant evaluative potential in this setting. [J Nurs Educ. 2021;60(4):229-234.].

Gaps identification in Saudi anesthesia residency training during early time of pandemic: Trainee view.

Background:COVID-19 pandemic was declared a worldwide crisis, as a response the community established new protocols and clinical pathways to prepare the health system in adapting to the expected surge of cases.Objectives:In this study, we aim to assess the effect of the pandemic on the anesthesia training program residents from their own view. Identification of gaps in training programs will help to overcome the challenge like pandemic in order to have competent anesthesia practitioners.Methods:We deployed an online survey in early May 2020 targeting the anesthesia residents in Saudi Arabia. We used mixed methods, containing both quantitative and qualitative questions. Our survey had 3 main sections: demographics, pandemic effect on the training, and pandemic effect on the trainees.Results:Our survey showed that in the first 2 months of the pandemic there was a vast decrease in educational activities and clinical activities. However, after that both the Saudi Commission for Health Speciality (SCFHS) and local hospitals employed alternative education methods like electronic learning and simulation to adopt these changes. We also found the average stress level among residents was 6.5 out of 10 with number one stressor is transmitting Covid-19 to family or self. Finally, Wellbeing resources were available to residents however were not used sufficiently by residents.Conclusion:During times of pandemic, assessment and gap identification in postgraduate training programs are necessary to help overcome challenges of training anesthesiologists. Other than the clinical competency residents' wellbeing needs to be monitored and make available resources easy to reach for the residents.

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult.

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. 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. 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. 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.

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult

Impact of the COVID-19 pandemic on anesthesia residency education.

The clinical role of anesthesia residents during the COVID-19 pandemic has not been well described. As qualified physicians trained in airway management, anesthesia residents could be considered essential personnel. Given the uncertain supply of protective equipment, decision-makers must consider the welfare of trainees in any decision to deploy anesthesia residents. This national survey of Canadian anesthesia residents will develop our understanding of medical education, safety, and perceptions towards training in the context of the COVID-19 pandemic. Our results may inform the Royal College of Physicians and Surgeons, program directors, and health officials in optimizing anesthesia residency training during future pandemic conditions.

Anesthesia Residency Training in Thailand and Canada: A Comparative Case Study

Anesthesia Residency Training in Thailand and Canada: A Comparative Case Study

Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum

The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected...

Correlation of Medical Knowledge and Non-Technical Skills Assessment in Anesthesia Residents

Objective: Non-technical skills training and assessment has been implemented in anesthesia residency training program to improve quality of patient care but have not been properly assessed. We hypothesized that trainees with good knowledge correlated with good cognitive parts of non-technical skills.Methods: Seventy anesthesia residents (24 PGY-1, 24 PGY-2 and 22 PGY-3) were assessed for their knowledge by 180-item MCQs, 5 key-feature essay questions, and 18-station OSCE’s. Subsequently, a perioperative anesthesia crisis situation was set up in the simulation lab for all residents and was video recorded. Non-technical skills were assessed by 2 independent trained raters using Anesthetists’ Non-Technical Skills (ANTS) behavioral markers. The residents’ scores were calculated to find the correlation within the ANTS rating scale.Results: The mean scores of knowledge tests were 164.3 ±18.4 out of 300 [165.5 ±18.0, 154.7 ±16.3 and 173.6 ±16.4 for PGY-1, PGY-2 and PGY-3 respectively]. The mean scores of ANTS was divided into 4 categories (rating scale 1 to 4): task management 2.9 (±0.6), teamworking 3.0 (±0.5), situation awareness 2.9 (±0.8) and decision making 2.8 (±0.7). The knowledge test results moderately correlated with ANTS score in task management, situation awareness and decision making [r=0.382 (p<0.01), r=0.433 (p<0.001) and r=0.350 (p<0.01) respectively] and weakly correlated with the teamworking category (r=0.166, p=0.16).Conclusion: Resident’s scores showed moderate correlation with non-technical skills assessment results in cognitive skills. Non-technical skills are required to be trained and assessed together with knowledge to enhance the patient’s safety and outcome.

Anesthesia Residency Training in Airway Management: A Competency-Based Model Curriculum.

The Accreditation Council for Graduate Medical Education (ACGME) is moving toward competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills, and behaviors expected of competent trainees. An assessment program is essential to provide formative feedback to trainees as they progress to competency in each outcome. This article describes the development of 2 model curricula for airway management training (basic and advanced) using a competency-based framework.

Assessing the Impact of Powerful Experiences During Anesthesia Residency Training

Formative events during training help shape professional identity and may impact well-being. This study sought to identify formative experiences during anesthesia residency and measure their perceived impact on well-being. A 24-item survey exploring the frequency and perceived impact of formative events was developed through a rigorous process involving a literature search, consultation with medical education experts, resident focus groups, graduate interviews, and pilot testing. All 80 anesthesiology residents at Johns Hopkins University were invited to participate. We measured the frequency of event exposure and perceived impact on well-being. Seventy-six residents (95%) completed the survey. Event exposure rate ranged from 56.6% to 100%. Events with greatest relative impact (RI) overall included leaving work earlier than expected (RIoverall = 85.8), a patient expresses genuine gratitude (RIoverall = 80.2), identifying a faculty role model (RIoverall = 75.7), and having a patient die under my care (RIoverall = 75.6). There was no statistically significant difference on RI for positive versus negative events. The perceived impact of events on well-being varied by gender. This work provides clarity for residency program leaders and educators about the commonly experienced formative events that have the greatest perceived impact on resident well-being. These results may inform curricular planning and can suggest times when trainees may need attention or support. Future research should evaluate the direct impact of formative events on well-being and the success of related interventions.

Problem-based learning for anesthesia resident operating room crisis management training

BackgroundSenior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in ‘Airway’, ‘Circulation’, ‘Central venous catheter’, and ‘Pain management complications’. Non-technical skills are an integral component of team-based OR emergency management.MethodsPrior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training.ResultsPost-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL.ConclusionOur findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.

Editorial introductions

Editorial introductions

Stress and burnout in anesthesia residency: an exploratory case study of peer support groups

Stress and burnout are alarmingly prevalent in anesthesiologists, with the highest risk occurring during anesthesia residency training. To better understand this phenomenon, we conducted a mixed methods case study of our anesthesia training program to explore the residents’ accounts of stress and burnout and the potential value of peer support groups. Eight out of thirty eight residents participated in nine monthly peer support group (PSG) meetings followed by a focus group interview about stress and burnout in training and the value of PSG. We compared the participants’ mean pre-and post-PSG Maslach Burnout Inventory® (MBI) and Perceived Stress Scale® (PSS) and analysed the focus group interview for recurring themes. We captured the perspectives of twenty seven out of thirty residents who did not participate in support groups (non-participants) through an online survey on stress and burnout. We found evidence of a high prevalence of stress and burnout from the MBI and PSS scores and survey responses. Analysis of the focus group interview showed that the specific stressors of anesthesia training included: an individually-based model of training that predisposes to isolation from peers, an over-reliance on the quality of the faculty-resident relationship and the critical, high stakes nature of the profession. Residents strongly endorsed the value of PSG in decreasing isolation, enhancing validation, and support through the sharing of experiences. Lack of dedicated time and integration into the training program were major barriers to PSG participation. These barriers need to be overcome in order to fully realize its role in mitigating stress and burnout.

Career and Leadership Education in Anesthesia Residency Training.

Being a well-rounded physician requires competencies that extend beyond traditional medical training. This study explores one residency program’s attempt to address the need to foster career management and leadership skills. A year-long didactic program was initiated to tackle both career management and leadership development. At the conclusion of the program, a survey revealed an increase in perceived competency in the domains taught. There was also a measurable increase in the amount of scholarly and quality improvement projects done in the department where the program was implemented. To support and develop physician competencies, healthcare organizations may derive immense benefit from a program that fosters both career management and leadership skills.

Anesthesia Residency Training in Cardiac Anesthesia: Development of a Model Curricula and Educational Resources: The Anesthesia Toolbox

Anesthesia Residency Training in Cardiac Anesthesia: Development of a Model Curricula and Educational Resources: The Anesthesia Toolbox

Career Development Guidance and Mentorship during Anesthesia Residency Training: An Internet Survey

We conducted a survey of Anesthesiology residency programs in the United States to identify current practice regarding mentorship and teaching of topics related to career development. Program directors for all currently accredited Anesthesiology residency programs (N=129 as of April 2016) were contacted by e-mail and invited to complete a short internet survey. Two follow-up e-mails were sent at one-week intervals to those who had not yet responded. 59 program directors responded, yielding 53 complete responses, for an adjusted response rate of 41.1%. Program and practice management type (university versus other, hospital versus private) were not strongly associated with presence of a career development curriculum (CDC). In general, larger residency programs (30 or more residents) and university-based programs were more likely to provide lectures on specific CDC topics. Whether residency program directors agreed or disagreed with the premise that instruction should be provided on other topics besides anesthesia, was unrelated to the presence of CDC in their programs. The results of this survey demonstrate that the establishment of a mentorship program (even a rudimentary one) may be the first step in creating a CDC. Apart from having a CDC program already in place, the strongest predictor of CDC content was the size of the residency program. Though there are training programs that openly stated on our survey that they do not have a CDC in place, some of these programs still provided lectures on one or more of the topics surveyed.