Anesthesiology Certification Research Articles

Publications Among Pain Medicine Fellowship-Trained American Board of Anesthesiology Diplomates.

American Board of Anesthesiology (ABA) diplomates who pursue clinical fellowship training in pain medicine may be better suited to lead scholarly projects and serve as first authors of publications in peer-reviewed journals given their additional training and clinical expertise. The primary aim of this study was to determine whether ABA certification in pain medicine is associated with a greater number of peer-reviewed publications. The secondary aim included assessments of whether pain medicine fellowship training is associated with a higher publication rate (publications per year) or publication in a larger number of peer-reviewed journals. A literature search was conducted in December 2023 using the Scopus database for publications related to anesthesiology and pain medicine in the United States between 2013 and 2023. First authors identified through the search were then individually searched within the ABA physician directory. The following data were collected: author name and identification number, year of publication, publication type (article or review), year of primary anesthesiology certification, and year of fellowship, if applicable. This study identified 9,612 publications and 6,924 unique first authors. Pain medicine fellowship training was associated with a statistically significant increase (p-value < 0.001) in the number of publications (0.546; 95% confidence interval {CI}, 0.386-0.707), publications per year (0.140; 95% CI, 0.121-0.159), and publication in a larger number of peer-reviewed journals (0.256; 95% CI, 0.182-0.330) in regression models adjusted for the number of years from certification. This query of the Scopus database and ABA physician directory indicates that pain medicine fellowship training is associated with statistically significant increases in research productivity, as defined by the number of publications, publications per year, or the number of publications in peer-reviewed journals. However, these increases in research output would not lead to a marked increase inscholarship productivity to justify pursuing a fellowship for this purpose.

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

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

Construct Validation of the American Board of Anesthesiology's APPLIED Examination for Initial Certification.

The American Board of Anesthesiology administers the APPLIED Examination as a part of initial certification, which as of 2018 includes 2 components-the Standardized Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE). The goal of this study is to investigate the measurement construct(s) of the APPLIED Examination to assess whether the SOE and the OSCE measure distinct constructs (ie, factors). Exploratory item factor analysis of candidates' performance ratings was used to determine the number of constructs, and confirmatory item factor analysis to estimate factor loadings within each construct and correlation(s) between the constructs. In exploratory item factor analysis, the log-likelihood ratio test and Akaike information criterion index favored the 3-factor model, with factors reflecting the SOE, OSCE Communication and Professionalism, and OSCE Technical Skills. The Bayesian information criterion index favored the 2-factor model, with factors reflecting the SOE and the OSCE. In confirmatory item factor analysis, both models suggest moderate correlation between the SOE factor and the OSCE factor; the correlation was 0.49 (95% confidence interval [CI], 0.42-0.55) for the 3-factor model and 0.61 (95% CI, 0.54-0.64) for the 2-factor model. The factor loadings were lower for Technical Skills stations of the OSCE (ranging from 0.11 to 0.25) compared with those of the SOE and Communication and Professionalism stations of the OSCE (ranging from 0.36 to 0.50). The analyses provide evidence that the SOE and the OSCE measure distinct constructs, supporting the rationale for administering both components of the APPLIED Examination for initial certification in anesthesiology.

Implementation of an Objective Structured Clinical Examination (OSCE) for Anesthesiology Certification in Chile

Anesthesiology became the first Chilean medical specialty certification board to incorporate an objective structured clinical examination (OSCE) into its certification system. The main reason for the introduction of an OSCE is to include an evaluation that allow candidates to demonstrate what they really "do" in clinical practice domains. Inherent in this justification is that the OSCE detects competences that are not well evaluated in current written and oral exams. This article describes the process of implementing an OSCE in Anesthesiology certification and a description of its application after one year of operation.

Connecting Purpose and Performance: Rethinking the Purpose of Maintenance of Certification.

American Boards of Medical Specialties have emphasized single point in time testing for summative assessment of cognitive expertise necessary for board certification. In 2016, the American Board of Anesthesiology introduced Maintenance of Certification in Anesthesiology (MOCA), a longitudinal assessment platform that provides diplomates formative feedback with continuous questions over time and adapts questions to areas of knowledge weaknesses over time. This paper describes the rationale, history, and early results of the American Board of Anesthesiology MOCA platform.

Editorial introductions

Editorial introductions

Development of an Objective Structured Clinical Examination as a Component of Assessment for Initial Board Certification in Anesthesiology.

With its first administration of an Objective Structured Clinical Examination (OSCE) in 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate this type of assessment into its high-stakes certification examination system. The fundamental rationale for the ABA's introduction of the OSCE is to include an assessment that allows candidates for board certification to demonstrate what they actually "do" in domains relevant to clinical practice. Inherent in this rationale is that the OSCE will capture competencies not well assessed in the current written and oral examinations-competencies that will allow the ABA to judge whether a candidate meets the standards expected for board certification more properly. This special article describes the ABA's journey from initial conceptualization through first administration of the OSCE, including the format of the OSCE, the process for scenario development, the standardized patient program that supports OSCE administration, examiner training, scoring, and future assessment of reliability, validity, and impact of the OSCE. This information will be beneficial to both those involved in the initial certification process, such as residency graduate candidates and program directors, and others contemplating the use of high-stakes summative OSCE assessments.

Association Between Participation and Performance in MOCA Minute and Actions Against the Medical Licenses of Anesthesiologists.

In January 2016, as part of the Maintenance of Certification in Anesthesiology (MOCA) program, the American Board of Anesthesiology launched MOCA Minute, a web-based longitudinal assessment, to supplant the former cognitive examination. We investigated the association between participation and performance in MOCA Minute and disciplinary actions against medical licenses of anesthesiologists. All anesthesiologists with time-limited certificates (ie, certified in 2000 or after) who were required to register for MOCA Minute in 2016 were followed up through December 31, 2016. The incidence of postcertification prejudicial license actions was compared between those who did and did not register and compared between registrants who did and did not meet the MOCA Minute performance standard. The cumulative incidence of license actions was 1.2% (245/20,006) in anesthesiologists required to register for MOCA Minute. Nonregistration was associated with a higher incidence of license actions (hazard ratio, 2.93 [95% confidence interval {CI}, 2.15-4.00]). For the 18,534 (92.6%) who registered, later registration (after June 30, 2016) was associated with a higher incidence of license actions. In 2016, 16,308 (88.0%) anesthesiologists met the MOCA Minute performance standard. Of those not meeting the standard (n = 2226), most (n = 2093, 94.0%) failed because they did not complete the required 120 questions. Not meeting the standard was associated with a higher incidence of license actions (hazard ratio, 1.92 [95% CI, 1.36-2.72]). Both timely participation and meeting performance standard in MOCA Minute are associated with a lower likelihood of being disciplined by a state medical board.

Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey.

IntroductionWe conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination.MethodsIn July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards.ResultsThere were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a pediatric anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children’s hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice.ConclusionThe extent to which pediatric anesthesiologists care for pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.

The American Board of Anesthesiology's Standardized Oral Examination for Initial Board Certification.

The American Board of Anesthesiology (ABA) has been administering an oral examination as part of its initial certification process since 1939. Among the 24 member boards of the American Board of Medical Specialties, 13 other boards also require passing an oral examination for physicians to become certified in their specialties. However, the methods used to develop, administer, and score these examinations have not been published. The purpose of this report is to describe the history and evolution of the anesthesiology Standardized Oral Examination, its current examination development and administration, the psychometric model and scoring, physician examiner training and auditing, and validity evidence. The many-facet Rasch model is the analytic method used to convert examiner ratings into scaled scores for candidates and takes into account how difficult grader examiners are and the difficulty of the examination tasks. Validity evidence of the oral examination includes that it measures aspects of clinical performance not accounted for by written certifying examinations, and that passing the oral examination is associated with a decreased risk of subsequent license actions against the anesthesiologist. Explaining the details of the Standardized Oral Examination provides transparency about this component of initial certification in anesthesiology.

Horst Otto Stoeckel: Clinician, Administrator, Researcher

Horst Otto Stoeckel was born September 26, 1930, in Lodz, Poland, which was part of the newly founded Second Republic of Poland until it was occupied by Nazi Germany in 1939. After World War II, his family immigrated to Meiningen, Germany, where he obtained his primary and secondary education. He attended Humboldt University and the University Hospital Charité of Berlin for his medical degree. Profs Theodor Brugsch, Karl Lohmann, and Friedrich Dost were important individuals who helped develop his interest in quantitative clinical pharmacology and pharmacokinetics. Prior to anesthesiology, Stoeckel trained in surgery, internal medicine, and obstetrics and gynecology in addition to clinical anesthesiology at a community hospital in East Germany. He completed 2 years of obligatory training to become an anesthesia specialist at the Teaching Hospital Hufeland and the Research Institute for Lung Diseases at Berlin-Buch. He also received training in anesthesia at the Humboldt University of Berlin. After escaping East Berlin through the Brandenburg Gate in August 1961, he obtained a position at the University of Heidelberg and obtained his West German board certification in anesthesiology in 1962. In the following 12-year period, Stoeckel was married, was promoted, passed his “habilitation” or lectureship period, started a family, and was granted the title of “Professor.” His administrative career began in February 1974 when he was selected as the first Chair of Anesthesiology at the University of Bonn, a position he held for 22 years. He also served as Dean of the medical school from 1980 to 1981. As Chair, he developed three areas: patient care, teaching, and research. He developed a long-term research program in the field of “Quantitative Clinical Pharmacology in Anesthesia and the Quantitative Modeling and Control in Anesthesia,” which required an interdisciplinary team of specialists in biochemistry, physics, and modern analytical methods. Over 20 years, the group's research program led to the discovery of basic algorithms providing the foundation of the automatic regulation of dosing control by the closed-loop feedback system, which is a concept important to the target-controlled infusion of intravenous and inhalation anesthetics. Following his career as a clinician, administrator, and researcher, he pursued a second career as a collector and museum founder.

Society for the Advancement of Transplant Anesthesia: Liver Transplant Anesthesia Fellowship-White Paper Advocating Measurable Proficiency in Transplant Specialties Training.

The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology, and not all anesthesia residency programs are associated with transplant centers. Yet there is evidence that patient outcome is affected by the experience of the anesthesiologist with liver transplants as part of a multidisciplinary care team. Requests for a formal review of the inequities in training opportunities and requirements led the Society for the Advancement for Transplant Anesthesia (SATA) to begin the task of developing post-graduate fellowship training recommendations. In this article, members of the SATA Working Group on Transplant Anesthesia Education present their reasoning for specialized education and conclusions about which pathways can better prepare trainees to care for complex transplant patients.

Basic Anesthesiology Examination Review.

Basic Anesthesiology Examination Review.

Clinical Performance Scores Are Independently Associated With the American Board of Anesthesiology Certification Examination Scores

Clinical Performance Scores Are Independently Associated With the American Board of Anesthesiology Certification Examination Scores

Standardized Mixed-Fidelity Simulation for ACGME Milestones Competency Assessment and Objective Structured Clinical Exam Preparation

Recent changes by the Accreditation Council for Graduate Medical Education (ACGME) evaluation process and the proposed changes to the American Board of Anesthesiology certification process require anesthesiology programs to create new tools for resident assessment and training. In response, we created a full-scale, standardized, mixed-fidelity simulation training program for residents that serves multiple functions including the following: (1) efficient and reliable means to meet the bi-annual ACGME reporting standards for milestone competency assessments, including evaluation of key milestones that are hard to observe; (2) preparation of residents for a future Objective Structured Clinical Examination (OSCE) style board examination; and (3) creation of a unique video portfolio of resident performance for critical self-assessment and improvement.

MINDFUL EM

FigureFigureFigureIf you like parasites, you will love TWiP (This Week in Parasitism), a podcast about all the noxious critters that wreak havoc in the human body, like Plasmodium (which causes malaria), Trypanosoma brucei (which causes sleeping sickness), Wuchereria bancrofti (which causes lymphatic filariasis or elephantiasis), Necator americanus (the bloodsucking roundworm that causes hookworm disease), and Taenia solium (the pig tapeworm that causes neurocysticercosis). If you're into viruses or bacteria, you can listen to TWiV (This Week in Virology) or TWiM (This Week in Microbiology). Physicians need to keep up with the latest in medicine, and podcasts are a great way of staying current and being exposed to just about any field of study our inquisitive heart desires. If microbiology isn't your thing, a plethora of emergency medicine podcasts are available to choose from, including Mel Herbert's EMRAP, Scott Weingart's EMCrit, Amal Mattu's EMCast, and Anton Helman's Emergency Medicine Cases. Many journals have podcasts, too, including Emergency Medicine News' Everyday Medicine with Ryan Stanton, MD, Annals of Emergency Medicine, the New England Journal of Medicine, and Emergency Medicine Clinics. Many high-quality medical blogs are also available, including R.E.B.E.L. EM (http://rebelem.com), Academic Life in Emergency Medicine (www.aliem.com), Life in the Fast Lane (http://lifeinthefastlane.com), Strip Tease (www.electricant.net/ekg), Resus.Me (http://resus.me), and The Poison Review (www.thepoisonreview.com). An exhaustive list of more than 300 emergency medicine and critical care blogs and podcasts are available on Life in the Fast Lane. Twitter also gives you minute-by-minute updates on the latest tidbits of interesting medical news and is arguably the best source for FOAMed (Free Open Access Medical Education), a collection of resources meant to assist physicians in keeping up with the latest in medicine. Beyond these modern methods for keeping up with the medical literature are still the old-fashioned approaches, such as reading medical journals, browsing medical textbooks, or attending one of dozens of medical conferences offered at various popular destinations throughout the world. More Effective Approach The one thing that is unlikely to help you keep up with the latest medical innovations or retain the knowledge you have gained since medical school, however, is the 10-year recertification examination, a mandatory requirement by the American Board of Emergency Medicine. It doesn't make sense to spend a couple of weeks every 10 years cramming for a test that does little to ensure that we stay up to date on our medical education. This is, in many ways, an obsolete exam that doesn't benefit our overall education. Our anesthesiologist colleagues have found a more effective approach than the recertification exam. The American Board of Anesthesiology this year became the first medical board to do away with the 10-year recertification exam. Instead, anesthesiologists will be offered a “more relevant and personalized approach ... to assess their knowledge and address knowledge gaps” through online quizzes and other educational material. (http://bit.ly/1S1Y5HJ.) Much of the criticism of the anesthesia recertification exam, which also applies to the emergency medicine 10-year test, argued that it was an expensive pass/fail assessment that did not provide feedback on performance or demonstrate that it was an effective way to keep anesthesiologists current in their field. Addressing these concerns, the regular online quizzes that are part of the MOCA 2.0 (Maintenance of Certification in Anesthesiology) program will give immediate comments, assist the practitioner in identifying any knowledge gaps, and provide better patient care. Our current technology allows for any of us with a computer or smartphone to have the entire breadth of medical knowledge at our fingertips. We are not naïve enough to think that every single practicing emergency physician will take advantage of the myriad podcasts, blogs, and other FOAMed resources, but cramming for a costly exam once a decade is not the most effective way to ensure we stay up to date with medical knowledge. The current Lifelong Learning and Self-Assessment program, through its yearly requirement of 10 to 15 journal articles and attached examination, is certainly a much more effective way to promote continuous learning, and does a much better job at encouraging us to stay current. Most emergency physicians agree that we should reform maintenance of board certification by abolishing the 10-year exam. Opposition continues to grow not only in our field but also throughout the medical community. If the 10-year recertification has been abandoned by one branch of medicine, shouldn't all of the others, including emergency medicine, follow suit? Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Practice Improvements Based on Participation in Simulation for the Maintenance of Certification in Anesthesiology Program

Background:This study describes anesthesiologists’ practice improvements undertaken during the first 3 yr of simulation activities for the Maintenance of Certification in Anesthesiology Program.Methods:A stratified sampling of 3 yr (2010–2012) of participants’ practice improvement plans was coded, c

Debriefing in Simulation and Beyond.

Debriefing, with its roots in military and aviation, is critically important to effective application of simulation education. With its widespread implementation and strong underpinnings in a variety of educational theories, debriefing is a central pillar of essentially all health care simulation centers. Even anesthesiologists who have completed training and practice outside of teaching centers will encounter debriefing when they participate in Part IV of Maintenance of Certification in Anesthesiology in endorsed simulation centers. Beyond this well-established presence, debriefing offers exciting opportunities for improvement of health care education and quality. First, debriefing practices should not be limited to the simulation setting. It is applicable to reflecting upon the crisis situations that are often faced by anesthesiologists, as well as a powerful tool for feedback on a daily basis. The improvement of feedback in both quality and quantity is considered by many educators to be a fundamental step in improving educational and training programs. The principles of debriefing, and probably more importantly the value of debriefing, are invaluable concepts for the clinical environment and amplify the impact of simulation in patient care. It can be reasonably argued that helping health care practitioners develop the habitual practice of giving and receiving feedback could become one of simulation educators' greatest contributions to patient safety. Another important role of debriefing should be in the area of IPE and practice. The challenges of IPE in simulation have been described; it is important for health care educators to be aware of these IPE experiences. These experiences have created a cadre of facilitators ready to participate in meaningful clinical debriefings across specialties and disciplines. Debriefing has played a central role in medical simulation since early implementation. This role is well founded in both history and in educational theory. Various techniques of debriefing have evolved according to learner types, personal preference, and the scenario objectives. Regardless of technique, debriefing offers the opportunity for meaningful change within participants by providing genuine reflection upon authentic experiences. These changes, when applied to clinical practice, are an important part of the claim that simulation can improve patient safety.

Learn It–Memorize It! Better Yet–Open Your Smartphone and Use the Information!

Learn It–Memorize It! Better Yet–Open Your Smartphone and Use the Information!

In the Land of the Blind, the One-eyed Man Is King

In the Land of the Blind, the One-eyed Man Is King